tbuckley/cabot-search huggingface dataset:
Bendamustine (B) + methylprednisolone (MP) and peg-filgastrim in indolent lymphoma.
Authors: Walter Quan, Meet Kadakia, Leah I Ramirez, Francine Marie Quan
Journal: Journal of Clinical Oncology (2020)

e20069 Background: Bendamustine is a cytotoxic agent with the alkylating properties of mechlorethamine and the purine antimetabolite properties of benzimidazole which was approved by the United States Food and Drug Administration in 2008 for the treatment of indolent non-Hodgkin’s lymphoma. When given for 6-8 cycles, neutropenia is a limiting toxicity. Despite the possible benefit of adding corticosteroids to Bendamustine, there is no published trial of MP + B in indolent lymphoma, particularly when B is limited to less than 6 cycles. Methods: In this retrospective study between 2008 and 2018, 20 pts: Follicular Lymphoma (9), Small Lymphocytic Leukemia (8), Marginal Zone (2) and Lymphoplasmacytic Lymphoma (1) were treated with B 100 mg/m2 and MP 125 mg IV on days 1 and 2 and peg-filgastrim 6 mg subcutaneously on day 3 every 28 days for 3-4 cycles. Results: Patient characteristics: 8 males/12 females, median age-57 (range: 41-88), stage III (2), stage IV (18), median ECOG status 1 (0-2). Prior therapy = none (11), rituximab (4), chemotherapy (3), steroid (2). Fifteen patients were treated with 3 cycles. Five received 4 cycles. Most common toxicities: nausea/emesis (13), arthralgia/myalgia (6), fatigue (6), fever (4) and reflux (4). No patients experienced febrile neutropenia. One patient was hospitalized with Mycoplasma Pneumonia. Responses were CR/CRu (9) and PR (11). Median duration of response is 23.4 months (range: 3.3-87.3). 6 patients have either experienced relapse or are lost to follow-up. 14 patients remain progression-free, with the longest at 53.25+ months. Median progression-free survival and overall survival have not been reached at 26+ months. Conclusions: B + MP has activity in indolent lymphomas and is well-tolerated.
Continuing professional development for general practitioners after residency training in Shanghai Weifang community health service center
Authors: Yaling Li, Zhaohui Du, Fang Zhang, Zhongying Meng, Shuwei Zhang, Juan Shou
Journal: BMJ (2017)

A continuing professional development program was implemented in Shanghai Weifang Community Health Center for general practitioners (GPs) who completed residency training. The program consisted of four aspects: clinical ability, scientific research ability, teaching ability, and management ability. Clinical ability-building included the re-practice of specialty skills, expert mentoring in clinics, continuing education courses and clinic skills competitions. The scientific research ability was built from participating in research projects and talent cultivation programs. GPs were encouraged to be clinical mentors, and teaching ability was developed through attending teacher-training class and teaching practice. For those who were interested in management, the administrative positions related to medical, teaching and research would be provided. The implementation of the program received strong policy support from the health administrations at various levels.


Key words: 
Community health services; General practitioner; Inservice training
Financial toxicity among breast cancer survivors with health insurance.
Authors: Wendy Landier, Chen Dai, Jessica Sparks, Katie Rose Anthony, Jeffrey S. Barrett, Lindsey Hageman, Liton Francisco, Gabrielle Betty Rocque, Erica Michelle Stringer-Reasor, Lisle Nabell, Smita Bhatia
Journal: Journal of Clinical Oncology (2020)

