tbuckley/cabot-search huggingface dataset:
Predictors of extensive subclinical spread in squamous cell carcinoma.
Authors: Anna Eversman, Elizabeth Tracey, Daniel Michalik, Marla Rodriguez, Isaac Briskin, Christine Poblete-Lopez
Journal: Journal of Clinical Oncology (2020)

e22093 Background: Extensive spread of squamous cell carcinoma (SCC) is often clinically imperceptible but has a profound impact on risk of recurrence and metastasis. Accurate identification of high-risk SCC enables educated choices in treatment modality and appropriate referrals for Mohs micrographic surgery (MMS). Methods: We conducted a retrospective cohort study of 1,019 patients with SCC removal by MMS at the Cleveland Clinic. We analyzed the relationship between various patient and tumor characteristics to aggressive subclinical extension (ASE), defined as tumors requiring &gt;3 Mohs layers to obtain clear margins. Tumor locations were grouped into zones according to the American Academy of DermatologyÕs appropriate use criteria (AUC). Results: 67 of 1,149 tumors required &gt;3 Mohs layers for removal. Tumor grade was the only statistically significant variable, with moderately-differentiated tumors having 1.828 times the odds of ASE compared to well-differentiated tumors (95% CI = [1.026, 3.255], p = 0.041). Poorly-differentiated tumors had 4.273 times the odds of ASE compared to well-differentiated tumors (95% CI = [1.755, 10.4], p = 0.001). Conclusions: Current treatment guidelines for SCC are largely derived from data on all non-melanoma skin cancers. SCC is associated with higher metastatic potential than basal cell carcinoma (BCC), emphasizing the importance of independent analysis of SCC. The power of this study was limited by the small number of extensively spread tumors. Despite this limitation, our analysis shows poorly and moderately-differentiated tumors are correlated with a higher rate of ASE compared to well-differentiated tumors. Moderately-differentiated tumor grade is not included in the AUC, however treatment of these tumors with MMS might improve patient outcomes and minimize costs associated with recurrence. Our results show risk stratification by zone has minimal utility in identifying ASE-SCC. Improved understanding of location-based differences in tumor behavior could reveal discrepancies between SCC and BCC, enabling revised zones specific to SCC. [Table: see text]
成功救治甲型H1N1流行性感冒危重症一例
Authors: 赵晔, 王晖, 于黎丽, 代璐, 陈晓红
Journal: BMJ (2010)

患者女,28岁,因咳嗽、咳痰、发热5 d入院.患者于2009年10月27日无诱因出现咳嗽,咳少量黄黏痰且难以咳出,伴周身肌肉酸痛,发热(达39.5 ℃),无畏寒、寒战,有恶心、呕吐少许胃内容物,无腹痛、腹泻.10月28日于社区医院静脉滴注氨曲南3 d,上述症状无好转,遂于10月31日就诊于本院,当时体温39.1 ℃,血白细胞6.6×109/L,分类中性粒细胞0.88,淋巴细胞0.082,X线胸片示左肺大片状阴影(图1),11月1日收入院.发病以来患者活动后气短,无咯血,无胸痛,二便正常.既往有先天弱智,生活能自理.无异地居住史和与甲型H1N1流行性感冒(甲流)患者密切接触史。
The tongue image in AIDS patients
Authors: Jiang-rong Wang, Xiao-rong Chen, Yin-zhong Shen, Hong-zhou Lu, Qin Zhang
Journal: BMJ (2009)

We retrospectively reviewed the tongue images and related clinical data of 118 AIDS patients treated in Shanghai Public Health Clinical Center Affiliated to Fudan University. The tongue images included: cyanotic and purplish tongue ( 33, 28.0% ), light-reddish tongue ( 32, 27.1% ), light-whitish tongue (21, 17.8% ) , bulgy tongue(19, 16.1% ), dark-red tongue (7, 5.9% ) and fissured tongue (6,5.1% ). There were significant differences in counts of CD4+T lymphocytes, white blood cells and red blood cells among different tongue imagine groups. The tongue image can indicate the pathogenic factors of disease as well as the functions of viscera in AIDS patients.

