tbuckley/cabot-search huggingface dataset:
Testicular cancer in Hispanics: Are we approaching ethnic parity?
Authors: Michelle Janania Martinez, Juan Garza, Tyler William Snedden, Prathibha Surapaneni, Flavia Fernandes, Madison H Williams, Ryan Williams, Travis Cox, Jean-Pierre Blaize, Brian Warnecke, Lakene Raissa Djoufack Djoumessi, James Yoo, Sushanth Kakarla, Kelly Pippin, Christine Ann Moore, Kate Ida Lathrop
Journal: Journal of Clinical Oncology (2020)

e17059 Background: Hispanics (HI) are the fastest growing ethnic group in the US, representing 52% of US population growth from 2010-2018. In the past decade, they have also experienced a rise in incidence of testicular cancer. Studies have shown that HI have a higher incidence of Non-Seminomatous Germ Cell Tumors (NSGCT), present at an earlier age, have advanced stage at diagnosis, and worse outcomes (including increased mortality) when compared to Non-Hispanics (NH). However, there is a paucity of data and a growing need to better characterize this patient population. To our knowledge, this is the largest cohort of testicular cancer patients from a single academic institution that serves primarily HI. Methods: We retrospectively reviewed 243 patients with Testicular Cancer, both Seminoma and NSGCT; all diagnosed between 2010-2018. Key variables included age, race/ethnicity, comorbidities, insurance status, diagnosis, stage, treatment received/response and vitality status in 2018. Continuously distributed outcomes were summarized with mean/standard deviation; categorical outcomes with frequencies/percentages. Significance of associations between categorical outcomes was assessed with Chi Square test of association. Results: We identified 243 patients with testicular cancer, 168 (69%) HI and 75 (31%) NH. See Table. Median duration of follow up was 18.7 months (SD 27.3). When comparing HI vs NH: 65% vs 64% achieved complete response after primary treatment (p value 0.982); 16% vs 23% had a disease relapse (p value 0.184); and 82 vs 90% were alive at end of 2018 (p value 0.257). Conclusions: Our study supports available data that HI present at an earlier age. However, we found no significant difference in insurance status, histology, stage at diagnosis and outcomes in HI compared to NH. HI predominance in our population could explain the lack of difference observed but further studies are needed. Research Sponsor: None.[Table: see text]
A population-based study of young-onset colorectal cancer patients: Effect of knowledge gaps among patients and providers on stage at diagnosis and quality of life.
Authors: Ronit Yarden, Kim Lynn Newcomer, Danielle Peterson
Journal: Journal of Clinical Oncology (2020)

4095 Background: Colorectal cancer (CRC) is one of the leading cause of cancer-related death in the US. Despite a decrease in overall incidence and mortality, there has been an alarming increase in CRC diagnosis among young adults (20-49 years old) and causes remain unknown. To explore the unique challenges and unmet needs of the young-adult patients many still establishing their life-long goals, the Colorectal Cancer Alliance launched a comprehensive survey for young-onset CRC patients and survivors via social media to track the self-reported pre-diagnosis awareness, path to diagnosis, and post-diagnosis quality of life experiences of this often overlooked group. Methods: A cross-sectional study, conducted in the form of an online survey, was launched via multiple channels of social media. The questionnaire was based on established instruments including PROMIS, EORTC-QOL-30, and EORTC-CR-29 and EORTC-SHC-22. Results: The survey was completed by 885 patients and survivors. The median age at diagnosis was 42 +/-7, significantly lower than the recommended screening age. Only 6% of respondents were diagnosed with Lynch syndrome although 29% reported some family history. Most respondents (63%) indicated they were not aware that CRC can affect people younger than 50, which may explain why the majority of patients waited more than 3 months and 23% waited over 12 months after noticing their symptoms to visit their doctor. The majority, 75%, of all patients visited 2+ doctors and 11% of those patients visited 10+ doctors before their doctor suspected colorectal cancer. A significant number of patients felt their doctors were dismissive of their symptoms. 77% of patients were diagnosed with advanced disease and were subjected to aggressive therapies that substantially affected their quality of life including neuropathy, anxiety, clinical depression, sexual morbidity, unemployment, and financial toxicity. Many young patients indicated that their doctors did not inform them about fertility preservation. Conclusions: Our survey indicates that medical professionals and young adults need to be aware of the increasing incidence of young-onset CRC, and the importance of timely screening when signs and symptoms are present, regardless of age.
Ixazomib-dexamethasone (Ixa-Dex) vs physician’s choice (PC) in relapsed/refractory (RR) primary systemic AL amyloidosis (AL) patients (pts) by prior proteasome inhibitor (PI) exposure in the phase III TOURMALINE-AL1 trial.
Authors: Efstathios Kastritis, Angela Dispenzieri, Ashutosh D. Wechalekar, Stefan O. Schönland, Kihyun Kim, Vaishali Sanchorawala, Heather Jolie Landau, Fiona Kwok, Kenshi Suzuki, Ray Comenzo, Giovanni Palladini, Deborah Berg, Guohui Liu, Arun Kumar, Douglas V. Faller, Giampaolo Merlini
Journal: Journal of Clinical Oncology (2020)

