tbuckley/cabot-search huggingface dataset:
Treatment patterns in pancreatic cancer: Differences between expert and community practitioners.
Authors: Ryan P. Topping, E. Gabriela Chiorean, Dan Laheru, Michael J. Pishvaian, Andrea Wang-Gillam, Timothy A. Quill, Andrew H. Ko
Journal: Journal of Clinical Oncology (2020)

e19207 Background: Expanding systemic therapy options continue to improve outcomes for patients (pts) with pancreatic cancer (PCa) in both the unresectable and resectable disease settings. We developed an online treatment (Tx) decision support tool designed to provide community healthcare providers (HCPs) with case-specific recommendations from 5 PCa experts. Here, we report an analysis of cases entered into the tool by HCPs, comparing their planned Tx with expert recommendations and assessing the impact of those recommendations on intended HCP Tx decisions. Methods: In July 2019, 5 expert panelists provided Tx recommendations for numerous distinct PCa cases. To use the tool, HCPs entered specific pt/disease factors along with their intended Tx plan for the case, after which they received expert Tx recommendations followed by a survey asking if the recommendations had changed their planned Tx course. Results: 251 HCPs entered 347 pt cases into the tool (83% by physicians). 68% of respondents reported treating &lt; 15 pts with PCa per yr, and 60% sought recommendations for a specific pt. Variance was observed between experts and HCPs for cases in several Tx settings (Table); eg, although FOLFIRINOX was the primary panel recommendation for many younger, healthier pts requiring neoadjuvant or adjuvant therapy or first-line Tx for unresectable disease, most HCPs did not select this therapy for these pts at baseline. Among HCPs whose planned Tx differed from the experts, 51% indicated that they would change their Tx based on panel recommendations. Conclusions: Analysis of data from an online Tx decision support tool for PCa revealed variance between expert recommendations and the intended Tx of HCPs for numerous scenarios, with education provided by the tool potentially increasing the number of clinicians who made optimal Tx decisions. A full analysis of Tx trends will be presented. [Table: see text]
The association between immune-related adverse events and efficacy outcomes with consolidation pembrolizumab after chemoradiation in patients with stage III NSCLC: an analysis from HCRN LUN 14-179.
Authors: Nikhil Shukla, Sandra K. Althouse, Ahad Ali Sadiq, Shadia Ibrahim Jalal, Salma K. Jabbour, Robin Zon, Goetz H. Kloecker, William B. Fisher, Karen L. Reckamp, Ebenezer A. Kio, Robert M. Langdon, Bamidele Adesunloye, Ryan D. Gentzler, Nasser H. Hanna, Greg Andrew Durm
Journal: Journal of Clinical Oncology (2020)