Key words: 
Tongue inspection; Acquired immunodeficiency symdrom
Survey of the experience of head and neck cancer patients with a percutaneous endoscopic gastrostomy tube.
Authors: Kamal Kant Sahu, Lisa Gibbs, Ahmad Daniyal Siddiqui
Journal: Journal of Clinical Oncology (2020)

e18501 Background: Many patients with advanced head and neck cancer become unable to obtain enough nutrition and hydration orally, leading to considerable weight loss and compromised clinical outcomes. PEG tube is ideal for this population who require longer term nutrition support because of cancer treatment. The study objective was to learn about the experience of patients with a PEG tube. Methods: A questionnaire was developed, tested, and used to collect data. This survey consisted of 20 questions pertinent to various domains of quality of life and aiming at various aspects of patient life: physical, emotional and social sectors and noting their experiences in the form of multiple-choice options using Likert scale and free text option for suggestions. Results: A total of 22 participants were involved in this study, 64 years,7 males and 5 females. Cancer site: Tongue (10), tonsils (5), pharynx (5) and larynx (2). All patients belonged to stage III or more. Majority were treated with chemoradiotherapy (17 ). Out of 22 patients, 18 had PEG tube placement before starting treatment and the other 4 agreed during the cancer treatment. Most patients had the PEG tube for 3-6 months (8/22 cases). 21 patients strongly agree that PEG tube insertion was useful to them for their treatment and nutrition. 21 patients agreed relying on PEG tube FOR &gt; 75% of their daily nutrition. While 4 patients agreed that PEG hampered their ADLs, 13 patients suggested that only rarely (7 cases) or sometimes (6 cases) they encountered difficulty in managing their ADLs. Only 2 patients had often trouble with sleep.15 cases did not feel any social embarrassment with PEG and did not miss any social events.19 patients answered that they followed oncologists to have PEG tube placement. Majority (15) managed the tube feed on their own. 16 cases never had any clinic/ER visit solely due to PET tube issues. 20 patients considered dietician as the first person to connect for concerns. 8 patients experienced issues like tube site infection (5), leakage (5), bleeding from site (4), tube blockade (5) or tube replacement (2). All patients except one agreed to have PEG placement again in future if required for any medical reason and would recommend others as well. Similarly, all patients except one thought that they would not have completed the cancer treatment without PEG tube support. Conclusions: Results indicate that the patient experience with the PEG tube is generally positive. This study will help improve understanding regarding the experience of living with a PEG tube from the patient perspective.
Clinical characteristics of diabetic patients with metabolic syndrome and its components at 15 urban communities in Beijing
Authors: Han-jing Fu, Shen-yuan Yuan, Liang-xiang Zhu, Ming-xia Yuan, Guang-ran Yang, Su-fang Pan
Journal: BMJ (2011)

Objective To study clinical characteristics of type 2 diabetic(T2D)patients with metabolic syndrome(MS)and its components in Beijing urban communities.Methods Totally,3295 T2D patients involved in a combined prospective diabetic management study from 15 urban communities in Beijing were classified as four groups, according to 2004 Chinese Diabetes Society's definition of MS, i. e, isolated T2D, T2D with one component of MS, T2D with two components of MS and T2D with three components of MS. Their clinical characteristics were analyzed. Results ( 1 ) Among 3295 T2D patients, 155 (4. 7% )were isolated T2D, 107 (32.6%) T2D with one component of MS, 1386 (42.1%) T2D with two components of MS and 679 (20.6%) T2D with three components of MS, with an overall 62.7% (2065/3295) of T2D patients complicated with MS. (2) In these T2D patients, the more components of MS they had, the higher body mass index (BMI), waist circumference, waist to hip circumference ratio (WHR),systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting serum levels of insulin and triglyceride (TG) and the lower level of high-density lipoprotein-cholesterol (HDL) were presented (P <0. 01 ). (3) Percentage of isolated T2D in women increased from 49. 0% (76/155) to 61.9% (420/679)of those with three components of MS ( P < 0 01 ), with increasing of components of MS. (4) Multiple logistic regression analysis showed that BMI, history of hypertension, decreased HDL, increased TG,increased blood pressure, all were risk factors for T2D patients complicated with MS. Conclusions Among T2D patients in urban communities of Beijing, 95.3% (3140/3295) of them complicated with one or more components of MS, and 61.9% (420/679) of them complicated with MS. So, community diabetic management must be implemented in an all-round way, including control of blood pressure, blood lipids,body weight and so on, in addition to control of blood sugar. 