8546 Background: The PI bortezomib is commonly used in first-line therapy of AL, but new therapies are needed that are tolerable in the context of multi-organ dysfunction and that, in RRAL, offer improved outcomes following prior bortezomib. Ixazomib is an oral PI, and in TOURMALINE-AL1, the first phase 3 trial conducted in RRAL, while the first primary endpoint of hematologic overall response rate (ORR) was not met, all clinically relevant time-to-event endpoint data favored Ixa-Dex vs PC (Dispenzieri et al, ASH 2019). Methods: RRAL pts with 1–2 prior therapies were randomized (1:1) to Ixa-Dex (n = 85) or PC (n = 83; Dex plus lenalidomide [n = 47], melphalan [n = 24], cyclophosphamide [n = 10], or thalidomide [n = 2]), stratified by cardiac stage, relapsed vs refractory disease, and prior PI exposure. The primary endpoints were hematologic ORR and 2-yr rate of vital organ deterioration or death. We report subgroup analyses of ORR and outcomes by prior PI exposure. Results: Of the 168 pts enrolled, 90 were PI-naïve and 78 PI-exposed (46 and 39 in the Ixa-Dex arm; 44 and 39 in the PC arm) per stratification; 28 and 27 pts in the Ixa-Dex and PC arms had received bortezomib in their last prior line. Hematologic ORR was 63% vs 50% for Ixa-Dex vs PC (odds ratio [OR] 1.71; 95% confidence interval [CI] 0.74–3.96) in PI-naïve pts, and 41% vs 51% (OR 0.66; 95% CI 0.27–1.62) in PI-exposed pts. For time-to-event outcomes (Table), hazard ratios (HRs) were 0.46–0.85 in favor of Ixa-Dex vs PC in both PI-naïve and PI-exposed pts. Conclusions: Hematologic ORR was higher with Ixa-Dex vs PC in PI-naïve pts but lower in PI-exposed pts (although not statistically significant), and long-term clinically relevant outcomes favored Ixa-Dex in both groups. Based on HRs, the magnitude of benefit appeared similar or greater in PI-naïve vs PI-exposed pts. Clinical trial information: NCT01659658 . [Table: see text]
Quality of life (QoL) and self-reported function with ripretinib in ≥4th-line therapy for patients with gastrointestinal stromal tumors (GIST): Analyses from INVICTUS.
Authors: Michael C. Heinrich, Suzanne George, John Raymond Zalcberg, Sebastian Bauer, Hans Gelderblom, Patrick Schoffski, Cesar Serrano, Robin L. Jones, Steven Attia, Gina Z. D'Amato, Ping Chi, Peter Reichardt, Claus C. Becker, Julie Nicole Meade, Rodrigo Ruiz-Soto, Margaret von Mehren, Jean-Yves Blay
Journal: Journal of Clinical Oncology (2020)

