tbuckley/cabot-search huggingface dataset:
Apatinib for patients (pts) with advanced soft tissue sarcoma (STS) after chemotherapy: A prospective, open-label, single-arm, multicentered study.
Authors: Haiyan Hu, Yang Yao, Zhengfu Fan, Hongmei Zhang, Jing Chen, Xing Zhang, Yong Chen, Guofan Qu, Gang Huang, Yuhong Zhou, Wenxi Yu, Xiaowen Wang, Rongyuan Zhuang
Journal: Journal of Clinical Oncology (2020)

11553 Background: The development of STS therapeutics has been challenging, especially patients who failed chemotherapy. Anti-angiogenesis inhibitors had shown activity in STS, Apatinib is a TKI targeting on VEGFR-2 which has shown activity in many solid tumors. Methods: A Phase II, open-label, Single-arm, multicentered study was conducted in previously treated pts with advanced STS in China. The patients received apatinib 500mg orally qd in a 28-day-cycle, until disease progression or unacceptable adverse events. Antitumor response assessment was performed every 8 weeks per RECIST V1.1. The primary endpoint was PFS rate in 6 months and secondary endpoint was ORR and OS. Results: As cut-off on Jan 20th 2019, a total of 53 patients were enrolled in 9 centers, 51 patients received at least 2 cycles of Apatinib, 1 patient is still in treatment. The main histological subtypes were alveolar soft part sarcoma(n = 11), synovial sarcoma(n = 6), leiomyosarcoma (n = 6), clear cell sarcoma(n = 6) and undifferentiated pleomorphic sarcoma(n = 5). Overall, 27 of 51 patients were progression free at six months and the 6-m PFS rate was 53.32% (95%CI 37.76%, 66.63%). Until final follow-up, the ORR was 18.75% (9/48) and DCR was 87.5% (42/48). Additionally, median PFS was 7.13 (95%CI 3.84, 9.23) months and median OS has reached up to 24.67 (9.30-NE) months. Adverse events (AEs) were detected among all pts, hypertension and proteinuria are the most common AEs, occurred in 84.91% and 73.57% pts respectively. Grade 3/4 related adverse events were detected in 86.79% of pts, Grade 3/4 hypertension was the most common grade3/4 AE (56.60%). Conclusions: Overall, the present study demonstrates that apatinib has a clinically meaningful anti-tumor activity in pretreated STS pts, showing durable responses and prolonged overall survival. Some of the pts had a long-time benefit from the treatment. Apatinib was safe and generally well tolerated. Further studies on specific STS subtypes would be meaningful. Clinical trial information: NCT03064243 .
Association ofnon-alcoholic fatty liver with plasma homocysteine and the methylenetetrahydrofolatereductase gene polymorphism in patients of type 2 diabetes mellitus in Shanxi, China
Authors: Ling Hu, Qiao-hui Zhang, Fang Miao, Jie Qin, fie Liu
Journal: BMJ (2009)

：To investigate therelationship between plasma level of homocysteine(Hcy) and the methylenetetrahydrofolatereductase ( MTHFR ) gene polyroorphism with non-alcoholic fatty liver in patients withtype 2 diabetes mellitus (T2DM). Methods In a case-control study, plasma levels of Hcy,folic acid (FA), vitamin B12 (VitB12), glycosylated hemoglobin Alc (HbAlc), fasting bloodglucose (FBG), total cholesterol and triglyceride were measured in 159 T2DM patients withand without non-alcoholic fatty liver ( NAFL), as well as 52 normal controls. Mutation ofthe C677T of MTHFR gene was determined by polymerase chain reaction-restricted fragmentlength polymorphism (PCR-RFLP) for all of them. Results Patients of T2DM both without NAFL(96 case) and with NAFL had higher prevalence of hyperhomocysteinemia (Hhcy) (49% and 21%,respectively ) than normal controls did (4 cases, 8% ) (P<0.05), while patients of T2DMwith NAFL had higher prevalence of Hhcy than those without it did (P <0. 05). Plasmalevel of Hey positively correlated to genotype frequency of the MTHFR gene, plasma 0levelsof HbAlc and FBG in patients of T2DM, with coefficients of correlation of 0.248, 0.423 and0.242, respectively (P < 0.05). Results of multiple logistic regression analysis showedthat course of the disease, body mass index, plasma levels of FBG and Hcy all wereindependent risk factors for non-alcoholic fatty liver in patients with T2DM. ConclusionsHhey was an independent risk for non-alcoholic fatty liver and plasma level of Hey wasinfluenced by frequency of the TT genotype of the MTHFR gene, plasma levels of FA andVitB12, as well as metabolic disturbance in patients with T2DM.
Quantifying the additional prognostic value of sentinel lymph node status over established clinicopathologic primary tumor features for predicting survival outcomes in melanoma patients.
Authors: Serigne Lo, Mary-Ann El Sharouni, Karijn Suijkerbuijk, Tasnia Ahmed, Witkamp Arjen, Anne E. Cust, Vigfús Sigurdsson, Paul J. van Diest, Richard A. Scolyer, Carla Van Gils, John F. Thompson
Journal: Journal of Clinical Oncology (2020)

