tbuckley/cabot-search huggingface dataset:
Comparison of outcomes with pembrolizumab monotherapy (P) versus combination with chemotherapy (P+C) in advanced non-small cell lung cancer (NSCLC).
Authors: Kartik Sehgal, Ritu R. Gill, Poorva Bindal, Anita Geevarghese Koshy, Danielle C McDonald, Deepa Rangachari, Daniel Botelho Costa
Journal: Journal of Clinical Oncology (2020)

e21579 Background: P and P+C are standard-of-care (SOC) treatment options for advanced NSCLC. However, they have not yet been directly compared in clinical trials. Methods: We conducted a retrospective cohort study of patients with advanced NSCLC who initiated treatment with SOC P±C at our center from 2/11/16 to 10/15/19 (data cutoff 1/15/20). Patient demographic, clinicopathologic, therapeutic and outcomes data were extracted. All radiographic scans were independently evaluated by a thoracic radiologist using iRECIST. Survival time was defined from the start of P±C. Kaplan-Meier and Cox proportional hazards model were utilized. Results: Of 103 patients with median follow up of 17.7 months, 74 (71.8%) had received P, while 29 (28.2%) had received P+C. In PD-L1 tumor proportion score (TPS) unselected population, there were no significant differences in age, sex, smoking status, driver mutation, tumor mutational burden (TMB), line of therapy, ECOG performance status (PS) or immune-related adverse events (irAE) between P and P+C groups. 71.6% in P vs 13.8% in P+C had PD-L1 TPS ≥50% (p &lt; 0.001). There were no significant differences between the two groups in objective response rate (ORR), disease control rate (DCR), unadjusted progression-free survival (PFS) or unadjusted overall survival (OS) (Table). Multivariable adjustment for confounding factors between P+C vs P revealed no differences in OS [hazard ratio (HR) for death, 1.53, 95% CI 0.55 – 4.25] or PFS [HR for progression/death, 1.75, 95% CI 0.63 – 4.91]. Further stratification into PD-L1 TPS ≥50% and &lt; 50% showed no significant differences between P+C vs. P in adjusted OS [HR for death, TPS &lt; 50%- 1.54 (95% CI 0.59 – 4.03); TPS ≥50%- 0.71 (95% CI 0.11 – 4.52)] or PFS [HR for progression/death, TPS &lt; 50%- 1.58 (95% CI 0.72 – 3.48); TPS ≥50%- 0.64 (95% CI 0.06 – 6.93)]. ECOG PS and development of irAE influenced OS in all groups, while TMB was relevant in PD-L1 ≥50% only. Conclusions: Our study shows no significant differences in outcomes with P vs P+C in advanced NSCLC in a real-world setting, albeit with limitations of single-center design, limited sample size, different line settings and lack of disease burden stratification. Ongoing phase III trials comparing front line P vs P+C will definitively address the long-term clinical benefits -if any- of combining cytotoxic chemotherapy with anti-PD-1 drugs. [Table: see text]
21-gene recurrence score assay as a predictor of pathological response in neoadjuvant chemotherapy administration for ER-positive/HER2-negative early-stage breast cancer.
Authors: Serafin Morales Murillo, Ariadna Gasol Cudós, Alvaro Rodriguez, Carles Canosa Morales, Jordi Melé Olivé, Felip Vilardell, Douglas Sanchez Guzman
Journal: Journal of Clinical Oncology (2020)