11535 Background: Ripretinib is a novel switch-control tyrosine kinase inhibitor (TKI) that broadly inhibits KIT and PDGFRA kinase signaling through a dual mechanism of action. In INVICTUS (NCT03353753), a randomized, double-blind, placebo-controlled trial of ripretinib in ≥4th-line advanced GIST, ripretinib reduced the risk of disease progression or death by 85% vs placebo and had a favorable overall safety profile in patients previously treated with ≥3 prior TKIs. Methods: As part of the INVICTUS trial, patient reported outcome (PRO) measures were collected using EQ-5D-5L (EQ5D) and EORTC QLQ-C30 (C30). In prespecified and additional analyses, ANCOVA models were built to compare changes from baseline to cycle 2 day 1 (C2D1) for PRO measures within the ripretinib and placebo arms and determine the difference between treatment arms. PRO measures included the EQ5D visual analogue scale (VAS) and the C30 physical functioning (PF) and role functioning (RF) scales (all scores range from 0–100; higher scores are better). The C30 overall health and overall QoL questions were also assessed (scores range from 1–7; higher scores are better). Fixed effects included treatment arm, number of previous anticancer treatments (3 vs ≥4), and ECOG score at baseline (0 vs 1/2). Results: Overall, 129 patients were randomized and 128 received treatment (85 to ripretinib 150 mg QD; 43 to placebo). All PRO p-values are nominal, and no statistical significance is being claimed. VAS scores improved an average 3.7 points from baseline to C2D1 with ripretinib vs an average decline of 8.9 with placebo (P = 0.004; improvement or no change, 67% vs 41% of patients, respectively). Similarly, the average PF score improved 1.6 points with ripretinib and decreased 8.9 with placebo (P = 0.004; improvement or no change, 68% vs 44%). RF scores also improved an average of 3.5 points with ripretinib vs a decrease of 17.1 with placebo (P = 0.001; improvement or no change, 77% vs 50%). For the overall health and overall QoL questions, scores increased with ripretinib an average of 0.20 and 0.28, respectively, and decreased 0.78 and 0.76 with placebo (both P = 0.001; improvement or no change, 74% vs 47% and 79% vs 59%, respectively). Conclusions: Based on the 5 PRO measures assessed, when compared with placebo and best supportive care, ripretinib provided patient-benefit in advanced GIST with PRO measures of role and physical function, VAS, overall health, and overall QoL remaining stable. Clinical trial information: NCT03353753 .
Long-term oncological safety of sentinel lymph node biopsy in early-stage cervical cancer.
Authors: Vincent Balaya, Benedetta Guani, Laurent Magaud, Bonsang-Kitzis Hélène, Charlotte Ngo, Patrice Mathevet, Fabrice Lecuru
Journal: Journal of Clinical Oncology (2020)

6006 Background: The goal of this study was to assess disease-free survival (DFS) and disease-specific survival (DSS) in patients with early-stage cervical cancer who underwent bilateral sentinel lymph node (BSLN) biopsy alone versus bilateral pelvic lymphadenectomy (BPL). Methods: An ancillary analysis of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) was performed. All patients with early stage cervical cancer (IA to IIB FIGO stage), negative SLN after ultrastaging and negative non-SLN after final pathologic examination were included. Risk-factors of recurrency and disease-specific deaths were determined by Cox proportional hazard models. Kaplan-Meier survival curves were compared by applying log-rank test. Results: Between January 2005 and July 2012, 259 patients met the inclusion criteria: 85 patients underwent only bilateral SLN biopsy whereas 174 patients underwent BPL. None had positive SLN at ultrastaging or positive non-SLN at final pathologic examination. Between the both groups, there was no differences in histology, final FIGO stage and type of surgical approach. In the BPL group, patients had more frequently tumor size larger than 20 mm (22.9% vs 10.7%, p = 0.02) and postoperative radiochemotherapy (10.7% vs 1.6%, p = 0.01). The median follow-up was 47 months (4-127). During the follow-up, 21 patients (8.1%) experienced reccurencies, including 4 nodal recurrences (1.9%), and 9 patients (3.5%) died of cervical cancer. The 5-year DFS and the DSS were similar between BSLN and BPL groups, 94.1% vs 97.7%, p = 0.14 and 88.2% vs 93.7%, p = 0.14 respectively. After controlling for final FIGO stage and margin status, BSLN compared to BPL was not associated with DFS (HR = 1.76, 95%CI = [0.69 – 4.53], p = 0.24) and DSS (HR = 2.5, 95%CI = [0.64 – 9.83], p = 0.19). Only final FIGO stage was independent predictor of DSS. Conclusions: SLN biopsy alone is oncologically safe in early-stage cervical cancer. Full lymphadenectomy could be omitted in case of bilateral negative SLN. Worse prognosis was associated with higher FIGO stage disease.
氯胺酮相关性膀胱炎五例临床分析
Authors: 孙璇, 张东方, 廖育芬, 夏昕晖, 王固新
Journal: BMJ (2012)