e22105 Background: Sentinel node (SN) staging not only provides important prognostic information for patients with primary cutaneous melanoma but it also assists in assessing eligibility for adjuvant systemic therapy and clinical trials. This study aimed to quantify the incremental value of SN status over established clinicopathologic prognostic factors in predicting survival outcomes. Methods: The training cohort (n = 9272) consisted of all Dutch melanoma patients who underwent SN biopsy (SNB) between 2004 and 2014. Melanoma patients having SNB during the same period were identified from the Melanoma Institute Australia (MIA) database as the validation cohort (n = 5644). Outcomes investigated included overall survival (OS), disease-free survival (DFS) and melanoma-specific survival (MSS, available for the MIA cohort only). Multivariable Cox proportional hazards analyses were performed with and without SN status and compared for each of the outcomes. The effect of adding SN status on the predictive performance of the models was quantified through discrimination index (Harrell’s C-statistic), calibration (plots) and reclassification (Net Reclassification Index (NRI)) at fixed follow-up time points. Results: In the Dutch cohort adding SN status to a model with Breslow thickness, ulceration, mitotic rate, age, gender, melanoma subtype, anatomic site and regression, improved the C-statistic from 0.72 (95% CI 0.70-0.73) to 0.76 (95% CI 0.75-0.77) for DFS and from 0.75 (95% CI 0.73-0.76) to 0.78 (95% CI 0.77-0.79) for OS. These findings were confirmed in the validation cohort, with the C-statistic increasing from 0.69 (95% CI 0.66-0.72) to 0.73 (95% CI 0.70-0.76) for DFS, 0.69 (95% CI 0.66-0.73) to 0.73 (95% CI 0.70-0.76) for OS and 0.71 (95% CI 0.69-0.73) to 0.76 (95% CI 0.74-0.78) for MSS. When setting 10% as the cut-off risk in NRI analysis, 54 Dutch and 26 MIA patients who experienced disease progression within the first 3 years after melanoma diagnosis, but were classified as low-risk patients, would have been reclassified as high-risk with addition of SN status. At the same time, 209 Dutch and 230 MIA patients who were disease-free within the first 3 years, but classified as high-risk would have been reclassified as low-risk with addition of SN status. Conclusions: Adding SN status significantly improved the predictive accuracy for OS, DFS and MSS models in melanoma patients.
Zhichuan decoction with glucocorticoid in treatment of bronchial asthma
Authors: Qing Wang
Journal: BMJ (2008)

Three hundred and ninety five patients with bronchial asthma were randomly divided into 4 groups:patients in group A received inhaled beclomethasone dipropionate(BDP)100μg and Zhichuan decoction;patients in group B were given inhaled BDP 200μg;patients in group C took Zhichuan decoction only;patients in group D were given inhaled BDP 100 μg.Methacholine airway reactivity,pulmonary ventilation function,serum acidophilia cationic protein and symptom score were determined before and after treatment.All above indicators were significantly improved in groups A and B,which suggests that Zhichuan decoction could reduce hormone dosage in control of airway chronic inflammation,reduction of airway reactivity and improvement of pulmonary ventilation function of patients with bronchial asthma.

