tbuckley/cabot-search huggingface dataset:
Does targeted therapy dominate in terms of a higher level of effectiveness for a given cost compared to wild-type treatment? An analysis of cost and outcome of metastatic lung cancer patients in Saudi Arabia.
Authors: Omar B. Da'ar, Ali Alkhybri, Saud Alshareed, Mohammad Alkaiyat, Abdul Rahman Jazieh
Journal: Journal of Clinical Oncology (2020)

e19361 Background: This study computed and analyzed aggregate and sub-aggregate healthcare costs of lung cancer care by demographic profiles, resource utilization, clinical conditions, and target therapy. Methods: This is a retrospective chart-review and descriptive analysis of resource use and direct medical cost for lung cancer care had at the Oncology Department, King Abdulaziz Medical City for the period 2016-2018. The cost difference between patients receiving targeted therapy (TT) and those with wild-type tumors and the incremental cost-effectiveness ratio (ICER) was performed. The relationship between aggregate cost and demographic profiles, resource utilization, clinical conditions, and treatment therapies using multivariate regression technique was conducted. Results: A total of 35 patients of lung cancer patients with non-small cell lung cancer were analyzed, of which, 34% received targeted therapy; the median age was 62 years (29-84), 43% were ≥ 65 years, 20% were alive; 74% were in stage IV, 69% had visited ED more than twice, and 69% were admitted for non-ICU-related issues. The mean aggregate cost for all patients was USD 197,300 and it was USD 176,000 for TT patients compared with USD 210,600 for non-TT patients. The mean cost for targeted patients was higher for medication components, which accounts for 87.8% of all the costs. On average, the targeted group had USD 34,600 less cost compared with wild type. At least in terms of non-ICU admissions, both groups had on average two admissions. Thus, in terms of ICER, the targeted therapy dominates as it shows lower average aggregate cost for a given level of effectiveness. While longevity (survival) was associated with a higher cost, having stage IV was associated with lower cost for the targeted group compared with wild-type. Generally, being female, &gt; 65 years of age, non-Saudi, and insurance eligibility were associated with lower costs. Conclusions: TT patients had a lower aggregate average cost in spite of expensive medications treatment. This lower aggregate cost presents an added value to the known advantages of patient survival and quality of life.
妊娠合并糖尿病酮症酸中毒10例临床分析
Authors: 邓庆珊, 杨慧霞
Journal: BMJ (2006)

对1981年1月至2004年12月在北京大学第一医院产科分娩的10例妊娠糖尿病酮症酸中毒患者的临床特点进行回顾性分析.10例中除1例失访外,9例最终诊断为糖尿病合并妊娠.酮症酸中毒发病的诱因包括胰岛素治疗量不足10例,感染4例,应激状态3例,使用糖皮质激素1例、静脉滴注葡萄糖1例及并发先兆子痫3例.发病时血糖10.2～29.1 mmol/L,5例血糖低于16.7 mmol/L,其中2例血糖最高10.2 mmol/L和10.5 mmol/L.10例孕妇无死亡,围产儿死亡4例,新生儿轻度窒息1例,足月低体重儿1例.提示尽管妊娠期酮症酸中毒发病率低,但对围产儿构成较大危害。
Risk factors of primary benign paroxysmal positional vertigo
Authors: Renliang Zhao, Tao Liu, Hui Sun, Qingxia Jia
Journal: BMJ (2016)

Benign paroxysmal positional vertigo (BPPV) is the most common kind of vertigo, which can be divided into idiopathic and secondary types. Head trauma, surgery, and inner ear diseases may induce the secondary BPPV, but the etiology and pathogenesis of idiopathic BPPV is still unknown. Recent studies indicate that multiple factors are associated with idiopathic BPPV; in this article we will review the risk factors of idiopathic BPPV.