9032 Background: Consolidation checkpoint inhibitor therapy (CPI) for up to 1 year following chemoradiation (CRT) is a current standard of care for pts with inoperable stage III NSCLC. However, some pts are not able to complete 1 year of CPI due to immune-related adverse events (irAES). In multiple retrospective studies, pts with stage IV NSCLC treated with CPI who experience irAEs generally receive fewer cycles of CPI without a significant detrimental effect on efficacy. The association between irAEs and outcomes with consolidation CPI after CRT has never been reported. Here we report the association between irAEs and efficacy outcomes from the HCRN LUN 14-179, a single-arm phase II trial of consolidation pembrolizumab following concurrent CRT in pts with unresectable stage III NSCLC. Methods: After completion of CRT eligible pts with stage III NSCLC without PD received pembrolizumab 200 mg IV q 3 wks for up to 1 yr. Demographics, disease characteristics, and number of cycles of pembrolizumab received were reported in pts who had any grade irAEs (except pneumonitis which included grade &gt;2 only) [Group A] and those without irAEs (except grade 1 pneumonitis) [Group B]. Chi-square test (or Fisher's Exact test) were used for comparisons for categorical variables and Wilcoxon test for continuous variables. The Kaplan-Meier method was used to analyze time to metastatic disease (TMDD), PFS, and OS. A log-rank test was used to compare groups. Results: 92 eligible pts for efficacy analysis were enrolled from March 2015 to November 2016. 4 yr OS estimate for all pts is 46.2%. Any grade irAEs (except grade I pneumonitis) (n = 37 pts) included pneumonitis (18.5%), colitis (3.3%), increased creatinine (5.4%), elevated transaminases (3.3%), hyperthyroidism (7.6%), hypothyroidism (13.0%). Grade ≥ 2 irAEs (n = 32 pts) included pneumonitis (18.5%), hypothyroidism (10.8%), and colitis (3.3%). Group A/B: male (21/38), female (16/17), current or former smoker (35/52), stage IIIA (20/35), stage IIIB (17/20), non-squamous (21/30), squamous (16/25). Median number of pembrolizumab cycles received in Group A/B pts were 9 vs 15 (p = 0.0942) respectively. 4 yr efficacy endpoints in Groups A/B were TMDD 35.3% vs 41.3% (p = 0.83), PFS 27.8% vs 28.7% (p = 0.97), OS 43.5% vs 47.9% (p = 0.99), respectively. Conclusions: Despite receiving fewer cycles of consolidation pembrolizumab, pts who experienced any grade irAEs (excluding grade 1 pneumonitis) did not have significantly reduced efficacy outcomes. Clinical trial information: NCT02343952.
Abstract 9639: Impact of Percutaneous Intervention of Coronary Chronic Total Occlusions on Left Ventricular Ejection Fraction: A Systematic Review and Meta Analysis
Authors: Qasim Malik, David Prutzman, Peter Puleo, Chris Sarnoski, Raymond Durkin, Jamshid Shirani
Journal: Circulation (2019)

Background: Percutaneous coronary intervention (PCI) of coronary artery chronic total occlusion (CTO) has been gaining popularity with reported high success rates in these anatomically complex and ...
A blood-based multi-mRNA liquid biopsy with &gt;90% accuracy for diagnosis and assessment of prostate cancers.
Authors: Kambiz Rahbar, Mark S. Kidd, Ignat A. Drozdov, Alexandra Kitz, Anna Malczewska, Pawel Rajwa, Martin Boegemann, Christof Bernemann, Lisa Bodei, Irvin Mark Modlin
Journal: Journal of Clinical Oncology (2020)

5574 Background: There are a paucity of blood-based biomarkers with clinical utility for prostate cancer (PCa). We developed a circulating mRNA (27-gene) prostate cancer signature to diagnose and manage PCa. Methods: Gene identification: Publicly available PCa transcriptome sets ( n= 1,159 samples) were evaluated and compared with normal blood-based transcriptomes using gene co-expression network enrichment, differential expression and functional enrichment analyses to identify candidate markers. Gene expression evaluation: Seven PCA cell lines and two normal prostate epithelial lines were used to assess candidate genes. Marker genes were determined in PCa tumor tissue ( n= 50) and validated in the TCGA-PRAD ( n= 500) dataset. Blood gene expression: Set #I: PCA: n= 132, BPH: n= 44, controls n= 55. Set #II: n= 50 (biochemical recurrence [BCR]). We constructed an artificial intelligence PCa model using classification algorithm analyses. Scoring: normalized algorithmically analyzed gene expression (0 to 100), positive score &gt;20. PSA: BPH ( n= 44) and PCa ( n= 132). Clinical score assessment: Surgical cohort: ( n= 47), samples: pre-surgical and post: 1 week - 14 months. Statistics: Kruskal-Wallis, Pearson-correlation, Fisher’s and AUROC analyses (Mean±SEM). Results: Transcriptomic analysis identified 27 candidates. Cell lines/tissue: Expression levels were significantly elevated ( p&lt; 0.001, 2.1-35.8-fold) in cell lines and PCa surgical samples. All 27 markers were confirmed in TCGA-PRAD samples (average TPM: 58 to 10,366). Blood: In Set#I, levels in PCa were 47±2 ( p&lt; 0.0001) compared to BPH (19±1) and controls (18±0.5); AUROC: 0.92 (BPH) and 0.94 (controls), with an accuracy of 85-88%, a sensitivity of 86% and specificities 82 and 93%. For PSA, the AUROC (PCa vs. BPH) was 0.51 ( p= 0.88). PSA was positive in 86% of BPH and was &gt; 10ng/ml in 30%. PSA was positive in 83% of PCa and &gt; 10ng/ml in 40% (Fisher’s p= 0.28). PSA accuracy ( &gt; 10ng/ml) was 48%. Levels in Set#II (BCR) were 44±3. ProstaTest-was positive in 48 (96%). Surgical cohort ( n= 47): Prostatest accuracy 100% pre-surgery. Resection decreased levels (KW-statistic: 57.4, p&lt; 0.0001) from 52±1 to 23.5±2. Conclusions: A 27-gene blood signature was developed for PCa that exhibited a diagnostic accuracy of 92%; significantly better than PSA (48%, p&lt; 0.0001). Surgical resection significantly ( p&lt; 0.0001) decreased levels. Biochemical recurrence was accurately detected (96%). A multi-gene prostate cancer liquid biopsy is likely to have clinical utility in both diagnosis and monitoring of PCa.
Expectations of overall survival for patients with metastatic pancreatic cancer (mPC).
Authors: Joanne P. Willey, Arden Buettner, Susan Lynne Britton, Maria L. Lankford, Mitchell Scharf, Bhavana Pendurthi Singh, Caio Max Sao Pedro Rocha Lima
Journal: Journal of Clinical Oncology (2020)

