tbuckley/cabot-search huggingface dataset:
Feasibility of an electronic risk score questionnaire in rural practice.
Authors: Ajaz Bulbul, Sara Campbell
Journal: Journal of Clinical Oncology (2020)

e19014 Background: Genetic testing (GT) has significant implications for cancer management. Its implementation is difficult in small rural practices (RP). We examined an electronic risk Score questionnaire (ERSQ) that blends genetic risk factors with clinical and cancer family history to determine its feasibility. Methods: Clinic encounters between Oct 18 - Jan 20 were evaluated. Prior to Oct 19 patients were screening based on physician recommendation (PRBS) without an established screening questionnaire. Between Oct 19 - Jan 20 an ERSQ on a tablet identified patients meeting either USPSTF (US preventative Task force), NCCN (National comprehensive cancer center) or ASBS (American Society of Breast Surgeons) guidelines for GT. Statistical analysis was performed using paired t-test. Out of pocket costs (OOP$), prevalence, patient care impact, High risk negative (HRN) requiring change in screening recommendation (CSR) were evaluated. Genetic telephonic genetic counselling was offered to patients. Results: Pre-ESRQ cohort covering 12 months included 3520 patient encounters; with 1024 encounters post-ESRQ lasting 90 days. Forty three GT’s were performed over 16 months. Pre-ESRQ, seventy three patients were offered PRBS. Sixteen were tested (22% compliance), 13 reported out with two positive results (15% prevalence) and one HRN requiring CSR in 23% (3/13). Post ESRQ, 257 patients were offered GT; 68/131 (51% compliance) (p &lt; 0.0001) screened with the ESRQ met at least one criteria for GT with one positive GT (1/18; 5% prevalence) and 4 HRN; CSR 5/18 (28% CSR)(p &lt; 0.0003). In the Post ESRQ cohort GT was cancelled due to cost burden to patients in 6/27 (22%) and in 2/18 (11%) of the pre ESRQ group (p &lt; 0.0001). Out of 26 patients with OOP$ information 23/26 (88%) incurred a zero OOP$. ESRQ took a median of 8 minutes in the office. Conclusions: An effective tablet based ESRQ may be feasible to adapt in a busy RP and help address disparity in access to genetic screening. There may be a beneficial effect on compliance with limited cost burden to patients that needs further study. ESRQ can improve CSR. A larger prospective cohort may help confirm these findings.
Outcomes of GDPT (gemcitabine, cisplatin, prednisone,thalidomide) versus CHOP in newly diagnosed peripheral T-cell lymphoma patients.
Authors: Ling Li, Yuanyuan Sun, Xin Li, Lei Zhang, Xinhua Wang, Xiaorui Fu, Zhenchang Sun, Xudong Zhang, Zhaoming Li, Jingjing Wu, Hui Yu, Yu Chang, Jiaqin Yan, Xiaolong Wu, Zhiyuan Zhou, Feifei Nan, Tongyu Lin, Mingzhi Zhang, Tian Li
Journal: Journal of Clinical Oncology (2020)