回顾性分析2008年11月至2010年4月我院收治的5例氯胺酮相关性膀胱炎患者的临床资料.5例患者的典型临床表现及膀胱镜所见均类似于间质性膀胱炎,通过使用喹诺酮类抗生素、抗胆碱能药物以及碱化利多卡因灌注膀胱扩张等多种治疗,效果仍不确定,但停用氯胺酮后半年症状逐渐改善。
A good death
Authors: Richard Smith
Journal: BMJ (2000)

> The art of living well and dying well are one.
> 
> Epicurus 
> Death is one of the attributes you were created with; death is part of you. Your life's continual task is to build your death.
> 
> Montaigne 
Are you ready to die? If not, then you might begin some preparation. Every BMJ reader will die this century, and death is constantly beside us. Montaigne urged, “One should be ever booted and spurred and ready to depart.” Yet that has not been the attitude of the past 50 years, and modern medicine may even have had the hubris to suggest implicitly, if not explicitly, that it could defeat death.1 If death is seen as a failure rather than as an important part of life then individuals are diverted from preparing for it and medicine does not give the attention it should to helping people die a good death. We need a new approach to death, and the debate of the age on older people has provided a clarion call: “We believe it is time to break the taboo and to take back control of an area [death] which has been medicalised, professionalised, and sanitised to such an extent that it is now alien to most people's daily …
Relationship between plasma level of homocysteine and urine microalbumin in incipient type 2 diabetic nephropathy
Authors: 岳红, 柳洁, 康文娟, 胡玲, 秦洁, 雷琨, 薛雪华
Journal: BMJ (2006)

目的 探讨血浆同型半胱氨酸(Hcy)水平及亚甲基四氢叶酸还原酶(MTHFR)基因多态性与2型糖尿病(T2DM)早期肾病的关系及影响因素.方法 对252例T2DM患者[140例为无并发症者(NDC组),112例为早期糖尿病肾病者(DN组)]和30例对照者,测定血浆Hcy、叶酸、维生素B12(VitB12)、糖化血红蛋白(HbA1c)、空腹血糖、餐后2 h血糖(PBG)、胆固醇(CHO)、甘油三酯(TG)、肌酐、转化生长因子β1(TGF-β1)水平,尿N-乙酰-D氨基葡萄糖苷酶(NAG)、微量白蛋白/肌酐(Malb/Cr)值、Malb水平,并以聚合酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP)检测MTHFR基因C677T突变率.结果 DN组血浆Hcy水平高于对照组[(16.6±12.6)与( 9.7±2.0)μmol/L,P＜0.05],DN组又高于NDC组[(16.6±12.6)与( 11.9±7.3)μmol/L,P＜0.05];高Hcy 血症患者的早期糖尿病肾病发生率明显高于血Hcy水平正常患者(61.4%与 36.1%,P＜0.05).T2DM患者血浆Hcy水平与MTHFR基因型、体重指数、HbA1c、空腹血糖、PBG、NAG、Malb/Cr、病程、吸烟、二甲双胍的使用呈正相关,与叶酸、VitB12呈明显负相关;logistic回归分析显示病程、舒张压、空腹血糖、NAG、Hcy均为早期糖尿病肾病的危险因素.结论 空腹高Hcy血症是早期糖尿病肾病的危险因素;MTHFR基因型、叶酸、VitB12、Malb/Cr、NAG以及代谢紊乱程度影响血浆Hcy水平。
Letter to the editor: SARS-CoV-2 detection by real-time RT-PCR
Authors: Trestan Pillonel, Valentin Scherz, Katia Jaton, Gilbert Greub, Claire Bertelli
Journal: Eurosurveillance (2020)