Key words: 
Benign paroxysmal positional vertigo; Risk factors
Prognostic and predictive value of ESR1 mutations in postmenopausal metastatic breast cancer (MBC) patients (pts) resistant to aromatase inhibitors (AI), treated with palbociclib (PAL) in combination with endocrine therapy (ET) or capecitabine (CAP) in the PEARL study.
Authors: Miguel Martin, Christoph Zielinski, Manuel Ruiz-Borrego, Eva Maria Carrasco, Eva Ciruelos, Montserrat Muñoz, Begoña Bermejo, Mireia Margeli Vila, Nicholas C. Turner, Maribel Casas, Antonio Anton, Laura Murillo Jaso, Istvan Lang, Cynthia Huang Bartlett, Maria Koehler, Nuria Martin, Massimo Corsaro, Claire Swift, Bella Nisenbaum, Miguel J. Gil Gil
Journal: Journal of Clinical Oncology (2020)

1022 Background: Prior retrospective data has shown ESR1 mutation is an acquired resistant mechanism to AI. However, little is known about ist prognostic and predictive value to endocrine-based therapy and chemotherapy. PEARL study compared PAL+ET vs CAP in AI resistant patients. Here we wxplored prospectively the ESR1 mutational status based on updated PFS and OS. Methods: PEARL is a phase 3 study with 2 subsequent cohorts: cohort 1 with 296 pts randomized to PAL+Exemestane (EXE) vs CAP and cohort 2 with 305 pts randomized to PAL+ Fulvestran (FUL) vs CAP. ESR1 hotspot mutations were analyzed in circulating free DNA at baseline by digital PCR. Cox regresion analysis for PFS and OS were performed. Adjusted hazard ratios (aHR) and interaction test between treatment and ESR1 status were calculated. Results: ESR1 mutational status was assessed in 557 pts, 91% and 94% treated with CAP and PAL+ET, respectively; 164 (29%) had ESR1 mutations. Characteristics between ESR1 wild-type (WT) and mutated pts were balanced except for ECOG, prior sensitivity to ET, treatment line, prior AI for metastatic disease and time from first metastatic diagnosis to randomization. Median follow-up was 22.5 months (m). Median PFS was 9.6 vs. 7.5 m (HR: 1.06 [0.88 - 1.28], p = 0.522) and median OS was 30.2 vs 30.3 (HR: 0.99 [0.78 - 1.26] p = 0.934), for CAP vs. PAL+ET, respectively. No interaction was seen between treatment arm and ESR1 status either for PFS (p = 0.538) or OS (p = 0.957). Conclusions: In luminal MBC, ESR1-mutated pts had poorer OS than ESR1-WT pts regardless of treatment received. Clinical trial information: NCT02028507 . [Table: see text]
高血压患者白大衣效应和白大衣高血压研究
Authors: 刘勇, 杨涛, 黄文良, 王崇良, 罗南渝, 曾玉琼, 林贞
Journal: BMJ (2004)

采用24 h动态血压监测研究白大衣高血压(WCH)和白大衣效应(WCE)在高血压患者和正常人中的差异,并观察不同高血压诊断标准对WCH检出的影响.结果显示各组诊所血压值中均包含了WCE值,其中高血压组大于正常对照组;偏低的高血压诊断标准更容易造成过度诊断高血压。
Current situation of otoscopy in general practice in China
Authors: Zhong-hua Zhou, Shi-hong Jin
Journal: BMJ (2010)

Objective To investigate current situation of otoscope use by practitioners at community health-care service facilities in Hainan and Shenzhen and explore its importance and feasibility of spread of its use in community health-care service facilities in China.Methods Group discussion, telephone personal interview, otoscope market survey and literature research all were used among 112 practitioners at 67 community health-care service facilities in Hainan, 47 practitioners at 23 community health-care service facilities in Shenzhen, Guangdong, and 11 representatives involved in general practice training from 11 districts.Results In Hainan, only one community health-care service facility ( 1.5% ) was equipped with otoscopes and only one practitioner (0.9% ) could use it.In Shenzhen, two community health-care service facilities (8.7%) were equipped with it, but which had never be used.All the practitioners at community health-care service facilities surveyed have not been trained for its use, so most practitioners there did not have basic skills to use otoscope.Conclusions Otoscope is not equipped at most community health-care service facilities in Hainan and Shenzhen, and it is little used there even equipped with it.Otoscopy should be used as an adequate and feasible technique at community health-care service and be spread among general practitioners in China.