8018 Background: Peripheral T-cell lymphoma(PTCL) is highly heterogeneous invasive NHL.There is no consensus standard treatment for it now. So outcomes of GDPT versus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in treating newly diagnosed PTCL were compared. Methods: An open-label prospective clinical trial with 153 newly diagnosed PTCL patients conducted between January 2010 and December 2018 was designed. Patients were randomly assigned to the GDPT group (77 cases) and CHOP group (76 cases). Patients in each group were further divided into four subgroups: PTCL-NOS, ALCL, AITL, and an other types, in accordance with pathological patterns. Based on expression of RRM1, TOP2A, TUBB3 and ERCC1, patients were divided into groups with high and low gene expression levels. Clinical characteristics, side effects, efficacy, PFS and OS were compared. Results: There were no significant differences in the basic clinical features or side effects between the GDPT and CHOP groups. The ORR of the GDPT group was better than that of the CHOP group (66.3%vs. 50.0%, P= 0.042), as was the CR rate (42.9% vs. 27.6%, P= 0.049). Patients in the GDPT group had a longer PFS and OS than the CHOP group. The 4-year PFS and OS rates in the GDPT group were both superior to those in the CHOP group (63.6% vs. 53.0% for PFS, P= 0.035; 66.8% vs. 53.6% for OS, P= 0.039).In the GDPT group, the difference in CR between the four subgroups was statistically significant (P = 0.046).In the CHOP group, differences in both CR and ORR among the four subgroups were statistically significant ( P= &lt; 0.001 and P= 0.005, respectively).There were also statistically significant differences in CR between patients treated with CHOP and GDPT in the PTCL-NOS subgroup, AITL subgroup, and the other types subgroup( P= 0.015; P= 0.003; P= 0.005, respectively).The data also showed a significant difference in OS among the four subgroups within the GDPT group ( P= 0.001).The OS of AITL was shorter than that of the other three subgroups. Four subgroups of CHOP showed a significant difference in PFS ( P= 0.019). There was no statistical association between responses and the gene expression levels of RRM1, ERCC1, TUBB3 and TOP2A. Conclusions: The GDPT group had better response rates and prolonged the patients’ PFS and OS. As a promising new regimen, GDPT is expected to become the first-line therapy for PTCL. New agents should be applied to patients who do not achieve good responses with previous treatment, such as those diagnosed with angioimmunoblastic T cell lymphoma. Clinical trial information: NCT01664975 .
北京市朝阳区社区卫生服务工作人员满意度调查分析
Authors: 周宾, 王凯, 沈雁
Journal: BMJ (2010)

目前,我国社区卫生服务已进入快速发展时期[1],社区卫生服务工作人员是开展社区卫生服务工作的主力,建设高素质、高满意度的社区卫生服务队伍,对提高患者与居民满意度、提升社区卫生服务水平及其可持续发展起着重要的作用[2-5].北京市朝阳区共有42家社区卫生服务中心,分布在城市、城乡结合部及农村3类地区.本研究调查朝阳区社区卫生服务工作人员的满意度情况,现报道如下。
Efficacy of androgen receptor antagonists in combination with androgen deprivation therapy in nonmetastatic, castration-resistant prostate cancer: A systematic review and meta-analysis of published phase III randomized controlled trials.
Authors: Nusrat Jahan, Shabnam Rehman, Francis Mogollon-Duffo, Somedeb Ball, Sariya Wongsaengsak, Lukman Aderoju Tijani
Journal: Journal of Clinical Oncology (2020)

e17606 Background: Nonmetastatic, castration-resistant prostate cancer (nmCRPC) often heralds metastatic disease which is responsible for majority of the morbidity and mortality associated with prostate cancer. Hence, delaying metastasis is an expedient therapeutic goal for the patients with nmCRPC. Three androgen receptor (AR) antagonists — apalutamide, enzalutamide, and darolutamide — have been approved recently for nmCRPC on the basis of prolongation of metastasis-free survival. The purpose of our meta-analysis is to consolidate the efficacy data of AR-antagonists prolonging metastasis-free survival in nmCRPC. Methods: We conducted a systematic search at PUBMED, MEDLINE, EMBASE, and meeting abstracts as per PRISMA guidelines from inception until November 2019. Phase 3 RCTs using AR-antagonists for nmCRPC were included in the final analysis. We used generic inverse variance method and random effects model to calculate the pooled hazard ratio (HR) for distant metastasis or death with 95% confidence interval (CI). Heterogeneity was tested with I 2 value and Cochran’s Q test. Results: Three phase 3 RCTs (ARAMIS, PROSPER, and SPARTAN) randomizing 2694 patients in the AR-antagonist arms and 1423 patients in the control arms are included in the final analysis. All studies enrolled only patients with prostate specific antigen (PSA) doubling time of 10 months or less. AR-antagonists used in the study arms were — ARAMIS: darolutamide, PROSPER: enzalutamide, and SPARTAN: apalutamide. Placebo was used in the control arms. All patients continued androgen deprivation therapy (ADT). Randomization was 2:1 in all studies. The pooled HR for distant metastasis or death was highly significant at 0.32 (95% CI: 0.25 - 0.41; P &lt; 0.00001, I 2 = 79%) in the favor of AR-antagonist arm in overall population. The pooled HR remained significant when patients were stratified according to PSA doubling time. For patients with PSA doubling time &gt; 6months, the pooled HR was 0.34 (95% CI: 0.27 - 0.43; P &lt; 0.00001, I 2 = 0%); for patients with PSA doubling time ≤6 months, the pooled HR was 0.32 (95% CI: 0.25 - 0.41; P &lt; 0.00001, I 2 = 73%). Conclusions: Our meta-analysis demonstrated addition of AR-antagonists to ADT significantly prolongs the metastasis-free survival in patients with nmCRPC — an exciting new development in the management of prostate cancer.
Status of health skills relating to infectious diseases among residents six districts in Beijing
Authors: Jing Li, Shuang-sheng Wu, Hai-yue Li, Chun-na Ma, Peng Yang, Yi Zhang
Journal: BMJ (2013)