e16788 Background: Pancreatic cancer is the 4 th leading cause of cancer-related death in the U.S. Metastatic pancreatic cancer has typically had a poor prognosis. However, the use of combination chemotherapy with novel agents have improved outcomes. First line therapy with either FOLFIRINOX (2011) or gemcitabine (gem)/nab-paclitaxel (2013) improved response rates (RR), progression-free survival (PFS) and OS versus (vs) gem alone. In 2015, second-line therapy with nanoliposomal irinotecan and fluorouracil (5FU) also improved RR, PFS, and OS vs 5FU. Since 2017, several newer agents have been approved for targeted patient populations – pembrolizumab for MSI-H/dMMR tumors, larotrectinib and entrectinib for NTRK gene fusion positive pts, and olaparib for germline BRCA-mutated pts. As more treatment (Tx) options become available, pts are more likely to receive Tx in later lines. A population-based study found that of mPC pts who completed 1st-line (1L) chemotherapy prior to December 31, 2014, 49% went on to receive 2nd-line (2L) Tx and 17% received 3rd-line (3L) Tx 6 . Methods: Prescribing patterns of 569 U.S.-based oncologists were studied using a validated, proprietary, case-based market research tool (Challenging Cases). Data were acquired using blinded, audience-response iPad technology at 8 live events during 2018-2019. Results: Estimate of mPC patients treated with 2L and 3L Tx in 2019 Estimates for mPC pts treated with 2L therapy rose from 2018 to 2019, with 46% treating &gt; 60% of mPC patients with 2L in 2018 compared to 54% in 2019. Oncologists estimated median survivals to be 7.4 months (mos) from the regimens they prescribe in 1L, 4.3 mos in 2L, and 2.3 mos in 3L. Conclusions: With the addition of new and more effective treatments for mPC, more patients are treated in the 2L and 3L settings. However, oncologists may underestimate the survival expectation with novel agents or regimens, particularly in later lines of therapy. [Table: see text]
血细胞减少的系统性红斑狼疮45例骨髓细胞学表现及治疗反应
Authors: 黄林喜, 吴贤仁
Journal: BMJ (2005)

对45例外周血细胞减少的SLE患者进行骨髓细胞检查,并与血象等其他临床资料综合分析,观察糖皮质激素和细胞毒药物治疗后血象的变化.结果示SLE骨髓损害缺乏特异性,大部分增生活跃或明显活跃,小部分为骨髓各系受抑制,少数再生障碍,骨髓受累程度较外周血轻;缺铁可能是狼疮贫血的部分原因;肝脾淋巴结肿大可能提示骨髓增生;外周血细胞减少而骨髓细胞形态无异常者应警惕SLE可能.血细胞减少者对糖皮质激素和细胞毒药物反应良好。
弓形虫致胸腔积液一例
Authors: 卢慧宇, 徐虹
Journal: BMJ (2010)