Key words: 
Community;  Diabetes, type 2;  Metabolic syndrome
Surgery at primary and metastatic sites for stage IV breast cancer (BC): A National Cancer Database (NCDB) analysis.
Authors: Nadeem Bilani, Leah Elson, Elizabeth Blessing Elimimian, Hong Liang, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2020)

1099 Background: There is no clear evidence of a survival benefit of primary tumor resection in patients with stage IV breast cancer (BC). This large study evaluated factors associated with undergoing primary tumor resection, and whether resection at the primary site, or distant site resection (metastasectomy), was associated with better overall survival (OS). Methods: This retrospective analysis of stage IV BC cases used the 2004-2016 National Cancer Database (NCDB) population. To evaluate variables associated with primary tumor resection, we used univariate analyses (chi-squared and Wilcoxon rank-sum test), followed by multivariate logistic regression. Consequently, we conducted multivariate Cox regression survival analyses on the following groups: 1) all stage IV BC patients; 2) a subset of those with only 1 site of metastasis; and 3) another subset with metastasis to &gt; 1 distant site. Results: A total of 54,871 stage IV BC patients were included in this analysis. From this, we analyzed a subset with only 1 distant site involved (n = 30,480) and another subset with multiple secondary sites (n = 17,344). In total, 15,661 patients underwent surgery at the primary site: 11,451 (73.1%) were non-Hispanic white; 2479 (15.8%) were non-Hispanic black; 981 (6.3%) were Hispanic and 484 (3.1%) were Asian. Variables associated with undergoing resection of the primary tumor were: age, race, Charlson/Deyo score, insurance and facility type, involved breast quadrant, receptor status, N-staging, extent of metastasis and year of diagnosis. Survival analysis of all stage IV patients showed that both lumpectomy (HR 0.59, 95% CI: 0.57-0.62, p &lt; 0.0001) and mastectomy (HR 0.62, 95% CI: 0.60-0.64, p &lt; 0.0001) were associated with better OS when compared to no surgery. The statistical effect was larger in the subgroup with metastasis to 1 site, but still significant in the subgroup with multiple metastatic sites. Distant site resection also yielded a survival benefit compared to no metastasectomy across all 3 groups. In the subgroup with metastasis to only 1 site, metastasectomy was associated with better OS when the metastatic site was liver (HR 0.60, 95% CI: 0.43-0.82, p = 0.0018), lung (HR 0.47, 95% CI: 0.37-0.61, p &lt; 0.0001), and brain (HR 0.70, 95% CI: 0.55-0.88, p = 0.0022). Conclusions: Across all 3 patient subgroups, primary tumor resection (lumpectomy or mastectomy) and metastasectomy were associated with improved OS. Additional stratified analysis in the subgroup with only 1 metastatic site showed benefit of metastasectomy when that site was the lung, liver or brain.
Trastuzumab deruxtecan (T-DXd; DS-8201) in patients with HER2-mutated metastatic non-small cell lung cancer (NSCLC): Interim results of DESTINY-Lung01.
Authors: Egbert F. Smit, Kazuhiko Nakagawa, Misako Nagasaka, Enriqueta Felip, Yasushi Goto, Bob T. Li, Jose Maria Pacheco, Haruyasu Murakami, Fabrice Barlesi, Andreas Nicholas Saltos, Maurice Perol, Hibiki Udagawa, Kapil Saxena, Ryota Shiga, Ferdinand M. Guevara, Suddhasatta Acharyya, Javad Shahidi, David Planchard, Pasi A. Janne
Journal: Journal of Clinical Oncology (2020)