e12630 Background: Neoadjuvant chemotherapy (NAC) is an optimal option in early breast cancer, but in ER-positive/HER2-negative (luminal) is still controversial, although a survival benefit has recently been observed when a histological response by symmands method type 0 or I is achieved. The 21-Gene recurrence score assay (Oncotype DX) is a validated test to assess the survival benefit of adjuvant chemotherapy in these patients but its role in neoadjuvant setting is not yet well established unknown. We analyze the correlation between Oncotype DX Recurrence Score result and the pathological response assessed by symmands method. Methods: We analyzed a prospective cohort of 63 early luminal breast cancer patients who received NAC after performing an Oncotype DX test. Patients with an Oncotype DX Recurrence Score result lower 11 were excluded. The median age was 54 years (31-84), initial tumor size was 37 mm (12 -97), 41 patients (65%) had initial nodal involvement and the median Ki67 index was 34% (8 – 85). Results: An Oncotype DX results inferior or equal to 25 (considered as a limited benefit of chemotherapy treatment) was observed in 25 patients (40%) and a Recurrence Score higher than 25 in 38 (60%). Pathological response type 0 was achieved in 5 patients (8%) and type I in 16 (25%). A strong correlation between pathological response type 0 and I and Recurrence Score result in the univariate and multivariate analysis (OR 0,946 p:0,023) was found. We have performed a threshold analysis finding the Oncotype DX the most significant predictor of pathological response (AUC:0,75 p:0,0 01 ) compared to Ki67 (AUC:0,61 p:171), Estrogen receptor (AUC:0,41 p:0,21) and initial tumor size (AUC:0,671 p:0,028). All the patients who achieved a complete pathological response had a Recurrence Score result ≥ 26. Conclusions: The Oncotype DX Recurrence Score could be a useful tool to select early breast cancer patients who will benefit from neoadjuvant chemotherapy. Oncotype DX is the most significant predictor variable of pathological response and patients with a Recurrence Score of 25 or greater are five times more likely to obtain a histological response type 0-1 (OR: 5,3 p &lt; 0,016). In our series the Oncotype DX test reaches the highest rate of complete pathological responses in this group of patients.
Somatic illness in community psychiatric patients: a clinical analysis of 146 cases
Authors: Xue Xue, Xishun Liu, Wei Shi
Journal: BMJ (2016)

对自愿参加政府免费体检的146例精神病患者的体检资料进行分析，显示其躯体健康问题的总检出率为89.0%，检出率由高到低的躯体问题依次为超重及肥胖(56.2%)、心电图异常(47.3%)、血糖异常(38.4%)、高血压(34.9%)、血脂异常(30.1%)、尿常规异常(32.2%)、肝功能异常(24.0%)、尿酸异常(19.9%)、血常规异常(11.0%)。不同年龄段精神病患者高血压的检出率差异具有统计学意义(P 0.05)。提示社区精神病患者躯体健康状况不容乐观，应加强对其的健康教育及躯体疾病治疗。
Aspirin resistance and its related factors in patients with stage 3-4 chronic kidney disease
Authors: Chunhua Zhang, Taigen Cui, Sumei Zhao, Sixiang Wang
Journal: BMJ (2014)

Objective
To investigate aspirin resistance (AR) and its related factors in patients with stage 3-4 chronic kidney disease(CKD).


Methods
The clinical data of 108 patients with stage 3-4 CKD from nephrology department in Beijing Chaoyang Hospital were collected (CKD group); and 110 age and sex-matched subjects with normal renal function served as control group. Anthropometric parameters, blood biochemistry index, ultrasonography and thromboelastograph (TEG) were examined in both groups; and inhibition ratio of arachidonic acid>50% on TEG was defined as AR.


Results
The incidence of cardio-cerebral vascular disease, the incidence of peripheral vascular disease, ratio of female, the intima-media thickness (IMT) of carotid artery, the levels of high-sensitive C-reactive protein(hsCRP), homocysteine(Hcy), evaluated glomerular filtration rate(eGFR) and maximal thrombelastodegree (MA) on TEG in CKD group were significantly higher than those in control group (all P<0.05), while R value was significantly lower in CKD group. Pearson's correlation analysis revealed that the levels of MA, hsCRP, Hcy, IMT were positively correlated and R value was negatively correlated with eGFR in CKD group. The incidence of AR in CKD group (32.4%) was significantly higher than in control group (20.0%). According to TEG, the patients were divided into AR group (n=35) and aspirin sensitive (AS) group (n=73). The incidence of cardio-cerebral vascular disease, the incidence of peripheral vascular disease, ratio of female, IMT, ratio of diabetes, the levels of hsCRP, Hcy, fasting plasma glucose (FBG), eGFR and MA in AR group were significantly higher than those in AS group (all P<0.05), while R value was significantly lower in AR group. Binary logistic regressive analysis revealed that the ratio of diabete, FBG, eGFR, hsCRP were independent risk factors for AR in patients with stage 3-4 CKD.