患者女,49岁,入院3 d前无明显诱因下出现左侧胸痛,为持续性,深吸气时明显,时有低热,无咳嗽、咯痰,无盗汗,无呼吸困难,曾在住院前门诊B超,示左侧胸腔少量积液,纯化蛋白衍生物试验弱阳性,遂以左氧氟沙星治疗,因胸痛不缓解于2008年4月11日收入呼吸科.病程中患者左肩关节疼痛,无关节晨僵,无皮疹。
Analysis of influence factors of hospital acquired pneumonia in patients with cervical spinal cord injury
Authors: Hongjie Li, Wenbin Zhang, Chunyang Fang
Journal: BMJ (2014)

To explore the influence factors of hospital acquired pneumonia(HAP) in patients with cervical spinal cord injury(CSCI). Regression analysis the clinical data of 478 cases of patients with CSCI, the CSCI patients were divided into the infection group and non-infection group.Firstly, the single factor analysis was used to compare the difference of the influence factors between the two groups.And then, logistic regression analysis was used to explore the influence factors of HAP in patients with CSCI.122 suffered HAP in the 478 patients with CSCI, accounted for 25.52%.There's significant difference in injured segments, JOAS scores on admission, methylprednisolone treatment within 8 h after injury, tracheotomy, history of smoking and lung disease between the infection group and non-infection group(P<0.05). logistic regression analysis showed that the injured segments(OR=4.474), JOAS scores on admission(OR=3.856), tracheotomy(OR=2.452), history of lung disease (OR=1.589)were the independent influence factors of HAP in patients with CSCI.The incidence rate of HAP was high in patients with CSCI, there were a variety of influence factors for the HAP, and we should take targeted intervention measures so as to reduce the incidence of HAP.


Key words: 
Spinal cord injuries; Hospital acquired pneumonia
Phase I study of afatinib plus selumetinib in patients with KRAS mutation-positive colorectal, non-small cell lung and pancreatic cancer.
Authors: Sanne Huijberts, Emilie Van Brummelen, Carla M.L.- Van Herpen, Ingrid M.E. Desar, Frans Opdam, Robin Van Geel, Serena Marchetti, Neeltje Steeghs, Kim Monkhorst, Bas Thijssen, Hilde Rosing, Alwin Huitema, Jos H. Beijnen, Rene Bernards, Jan H. M. Schellens
Journal: Journal of Clinical Oncology (2020)

3613 Background: Mutations in the KRAS gene result in a constitutively activated RAS-RAF-MEK-ERK (MAPK) pathway. In KRAS mutant tumors, the anti-tumor activity of MEK inhibitors is limited due to intrinsic resistance caused by feedback activation of upstream epidermal growth factor receptors (HER). This upstream activation not only reactivates MAPK, but also the phosphoinositide 3-kinase (PI3K)-AKT pathway in preclinical research. Based on these data, a phase I clinical trial was initiated with the combination of the orally administered pan-HER inhibitor afatinib and the MEK inhibitor selumetinib in patients with KRAS mutant and PIK3CA wildtype colorectal cancer (CRC), non-small cell lung cancer (NSCLC), or pancreatic cancer to determine the recommended phase 2 regimen (RP2R). Methods: In this multicentre study, patients received escalating doses of afatinib and selumetinib according to a 3+3 design starting with 20 mg afatinib once daily (QD) continuously and 25 mg selumetinib twice daily (BID) in a 21 days on/7 days off schedule. Continuous and intermittent dosing were explored to assess optimal exposure and tolerability. The primary aim was determining the RP2R. Secondary objectives included assessment of anti-tumor activity and the analyses of pharmacokinetic and pharmacodynamic parameters for target inhibition. Clinicaltrials.gov identifier: NCT2450656. Results: In total, 26 mostly heavily pretreated patients with CRC (n=19), NSCLC (n=6) and pancreatic cancer (n=1) were enrolled among 5 dose-levels. Dose-limiting toxicities (DLTs) occurred in 6 patients and consisted of grade 3 diarrhea (n=3), decreased appetite (n=1), nausea/vomiting (n=1), dehydration (n=2) and mucositis (n=1). Clinical efficacy was limited with no responses according to RECIST v1.1 and stable disease for 221 days in a patient with NSCLC as best response. Conclusions: The RP2R was determined at 20 mg afatinib QD continuously and 25 mg selumetinib BID 21 days on/7 days off for continuous dosing. The 3 patients treated in the escalation cohort of the ongoing intermittent dose-level with 20 mg afatinib QD and 25 mg selumetinib BID 5 days on/2 days off, experienced no DLTs. Pending the latest safety results of the expansion cohort for this ongoing dose-level, the RP2R of intermittent dosing has not been established at the moment. Clinical trial information: NCT2450656 .
产前应用维生素K1预防早产儿脑室周围-脑室内出血的临床研究
Authors: 秦桂莲, 高峰, 张晓辉, 刘敬, 陈妍华, 王琪, 赵金辉, 孙平, 朱立春
Journal: BMJ (2005)