12073 Background: Cancer treatment and its sequelae have been associated with financial toxicity in breast cancer survivors, particularly those who have no health insurance. However, the prevalence of financial toxicity in the insured survivors, and the underlying factors are not well understood. Methods: Breast cancer survivors attending a survivorship clinic (University of Alabama at Birmingham) completed a survey assessing demographics, financial toxicity (i.e., material resources; food/housing/energy insecurity), and health-related quality of life (HRQL: SF-36). Clinical characteristics were abstracted from medical records. A multivariable logistic regression model was developed to understand factors associated with financial toxicity; the model included survivor age, race, socioeconomic status, insurance type, marital status, cancer stage, time since diagnosis, current medications, and physical and mental domains of HRQL. Results: The 368 participants (1% male; 67% white, 25% African American, 8% other) were a median of 61y of age (range, 33-86y) and 4.3y post-diagnosis (1-34y) at survey completion; 90% had stage 0-II disease; 34% were single (not currently married/partnered); type of health insurance included private/military (57%), Medicare (39%), and Medicaid/self-pay (4%). Overall, 31% reported financial toxicity; 26% endorsed not being able to live at current standard of living &gt; 2 mo. if they lost all current sources of income; 6% endorsed energy insecurity, 5% endorsed food insecurity, and 4% endorsed housing insecurity. In a multivariable model, financial toxicity was associated with age ≤60y at survey (Odds Ratio [OR] 5.1; 95% confidence interval [CI] 2.0-13.3); household income &lt; $50K/y (OR 5.3; 95%CI 2.5-11.2); being single (OR 2.6; 95%CI 1.3-5.4); and lower physical (OR 2.6; 95%CI 1.2-5.4) and mental (OR 2.2; 95%CI 1.2-4.3) HRQL. Cancer stage, race, time from diagnosis, and insurance type were not associated with financial toxicity. The prevalence of financial toxicity among survivors who were single, ≤60y at survey, and with household income &lt; $50k/y was 79.3%, compared with 6.7% among those who were older, married/partnered, and with higher income. Conclusions: Financial toxicity is prevalent among insured breast cancer survivors several years after cancer diagnosis, and is exacerbated among the younger survivors who are single, with low household income, and endorse poorer physical and mental quality of life. These findings inform the need to develop interventions to mitigate financial toxicity among at-risk breast cancer survivors.
Survey on continuing medical education needs for general practitioners in community
Authors: Qi Xu, Jie Gu, Kaijian Fan, Chunhong Tang, Pu Zhang, Wentao Zheng, Yin Lu
Journal: BMJ (2014)

One hundred and seventeen general practitioners from five community health service centers in Shanghai Pudong, Baoshan, Minhang, Jing'an and Luwan Districts were randomly selected for survey. The current situations, the intention and the related factors in GP continuing  were surveyed by using self-designed questionnaire. The survey showed that the rate of continuing  was 73.5%, which was lower than the requirements of the Ministry of Health. There were significant differences in motivation (for credit and promotion ), training needs ( doctor and patient communication or basic theory ), training mode ( on-line education or short term study ), and teaching methods ( classroom lecturing or PBL ) among GPs with different length of service (all P<0.05). The results indicate that to improve the quality of continuing medical  for GPs in community it is necessary to strengthen supervision, broaden the training channels to meet the different needs of general practitioners.


Key words: 
General practitioner; Education, continuing
Incidence of levodopa-induced dyskinesia in ederly patients with Parkinson's disease and related factors
Authors: Shuhua Li, Wen Su, Xiangyu Zeng, Haibo Chen
Journal: BMJ (2016)

One hundred patients with Parkinson's disease (PD) aged 60 and above treated with levodopa were enrolled in this cross section study. The general conditions, medication, unified Parkinson's disease rating scale (UPDRS) scores and the incidence of levodopa-induced dyskinesia (LID) were documented. The incidence rate of LID in this group of PD patients was 37.0% (37/100). The incidence was significantly higher in patients with levodopa treatment ≥4 years than that in patients with levodopa treatment <4 years(55% vs. 26%, χ2=8.770, P=0.003). The incidence rate ofpeak dosagedyskinesia in tremor-dominant PD patients was lower than that in rigidity-dominant PD patients(χ2=4.399, P=0.036). The incidence rate of LID was correlated with the duration of levodopa therapy. Amantadine may reduce the incidence ofoffdystonia.


Key words: 
Dyskinesia, drug-induced; Parkinson disease; Levodopa
Three versus one year of adjuvant imatinib for high-risk gastrointestinal stromal tumor (GIST): Survival analysis of a randomized trial after 10 years of follow-up.
Authors: Heikki Joensuu, Mikael Eriksson, Kirsten Sundby Hall, Annette Reichardt, Barbara Hermes, Jochen Schuette, Silke Cameron, Peter Hohenberger, Philipp Jost, Salah-Eddin Al-Batran, Lars H Lindner, Sebastian Bauer, Eva Wardelmann, Bengt E. Nilsson, Raija S. Kallio, Panu Jaakkola, Jouni Junnila, Thor Alvegard, Peter Reichardt
Journal: Journal of Clinical Oncology (2020)