Conclusions
CKD stage 3-4 is associated with increased ratio of platelet activation and atherosclerosis, and this condition is aggravated while eGFR declining. Incidence of AR is 32.4% in this group of CKD patients, the independent risk factors of AR in CKD patients are the ratio of diabetes, FBG, eGFR and hsCRP.


Key words: 
Chronic kidney disease; Aspirin resistance; Risk factors
Clinical analysis of 77 cases of papillary thyroid microcarcinoma
Authors: Jinping Zhang, Yifan He, Ying Shuai, Aiping Song, Ye Wang, Lulu Song, Xiaoyan Xing, Wenying Yang, Xiaopin Cai
Journal: BMJ (2017)

Objective
To analyze the clinical characteristics of papillary thyroid microcarcinoma (PTMC).


Methods
One hundred and twenty nine patients preoperatively diagnosed as papillary thyroid carcinoma(PTC) or suspicious PTC by fine needle aspiration biopsy (FNAB) underwent thyroidectomy, and 127 cases were confirmed as PTC histopathologically, among whom 77 cases were microcarcinoma (60.6%). The clinical data of 77 PTMC cases were retrospectively analyzed with SPSS (20.0) statistical software.


Results
In 77 PTMC cases, BRAF gene detection was performed in 69 cases, 51 cases showed positive BRAF (73.9%) and 18 cases were negative. Among patients with positive BRAF, 17 cases had cervical lymph node metastasis (33.3%); and in those with negative BRAF, 5 cases had metastasis (5/18, χ2=0.189, P>0.05). In 31 patients with multiple lesions, 14 had cervical lymph node metastasis (45.2%); while in 46 patients with single lesion, 9 had metastasis (19.6%) (χ2=5.792, P<0.05).


Conclusion
Although PTMC growth is slow and occult, early lymph node metastasis is not rare, particularly for patients with multiple lesions.


Key words: 
Thyroid neoplasma; Carcinoma, papillary; Biopsy, fine-needle; BRAF gene
Cabozantinib in Advanced Hepatocellular Carcinoma: Efficacy and Safety Data from an International Multicenter Real-Life Cohort
Authors: Fabian Finkelmeier, Bernhard Scheiner, Catherine Leyh, Jan Best, Thorben Wilhelm Fründt, Carolin Czauderna, Alica Beutel, Dominik Bettinger, Johannes Weiß, Tobias Meischl, Fabian Kütting, Dirk-Thomas Waldschmidt, Pompilia Radu, Michael Schultheiß, Kai-Henrik Peiffer, Thomas J. Ettrich, Arndt Weinmann, Henning Wege, Marino Venerito, Jean-Francois Dufour, Christian M. Lange, Matthias Pinter, Oliver Waidmann
Journal: Liver Cancer (2021)

&lt;b&gt;&lt;i&gt;Background and Aims:&lt;/i&gt;&lt;/b&gt; The multikinase inhibitor cabozantinib has been approved for hepatocellular carcinoma (HCC) previously treated with sorafenib. We report safety and efficacy data of an international, multicenter, real-life cohort of patients with advanced HCC treated with cabozantinib. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Patients with HCC who were treated with cabozantinib were retrospectively identified across 11 centers in Austria, Switzerland, and Germany. Patients’ characteristics, adverse events, duration of treatment and overall survival (OS) data were analyzed until April 1, 2020. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Eighty-eight patients from 11 centers were included. The predominant underlying liver diseases were NAFLD/NASH in 26 (30%) and hepatitis C infection in 21 (24%) patients. Seventy-eight patients (89%) were classified as Barcelona clinic liver cancer (BCLC) stage C. Sixty patients (68%) were Child-Pugh A, whereas 22 (25%) were Child-Pugh B, respectively. Cabozantinib was used as systemic second- and third-line or later treatment in 41 (47%) and 46 (52%) patients, respectively. The following best responses under cabozantinib were documented: partial response in 6 (7%), stable disease in 28 (32%), and progressive disease in 28 (32%) patients, respectively. Fifty-two patients (59%) died during follow-up. The median OS from start of cabozantinib treatment was 7.0 months in the entire cohort and 9.7 months in Child-Pugh A patients, while Child-Pugh B patients had a median OS of 3.4 months, respectively. Thirty-seven (42%) patients fulfilled the CELESTIAL inclusion and exclusion criteria, showing a median OS of 11.1 months. Most common adverse events were fatigue (15.6%) and diarrhea (15.6%). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Cabozantinib treatment was effective, safe, and feasible in patients with advanced HCC in patients with compensated cirrhosis. Patients in the real-life setting had more advanced liver disease – in which 25% of patients were Child-Pugh B. However, OS in patients with Child-Pugh A cirrhosis was similar to that reported in the phase 3 trial (CELESTIAL).
Trends in real-world clinical outcomes among patients (pts) with metastatic pancreatic adenocarcinoma (mPDAC) treated with liposomal irinotecan based regimens in the United States (US).
Authors: Jim M. Koeller, Paul Cockrum, Bruce Belanger, Frank A. Corvino, Andy Surinach, George P. Kim
Journal: Journal of Clinical Oncology (2020)