随机选择因有早产高危因素而住院且分娩时胎龄不足35周的孕妇40例,于分娩前给予维生素K110 mg/d静脉注射或肌内注射,疗程2～7 d.所生早产儿与同期出生但产前未用维生素K1的相同孕周的50例孕妇的早产儿比较.结果提示产前应用维生素K1可显著降低早产儿脑室周围-脑室内出血发生率,还可减轻出血的程度。
Preliminary study on a new model of Community-based Hypertension group-interference management model
Authors: Lan Zhu, Ke-ming Wu, Feng Ling, De-an Liu
Journal: BMJ (2010)

369 patients with hypertension living in Xietu community were randomized into 2 groups:intervention group receiving the group-interference-management and control group receiving routine hypertension management services.We found that patients in the intervention group had better self-management behaviors,self-efficacy and health status in comparison with the control group (P＜0.05).The systolic and diastolic blood pressure in the intervention group decreased more remarkably than that in the control group (P＜0.05).Our result suggested that the community-based hypertension group-interference-management model is more effective to control hypertension than the routine hypertension management services.

Key words: 
Hypertension; Disease management
LM02-trial perioperative treatment with panitumumab and FOLFIRI in patients with wild-type RAS, potentially resectable colorectal cancer liver metastases.
Authors: Gudrun Piringer, Thomas Gruenberger, Irene Kuehrer, Dietmar Oefner, Klaus Kaczirek, Friedrich Laengle, Istvan Levente Viragos-Toth, Arno Amann, Wolfgang Eisterer, Reinhold Fuegger, Johannes Andel, Angelika Pichler, Judith Stift, Lidija Soelkner, Michael Gnant, Josef Thaler
Journal: Journal of Clinical Oncology (2020)

