tbuckley/cabot-search huggingface dataset:
What is most important in predicting survival? Quantifying the relative effect of patient factors, stage, hospital, quality metrics, and treatment on survival following GI cancer resection.
Authors: Christopher Thomas Aquina, Adan Z Becerra, Allan Tsung
Journal: Journal of Clinical Oncology (2020)

e19203 Background: Prior studies have identified patient characteristics, TNM stage, quality metrics, and systemic therapy as factors associated with survival. However, studies have not quantified the relative predictive impact these factors have on survival. The purpose of this study was to rank the importance of factors effecting survival following GI cancer resection. Methods: The National Cancer Database identified patients who underwent potentially curative surgery for esophageal, gastric, pancreatic, colon, or rectal cancer from 2006-2015. Hierarchical Cox proportional hazards models for the outcome of 5-year overall survival assessed the proportion of explained variance by sociodemographic patient factors, TNM stage, the hospital where surgery was performed, perioperative quality metrics (lymph node [LN] yield, margin status, prolonged length of stay [LOS], unplanned readmission), and treatment (chemotherapy and radiotherapy [RT]). Results: Among 306,164 GI cancer resections, stage, LN yield, margin status, prolonged LOS, readmission, and chemotherapy were independently associated with survival. The relative importance of these factors varied by organ system. However, aside from patient factors, the hospital where surgery was performed ranked as one of the most important factors across all organ systems, and prolonged LOS was important across all organ systems. Conclusions: The hospital where surgery is performed is one of the most important factors explaining variation in survival, and it appears that prolonged LOS, which serves as a proxy for postoperative complications, also has a strong predictive ability on survival. Research identifying differences between hospitals that explain this hospital effect as well as which complications reduce survival is warranted. [Table: see text]
Flexible dilatation combined with topical betamethasone cream in treatment of child phimosis
Authors: Zihan Xu, Wenjie Gao, Benfeng Wang, Yadong Guo
Journal: BMJ (2016)

Two hundred and twenty five children aged 4-12 years with phimosis were treated by flexible dilatation combined with topical betamethasone cream from January 2003 to January 2015. Two hundred and eight cases (92.44%) were completely cured and penile edema and urination were returned to normal 7 d after a single operation; while, 17 children received 2-3 additional flexible expansion. During follow-up of 2-24 months, 221 children achieved the cure standards with an overall cure rate of 98.22%. Flexible dilatation combined with topical betamethasone cream is effective modality for phimosis in children, with less surgical trauma and low complication rate.


Key words: 
Dilatation, phimosis; Foreskin; Betamethasone
Comparison of blood pressure control in community hypertensive patients with different management methods
Authors: Mei Zhu, Junling Gao, Guiqin Jin, Jianying Zheng, Qin Huang, Jueying Chen
Journal: BMJ (2015)

Objective
To compare blood pressure control in community hypertensive patients with different management methods.


Methods
Two neighborhood committees in a community of Pudong were selected as study area using cluster sampling method.A total of 5 166 residents aged ≥35 y were screened for blood pressure; the subjects with high blood pressure and had antihypertensive medication in last 6 months were included, and patients with secondary hypertension was excluded.The patients who entered community hypertension management program and got medication from community were included in community group; those who did not enter in community management program and/or not get medication from community were included in non-community group.Self-designed questionnaire was used for investigation.The medication compliance, awareness of hypertension risk factors and high blood pressure control were compared between two groups.


Results
Among 5 166 residents 4 763 were surveyed for hypertension with a response rate of 92.2% and hypertension prevalence rate of 23.2% (1 105/4 763). Among 1 012 patients with drug treatment for more than 6 months, there were 878 cases in community (86.8%) and 134 cases (13.2%) in non-community group. There were no significant differences in gender, age, education, working condition between community group and non-community group (P>0.05).44.3% (389/878) patients in community group had a history of high blood pressure >10 y and that was 56.7% (76/134) in non-community group (P=0.011); 28.6% (251/878) patients in community group were at high risk for risk stratification and that in non-community group was 47.8% (64/134) (P<0.001). The awareness of hypertension risk factors in community group and non-community group was 83.9% and 95.5%, respectively (P<0.001). The medication compliance and blood pressure control rates in two groups were 93.2% and 84.3% (P<0.001), 68.6% and 51.5%, respectively (P<0.001).