e16751 Background: The NAPOLI-1 study, a randomized phase 3 study in pts with mPDAC previously treated with gemcitabine-based therapy, demonstrated an improvement in overall survival (OS) with liposomal irinotecan + 5-fluorouracil/ leucovorin (5-FU/LV) vs. 5-FU/LV. In this analysis we describe the trends in pt characteristics, real-world OS (rwOS), and real-world time to-treatment failure (rwTTF) among pts with mPDAC treated with liposomal Irinotecan based regimens overall and stratified by tx initiation prior to 2018 (pre-2018) or after 2018 (post-2018). Methods: This retrospective observational study used de-identified data from Flatiron Health EHR database from over 280 cancer clinics in the US. Pt characteristics, rwOS, and rwTTF were assessed in adult pts diagnosed with mPDAC who received liposomal irinotecan treatment (tx) between January 1, 2016 and October 31, 2019. Results: Of the 590 pts treated with liposomal irinotecan based regimens, 53% were male, 56% were initially diagnosed with Stage IV disease, 92% were treated in the community setting, and median age at tx initiation was 69 (IQR: 62 – 75) years. Among pts with available ECOG scores (N = 435), 77% had a score of 0 or 1. 43% (n = 254) initiated tx pre-2018 and 57% (n = 336) post-2018. Pre-2018, 106 (42%) pts initiated liposomal irinotecan in the third line metastatic setting or later (3rd line+), 125 (49%) had ECOG score of 0-1, and median age was 68 (62–74) years. Post-2018, 36% of pts initiated tx in 3rd line+, 211 (63%) had ECOG score of 0-1, and median age was 70 (63 – 75) years. Median rwOS was 4.4 months [95% CI: 4.3–6.2] pre-2018 and 5.2 mos [4.3–6.2] post-2018. rwTTF was 1.6 mos [1.4–1.9] pre-2018 and 2.1 mos [1.6–2.5] among pts post-2018. Among pts treated in first- or second-line, pre-2018 rwOS was 5.3 mos [3.9–6.4] and post-2018 rwOS was 6.3 mos [5.0– 7.6]. Conclusions: In this descriptive real-world study of pts with mPDAC receiving liposomal irinotecan based regimens, pts initiating treatment post-2018 appear to be less pre-treated, older, and have better performance status than pts pre-2018. Pts treated post-2018 experienced numerically longer rwTTF and rwOS than pts treated pre-2018.
Surface electromyographic characteristics of sternocleidomastoid muscle in infants with congenital muscular torticollis following rehabilitation
Authors: Xuan Zhou, Qing Du, Xiaoyan Yang, Lin Mao, Jüping Liang, Mengmeng Tan
Journal: BMJ (2019)

Objective
To identify the surface electromyographic (sEMG) characteristics of bilateral sternocleidomastoid muscles in infants with congenital muscular torticollis (CMT) after rehabilitation.


Methods
One hundred and twenty two infants were enrolled from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2013 and December 2015, including 63 cases receiving rehabilitation (treatment group) and 59 cases without rehabilitation (control group). The sEMG parameters of bilateral sternocleidomastoid muscles in cervical neutral, left and right rotation and stretching posture in the supine position were retrospectively collected before and after treatment/follow-up; and the root mean square (RMS) was analyzed.