Key words: 
Anti-asthmatic agents; Plants,medicinal
Therapy monitoring of combined detection of ProGRP and neuron-specific enolase in small cell lung cancer patients
Authors: Xiao-min Li, Ya-juan Wu, Qi Li, Wen-hua Cheng
Journal: BMJ (2013)

Before and after treatment as well as before metastasis, the combined detection of pro-gastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) was performed in 150 patients with small cell lung cancer. The follow-up period was 1 year. Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay were conducted. The result showed a negative correlation between the serum levels of ProGRP and NSE the curative effect. And a positive correlation existed between the serum levels of ProGRP and NSE and disease development. The difference had statistical significance (P<0.05). The levels of ProGRP and NSE may be used to indicate the disease development and evaluate the curative effect.


Key words: 
Carcinoma, small cell; Treatment outcome
2型糖尿病危险因素的病例对照研究
Authors: 马士学, 黄孝全
Journal: BMJ (2006)

应用1:1配对的病例对照研究方法,对首次确诊的2型糖尿病患者216例进行多因素条件logistic回归分析.结果有高脂血症、高血压、糖尿病家族史、脂肪摄入多、体重指数大和腰臀比大6个变量进入主效应模型,其OR值分别为3.64、1.67、4.27、1.63、2.04和3.24。
“Smoke and screens”: How streaming spreads the habit of smoking.
Authors: Maximiliano Brandon, Ilene Ramirez, Mariana Abal, Carlos Garcia Gerardi, Flavio Tognelli, Dario Niewiadomski, Alba Marin Ordoñez, Ernesto Gil Deza, Lourdes Gil Deza, Natasha Gercovich, Edgardo G. J. Rivarola, Eduardo L. Morgenfeld, Felipe G. Gercovich
Journal: Journal of Clinical Oncology (2020)

e13563 Background: In Argentina, half of the media content reaches viewers through streaming platforms. This papers studies the frequency of smoking in fifty of the most watched programs on Netflix Argentina, and the average exposure to this habit in one hour of viewing. Methods: Between October 1, 2019, and January 10, 2020, we observed fifty of the most watched series on Netflix Argentina, set in the twentieth century or afterwards. The programs were grouped by Netflix Maturity Rating to analyze the frequency of smoking in shows available to different age groups. We established if smoking was present in the show and randomly selected one episode of each to time the amount of smoking. All times were standardized to 60 minutes to compare episodes of different duration. Results: Table shows the frequency of smoking in each of the Netflix Maturity Rating categories. The average exposure time to smoking is 2.5 minutes (r = 0-8 min) every 60 minutes. Conclusions: 1) Viewers are exposed to smoking in 64% of the most watched series on Netflix Argentina, for an equivalent of time to at least three tobacco advertisements per hour. 2) Smoking takes place in 50% to 73% of the series available to teenage viewers (rated 13+ or 16+). 3) Netflix has publicly committed to eradicate smoking from its series. We must ensure this commitment is fulfilled and extended to other streaming platforms and production companies. [Table: see text]
Survival and prognostic tests in a real-world phase II experience with a safe, moderate-dose, sequential chemotherapy (CT) algorithm (ALGO) for metastatic pancreatic adenocarcinoma (PANC).
Authors: Robert L. De Jager, Howard Bruckner, Fred Bassali, Azriel Hirschfeld, Daniel Gurell, Van Nghiem, Shoshana Distenfeld, Noah Weinberger, AJ Book
Journal: Journal of Clinical Oncology (2020)