11503 Background: Adjuvant imatinib improves recurrence-free survival (RFS) when administered after surgery to selected patients with operable gastrointestinal stromal tumor (GIST). It is uncertain whether overall survival (OS) improves, since imatinib improved OS in only one of the 3 large randomized trials conducted, and in this trial (the Scandinavian Sarcoma Group XVIII/German trial; SSGXVIII/AIO; NCT00116935) the statistical significance for OS remained borderline. The objective of the present analysis was to evaluate long-term OS of patients who participated in the SSGXVIII/AIO trial. Methods: SSGXVIII/AIO is an open-label, randomized (1:1), multicenter phase 3 trial. Four hundred patients who underwent macroscopically complete surgery for GIST with a high estimated risk for recurrence according to the modified National Institutes of Health Consensus Criteria were accrued between February 2004 and September 2008. Imatinib was scheduled to be administered 400 mg/day orally for either 12 months or 36 months after surgery. The patients were scheduled to be followed up for 10 years after study entry. Imaging of the abdomen was carried out periodically. The primary end point was RFS; the secondary objectives included OS and treatment safety. Results: The median follow-up time was 119 months. In the Intention-To-Treat Population 194 RFS events and 96 OS events were recorded. In the 36-month group, 5-year and 10-year RFS was 71.4% and 52.5%, and in the 12-month group, 53.0% and 41.8%, respectively (HR 0.66, 95% CI 0.49-0.87; P = .003). In the 36-month group, the 5-year and 10-year OS rates were 92.0% and 79.0%, and in the 12-month group, 85.5% and 65.3%, respectively (HR 0.55, 95% CI 0.37-0.83; P = .004). In the Efficacy Population, from which 15 patients who did not have GIST in central pathology review and 24 patients who had intra-abdominal metastases removed at surgery were excluded, 10-year OS was 81.6% in the 36-month group and 66.8% in the 12-month group (HR, 0.50, 95% CI 0.32-0.80; P = .003). No new safety signals were detected. Conclusions: About 50% of deaths can be avoided during the first decade of follow-up after surgery with 3-year imatinib treatment as compared to 1-year treatment. Clinical trial information: NCT00116935 .
Phase I study of BPM31510 and vitamin K in patients with high grade glioma recurrent after a bevacizumab-containing regimen.
Authors: Seema Nagpal, Reena Parada Thomas, Sophie Bertrand, Hari Priya Yerraballa, Michael Iv, Gordon Li, Alison Klotz, Michael A. Kiebish, Niven R. Narain, Rangaprasad Sarangarajan, Elder Granger, Lawrence David Recht
Journal: Journal of Clinical Oncology (2020)

2543 Background: BPM31510 is an ubidecarenone-lipid conjugate nanodispersion in clinical development for advanced malignancies, including high grade glioma (HGG). BPM31510’s anti-cancer effect is mediated by induction of mitochondrial superoxide and activation of cell death in glioblastoma models. Herein, we present preliminary pharmaco-kinetic and dynamic data, and survival from a phase I study of BPM31510 + Vitamin K in HGG with progression after bevacizumab (BEV). Methods: This was an open-label phase I study of BPM31510 continuous infusion with Vitamin K (10mg IM qweek) using a mTPI design, starting at 110mg/kg 2X/week, allowing 2 dose escalations &amp; 1 de-escalation. Patients had received ChemoRT and were in recurrence after BEV. Results: Of 12 patients treated with BPM31510, 9 completed the 28-day DLT period. 2 patients came off study for progressive disease; 1 patient after asymptomatic hemorrhage into tumor bed (G1). 10 patients had primary GB, 2 had AA. Median age was 54.5yo (27-67) and KPS 70 (60-90). On Day 1 of BPM31510, a dose dependent increase in Cmax was observed; Tmax values were similar for all doses. AUC was linear with dose escalation. For all doses, Day 4 Cmax values were higher compared to Day 1. In contrast there was variable decrease in Tmax (table). Of evaluable patients, 4 patients received the highest dose 171mg/kg, where a single patient experienced DLT: G3 AST &amp; ALT. The most common grade 1/2 AEs were elevated AST, rash, and fatigue, each occurring in 4 patients. The mOS for 9 eligible/evaluable patients was 128 days (95% CI: 48-209) while PFS was 34 days (95% CI of mean 8.9). Two patients are currently alive &gt;12 months. Conclusions: BPM31510 + vitamin K demonstrated a safe profile to maximum dose of 171mg/kg twice/week with potential therapeutic utility in treatment-refractory HGG patients. Multi-omic molecular profiles characterizing AE and response to be reported from the study will be investigated for next phase of clinical development. Clinical trial information: NCT03020602 . [Table: see text]
Primary Care–Based Interventions to Prevent Illicit Drug Use in Children, Adolescents, and Young Adults
Authors: Alex H. Krist, Karina W. Davidson, Carol M. Mangione, Michael J. Barry, Michael Cabana, Aaron B. Caughey, Katrina Donahue, Chyke A. Doubeni, John W. Epling, Martha Kubik, Gbenga Ogedegbe, Lori Pbert, Michael Silverstein, Melissa A. Simon, Chien-Wen Tseng, John B. Wong
Journal: JAMA (2020)