Results
Before treatment, the RMS values of the affected side in cervical neutral position, cervical rotation and stretching posture were significantly lower than those of the unaffected side in both groups(t=15.758 and 11.950, 4.871 and 4.746, 4.142 and 4.318,P<0.01). In the follow-up for control group, the RMS values of the affected side in cervical neutral position, cervical rotation and stretching posture were significantly lower than those of the unaffected side (t=10.692, 2.198 and 3.239; P<0.01, =0.03 and <0.01).In the treatment group there were no significant differences in the RMS values in cervical neutral position, cervical rotation and stretching posture between affected side and unaffected side after treatment (t=1.647, 1.090 and 0.136, P=0.10, 0.28 and 0.89).


Conclusion
Rehabilitation reduces the difference of the RMS values between the affected and unaffected sternocleidomastoid muscles in infants with CMT.


Key words: 
Torticollis; Rehabilitation; Electromyography
Prognostic implications of gene amplifications identified by circulating tumor DNA (ctDNA) analysis in metastatic prostate cancer (mPC).
Authors: Toros Dincman, Antonio Giordano, Hong Li, Theodore Stewart Gourdin, Leylah Drusbosky, Philip Howe, Michael B. Lilly
Journal: Journal of Clinical Oncology (2020)

e17594 Background: mPC is a dynamic disease that confers a poor prognosis- particularly in the metastatic castration-resistant prostate cancer (mCRPC) setting. Analysis of ctDNA provides an opportunity to identify and monitor somatic alterations (SAs) in a patient’s treatment course. However, how certain SAs can inform disease management is not fully characterized. We evaluated whether the presence of specific gene amplifications (GAs) and changes in plasma copy number (PCN) are associated with disease features and prognosis. Methods: This is a retrospective study of mPC patients seen at the Hollings Cancer Center between 2015-2019 who underwent ctDNA profiling using Guardant360 (Guardant Health Inc). Guardant360 identifies SAs and GAs of select genes by NGS. Descriptive statistics were used to summarize baseline patient characteristics. The chi-square test and odds ratio (OR) were used to evaluate associations between clinical factors and GAs. The Kaplan-Meier method was used to estimate OS from either the date of GA detection or the initiation of systemic therapy. Results: 130 men with mPC were identified as having ≥1 GA. The presence of liver and/or lung metastases were associated with GAs of BRAF (OR 2.5; 95%CI 1.1-5.8, p &lt; 0.05) , CDK6 (OR 2.3; 95%CI 1.4-8.0, p &lt; 0.01) , PI3KCA (OR 4.4; 95%CI 1.8-10.7, p &lt; 0.01) , and FGFR1 (OR 3.1; 95%CI 1.1-9.0, p = 0.038). These GAs were also associated with having ≥2 concurrent GAs (p &lt; 0.01 for each gene). From this cohort, survival analyses were completed on 59 patients with mCRPC. Men with only 1 GA, compared to men with ≥2 GAs, had improved median survival (mo.) from date of initial GA(s) detection (16.5 vs 9.4, p &lt; 0.01) or therapy initiation (16.0 vs 9.0, p &lt; 0.01). Among men with mCRPC, AR and/or MYC GA, median survival improved in men who had reduction in AR or MYC PCN during therapy compared to men without a PCN decrease (25.1 vs 15.9 p &lt; 0.01). Conclusions: Patients with mPC who had liver and/or lung metastases were associated with having specific GAs in BRAF, CDK6, PI3KCA, and FGFR1. Notably, the presence of liver or lung metastases was not associated with AR GA. In mCRPC, patients with ≥2 GAs had decreased OS compared to men with one GA. Having an increased number of GAs is likely reflective of greater chromosomal instability and be associated with more aggressive disease. Our study reveals serial monitoring of AR and MYC PCN during therapy demonstrated reduced OS in patients without PCN reduction. This supports the use of serial ctDNA monitoring of PCN to inform therapeutic response and prognosis.
Evaluation of saliva examinations in children
Authors: 吴虹桥, 童梅玲, 张敏
Journal: BMJ (2008)