To assess the level of health skills relating to infectious diseases among residents in Beijing and develop more effective strategies for controlling infectious diseases. We conducted a multistage sampling, retrospective cross-sectional survey of residents aged 18 and above from 6 districts by self-administered and anonymous questionnaires in January 2011. The questionnaires consisted of health skills relating to infectious diseases. A total of 13 042 respondents completed the survey. The proportions of people with the skills for acquiring knowledge about infectious diseases, being able to read medicinal package insert, being able to read brochures with regard to basic knowledge about infectious diseases, being able to read laboratory test report and proper use of thermometer were 57.7%, 71.0%, 70.2%, 47.9% and 76.8% respectively. The levels of health skills were different among different populations (P<0.01). A low level of health skills was observed among the poorly-educated people and elders. Therefore measures such as health education and skills training about infectious diseases should be taken to improve the health skills.


Key words: 
Infectious diseases; Health knowledge, attitude, practice
COVID-19 and systemic lupus erythematosus: a case series
Authors: Yevgeniya Gartshteyn, Anca D Askanase, Nancyanne M Schmidt, Elana J Bernstein, Leila Khalili, Rachel Drolet, Rachel J Broderick, Laura Geraldino-Pardilla, Teja Kapoor
Journal: The Lancet Rheumatology (2020)
Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma
Authors: Cristian Navarrete-Dechent, Konstantinos Liopyris, Ayelet Rishpon, Nadeem G. Marghoob, Miguel Cordova, Stephen W. Dusza, Aditi Sahu, Kivanc Kose, Margaret Oliviero, Harold Rabinovitz, Klaus J. Busam, Michael A. Marchetti, Chih-Chan J. Chen, Ashfaq A. Marghoob
Journal: JAMA Dermatology (2020)

Basal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures.To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC.In this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015). A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019.Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light.The primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated.A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs.The findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.
Association between Helicobacter pylori infection and prevalence of type 2 diabetes
Authors: Huanli Jiao, Shuhong Liu, Qing Zhang, Kun Song, Bangmao Wang
Journal: BMJ (2016)

To investigate the association between Helicobacter pylori (Hp) infection and type 2 diabetes.Total 4 129 health check up subjects aged (49.1±11.3) years (18-92 years), including 2 649 males and 1 480 females were enrolled in this cross-section study.Hp infection was confirmed by 13C-urea breath test; type 2 diabetes mellitus was diagnosed according to WHO criteria (1999). Single factor analysis and multiple regression analysis were used to evaluate the association between Hp affection and the prevalence of type 2 diabetes.Hp infection rate in diabetic group was significantly higher than that in non-diabetic group (45.6% vs. 39.0%, P<0.05). Hp infection rate in subjects with newly diagnosed diabetes was highest than those with previously diagnosed diabetes and non-diabetic subjects (P<0.05). The glycosylated hemoglobin level in Hp infection group was higher than that in non infection group [(5.88±0.64)% vs. (5.62±0.88)%, P<0.05]; the fasting plasma glucose and postprandial blood glucose levels in Hp infection group were also higher than those in non-infection group (P<0.05). Logistic regression analysis showed that Hp infection was one of the independent risk factors of type 2 diabetes (OR=2.002, 95%CI: 1.564-2.563, P<0.05). The study indicates that Hp infection is closely associated with type 2 diabetes mellitus.