e16763 Background: Gemcitabine (G), 5-fluorouracil (F), leucovorin (L), irinotecan (I), and oxaliplatin (O), (GFLIO) is safe, employs moderate 1/2-1/3 dosages, offers expanded eligibility (0-2 ECOG PS; no age limit)). Each step reverse resistance (RR) to CT; drug synergism 4-6 simultaneous pairs) improve responses (Rs) and survival (S) (Bruckner ASCO 05, 08, 11, AntiCancer Res 2016; 36 (1), 2018; 38 (1) (ACR), and the immune system (Correale P: J. Immunother 2014; 37). M Caraglia: Front Oncol. 2019). Methods: Eligibility: intent to treat active metastatic PANC, no prior CT: any age: PS 0-2 and expected &gt; 6 weeks S. IRB required safety &lt; 1/10 severe events. ALGO in mg/m 2 : G 500, F 12-1500 over 24 hrs, L 180, I 80, day2 O (GFLIO) q2 wks, and on progression added in sequence, day 2, docetaxel 20-25 and good counts only mitomycin C 3-6 then bevacizumab 10mg/kg with prior monitoring and modifications (ACR). Median 12, 18, 24 mos Overall Survival (OS), Kaplan Meier estimates with 95% CI were evaluated with age, sex and normal nl and abnl baseline bloods: neutrophils N ANC; Lymphs Ly ALC; platelets; albumin (ALB); Alkaline phosphatase (Alk Ph) abn N alb 3.5 N/L; 2.1 L/monocyte ratios and the A.L.A.N (AS) composite prognostic score (M. Salati E.J.Ca. 2019; 117: 84-90). Results: OS @ 6, 12, 18 &amp; 24 mos, for 53 pts, was 75; 57; 36; 26 % (+/- 8-10%). Median M S was 14.5 mo (CI 9-17mos); S @ all ages ≥ 60, 65 or 70, was not inferior. Women's M S 17 mo. was &gt; men's 10.5: 95/65; 75/46; 48/29; 42/29%. AS for abnl tests was: 0 (18pts): 93: 81: 48; 34% &amp; MS 17 mo vs 1-2 (23)90: 58;42;32% &amp; MS 15.5mo vs 3-4 (12)MS 3 mo. Pts with best 17-14.5 mo MS had nl AS 0 &gt; Alb &gt; AS 1-2 &gt; APh &gt; ANC. Pts with worst 3-6 mo MS had abnl: AS 3-4 &lt; Alb &lt; ANC. No pt had severe infection, neuropathy or gastroenteritis. Pts -/+ 75-100gm ascorbic acid, 25, did not have inferior S in ALAN subsets (H.Bruckner AACR 17). Conclusions: The sequential moderate dose CT ALGO improves eligbility and provides pts with metastatic PANC of any age a well tolerated CT regimen with a high therapeutic index and strong, 12, 18, 24 mo, survival. Prognostic tests can identify subgroups ≥ 75% with favorable vs. unfavorable criteria and improve personalized choices and measures to remedy individual risk factors. Clinical trial information: NCT01905150 .
内镜下取出刺入胃壁的缝衣针二例
Authors: 宋建平
Journal: BMJ (2004)

例1 男,22岁,因吞服缝衣针1根6 h,上腹部轻度疼痛不适于2001年12月20日入院.腹部X线透视:胃幽门管见一针影.胃镜检查:缝衣针前约2/3已刺入胃幽门管壁内,后约1/3留在胃幽门管腔内,且随着胃的蠕动而活动,周围胃黏膜未见异常.用活检钳先从针尾有孔处夹取数次未成功,后改为从针干处一次夹取成功,固定活检钳位置,连同镜身一起向胃腔内牵拉,针前部即从胃幽门管壁内抽出,针眼处有少量流血.镜身前端退至胃窦部,松开活检钳,暂置缝衣针于胃窦壁平坦处,再仔细夹取针尾有孔处3次即告成功,然后缓慢将活检钳连同已夹住的缝衣针退入活检通道内,估计针尖入孔约1～2 cm停退.再次固定活检钳位置,在持续直视下缓慢将镜身退出口腔后,从活检孔道内推出夹住缝衣针的活检钳,松钳取针,经测量该缝衣针长为3.5 cm。
社区躯体慢性病与相关精神障碍
Authors: 侯也之
Journal: BMJ (2009)