Conclusion
The outcomes of hypertension management in terms of medication compliance and blood pressure control in community group are better than those in non-community group.


Key words: 
Hypertension; Treatment methods; Community health services
A DNA-mutational panel for liquid biopsy-based pan-cancer early detection.
Authors: Zhao Yi, Weizhi Chen, Ji He
Journal: Journal of Clinical Oncology (2020)

e13687 Background: Early detection through liquid biopsy can significantly increase the successful chances of treatment. The sensitivity and specificity of early detection are limited by lower signal-to-noise ratio. Thus, well design of liquid biopsy panel is important. Methods: We adopted comprehensive data sources for designing the liquid biopsy panel, including databases of TCGA, ICGC, COSMIC, MSK Cancer Hotspots, while the panel of HCCscreen and CancerSeek. We also considered the database of somatic mutations in Chinese cancer patients generated by us (Genecast (Beijing) Biotechnology Co., Ltd.). We first calculated pan-cancer carrier ratio of somatic mutations in each database and constructed the distribution of mutation counts on step-wise increased carrier ratio. Then, we selected the set of somatic mutations with “elbow point” carrier ratio from each database as part of the panel. Finally, we integrated collected hotspots with the panel of HCCscreen and CancerSeek. Results: We selected 408, 521, 214, 146 and 330 hotspots from databases of TCGA, ICGC, COSMIC, MSK Cancer Hotspots and somatic mutations in Chinese cancer patients, respectively. After integration with the panel of HCCscreen and CancerSeek, this designed panel contains 3,334 bases distributed on 23 chromosomes and 915 gene models. Comparison of hotspots collected from different databases showed that few of them shared the same genomic location except for ones from the database of MSK Cancer Hotspots, indicating the well complementarity between them. Especially, there are 186 unique hotspots collected from the database of somatic mutations in Chinese cancer patients, which can improve the sensitivity of early detection for Chinese and Asian population. Next, we evaluated detected sensitivity of the designed panel based on sequencing data of plasma samples from more than 12,000 Chinese cancer patients collected in Genecast. The result showed that the maximum sensitivity is 66.67% for small cell lung cancer and the overall sensitivity is 45.71% for 26 cancer types, in which hotspots uniquely collected from the database of somatic mutations in Chinese cancer patients accounted for 5.11%. Conclusions: We designed a liquid biopsy panel for pan-cancer early detection and evaluated its sensitivity based on sequencing data of plasma samples from more than 12,000 Chinese cancer patients. Satisfactory performance of our designed panel shows its potential application in cancer screening for healthy and highly risky individuals.
云南省国际奥比斯小儿眼科项目社区服务模式和思考
Authors: 李丽红, 许平
Journal: BMJ (2008)

奥比斯是一个中立的、非盈利的国际人道主义发展组织,是国际防盲协会的主要成员之一,积极参与全球防盲运动,包括视觉2020,享有看见的权利(Vision 2020:the Right to Sight)行动,奥比斯是该项目的发起成员组织之一。
Genetic testing experiences and emotional reactions among individuals with variant of uncertain significance results from cancer multiplex genetic testing.
Authors: Jada G. Hamilton, Jamie Brower, Dana Clark, Jessica E Ebrahimzadeh, Sarah R. Kane, Pauleen Sanchez, Temima Wildman, Margaret Merrill, Fergus Couch, Judy Ellen Garber, Kenneth Offit, Mark E. Robson, Susan M. Domchek
Journal: Journal of Clinical Oncology (2020)