9504 Background: T-DXd is an antibody-drug conjugate composed of an anti-HER2 antibody, cleavable tetrapeptide-based linker, and topoisomerase I inhibitor payload. In a phase I trial, patients (pts) with HER2-mutated NSCLC who received T-DXd had a confirmed objective response rate (ORR) of 72.7% (8/11) (Tsurutani et al, WCLC 2018). DESTINY-Lung01 (NCT03505710) is an ongoing, multicenter, phase II study of T-DXd in pts with non-squamous NSCLC overexpressing HER2 or containing a HER2-activating mutation. We report data for the cohort with HER2 mutations after a median follow-up of 8.0 mo (range, 1.4-14.2 mo). Methods: Pts were treated with T-DXd 6.4 mg/kg every 3 weeks. The primary endpoint was confirmed ORR (complete response [CR] + partial response [PR]) by ICR. Additional endpoints were disease control rate (DCR; CR + PR + stable disease), duration of response (DOR), progression-free survival (PFS), and safety. Results: At data cutoff (25 Nov 2019), 42 pts (64.3% female) had received T-DXd. Median age was 63.0 years (range, 34-83 years; &lt; 65 y, 59.5%); 45.2% had central nervous system metastases; ECOG performance status was 0 in 23.8% of pts and 1 in 76.2%. HER2 mutations were predominantly in the kinase domain (90.5%). Most pts (90.5%) had prior platinum-based chemotherapy and 54.8% had anti–PD-1 or –PD-L1 treatment; median number of prior treatment lines was 2 (range, 1-6). Median treatment duration was 7.75 mo (range, 0.7-14.3 mo); 45.2% of pts remained on treatment. Confirmed ORR by ICR among the 42 pts was 61.9% (95% CI, 45.6%-76.4%); median DOR was not reached at data cutoff; 16 of 26 responders remained on treatment at data cutoff; DCR was 90.5% (95% CI, 77.4%-97.3%); estimated median PFS was 14.0 mo (95% CI, 6.4-14.0 mo). All pts (42/42) had treatment-emergent adverse events (TEAEs); 64.3% were grade ≥ 3 (52.4% drug-related), including decreased neutrophil count (26.2%) and anemia (16.7%). There were 5 cases (11.9%) of drug-related interstitial lung disease (ILD) as adjudicated by an independent committee (all grade 2, no grade ≥ 3) and 1 case of grade 1 ILD is pending adjudication. TEAEs led to dose interruption in 25 pts (59.5%), dose reduction in 16 pts (38.1%), and treatment discontinuation in 10 pts (23.8%). Conclusions: T-DXd demonstrated promising clinical activity with high ORR and durable responses in pts with HER2-mutated NSCLC. The safety profile was generally consistent with previously reported studies. Clinical trial information: NCT03505710 .
Accuracy of CT-guided percutaneous automated cutting needle biopsy of lung lesions
Authors: Mei-yan Liao, Yun-feng Zhou, Wei-dong Hu, Zai-peng Zhang, Bi-cheng Wang, Hao Hu
Journal: BMJ (2009)

Objective Purpose of this study was to evaluate the accuracy of CT-guided percutaneous automated cutting needle biopsy (ACNB) of lung lesions and to determine its influencing factors in diagnosis of malignancy.Methods Clinical data of 352 patients undergone with ACNB was retrospectively analyzed for its accuracy in diagnosis of malignancy and its potential predictive variables, with unconditional logistic regression model.Results Mean length of percutaneous puncture for ACNB was (16.0 ± 2.0) min.Two hundred and forty-six of 352 patients were diagnosed as malignant, with sensitivity and specificity for diagnosis of malignancy of 92.7% and 100.0%, and positive and negative predictive values of 100.0% and 85.5%, respectively.Overall accuracy of its diagnosis of malignancy was 94.9%.Results of multivariate analysis showed that size of lung lesion equal to or smaller than 20 mm and those complicated with pulmonary atelectasis (with ORs of 4.198 and 2.210, respectively) associated with its negative positivity.Eighty (22.7%) cases presented pulmonary hemorrhage, 18 (5.1%) hemoptysis, 60 cases (17.0%) pneumothorax and two (0.6%) needed a chest tube for drainage after the procedure.One case had insistent pain for more than one month and one with pleural reaction caused by pulmonary cryptococcus infection.Conclusions CT-gnided ACNB was a feasible, safe and accurate method for diagnosing pulmonary lesions, pulmonary malignant lesions less than 20 mm in diameter and complicated with pulmonary maybe affect accuracy.

Key words: 
Lung disease;  Biopsy;  Tomography;  spiral computed
Outcome in patients with refractory high-risk neuroblastoma.
Authors: Amir Bari Siddiqui, Akosua Oppong, Cindy Yuan, Guimin Gao, Rochelle Bagatell, Katherine Berg, Elizabeth Sokol, Kyle MacQuarrie, Navin R. Pinto, Anurekha Gollapudi, Rajen Mody, Ian Wolfe, Suzanne Shusterman, Jennifer Foster, Valeria Smith, Susan Lerner Cohn, Ami Vijay Desai
Journal: Journal of Clinical Oncology (2020)