Preview this article: Letter to the editor: SARS-CoV-2 detection by real-time RT-PCR, Page 1 of 1 < Previous page | Next page > /docserver/preview/fulltext/eurosurveillance/25/21/eurosurv-25-21-5-1.gif
泌尿生殖道解脲支原体与人型支原体感染165例药敏分析
Authors: 李士杰, 孔秋菊, 刘广德, 刘立亚, 黎萍, 万敏
Journal: BMJ (2012)

165例初次发病的泌尿生殖道支原体感染患者中,109例为解脲支原体(Uu)、56例为人型支原体(MH)和Uu混合感染;药物敏感者最多的抗生素,Uu感染者为交沙霉素,Uu和MH混合感染者为强力霉素.根据药敏结果选用敏感度高的抗生素治疗,病原体清除率为90.9％(150/165)。
Depth of response prior to autologous stem cell transplantation to predict survival in light chain amyloidosis.
Authors: Iuliana Vaxman, M Hasib Sidiqi, Abdullah S. Al Saleh, Shaji Kumar, Eli Muchtar, Angela Dispenzieri, Francis Buadi, David Dingli, Martha Lacy, Suzanne R. Hayman, Nelson Leung, Wilson I. Gonsalves, Taxiarchis Kourelis, Rahma M. Warsame, William J. Hogan, Morie A. Gertz
Journal: Journal of Clinical Oncology (2020)

8516 Background: The role of induction therapy prior to autologous stem cell transplant (ASCT) in immunoglobulin light chain (AL) amyloidosis remains controversial. Data on the prognostic impact of response to induction in a transplanted cohort are lacking. The aim of this study was to assess the impact of response to induction therapy on survival in patients undergoing ASCT for AL amyloidosis. Methods: We conducted a retrospective study of all newly diagnosed AL amyloidosis patients who received induction prior to ASCT between January 2007 and August 2017 at Mayo Clinic, Rochester, Minnesota. Patients receiving only corticosteroids prior to transplant were excluded as were those with an involved light chain of less than 5 mg/dL (not measurable for response). Results: 134 patients met inclusion criteria. The median age at diagnosis was 60 (range 36-74) and 85 (63%) were men. The most commonly used induction regimen was proteasome inhibitor-based (73.1%, n=98). The overall response rate to induction was 83% (complete response 17%, very good partial response 30% and partial response 36%). With a median follow up of 56.5 months, the median PFS and OS was 48.5 months and not reached, respectively. Response depth to induction therapy was associated with improved PFS and OS and was independent of the bone marrow plasma cell percentage. The median PFS was not reached for patients achieving ≥VGPR prior to ASCT and 33.8 months for patient achieving PR or less (P=0.001). The median OS was longer in patients with deeper responses (not reached for patients achieving ≥VGPR vs. 128 months for patients achieving PR or less (P=0.02). On multivariable analysis, independent predictors of OS were melphalan conditioning dose (RR= 0.38; P=0.018) and depth of response prior to transplant (RR 2.52; P=0.039). Conclusions: Hematologic response prior to transplant predicts post-transplant outcomes in patients with AL amyloidosis. [Table: see text]
Effect of epigenetic imprinting biomarkers in urine exfoliated cells (UEC) on the diagnostic accuracy of low-grade bladder cancer.
Authors: Ning Zhou, Tong Cheng, Xing Li, John P. Pineda, Rulong Shen, Xiaonan Wang, Han Si, Panying Shi, Shuxiong Zeng, Chuanliang Xu
Journal: Journal of Clinical Oncology (2020)