Key words: 
Helicobacter pylori; Diabetes mellitus, type 2; Cross-sectional studies
Tumor-infiltrating lymphocytes in ipsilateral breast tumor recurrences predict prognosis.
Authors: Axel Stenmark Tullberg, Emma Nimeus-Malmström, Fredrika Killander, Martin Sjöström, Henri A.J. Puttonen, Felix Y Feng, Aniko Kovacs, Dan Lundstedt, Erik Holmberg, Per Karlsson
Journal: Journal of Clinical Oncology (2020)

546 Background: The antitumoral immune response is dynamic and changes with tumor progression. Previous studies show that immunohistochemical (IHC) assessment of TILs in local recurrences can predict prognosis. It is not clear how adjuvant radiotherapy (RT) can alter the local immune response or if gene expression analyses of TILs in recurrences can provide prognostic information. Methods: Matched biopsies from primary tumors and ipsilateral breast tumor recurrences (IBTRs) from the randomized SweBCG91RT trial were assessed for TILs. Analyses were performed using gene expression (86 matched pairs) and IHC assessment (126 matched pairs). Results: The median time to IBTR was 8.0 years among irradiated patients and 3.6 years among unirradiated patients. In the gene expression analyses, higher absolute values of CD8+ T cells, CD4+ effector memory and CD8+ effector memory T cells in the recurrence could significantly predict a decreased risk of subsequent distant metastasis. In addition, a net increase of these cells in the IBTR compared to the primary tumor was associated with a significantly lower risk of metastasis. TILs did not change significantly between the matched tumors for the whole group or among irradiated patients versus unirradiated patients in the gene expression or IHC analyses. Surprisingly, the group with unchanged TILs levels as measured by IHC had the lowest risk of metastasis while an increase or a decrease in TILs was significantly associated with an increased risk. Conclusions: Cytotoxic and memory T cells in the recurrence protect against subsequent distant metastasis although IHC measurement of TILs could not confirm these results. No significant differences in TILs infiltration between irradiated versus unirradiated patients could be determined in the recurrences. Further analyses including changes of subtypes between the primary tumor and the recurrence will be presented.
Childhood IQ and mortality during 53 years’ follow-up of Swedish men and women
Authors: Wallin Alma Sörberg, Allebeck Peter, Gustafsson Jan-Eric, Hemmingsson Tomas, 张春雨
Journal: BMJ (2020)

背景
儿童时期以智商水平（IQ）测试为标准的认知能力和死亡率之间的相关性有了正式的研究报告。然而，这种相关性在女性中的研究很少，且有争议，而且其内在相关性的机制也不明确。


方法
本研究收集了出生于1948年和1953年的19 919名男性和女性13岁时在学校的IQ数据。通过国家登记注册，收集了这些参加者的儿童期社会经济地位信息，以及截至2013年，参加者的中年时期的社会经济地位、社会环境状况和死亡率信息。


结果
较低的IQ水平与成年期全因死亡率增高有关，其中男性有1 070名参加者[危害比（HR）1.31，95%可信区间1.23~1.39，针对智商水平每下降一个标准差而言]，女性有703名受试者（HR 1.16，95%可信区间1.08~1.25）。IQ水平与男性由于严重事件导致的死亡率有关，与女性由于癌症和心血管疾患导致的死亡率有关。用儿童期的社会经济学因素进行校正后发现，成年人时期，在男性中这种相关性显著减小，在女性中这种相关性几乎完全消失。


结论
更低的IQ水平与男性和女性的死亡率增加有关。可以解释的社会经济学因素对成年人时期的影响，是促成IQ水平和死亡率相关性的重要因素，特别是在女性中。
Pancreatic cancer: Do disparities in mortality rates exist with respect to socioeconomic status?
Authors: Richard Stephen Sheppard, Adewumi Adekunle, Stefani Beale, Janet Joseph, Gerald Fletcher, Meena Ahluwalia
Journal: Journal of Clinical Oncology (2020)