Key words: 
Otoscope;  General practice;  Community health service
Advanced renal cell carcinoma and COVID-19 — a personal perspective
Authors: Yasser Ged, Mark C. Markowski, Phillip M. Pierorazio
Journal: Nature Reviews Urology (2020)

The management pathways of advanced renal cell carcinoma (RCC) have considerably evolved in the past 5 years, presenting a particular challenge during the coronavirus disease 2019 (COVID-19) pandemic. In this Comment, we propose a management algorithm on the basis of the current evidence to safely manage patients with advanced RCC during this pandemic.
Neoadjuvant chemotherapy versus adjuvant chemotherapy in breast cancer patients: Analysis of breast conserving rate and de-escalation of axillary surgery in 5,141 Korean women.
Authors: Young Joo Lee, Jisun Kim, Sung-chan Gwark
Journal: Journal of Clinical Oncology (2020)

e12531 Background: Neoadjuvant chemotherapy (NCT) in breast cancer has several advantages such as more breast conservation surgery (BCS) rate and de-escalation of extent of axillary surgery. Actual practice change in this area compared with adjuvant chemotherapy (ACT) is not well established. Methods: We retrospectively analyzed 5,141 women diagnosed with breast cancer from 2009 to 2013, treated with chemotherapy before or after definite surgery. BCS rate and axillary surgery categories (sentinel lymph node biopsy (SNB), axillary lymphnode dissection (ALND) or SNB followed by ALND) are compared between two groups. Results: Among 5,141 patients, 3930 (76.4%) women had ACT and 1211 (23.6%) had NCT. Median age at diagnosis was 48 (range 22-83). BCR rate was lower in T2 (57.1% vs 64.1%), T3 (12.6% vs 20.9%) group between ACT vs NCT ( p=0.03, 0.001), no difference was shown in T1 and T4 tumors. SNB try (SNB only or SNB followed by ALND) rate was still higher in ACT group with cN0 (98.4% vs 95.4%), cN1 (89.3% vs 73.5%), cN2 (77.9% vs 62.1%) tumors ( p=0.001, &lt;0.001, 0.003, respectively). SNB only rate which means that patients spared ALND, was lower in ACT group with all cN stage (cN1; 17.5% vs 29.2%, cN2; 3.2% vs 5.9%, cN3; 5.1% vs 20.5%, all p=0.000) except cN0 (95.6% vs 81.4%, p&lt;0.001). Axillary surgery rate analyzed with pathologic N stage showed more ALNDs attempted even after achieving pathologic complete nodal response or minimal residual N disease (ypN0: 4.4% vs 27.2%, ypN0(i) &amp; ypN1mi; 26.2% vs 57.6%, p&lt;0.001, =0.001 respectively). In contrast however, average of total axillary nodes retrieved by cN stage were statistically lower in NCT group in clinically positive tumors (N1; 15.3 vs 12.7, N2; 19.1 vs 14.6, N3; 25.1 vs 15.6, all p&lt;0.001). Conclusions: NCT had shown advantage to perform more BCS than ACT in T2, T3 tumors. SNB attempts in NCT was comparable to ACT. Still, patients with NCT received more aggressive axillary surgery than ACT shown by axillary surgery category irrespective of negative SNB results.
Factors impacting use of adjuvant therapy in lip and oral cavity squamous cell carcinoma: A NCDB analysis.
Authors: Poornima Ramadas, Dongliang Wang, Danning Huang, Abirami Sivapiragasam
Journal: Journal of Clinical Oncology (2020)