<h3>Importance</h3> In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. <h3>Objective</h3> To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults. <h3>Population</h3> This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. <h3>Evidence Assessment</h3> Because of limited and inadequate evidence, the USPSTF concludes that the benefits and harms of primary care–based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed. <h3>Recommendation</h3> The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. (I statement)
Abstract 19924: AnxV- Endothelial Microparticles Are Significantly Increased in Active Takayasu Arteritis Patients
Authors: Xuesen Cheng
Journal: Circulation (2017)

Background: Takayasu Arteritis (TA) is a chronic inflammation involving the aorta and its main branches, often leading to a combination of dilatation and secondary thrombus formation. However, the ...
Diagnostic values of three inflammatory markers in causes of fever after neurosurgical procedures
Authors: Jiadong Qian, Deming Xu
Journal: BMJ (2015)

A prospective study was conducted for 91 cases of fever patients after neurosurgical procedures during the period of January-December 2013. They were divided into non-infection (n=42) and infection (n=49) groups according to whether there was infection complication. And another 51 non-surgical hospitalized patients without fever or infection were selected as control group. The levels of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) were detected respectively. Statistical analysis showed that the level of PCT had no significant difference between non-infection and control groups (P>0.05). However, it was markedly elevated in infection group than non-infection group (P<0.01). The level of CRP was significantly different between non-infection and control groups (P<0.01). And it was the same between infection and non-infection groups. The level of WBC had significant difference between non-infection and control groups (P<0.05) and infection and non-infection groups (P<0.01). The receiver operating characteristic (ROC) curve showed that either sensitivity or specificity of PCT was the highest. Compared with CRP and WBC, PCT may identify more accurately the causes of fever after neurosurgical procedures.


Key words: 
Procalcitonin; Fever
A randomized phase II study of oxaliplatin/5-FU (mFOLFOX) versus irinotecan/5-FU (mFOLFIRI) chemotherapy in locally advanced or metastatic biliary tract cancer refractory to first-line gemcitabine/cisplatin chemotherapy.
Authors: Jin Won Kim, Koung Jin Suh, Ji-Won Kim, Jin Hyun Park, Ki Hwan Kim, Yu Jung Kim, Jin-Soo Kim, Jee Hyun Kim, In Sil Choi
Journal: Journal of Clinical Oncology (2020)

4603 Background: In locally advanced or metastatic biliary tract cancer (BTC), second-line chemotherapy is challenging after progression from first-line gemcitabine/cisplatin, although mFOLFOX has been proven to be superior to active symptom control in ABC-06 trial. Irinotecan is an active drug in other gastrointestinal cancers. This study evaluated whether mFOLFIRI was superior to mFOLFOX in second-line treatment of BTC. Methods: Patients diagnosed with BTC with disease progression after prior gemcitabine/cisplatin were randomized (1:1) to either mFOLFOX (oxaliplatin 100mg/m2 over 2 hours, leucovorin 100mg/m2 over 2 hours, 5-fluorouracil 2400mg/m2 over 46 hours, every 2 weeks) or mFOLFIRI (irinotecan 150mg/m2 over 2 hours, leucovorin 100mg/m2 over 2 hours, 5-fluorouracil 2400mg/m2 over 46 hours). Randomization was stratified by tumor location (intrahepatic vs extrahepatic vs gallbladder vs ampulla of vater) and ECOG performance status (0, 1 vs 2). Primary end-point was overall survival (OS) rate at 6 months. Results: In total, 120 patients were enrolled and 114 patients were treated (mFOLFOX:57, mFOLFIRI:57). Median age was 63 years old. Most patients had ECOG 0/1 (89.5%). Tumor location was intrahepatic in 47 patients (41.2%), extrahepatic in 27 (23.7%), gallbladder in 35 (30.7%) and ampulla of vater in 5 (4.4%). At the median follow-up duration of 10.7 months (95% CI, 8.2-13.2), 6-month OS rate was 58.1% in mFOLFOX and 46.0% in mFOLFIRI. Of 102 evaluable patients (mFOLFOX:51, mFOFIRI:51), objective response rate and disease control rate were 5.9% (95% CI, 0-12.4) and 64.7% (95% CI, 51.6-77.8) in mFOLFOX and 3.9% (95% CI, 0-9.2) and 58.8% (95% CI, 45.3-72.3) in mFOLFIRI. Median progression-free survival was 2.8 months (95% CI, 2.3-3.3) in mFOLFOX and 2.1 months (95% CI, 1.3-2.9) in mFOLFIRI (p = 0.682). Median OS was 6.6 months (95% CI, 5.6-7.6) in mFOLFOX and 5.9 months (95% CI, 4.3-7.5) in mFOLFIRI (p = 0.887). The most common grade 3/4 adverse events were neutropenia (26.3%) and AST/ALT elevation (15.8%) in mFOLFOX and neutropenia (24.6%) and anemia (17.5%) in mFOLFIRI. Peripheral neuropathy (36.8%) and thrombocytopenia (35.1%) in mFOLFOX and vomiting (19.3%) and cholangitis (10.5%) in mFOLFIRI occurred more frequently. No chemotherapy-related deaths were reported. Conclusions: In second-line treatment of BTC, mFOLFIRI was tolerable But, mFOLFIRI was not superior to mFOLFOX. Adverse events were different between two groups. Clinical trial information: NCT03464968 .
关节镜治疗膝关节色素沉着绒毛结节性滑膜炎的疗效分析
Authors: 刘宇, 王静成, 施晓明, 王骅, 顾加祥, 冯新民, 颜连启, 费文勇
Journal: BMJ (2011)