e19007 Background: Pancreatic cancer continues to have one of the highest mortality rates among major cancer diagnoses with rates greater than 90 percent for all stages and with five year survival rates below 10 percent. With access to treatment modalities such as chemo-radiation, staged surgical interventions and targeted therapies, survival times have increased but due to the costs of these procedures, they may not be accessible to all members of society. Recent studies have shown that lower socioeconomic status is associated with higher mortality rates and lower survival times. With this study we aim to investigate if disparities exist among socioeconomic classes, based on zip code location, in a major multi-ethnic metropolitan city using census data. Methods: Malignant neoplasm mortality data at the ZIP code level was gathered from the New York City Department of Health Vital Statistics Mortality Data from years 2009-2011. NYC population data was gathered from the U.S. Census Bureau 2010 decennial census. We used ordinary least squares regression to assess the independent association between neighborhood median income and neighborhood mortality from malignant neoplasms arising from the pancreas. Results: In 2009-2011, 2,527 deaths from malignant neoplasms arising from the pancreas were recorded across NYC. There is no statistically significant correlation between neighborhood median income and age-adjusted mortality from malignant neoplasms arising from the pancreas for males and for females. For males, there was an R-squared of 0.001721 ( P-value &gt; 0.05). For females, there was an adjusted adjusted R-squared of 9.818e-05 ( P-value &gt; 0.05). Conclusions: Neighborhood median income is not associated with an increase in mortality rate with respect to neoplasms arising from the pancreas.
Vital status ascertainment in cancerlinq discovery (CLQD): Improvement in mortality capture with a supplemental data source.
Authors: Danielle Potter, Melinda Kaltenbaugh, Shaum Kabadi, Aliki Taylor, Esther Pascual, Jacob Koskimaki, Raven Brothers, Philip Stoeber, Jose Mena, Elizabeth Garrett-Mayer
Journal: Journal of Clinical Oncology (2020)

7064 Background: Overall survival (OS) is the gold standard outcome in clinical cancer research but many clinical trials cannot assess long-term OS. Real-world data sources can be used to calculate long-term OS, but only if vital status is accurately captured. Methods: The primary goal was to assess concordance of death dates from CLQD and an external source, and the effect of incorporation of external death data on estimates of OS. CLQD obtains electronic medical record (EMR) data from participating US oncology sites. Under-reporting of vital status is a common problem with EMR data; we investigated the value of including death data from a commercially available database, obituarydata.com (OBD) into CLQD. OBD pulls death data from published obituaries across the US. A matching algorithm is used to match patients in CLQD and OBD. OBD death data from breast, lung, ovarian, and pancreatic cancer patients diagnosed between 2010–2018 supplemented the CLQD in this study. OS was calculated using Kaplan-Meier estimation; Pearson correlation was used for comparing time to death. Results: The addition of OBD modestly changes OS estimates (see Table). Among a subset of patients with death dates in both CQLD and OBD, dates were highly correlated for breast (r = 0.98), lung (r = 0.93), ovarian (r = 0.99), and pancreatic (r = 0.88) cancers. When date differences existed, they were ≤10 days for &gt; 95% of the patients. These results suggest death dates are reliable in CLQD EMRs. OS curves were as expected, with OS decreasing by stage and age at diagnosis. Conclusions: Incorporating OBD modestly improves OS estimates and shows that when death data is present in CLQD, it is reliable. Future enhancements will focus on improving sensitivity of mortality ascertainment with external data linkages, without compromising specificity. [Table: see text]
免疫净化治疗在风湿性疾病中的应用
Authors: 叶华, 栗占国
Journal: BMJ (2006)

免疫净化治疗是通过去除血液中异常的免疫物质和炎症因子或有形成分,达到延缓自身免疫炎症病变进展的目的.许多风湿性疾病患者体内存在多种自身抗体和免疫复合物,目前已有大量临床研究表明,免疫净化治疗对部分风湿性疾病的治疗效果确切,不良反应少,其应用已日趋普遍.但是必须严格掌握其适应证,同时应注意与免疫抑制剂联合应用才能使患者的病情长期缓解.以下主要对这一技术在风湿性疾病中的应用进行概述。
Combination of multi-slice spiral CT with MRI in diagnosis of rare types of pancreatic tumors
Authors: Wenjing Cui
Journal: BMJ (2019)

With the progress of pathology and imaging the detection rate of rare pancreatic tumors has gradually increased. This article reviews the epidemiology, pathology, imaging features and differential diagnosis of rare pancreatic tumors.


Key words: 
Pancreatic neoplasms; Carcinoma, pancreatic ductal; Rare diseases; Diagnostic imaging; Diagnosis, differential