唾液是由唾液腺分泌的一种无色、无味、近于中性的低渗液体,主要成分为水、电解质、糖、脂类、蛋白质等.大量的研究证实,唾液中的许多成分不仅与口腔健康有关,而且能反映机体的营养、免疫和疾病状况[1-2].唾液检测因其易于采集、操作简便、非侵入性,已经成为评价疾病和解决一些医学问题的重要辅助手段之一。
Survey on clinical knowledge of coronary artery disease management in general practitioners in Beijing
Authors: Zhaoxia Yin, Kai Huang, Yang Chen, Xiumei Tong
Journal: BMJ (2014)

A survey on clinical knowledge of coronary artery disease (CAD) management in general practitioners (GPs) in Beijing was conducted from March to September, 2013. The questionnaire contained 4 cases (stable angina pectoris, post-percutaneous coronary intervention, acute anterior myocardial infarction and acute inferior myocardial infarction) and related clinical questions. Five hundred questionnaires were distributed and 471 valid questionnaires were returned with a recovery rate of 94.2%. The correct rate was 87.3% and 61.8% for diagnosis and treatment of emergent events in acute anterior myocardial infarction; however, the correct rate for other knowledge was ranged between 23.4% and 40.6%. The correct rate increased with the educational levels in 5/11 items(P<0.01)and increased with the professional titles(P<0.001)in 3/11 items, which was not associated with the attendance of training or frequency of training attendance. The results indicate that clinical knowledge of CAD management for GPs in Beijing should be improved and the training methods should be focused on the clinical capacity.


Key words: 
General practitioner; Disease management
Evaluation of pulmonary hypertension with echocardiography
Authors: Wenying Jin, Zhilong Wang, Tiangang Zhu
Journal: BMJ (2019)

超声心动图是临床筛查肺动脉高压的重要手段。根据三尖瓣反流最大流速或肺动脉瓣反流速度可以估测肺动脉压力；此外，右心室压力负荷过重、室间隔平直、右心室扩大、右心室游离壁运动幅度减低等，是常见的肺动脉高压超声表现。超声心动图可作为肺动脉高压危险分层的重要依据。
Prediction of esophageal fistula from esophageal cancer CT images using multi-view multi-scale attentional convolutional neural network (MM-Atten-CNN).
Authors: Yiyue Xu, Hui Cui, Bingjie Fan, Bing Zou, Xindong Sun, Jinming Yu, Linlin Wang
Journal: Journal of Clinical Oncology (2020)

4553 Background: We aimed to propose a risk model based on MM-Atten-CNN for predicting esophageal fistula in patients with esophageal cancer (EC) from computerized tomography (CT) -based radiomics. Methods: EC patients who didn’t received esophageal surgery between July 2014 and August 2019 were collected. Of these, 186 patients (cases) who developed esophageal fistula were enrolled and compared with 372 controls (1:2 matched with the diagnosis time of EC, sex, marriage, and race). All 558 patients were divided into training set (n = 390) and validation set (n = 168) randomly. The MM-Atten-CNN risk model was trained over 2D slices from nine views of planes, where there were three patches of contextual CT, segmented tumor and neighbouring information in each view. In the training set (130 cases and 260 controls), data augmentation was performed including pixel shifting [-10, -5, +5, +10] and rotation [-10, +10]. In total, there were (130+260) *16*2 = 12480 subjects used for training. Finally, the risk model was validated in the validation set (56 cases and 112 controls) and measured by accuracy (acc), sensitivity (sen), and specificity (spe). Results: The developed risk model achieved (acc, sen, spe) of (0.839, 0.807, 0.926), which were more predictive for the occurrence of esophageal fistula when compared to CNN models using single coronal view (acc 0.763, sen 0.581, spe 0.837), multi-view 2D contextual CT slices (acc 0.779, sen 0.656, spe 0.896), and 3D CNN using contextual CT volumes (acc 0.781, sen 0.689, spe 0.852). Conclusions: MM-Atten-CNN CT-based model improved the performance of esophageal fistula risk prediction, which has the potential to assist individualized stratification and treatment planning in EC patients.