e18556 Background: Two trials followed by a combined analysis of the trials in head and neck squamous cell carcinoma (SCC) established that the benefit of adjuvant chemotherapy concurrent with radiation (CRT) was only noted in patients with extracapsular extension of nodal disease (ECE) and positive resection margins (PM). Despite this recommendation, other high-risk pathological features including pT3 or pT4 disease, positive lymph nodes, perineural involvement, vascular tumor embolism and level IV or V lymph node involvement have been noted to increase the risk of recurrence and adjuvant chemotherapy has been utilized for these patients. We report an observational study to evaluate the factors impacting use of CRT in patients with oral cavity and lip SCC. Methods: We conducted a retrospective study of patients with oral cavity and lip SCC who underwent resection of primary tumor with or without neck dissection in the reporting hospital in the NCDB database. We compared demographic, clinical and pathological characteristics of patients who received adjuvant CRT versus radiation alone. Multivariate analysis was performed using logistic regression model. Results: Out of the 58,481 patients reported to have surgery in NCDB from 2004 to 2016, 11,413 patients received adjuvant therapy. In univariate analysis, patients who received CRT were most likely less than 65 years of age, males, patients with no insurance or private insurance, lower Charlson Deyo score, Stage IVA, pT4, grade 2 or higher, tumor size &gt; 4cm, positive lymph nodes, involvement of level IV and V nodes, lymphovascular invasion, ECE and PM. In multivariate analysis, factors which influenced receiving CRT were age between 40 and 65 years, males, Stage IVA (compared to Stage I to III), positive nodes, ECE and PM. A total of 984 patients received CRT without having ECE or PM. Conclusions: In addition to ECE and PM, positive lymph nodes was the major pathological factor in patients receiving CRT compared to RT alone.
胃间质瘤的X线及CT诊断
Authors: 宋晓明, 王海屹, 叶慧义
Journal: BMJ (2012)

胃肠道间质瘤是消化道最常见的原发性间叶源性肿瘤.胃间质瘤的早期诊断成为提高诊治水平、改善预后的重要途径,其中影像学检查是关键手段之一.作为胃镜检查的补充,影像学检查在胃间质瘤的术前诊断及术后复查等方面,起着越来越重要的作用。
Highly accurate NGS-based multi-gene testing in the diagnosis of thyroid nodules with indeterminate cytology.
Authors: Yuntao Song, Bin Zhang, Tonghui Ma
Journal: Journal of Clinical Oncology (2020)

e13579 Background: Thyroid nodules are highly prevalent, Fine-needle aspiration (FNA) is the standard pre-operative tool for diagnosis. However, some of the samples are classified as indeterminate, which leads to unnecessary surgery. BRAF V600E mutation is often used as a diagnostic marker for thyroid cancer, and it is highly specific for papillary thyroid carcinoma (PTC). But BRAF mutation is rarely occurred in thyroid nodules with indeterminate cytology. To diagnose the indeterminate thyroid nodules precisely, some NGS-based multi-gene testing panel has been developed and clinically used in America and Europe, but rare research was reported in China. In this study, we evaluated the value of a next-generation sequencing (NGS) panel to cancer diagnosis in indeterminate thyroid nodules. Methods: From February 2018 to September 2018, 360 patients with thyroid nodules who underwent FNA at Peking University Cancer Hospital were enrolled. And the FNA samples with indeterminate cytology were evaluated using a next-generation sequencing (NGS) assay, including 16 genes analyzed for point mutations and 26 types of gene fusions. Diagnostic performance of this multi-gene testing panel was compared with BRAF V600E single gene mutation analysis. Results: 141 nodules were cytologically indeterminate among 360 patients on FNA biopsy, 72 of which were resected and analyzed by NGS successfully. Histologic analysis after surgery revealed 41 (56.9%) cancers in these 72 patients. The multi-gene testing assay could classify 30/41 cancers correctly, showing a sensitivity of 73.2%, specificity of 96.8%, positive predictive value of 96.8%, and negative predictive value of 73.2%. The diagnostic accuracy of the multi-gene testing was significantly higher than the BRAF V600E mutation analysis (83.3% vs 73.6%, x 2 = 31.588, p &lt; 0.01). Conclusions: Our study demonstrated that the multi-gene testing provided both high sensitivity and high specificity for cancer detection in thyroid nodules with indeterminate cytology, and its accuracy was much higher than BRAF V600E mutation test.
慢性家族性良性天疱疮一例
Authors: 晋红中
Journal: BMJ (2007)