e17027 Background: Urine Exfoliated Cells (UEC) is the most widely used sample for noninvasive bladder cancer detection. However, current UEC-based methods including urinary cytology and other molecular detections showed low sensitivities especially for low-grade cancer (&lt; 50% sensitivity). Epigenetic alterations such as elevated allelic expression of imprinted genes usually occur at early stages of malignancy, and can be considered as potential bladder cancer biomarkers. In this study, Quantitative Chromogenic Imprinting Gene In-Situ Hybridization (QCIGISH) was conducted to analyze the biallelic expression (BAE) and multiallelic expression (MAE) in UEC, and develop a more accurate method for early stage bladder cancer. Methods: 53 patients with urinary system diseases including 13 low-grade bladder cancer, 24 high-grade bladder cancer and 16 benign lesions, as well as 28 healthy volunteers were recruited in clinical trial NCT03563443 for validation. The total expression (TE), BAE and MAE of imprinted genes GNAS, PEG10, GRB10, SNRPN and HM13 were blindly detected by QCIGISH. The severity of malignancy was predicted by a grading model previously established on 229 tissue FFPE and cystoscopic biopsy samples, and subsequently validated with the pathology and clinical diagnosis results. Results: The QCIGISH method achieved 84.6% and 95.8% sensitivities for low- and high-grade bladder cancers, respectively, with an equally high specificity of 97.7%. The sensitivity of QCIGISH for low-grade bladder cancer is much higher than standard urinary cytology (16%), and FDA-approved molecular tests such as Hemoglobin Dipstick (38%), BTA Stat (36%), NMP22 BladderChek (25%), and ImmunoCyt (47%). Conclusions: The high accuracy of QCIGISH especially for low-grade bladder cancer demonstrated its great potential in becoming an important and powerful clinical tool for noninvasive diagnosis and large-scale screening for early bladder cancer.
Value of serum procalcitonin level in differentiation between infections and tumor-related fever in patients with malignant tumors
Authors: Na Zhang
Journal: BMJ (2018)

Objective
To assess the value of serum procalcitonin (PCT) level in the differentiation between infections and tumor-related fever in patients with malignant tumors.


Methods
Serum levels of PCT and related indicators were measured in 139 patients (173 times) with malignant tumors admitted in the First Affiliated Hospital of Anhui Medical University from December 2014 to December 2015. There were 64 cases of infection with fever, 44 cases of infection without fever, 36 cases of tumor-related fever and 29 non-infection, non-fever cases. Serum PCT levels of patients in 4 groups were compared by non-parametric test, and the value of PCT in the differentiation of infections and tumor-related fever was assessed by receiver operating characteristic (ROC) curve.


Results
There were significant differences in serum PCT levels among patients with different type of tumors (χ2=11.238, P=0.047) and between patients with metastases and without metastases (χ2=12.658, P=0.005) in infected patients, as well as in non-infected patients (χ2=12.374, 9.942, P=0.015, 0.019; respectively). The PCT levels of infection with fever group, infection without fever group, tumor-related fever group and non-infection, non-fever group were 0.449(0.148, 2.090)μg/L, 0.107(0.056, 0.441)μg/L, 0.254(0.100, 0.530)μg/L and 0.058(0.043, 0.124)μg/L, respectively. There was no significant difference in PCT levels between tumor-related fever group and infection without fever group(Z=-1.480, P=0.139), between tumor-related fever group and blood culture negative infection with fever group (Z=-0.965, P=0.334). According to the ROC, the cut-off value for PCT was defined at 0.955 μg/L, the sensitivity and specificity of PCT in differentiation between infection and tumor-related fever was 0.34 and 0.94, respectively.


Conclusion
Tumor types and metastasis can affect serum PCT level, and PCT level can be increased in tumor-related fever, which would affect value of PCT in diagnosis of infection in tumor patients.


Key words: 
Neoplasms; Infection; Procalcitonin; Tumor-related fever