e13680 Background: Multiplex genetic testing (MGT) simultaneously analyzes multiple cancer susceptibility genes and can reveal genetic variants of uncertain significance (VUS) that have unclear associations with cancer risks. Little is known about how people are prepared for receiving VUS results from MGT, or whether their emotional reactions differ based on the levels of cancer risk to which they may be susceptible. Methods: We recruited participants from the online Prospective Registry of Multiplex Testing (PROMPT). Those with only a VUS in a cancer predisposition gene completed a survey including measures of their MGT experience, distress (range 0-30; α = .87), uncertainty (0-45; α = .83), and positive experiences (0-20; α = .75). We used generalized linear modeling to examine how demographics, awareness of the possibility of VUS before testing, and level of cancer risks associated with their VUS gene were related to emotional outcomes. Results: Data were available from 661 individuals (40% response rate, 95% female, 90% white, 78% college graduate, 69% cancer history, age 23-93) with VUS in a gene of high risk (47%), moderate/low risk (35%) or limited evidence of risk (18%). Among the sample, 80.8% reported ever receiving cancer genetic counseling, and only 50.8% reported being aware of the possibility of VUS when deciding about testing. Participants reported low current distress ( M± SD= 3.25±5.19), uncertainty (9.18±8.35) and positive experiences (7.83±5.98). Distress was associated with younger age, less family cancer history, and being unaware of the possibility of VUS before testing; distress was also higher among those with VUS in a gene of high risk than those with VUS in a gene of moderate/low risk or limited evidence of risk ( ps≤.023). Uncertainty was associated with younger age, non-white race, less education, and being unaware of the possibility of VUS; uncertainty was also higher among those with VUS in a gene of high risk than those with VUS in a gene with limited evidence of risk ( ps≤.05). Fewer positive experiences were associated with more education and more family cancer history; those with VUS in a gene of high risk had fewer positive experiences than those with VUS in a gene with limited evidence of risk ( ps≤.03). Conclusions: Many individuals undergoing MGT may not fully understand the prospect of receiving VUS. Clinicians should consider patients’ background, preparation, and level of cancer risk to which they are potentially susceptible, as these factors may affect their emotional adaptation.
Detection of chronic lymphocytic leukemia subpopulations in peripheral blood by phage ligands of tumor immunoglobulin B cell receptors
Authors: Selena Mimmi, Domenico Maisano, Nancy Nisticò, Eleonora Vecchio, Federico Chiurazzi, Katia Ferrara, Marialuigia Iannalfo, Alessandro D’Ambrosio, Giuseppe Fiume, Enrico Iaccino, Ileana Quinto
Journal: Leukemia (2020)

The B cell receptor (BCR) is an immunoglobulin (Ig) expressed on the membrane surface of mature B cells [1].The IgBCR has two heavy and two light chains, each one made by a constant and a variable region.The variable sequences of the IgBCR are generated during B-cell differentiation through somatic recombination, so called VDJ recombination, and somatic hypermutation [2].Once assembled on the B-cell surface, the IgBCR recognizes a specific antigen through its binding to the variable regions.This event triggers the B-cell immune response against the antigen.Since the variable regions are B cell specific, the sequence of IgBCR allows the identification of single B-cell clones [3].In B-lymphoproliferative disorders, the IgBCR plays a key role in the development, proliferation, and survival of tumor B cells [4], by an antigen-driven process that triggers a molecular cascade of events that lead to transcriptional activation of proliferative and antiapoptotic genes [5][6][7].Chronic lymphocytic leukemia (CLL) is a Bproliferative disorder characterized by a clonal expansion and accumulation of neoplastic CD19/CD5/CD23/ CD20-positive B-lymphocytes in blood, bone marrow, and other tissues [8].Several studies support the hypothesis that a common pool of environmental antigens or self-antigens drives the selection of tumor B cells through the persistent triggering of IgBCR [9, 10].Consistently, the sequence analysis of VDJ rearrangement of tumor IgBCRs revealed a high level of homology in more than 30% of CLL patients, defined as stereotyped IgBCR, with the prevalence of VH1, VH3, and VH4 families [11,12].CLL are defined as mutated (M-CLL) or unmutated (U-CLL) depending on the mutational rate of the IgBCR variable regions, being more or less than 2% respect to the germline, respectively [11,12].U-CLL cells expressing the VH1-69 rearrangement usually have an inducible IgBCR and show an aggressive behavior [11,12].In this regard, it would be useful to develop new molecular tools for rapid detection of aggressive CLL clones in peripheral blood.We previously used phage display for identifying peptide ligands of B-lymphoma, multiple myeloma, and CLL IgBCRs [3,[13][14][15].In CLL patients, we documented the co-existence of different CLL clones in a single patient as detected by phage-expressed peptide ligands of the tumor IgBCRs [3,15].In this study, we used the phage display for identifying a peptide sequence that was commonly recognized by VH1-69 U-CLL clones of two CLL patients.These patients, named CLL#1 and CLL#5, were randomly referred to the Hematology Unit-University Federico II of Naples and initially diagnosed as CLL Binet stage A. At month 8, CLL#1 worsen to Binet stage C and returned to Binet stage A after 6 months of
The prognostic biomarkers of the patients treated with platinum-based chemotherapy in treatment emergent or related neuroendocrine prostate cancer.
Authors: Takeo Kosaka, Hiroshi Hongo, Yota Yasumizu, Kazuhiro Matshumoto, Ryuichi Mizuno, Mototsugu Oya
Journal: Journal of Clinical Oncology (2020)