患者女,49岁,主因腋窝反复起红斑、水疱1年,伴项部、腹部、肛周皮损2个月,于2006年11月6日来我科就诊.1年前,患者双腋下出现红斑、丘疹,瘙痒明显,按湿疹给予口服抗组胺及外用糖皮质激素治疗,瘙痒减轻,但皮疹持续不消退.2个月前,项部、腹部、肛周出现同样损害,瘙痒明显.发病以来,无其他不适。
Health Care Costs by Type of Expenditure across eGFR Stages among Patients with and without Diabetes, Cardiovascular Disease, and Heart Failure
Authors: Gregory A. Nichols, Anastasia Ustyugova, Anouk Déruaz-Luyet, Maureen O’Keeffe-Rosetti, Kimberly G. Brodovicz
Journal: Journal of the American Society of Nephrology (2020)

Significance Statement Information about the type of health care costs associated with CKD across all stages in a general population with a substantial comorbidity burden is lacking. Using electronic medical records of an integrated delivery system, the authors evaluated health care costs in patients with CKD, with or without diabetes mellitus, cardiovascular disease, and heart failure, and by eGFR level. Despite high use of currently available therapies, inpatient costs were an increasing proportion of the total health care costs with each higher eGFR category, regardless of the presence of comorbidities. This trend began in earlier stages of CKD and escalated as kidney function declined. Additional therapies to reduce CKD incidence, slow CKD progression, and lower the risk of hospitalizations are needed to benefit patients and reduce the economic burden of CKD. Background CKD is associated with higher health care costs that increase with disease progression. However, research is lacking on the type of health care costs associated with CKD across all stages in a general population with a substantial comorbidity burden. Methods Using electronic medical records of an integrated delivery system, we evaluated health care costs by expenditure type in general and in patients with CKD by eGFR and presence of comorbidities. We categorized 146,132 patients with eGFR data in 2016 or 2017 and examined nonmutually exclusive groups according to presence of diabetes mellitus, cardiovascular disease, or heart failure. We used 1 year of follow-up data to calculate outpatient, inpatient, emergency, pharmaceutical, dialysis, and total health care costs by eGFR (Kidney Disease Improving Global Outcomes–defined eGFR categories), adjusted for age, sex, and nonwhite race. Results Mean total health care costs among patients with CKD without comorbidities were 31% higher than among patients without CKD ($7374 versus $5631, respectively). Hospitalizations accounted for 35% of total costs among those with CKD and no comorbidities but up to 55% among patients with CKD and heart failure. The proportion of costs attributable to hospitalizations accelerated with declining kidney function, reaching as high as 66%. Conclusions Poorer kidney function and the presence of diabetes mellitus, cardiovascular disease, or heart failure drive substantial health care costs and increase the proportion of costs attributable to inpatient care. The large contribution of inpatient costs begins in earlier stages of CKD and escalates as kidney function declines. Additional therapies to reduce CKD incidence, slow CKD progression, and lower hospitalization risk are needed to benefit patients and reduce CKD’s economic burden.
Individual and community respite as supportive care for adult cancer patients, their caregivers and their families.
Authors: Marcella Schankweiler
Journal: Journal of Clinical Oncology (2020)

e24183 Background: When a young adult (ages 24 to 55) is diagnosed with cancer, the entire family is traumatized. The psychosocial, emotional, economic and spiritual concerns become forefront and often, the family unit is unable to cope with a potentially devastating outcome. Respite becomes helpful in in addressing these traumas by providing a haven for honest, open dialogue about coping with today and preparing for an uncertain future. Each patient and family are provided a seven-day respite experience to a mutally selected destination suitable for travel and congruent with the family's psychosocial needs at the time with limited programming and schedule flexibility. Methods: Respite impact will be presented with qualitative and quantitative outcome measures provided by the treating clinicians. Using a multidisciplinary approach as outlined by a FPS program committee comprised of nominating oncologists, nurses, social workers and patient coordinators, these measurements are gathered both pre and post respite and gauge the patient/caregivers/children ability to cope with cancer after respite experiences. Further, the treating clinician observes and assesses said parties' ability to cope upon respite completion and return to clinic. Results: See table below. Conclusions: Studies support that respite is critical as complementary therapy in treatment protocol in the adult population segment with young families. Care-free, cost-free organized respite helps improve one's overall coping with a cancer diagnosis, improves the families' psychosocial health, results in increased communication and strengthened relationships as a family unit, reduces anxiety and improves patient compliance with future treatment protocol. FPS has also studied the impact of group respite v. individual respite and documents that a group setting lessens anxiety, strengthens relationships and promotes communication with peer support. Best practices from this respite program can assist in both short term and long term psychosocial and mental health of patients and their families so to optimize coping and healing related to cancer. [Table: see text]
低钾血症转变为高钾血症一例
Authors: 柳玉华, 邢艳芳, 王媛, 李海永
Journal: BMJ (2005)