慢性非传染性疾病(简称慢病)是一类病程超过3个月的非传染性疾病,与职业和环境因素、不良行为和生活方式密切相关,这类疾病主要有心血管疾病、肿瘤、糖尿病、精神病、慢性阻塞性肺疾病等.由于其对健康损害和社会危害严重等特点,成为全球的一个重要公共卫生问题.对此类疾病的研究发现,患病的危险因素和生活方式以及社会心理因素有一定的关系,所以防治上要用生物-心理-社会模式来进行预防和干预.目前认为,对此类疾病进行社区防治是一种科学、高效的措施。
BMX-HGG: Phase II trial of newly diagnosed high-grade glioma treated with concurrent radiation therapy, temozolomide, and BMX-001.
Authors: Katherine B. Peters, Adam Louis Cohen, Nicholas A. Butowski, John L. Villano, Pierre Giglio, Tresa McGranahan, Chi Zhang, Timothy Francis Cloughesy, James Emmett Herndon, Patrick Healy, David MacLeod, Sara Penchev, David Silberstein, Ines Batinic-Haberle, Ivan Spasojevic, Shayne Gad, David Radoff, Daniel Barboriak, James Crapo
Journal: Journal of Clinical Oncology (2020)

TPS2577 Background: Patients diagnosed with malignant high-grade gliomas (WHO grade III-IV) experience significant morbidity and mortality associated with these cancers. While the mainstay of therapy for patients with newly diagnosed high-grade glioma is surgery followed by concurrent chemotherapy and radiation therapy (RT), the outcomes remain very poor. BMX-001 (MnTnBuOE-2-PyP 5+ ) is a metalloporphyrin with differential action in response to radiation therapy and chemotherapy-induced oxidative stress. Early preclinical studies demonstrated BMX-001’s ability to act as a radioprotectant to healthy tissue such as a central nervous white matter and as a radiosensitizer to cancer cells, in particular, human glioblastoma xenografts. We evaluated the safety of BMX-001 in combination with concurrent RT and temozolomide (TMZ) in a phase I study of newly diagnosed high-grade glioma patients, and we found that BMX-001 is safe and well-tolerated in this population. The maximum tolerated dose of BMX-001 during concurrent RT and TMZ was determined to be 28 mg delivered subcutaneously (SC) followed by 16 biweekly SC doses at 14 mg (Peters et al., Neuro-Oncology 2018). Methods: For this multi-site, open-label, phase II study (NCT02655601), we will randomize approximately 160 patients 1:1 to concurrent RT and TMZ with BMX-001 versus concurrent RT and TMZ alone. Key eligibility criteria include newly diagnosed histologically confirmed high-grade glioma (WHO III-IV), 18 ≥ years, and Karnofsky performance status ≥ 70%. The primary endpoint is overall survival. Secondary endpoints include cognitive performance as assessed by standardized cognitive testing, bone marrow protection, safety and tolerability, progression-free survival, overall tumor response rate, and plasma pharmacokinetics. Exploratory endpoints are health-related quality of life (as assessed by Functional Assessment of Cancer Therapy–Brain, Functional Assessment of Cancer Therapy-Cognition, and Functional Assessment of Chronic Illness Therapy-Fatigue), qualitative hair loss, and white matter integrity (as measured by MRI diffusion tensor/susceptibility imaging). Since November 2018, this phase II study has enrolled 64 of 160 high-grade glioma patients at six sites with future sites planned to be implemented. Clinical trial information: NCT02655601 .
Real-world testing compliance to NCCN guideline and factors of underutilization in U.S. community clinics.
Authors: Eric Bernicker, Yan Xiao, Anup Abraham, Stella Redpath, Julia Engstrom-Melnyk, Denise Croix, Baiyu Yang, Roma Shah, Jaya Madala, Timothy Allen
Journal: Journal of Clinical Oncology (2020)