e17576 Background: Treatment emergent or related neuroendocrine prostate cancer (tNEPC) is an aggressive subtype of prostate cancer in patients previously treated with androgen receptor pathway inhibitor (ARPI) as a mechanism of resistance. These patients are typically treated platinum-based chemotherapy using small cell lung cancer (SCLC). The clinical features of tNEPC are poorly defined. The aim of the present study was to investigate the prognostic biomarkers of the patients treated with platinum-based chemotherapy in tNEPC. Methods: We reviewed baseline, treatment and outcome data of 41 patients with tNEPC. Clinicopathological factors and laboratory data before administering the first cycle of platinum-based chemotherapy were collected to assess the prognostic factors for overall survival (OS). Definition of tNEPC were based on NEPC morphology on the basis of any current or prior tissue sample, development of liver metastases in the absent of PSA progression, or elevated serum neuron specific enolase (NSE). Results: Median PSA and NSE were 119.8 ng/ml and 18.2 ng/ml, respectively. Twenty-four patients had pathologic features of NEPC. NSE were elevated above the 32 patients. The median OS from the start of platinum-based chemotherapy treatment was 10 months. Univariate analysis revealed that LDH (p = 0.003), absolute monocyte count &lt; 280 (p = 0.022), visceral metastasis (p = 0.014) prior to platinum-based chemotherapy were significantly associated with shorter OS. Multivariate analysis revealed that LDH (p = 0.047), absolute monocyte count &lt; 280, (p = 0.012), visceral metastasis (p = 0.005) prior to platinum-based chemotherapy treatment were independent prognostic indicators for OS. Based on the relative risk of death, NEPC patients before platinum-based chemotherapy were divided into 3 risk groups: low, intermediate and high ( p&lt; 0.001). Conclusions: Our findings provide new insights into the practical implication of NEPC. Our results might be to tailor the management of NEPC treated with platinum-based chemotherapy.
Nutritional management of diabetes is ssential
Authors: 张爱珍
Journal: BMJ (2010)

人们生活水平逐渐提高的同时,由于对膳食营养与人体健康的相关性认识不足或者不认识,我国糖尿病发病人数逐年增加,其并发症也随之增多而严重.糖尿病治疗特点是综合性、终生性以及社区和居家治疗.临床营养治疗是糖尿病管理的一个基本组成部分,它不仅能使血糖控制理想,同时还能减少心血管疾病的危险[1].糖尿病基础治疗是膳食营养治疗,不同糖尿病患者的膳食营养治疗方案都不尽相同;患者在不同病情、不同时期与不同的生理条件,膳食营养治疗方案也有区别.因此糖尿病膳食营养管理要遵从个性化和人性化的原则。
Risk factors of post-stroke disability in patients with acute cerebral infarction
Authors: Shenjun Li, Xiaoling Wang, Lei Zhang
Journal: BMJ (2016)

Objective
To analyze the risk factors of post-stroke disability in patients with acute cerebral infarction.