膝关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)临床不是很多见,治疗比较困难,传统的开放手术难以完全切除滑膜、易复发,术后容易引起膝关节的功能障碍.2007年1月至2008年12月我科收治膝关节PVNS患者12例,均采用关节镜下滑膜切除术,8例弥漫性病变者术后4周左右辅以放疗和化疗,取得良好疗效。
Exploring the Cancer Genome Atlas (TCGA) for the molecular profile of young onset colorectal cancers.
Authors: Seyed Ali Khalessi Hosseini, Christy Morrissey, Takahiro Nakamura, Daniel Jacob Becker
Journal: Journal of Clinical Oncology (2020)

3548 Background: Colorectal cancer (CRC) incidence and mortality has been declining, in part due to increased implementation of screening, but the incidence among patients under 50 (young onset, YO) is increasing at a rate of 2% per year. The cause of this increasing incidence remains poorly understood, but differences in mutation profiles can help understand pathogenesis, prognosis, and identify targets for therapy. Methods: Genomic and clinical data for 488 TCGA CRC patients was used to evaluate differences in genetic alterations between YO and patients over 50. Chi-squared tests were used to determine differences in somatic mutation frequency in critical pathways implicated in CRC: DNA MMR, P53, WNT, RAS-MAPK, PI3K/AKT/mTOR, and TGF-B pathways. For 85 of the patients, proteomic data via RPPA was also available and analyzed. Results: The average age of included patients was 66 (SD 12.8). 76 (12.2%) were under 50 at time of diagnosis. When comparing YO with those over 50, there were no differences in microsatellite instability, histologic type (adeno or mucinous), location (colon or rectal), tumor size, or metastasis. YO patients were more likely to have nodal involvement (p = 0.007) and higher histological grade (p = 0.022). YO patients were more likely to have mutations in the MMR pathway (43% vs 23%, p = 0.002) and the PI3K/AKT/mTOR pathway (70% vs 54%, p = 0.024). Specifically, YO were more likely to have mutations in MSH2 (7% vs 1%, p = 0.001), MSH6 (24% vs 7%, p = 0.000); ATM (46% vs 30%, p = 0.015); FZD10 (7% vs 2%, p = 0.007); ERBB2 (15% vs 7%, p = 0.027); PIK3R1 (20% vs 9%, p = 0.014), PTEN (61% vs 35%, p = 0.000), and TGFBR2 (13% vs 4%, p = 0.004). When looking at proteomic data, YO were more likely to have decreased expression of MSH2 (p = 0.003) and MSH6 (p = 0.005). Conclusions: Patients with YO CRC are more likely to have somatic mutations in genes involved in the MMR pathway and the PI3K/AKT/mTOR pathway. Specifically, in MSH2, MSH6, ATM, FZD10, ERBB2, PIK3R1, PTEN and TGFBR2. When including proteomic data, significant differences were only seen in expression of MSH2/6. Some of these genes (e.g. ERBB2/HER2) are targets for existing therapies, and others are being actively investigated as potential therapeutic targets. Establishing differences in tumor genetic profiles is a first step towards understanding the increase in YO CRC, and simultaneously identifies targets for therapy. However, because of post-transcriptional changes (e.g. RNAi, methylation), genetic profiling alone cannot always reliably establish differences in protein expression, and thus therapy targets.