e16046 Background: Nearly half of patients with colorectal cancer develop liver metastases and only 20% are initially resectable. Surgical resection of liver metastases results in five-year survival rates of 24-48%. Perioperative FOLFOX therapy increases progression free survival. In advanced disease the addition of targeting therapies to chemotherapy results in an overall survival advantage. In this study the efficacy and safety of perioperative panitumumab and FOLFIRI therapy were investigated. Methods: Patients with previously untreated, wild-type RAS, potentially resectable colorectal cancer liver metastases were included. Chemotherapy consisted of irinotecan 180mg/m 2 intravenously over 120 minutes and fluorouracil bolus 400mg/m 2 intravenously, followed by a 46 h infusion of fluorouracil 2400mg/m 2 repeated every 2 weeks. Panitumumab was given as an intravenous dose of 6mg/kg every 2 weeks. Preoperative 4 cycles and postoperative 8 cycles were administered. Primary objectives were the evaluation of efficacy and safety. Results: We enrolled 36 patients in 7 centers in Austria. ITT-analyses included 35 patients. There were 28 men and 7 women, the median age was 66 years. 91.4% completed the planned 4 cycles of preoperative therapy and 82.9% underwent liver resection. R0 resection rate was 82.7%. 20 patients started postoperative chemotherapy and 12 patients completed the planned 8 cycles. Objective response rate after preoperative therapy was 65.7% with one radiological complete remission and 22 partial remissions. In 20% and 5.7% of patients stable disease and progressive disease were documented, respectively. Three patients discontinued preoperative treatment due to adverse events without response evaluation. The most common grade 3 adverse events were diarrhea (n = 4), rash (n = 3) and leukopenia (n = 3) during preoperative therapy. One patient died due to sepsis and one had a pulmonary embolism grade 4. After surgery two patients died due to hepatic failure and one patient had a suture related complication grade 3. Most common grade 3/4 adverse events during postoperative therapy were rash (n = 2), stroke (n = 1) and intestinal obstruction (n = 1). Conclusions: Panitumumab in combination with FOLFIRI as preoperative therapy for operable colorectal liver metastases in RAS wild-type patients results in a radiological objective response rate in 65.7% of patients with a manageable grade 3 diarrhea rate of 14.3%. Progression-free survival and overall survival are still monitored. Clinical trial information: 2012_000265-20 .
Incidence of graft versus host disease in peri transplant hospitalization after <i>clostridium difficile</i> infection.
Authors: Drew Carl Drennan Murray, Rohit Kumar, Shruti Bhandari, Mohamed M. Hegazi
Journal: Journal of Clinical Oncology (2020)

7542 Background: Hyperacute graft versus host disease (GVHD) after allogenic stem cell transplantation (SCT) has adverse outcomes with increased rates of chronic GVHD and relapse. GVHD risks include mismatched related or matched unrelated donors, myeloablative conditioning, heavy pretreatment, and donor-recipient sex mismatch. Clostridium difficile infection (CDI) is a leading cause of diarrhea in immunocompromised patients. Proposed microbiome effect on immunity and GVHD in allogenic SCT recipients prompts concern of microbiome modulation from CDI and antibiotics inciting GVDH. Methods: National Inpatient Sample database 2014 for hospitalizations with allogeneic SCT in patients ≥18yo. Characteristics (age, sex, race, insurance, graft source, hospital type, region, comorbidities) were compared for hospitalizations with and without CDI. Primary outcome was the difference in the incidence of GVHD during the transplant hospitalization between the 2 groups. Other outcomes were mortality, length of stay and hospital charges. Chi-square, t-test, and multivariate logistic regression utilized. Results: Of 6210 patients with allogenic SCT, 745 (12%) had CDI during the transplant hospitalization. In transplanted patients without CDI the average age was 55yo, 43.9% female, 69.5% Caucasian (C), 7.1% African American (AA), 8.6% Hispanic (H), 32.1% had Medicare/Medicaid, 61.8% private insurance, 5.7% uninsured, 44.7% had hypertension, 13.7% had diabetes, graft source was 84.3% PBSC (peripheral blood stem cells), 11.3% bone marrow, and 4.4% cord blood. CDI group the average age was 52.5yo, 45.3% female, 73% C, 4.7% AA, 8.1% H, 25.7% had Medicare/Medicaid, 66.2% private insurance, 8.1% uninsured, 41.9% had hypertension, 10.1% had diabetes, graft source was 83.8% PBSC, 10.8% bone marrow, and 5.4% cord blood. 25.7% of patients with CDI developed GVHD during that hospitalization while 14.2% of patients without CDI developed GVHD during the hospital stay (OR 2.1, p &lt; 0.001 multivariate analysis). GVHD during the hospitalization had no difference in length of stay (p = 0.32), total cost of stay (p = 0.50) or same hospitalization mortality (p = 0.94). Conclusions: Allogeneic SCT patients with CDI develop GVHD on the same hospitalization at significantly higher rates than patients without CDI. This is true after controlling for age, sex, race, insurance, comorbidities, graft source, hospital location, and type of institution. Despite known associations of early evidence of GVHD on relapse, overall mortality was not different between the two groups.