e21592 Background: Over the last 10 years, guideline recommendations for testing advanced non-small cell lung carcinomas (aNSCLC) have rapidly evolved with the identification of driver mutations and associated therapies. A retrospective study of the testing rates for ALK was initiated to understand real world adherence to guidelines. Methods: A retrospective study of the testing rates (negative category = not tested/unknown testing status) for ALK utilizing the nationwide Flatiron Health electronic record-derived de-identified database was initiated. Patients diagnosed with NSCLC (Stage IIIB-IV) were initially included (41,728 patients from Jan 2012 to May 2019) to describe the trend of ALK testing in community setting. An increase in ALK testing was seen from 59.5% to 84.1% of NCCN guideline eligible patients from 2012-2019. There was also an increase in the number of ineligible patients (smokers with squamous histology) tested (15.6% in 2012 to 50.8% in 2019). This 2012-2019 patient population was then limited to diagnosis from Jan 2015 to May 2019 to assess factors related to test utilization. In 26,617 aNSCLC patients, 75% were ALK testing eligible (by NCCN guidelines) with one quarter ineligible. Multivariable logistic regression analysis was used to assess clinical and demographic factors for impact on testing rates. Results: Both histology type and smoking status played an important role impacting ALK testing rate. Compared to non-squamous non-smokers (9.3% ALK-positive, 87.9% testing rate), non-smokers with squamous cell histology had a relatively high rate of ALK mutation (3.3%) but a low testing rate (55.03%) (Odds ratio (OR) 7.6, 95% CI 5.6-10.4). Other histology type and smoking status also had lower testing rate, including non-smoker with NSCLC non-specific type (OR 1.8, 95% CI 1.1-3.2), and smoker with non-squamous type (OR 1.5, 95% CI 1.3-1.7). Additional factors related to underutilization were patients with poorer ECOG scores and earlier stage at diagnosis. Demographic characteristics that also played a role in underutilization were older age ( &gt; 50 yrs), non-commercial insurance, male, and patients diagnosed before 2017. Conclusions: This analysis of real world data shows that test utilization has increased but there remains room for improvement. While testing ineligible patients is an inefficient use of resources (smokers with squamous histology), smokers with a small biopsy should be tested as they might be harboring an actionable driver mutation. Eligible patients still remain untested and potentially missing therapeutic options.
How much is too much? Multidisciplinary management of elderly early-stage breast cancer (BC) patients.
Authors: Elizabeth R. Berger, Srinivasa Sevilimedu Veeravalli, Monica Morrow, Alexandra S. Heerdt
Journal: Journal of Clinical Oncology (2020)

e12525 Background: Optimal approach to early-stage breast cancer (BC) management in women ≥70y is unclear. Studies have demonstrated improved local control but no survival advantage with use of radiation therapy (RT) after breast-conservation therapy (BCT). The impact on survival of other management decisions, including breast procedure, axillary staging (AS), systemic treatment, and patient comorbidities is unknown. We evaluate the effect of each treatment decision on overall survival (OS), disease-free survival (DFS), and breast-cancer specific survival (BCSS). Methods: Patients age ≥70y with cT1N0/ER+/HER2- tumors undergoing surgery from 2011-2013 were identified from a prospectively maintained, single-institution database. Clinicopathologic features were evaluated. 10-year estimated mortality from comorbidity was calculated using a Suemoto index (SI). Univariate and multivariable associations were assessed using Cox modeling. Kaplan-Meier method was used to estimate OS and DFS. Results: 338 patients were identified: 312 (92%) underwent BCT; 26 (8%) had mastectomy. Median age was 75.5y (70-101); median tumor size was 1.0cm (0.1-1.9); median SI was 42.5(22-99). With a median follow-up of 60 mos, 25 patients died—1 from BC, for an OS rate of 92.8% and BCSS of 99.7%. 9 patients developed a locoregional recurrence and 1 developed distant recurrence, representing a 5-year DFS rate of 97.8%. There were no differences in DFS by age groups (≤75, 76-80, &gt; 80; p = 0.1). On univariate analysis, DFS did not vary by age, breast procedure, or receipt of chemotherapy. It was improved in those who had AS and a lower SI (p &lt; 0.01). OS was better in those patients who had AS, had recurrence score performed and had radiation therapy, reflecting lower SI. On multivariable analysis, lack of AS (HR 10.5, p &lt; 0.01) and higher SI (HR 1.03, p &lt; 0.01) were the only variables associated with worse OS. Lack of AS became non-significant in those &gt; 80y. No treatment decision led to improved BCSS. When comparing patients with local or systemic recurrence vs those without recurrence, there was no difference in OS (p = 0.4) or BCSS (p = NS). Conclusions: Decisions in early-stage BC in the elderly are complex due to competing morbidities. While DFS and OS may vary based on treatment variables, no specific care component affected BCSS. Treatment discussions in elderly BC patients should emphasize the risks/benefits of each care component, taking into consideration the patient’s comorbidities and allowing for the patient’s understanding of outcomes and quality of life.