Methods
Total 1 137 consecutive patients with acute cerebral infarction admitted in Department of Neurology, General Hospital of Jinan Military Region, were prospectively recruited from August 2010 to August 2014. According to Oxfordshire Community Stroke Project(OCSP), 275 patients were classified as total anterior circulation infarction, 377 as partial anterior circulation infarction, 305 as posterior circulation infarction and 180 as lacunar infarction. The baseline data including age, gender, National Institute of Health Stroke Scale (NIHSS) score were recorded. Recovery was assessed by modified Rankin Scale (mRS) 6 months after stroke by telephone interview (mRS≤2: good prognosis, 2<mRS≤5: disability). Univariate and multivariate regression were used to analyze risk factors of disability 6 months after disease onset.


Results
During the study period 123 patients died. Among remaining 1 014 patients, 638 were males and 376 were females; and 283 patients were disabled after stroke, including 156 males and 127 females. The disability rate in females were significantly higher than that in males(33.8% vs. 24.5%, χ2=9.86, P=0.002). Univariate analysis also showed that age ≥73 years(P=0.000), NIHSS score ≥ 8 (P=0.000), myocardial infarction(P=0.001), congestive heart failure(P=0.000), diabetes(P=0.002), artrial fibrilation(P=0.000), hyperlipidemia(P=0.003), recurrent cerebral infarction(P=0.000), smoking(P=0.003), alcohol drinking(P=0.004)and lacunar infarction(P=0.000)were correlated with disability. Multivariate regression analysis showed that female sex (OR=1.681, 95%CI: 1.183-2.390, P=0.004), age ≥73 years (OR=3.955, 95%CI: 2.708-5.776, P=0.000), NIHSS score ≥8 (OR=7.473, 95%CI: 5.154-10.837, P=0.000), recurrent cerebral infarction (OR=3.149, 95%CI: 2.150-4.614, P=0.000), atrial fibrillation (OR=2.558, 95%CI: 1.465-4.466, P=0.001), diabetes (OR=2.010, 95%CI: 1.415-2.855, P=0.000) were independent risk factors of post-disability 6 months after onset of cerebral infarction, while lacunar infarction (OR=0.226, 95%CI: 0.112-0.456, P=0.000) was a protective factor.


Conclusion
Female gender along with other risk factors are associated with the post-stroke disability in patients with acute cerebral infarction.


Key words: 
Brain infarction; Sex factors; Disbility
Comparison of the China growth charts with the WHO growth standards in assessing malnutrition of children
Authors: 杨振宇, 段一凡, 马冠生, 杨晓光, 荫士安
Journal: BMJ (2015)

目的
比较中国儿童生长标准与WHO的儿童生长标准评价我国5岁以下儿童营养不良状况的差异。


地点
调查的家庭来自中国大陆31个省、自治区、直辖市(不包括台湾、香港和澳门)。


研究对象
采用分层多阶段整群随机抽样，选取调查家庭中5岁以下儿童(n＝15 886)参与调查。


主要的结果
低体重、生长迟缓、消瘦、超重和肥胖。


结果
根据中国儿童生长标准估计的低体重(8.7%比4.8%)、生长迟缓(17.2%比16.1%)、消瘦(4.4%比3.0%)率都显著高于采用WHO标准的估计值(P<0.001)；超重率则低于WHO标准估计值(9.4%比10.2%, P<0.001)。在多数情况下，用中国生长标准估计营养不良率时都偏高。然而，对于3～4、6、8、10、12～18和24月龄的男童，中国生长曲线估计的超重率明显偏低。


结论
WHO生长标准评价营养不良较谨慎，适合用于同其他国家进行比较。在具有当地生长曲线的国家且同WHO生长曲线存在明显差异时，应进一步研究WHO生长标准在这些国家的适用性。
Lymphoma cell-killing activity and cytokine release by CD20-directed bispecific IgM antibody-based T-cell engager (IGM-2323).
Authors: Bruce Keyt, Ramesh Baliga, Keyu Li, Marigold Manlusoc, Paul Hinton, Dean Ng, Madeline Tran, Bing Shan, Hai Lu, Sachi Rahman, Avneesh Saini, Yuan Cao, Chitra Saraiya, Marvin Peterson, Wayne R Godfrey, Steve Carroll
Journal: Journal of Clinical Oncology (2020)