10537 Background: Outcome for high-risk neuroblastoma (HRNBL) patients (pts) with refractory disease at end of induction (EOI) is poor. The impact of therapies such as I-131-MIBG or irinotecan/temozolomide/dinutuximab (I/T/DIN) prior to autologous stem cell transplant (ASCT) on outcome is unknown. Methods: A multi-center, retrospective study of HRNBL pts diagnosed between 2008-2018 with refractory disease at EOI was conducted. Demographics, tumor biology, treatment response, and outcomes were abstracted. 3-year (yr) EFS and OS from time of diagnosis were estimated by the Kaplan-Meier method. Results: 3-yr EFS and OS were 54% and 79% for the 136 pts analyzed. 91 pts received no additional therapy prior to ASCT (Cohort 1); 32 pts received post-induction therapy prior to ASCT (Cohort 2); and 13 pts did not undergo ASCT (Cohort 3). The prevalence of metastatic disease in Cohort 1, 2, and 3 was 65%, 97%, and 85%. 3-yr EFS and OS were not statistically different between Cohort 1 (3-yr EFS and OS; 62% and 81%) and Cohort 2 [3-yr EFS and OS; 49% (p = 0.48) and 82% (p = 0.19)]. Outcome for Cohort 3 pts was significantly worse than Cohort 1 [3-yr EFS: 15% vs. 62% (p &lt; .001); and 3-yr OS: 48% vs. 81% (p = 0.003)] and Cohort 2 [3-yr EFS: 15% vs. 49% (p &lt; .001); and 3-yr OS 48% vs. 82% (p = 0.035)]. For Cohort 2 pts with metastatic disease, post-induction therapy included I/T/DIN (n = 12), MIBG (n = 16), MIBG plus I/T/DIN (n = 1), and other (n = 2). Metastatic disease response was observed in 10/12 (83%) pts who received I/T/DIN and 9/16 (56%) who received MIBG. MIBG plus I/T/DIN (n = 1) or MIBG with chemotherapy (n = 1) also induced response. Among the 21 pts with metastatic disease response, 3-yr EFS and OS were 69% and 94%; significantly better than Cohort 2 patients who did not respond to post-induction therapy [3-yr EFS and OS: 11% (p = 0.016) and 66% (p = 0.2)]. 6 Cohort 2 pts achieved a complete response (CR) in metastatic sites following I/T/DIN (n = 5) or MIBG (n = 1), and all are alive without relapse with median follow-up of 3.4 years (range 2.7-8.1). The single Cohort 3 patient who achieved a metastatic CR with I/T/DIN and did not undergo ASCT remains disease-free 2.4 years from diagnosis. Conclusions: Patient characteristics differed in the 3 Cohorts, reflecting the influence of refractory disease on treatment decisions. For Cohort 2 pts, outcome was better for those with metastatic disease at EOI who responded to post-induction therapy compared to those who did not. Pts who achieved a metastatic CR of refractory disease had excellent survival. Prospective studies testing the efficacy of I/T/DIN in pts with refractory metastatic disease at EOI are warranted.
targetSCAPE and ultraSCAPE: Simultaneous identification and deep profiling of human antigen-specific T cells and other immune cell subsets by mass cytometry.
Authors: Brian Abel, Faris Kairi, Alessandra Nardin, Evan Newell, Michael Fehlings
Journal: Journal of Clinical Oncology (2020)

e15204 Background: During clinical trial immune monitoring, especially in the field of immunotherapy, it is critical to collect in-depth phenotypic information from multiple immune cell populations in order to assess the biological activity of the immunotherapy, to identify biomarkers of response or disease progression, and/or to identify new drug targets. However, patient samples such as peripheral blood mononuclear cells or tissues, are often scarce and current methods face limitations in either achieving a sufficient depth of analysis and/or cell throughput. Methods: In order to identify therapy-relevant antigens and to facilitate a concurrent in-depth characterization of T cells directed towards these targets, immunoSCAPE leverages the high-dimensional immune profiling capabilities of mass cytometry and a unique methodology allowing the identification and characterization of rare antigen-specific T-cell subsets (targetSCAPE). By implementing a new cutting-edge technology that combines flow and mass cytometry in parallel with a combinatorial live cell barcoding strategy, we further increased the high-dimensional phenotyping capacities to over 100 different marker molecules on up to four different immune cell subsets simultaneously within the same sample. Results: We isolated 4 different immune cell populations from a single sample and combined 3 different phenotypic panels consisting of 35 makers each together with a combinatorial tetramer multiplex and phenotyping panel for deep profiling of myeloid cells, NK cells, B cells and T cells. We demonstrate the potential of this novel immuno-phenotyping method, by tracking virus-specific T cells while simultaneously characterizing 4 immune cell subsets with over 100 distinct phenotypic markers from a single sample, which is currently impossible employing modern flow cytometers or classical mass cytometry methods. Conclusions: With its ability to provide an unprecedented picture of the immune status within a single sample, including T cell specificity information and in-depth profiling of relevant immune cell subsets, ultraSCAPE in combination with targetSCAPE can provide detailed insights on the effects of immunotherapy on the immune cell population. Information learned from in-depth immune phenotyping of several immune cell subsets such as T, B, NK and myeloid cell subsets can be leveraged for the development of novel diagnostics, biomarker discovery and monitoring therapeutic strategies in immunotherapy clinical trials.