患者男,16岁.因长跑800 m 后出现全身无力、恶心、呕吐来院,近期无上呼吸道感染、腹泻史,无甲状腺、肾脏疾病史.查体:四肢为对称性软瘫,近端肌力2级,远端肌力1级.无明显感觉异常,无肌萎缩,腱反射消失.血钾1.7 mmol/L,心电图提示低血钾.经静脉、口服补钾等治疗,患者症状明显好转,能自由活动.家属又自购自服10%氯化钾300 ml,患者肌无力再次加重至0级,同时感胸闷、呕吐,排尿困难.此时静脉、口服补钾共39 g/36 h(其中口服补钾31.5 g).急查血钾8.36 mmol/L,心电图提示高血钾.立即给予静脉推注10%葡萄糖酸钙20 ml、速尿20 ml,静脉滴注5%碳酸氢纳、10%葡萄糖液+短效胰岛素(4 g糖+1 U短效胰岛素),监测血钾、心电图、血糖、尿量.经处理患者四肢肌力渐恢复,胸闷消失,能主动排尿.24 h后患者完全恢复正常,血钾降至6.0 mmol/L,心电图正常。
睡眠呼吸暂停与糖尿病
Authors: 孙赟, 张希龙
Journal: BMJ (2010)

睡眠呼吸暂停综合征(SAS)和糖尿病均是具有较高潜在危害性的现代常见病,两者的临床并存率较高,提示可能具有较密切的相关性.近年来国内外对两者的相关性和机制、可能的干预治疗方法进行了较多的研究。
Single-institution experience of small cell bladder cancer at a community center.
Authors: Mina Makary, Tullika Garg, Delnaz Bakht, Zeeshan Solangi, Karen Hassanzadeh, Haiyan Liu, Rajiv Prasanna Panikkar, Joseph Vadakara, Li Zhang
Journal: Journal of Clinical Oncology (2020)

e17021 Background: Small cell bladder cancer (SCBC) is a rare malignancy with poor prognosis. Previous retrospective studies mainly focused on answering whether radical cystectomy is superior to radiation. Little is known about the disease characteristics and clinical course. Methods: Patients were identified via Geisinger cancer registry from 1991 to 2019, and retrospective chart review was performed through the electronic health records, EPIC. We described patient characteristics and outcomes. OS was measured from time of initial diagnosis to death or last follow up. Kaplan-Meier analyses were done on OS. Results: 50 patients were identified; 7 patients were excluded due lack of information. M: F≈1, 60% patients had pure small cell carcinoma (SCC) histology (≥ 95%), 37% with SCC and urothelial carcinoma mixed histology, MIB-1 index was 80-100%. Median OS for localized disease (IQR) was 22 months (9,73), and 11 months (7,16) for metastatic disease. For localized disease, OS were similar between patients with or without pure small cell history (P = 0.47). 8 patients were alive at 5 years; 3 patients received neoadjuvant chemotherapy followed by radical cystectomy, 2 patients underwent radical cystectomy alone, 2 patients had concurrent chemotherapy with radiation; 1 patient had complete pathological response to Cisplatin and etoposide chemotherapy, did not receive additional therapy and recurred 6 years later. Recurrence ranged from 6 to 79 months. 10 patients had disease progression despite of palliative chemotherapy. Conclusions: Small cell bladder cancer is a heterogenous disease, early stage disease can be curable but late recurrence does occur, continued surveillance is warranted even after 5 years. New treatment modality is in need to improve outcome for patients with metastatic disease.