e15007 Background: Bispecific antibodies which tether T-cells to cancer cells, and additionally activate T-cell mediated killing, have shown promise in treating B-cell malignancies. Dose intensity, however, is limited by cytokine release from the activated T-cells. Side effects include fever, hypotension, and hypoxia. Methods: A novel type of bispecific antibody (IGM-2323) was constructed using the pentameric IgM framework. Recombinant IgM heavy chains and kappa light chains with high affinity variable domains derived from an anti-CD20 IgG, were co-expressed with a J-chain fused to anti-CD3 single chain Fv domain. IGM-2323 has 10 binding domains for CD20, and one binding domain for CD3. Results: IGM-2323 binds to the CD20 antigen with &gt; 1000-fold increased avidity relative to an IgG antibody format. IGM-2323 in human cell cultures shows highly potent T cell dependent cytotoxicity (EC 50 20 pM), even on cells with very low cell surface expression of CD20, rituximab-resistant lymphoma cell lines, and patient derived CLL cells. Significantly, IGM-2323 exhibits vastly reduced cytokine release, with equivalent T cell dependent killing of CD20-expressing cancer cells, as compared to corresponding IgG-based T cell bispecifics made with the same binding domains. IGM-2323 mediated killing can occur at low T-cell/cancer cell ratios, as low as (1:5). In addition, IGM-2323 mediates complement dependent cytotoxicity (CDC) of CD20-expressing cells with &gt; 100-fold higher potency than IgG. IgM-based bispecific (anti-CD20 x anti-CD3) completely depletes circulating B cells in cynomolgus monkeys at doses of &gt; 300 µg per kg. Furthermore, durable depletion of B cells in spleen and lymphoid tissues was noted with multiple doses of &gt; 1 mg/kg. Importantly, in these studies no observable adverse effects were seen, despite repeated doses at up to 25 mg/kg (the highest dose tested). Low levels of transiently increased circulating IL-6 and no increased levels of circulating TNF-α and IFN-γ were observed in these primate studies. Conclusions: These data indicate that IgM-based bispecifics can induce T cell engagement and very potent cytotoxicity that can be dissociated from cytokine release syndrome in the primate model. These preclinical data demonstrate the potential for broad application of this novel modular IgM-based bispecific antibody format. A Phase I dose-escalation study of IGM-2323 in patients with relapsed/refractory Non-Hodgkin’s lymphoma has been initiated (NCT04082936) and is currently enrolling patients.
全科医学师资培养探讨
Authors: 祝墡珠, 江孙芳, 邹健
Journal: BMJ (2004)

我院于1994年设立全科医学科,在综合性医院和社区开展全科医疗,以医学院临床专业本科或硕士毕业的医师为主,高起点培养全科医师和全科医学师资.2000年我医院全科获得美国中华医学基金会的资助,进行了全科医学高级师资的培养,总结如下。
嗜酸粒细胞性胃肠炎一例
Authors: 阮颖, 牛姝媛, 李晓梅, 郭箭
Journal: BMJ (2006)

患者男,66岁,因腹泻1周入院.病前1周因进食肉馅饺子而出现脐周疼痛,腹泻、水样便7～8次/d,无脓血,伴恶心,无呕吐、发热,于当地卫生所静脉滴注头孢哌酮钠(先锋必)5 d(用量不详),症状元改善,来我院就诊.无寄生虫病史及食物、药物过敏史.体格检查:心肺无异常,腹软,脐周轻压痛,移动性浊音阴性,肠鸣音活跃,15次/min.实验室检查:血白细胞40.14×109/L,分类示中性粒细胞0.09,淋巴细胞0.06,嗜酸性粒细胞0.80;血红蛋白130g/L;血小板200×109/L.粪便常规:白细胞1～2个/HP;便培养阴性.结肠镜检查示:降结肠黏膜皱襞粗大并有充血、水肿及片状浅糜烂.病理学检查示:黏膜内大量嗜酸性粒细胞浸润.胃镜检查示:浅表性胃炎.诊断为嗜酸粒细胞性胃肠炎.给予泼尼松40mg/d口服,10 d后腹泻停止,3周后复查血常规正常。