tbuckley/cabot-search huggingface dataset:
Short and intermediate-term results of transcatheter intervention therapy for congenital heart diseases
Authors: Bi-rong Zhou, Tai-ping Wang, Yan Xu, Xue-gong Shi
Journal: BMJ (2009)

Objective To evaluate the efficacy and safety of transcatheter intervention therapy in patients with congenital heart diseases(CHD). Methods Two hundred and six patients with congenital heart diseases were enrolled in the study, including 56 cases of patent ductus arteriosus (PDA), 51 cases of atrial septal defect (ASD) , 79 cases of ventricular septal defect (VSD) and 20 cases of pulmonary stenosis. The patients were treated with occluder devices through the percutaneous procedure under fluoroscopy angiography and transthoracic echocardiography. All patients were followed up for 3 months after the closure. Results The procedure-related mortality rate was 0. The technical successful rate was 98. 1% (202/206), transthoracic echocardiography and X-Ray examination showed no residual shunts in all the cases 1 -3 month later. Arrhythmia occurred in 17 cases and in 2 cases occurred small hematoma at puncture place after operation. Conclusion Interventional therapy of congenital heart disease is a reliable treatment with simple operation, high successful rate, high safety, less invasiveness and low complication rate.

Key words: 
Congenital heart disease;  Interventional therapy;  Clinic assessment
Trends in ALK inhibitors for non-small cell lung cancer.
Authors: Denise Meade, Marie Ng, S Alford
Journal: Journal of Clinical Oncology (2020)

e14046 Background: Rearrangements in the gene encoding anaplastic lymphocyte kinase (ALK) are found in 3%–5% of patients. Treatment options have significantly expanded with ALK inhibitor drug approvals including crizotinib in 2011, ceritinib in 2014, alectinib in 2015, brigatinib in 2017 and lorlatinib in 2018. We sought to better understand the real-world treatment utilization and cost of ALK inhibitors in lung cancer (LCA) over the most recent period for which adjudicated claims are available, October 2017-September 2018. Methods: A LCA disease model was built in IBM Access and Value Connect to interrogate patient demographics, payer types, clinical characteristics, clinical outcomes, utilization, costs, and treatment sequencing, informed by United States Food and Drug Administration (FDA) labels for approvals, professional society guidelines, clinical and economic literature review, and subject matter expertise. Patients were selected from IBM Marketscan Commercial and Medicare Claims database and have an approved LCA treatment, at least one diagnosis claim for LCA within 30 days of treatment, and a minimum treatment period of 90 days, but do not have claims for other cancers or pregnancy during the study period. Using advanced visual analytics, we identified trends in the cost, utilization, and clinical outcomes of LCA patients. Results: There were 2,300 LCA treated patients in our 12-month cohort from October 2017-September 2018, of which 6% were treated with an ALK inhibitor. Of those 145 patients, 59% were treated with alectinib and 33% with crizotinib. Overall all cause per-member per-month costs for alectinib and crizotinib patients were $18,541 and $19,078, respectively. While the overall costs for alectinib and crizotinib were roughly the same, ER and in-patient costs were higher for crizotinib at $1,635 and $404, respectively, compared to $503 and $57 for alectinib. Conclusions: Our analyses demonstrate alectinib is the preferred first-line ALK inhibitor in the last twelve months of available data. Furthermore, the increased ER and in-patient costs may substantiate the findings of the ALEX trial, notably higher liver toxicity and more nausea, vomiting, and diarrhea for crizotinib. There is not yet sufficient data on the newer ALK inhibitors, brigatinib and lorlatinib in the real-world.
Association of Microvesicles With Graft Patency in Patients Undergoing CABG Surgery
Authors: Marina Camera, Marta Brambilla, Paola Canzano, Laura Cavallotti, Alessandro Parolari, Calogero C. Tedesco, Chiara Zara, Laura Rossetti, Elena Tremoli
Journal: Journal of the American College of Cardiology (2020)

Graft patency is one of the major determinants of long-term outcome following coronary artery bypass graft surgery (CABG). Biomarkers, if indicative of the underlying pathophysiological mechanisms, would suggest strategies to limit graft failure. The prognostic value of microvesicles (MVs) for midterm graft patency has never been tested. The aim of this study was to evaluate whether MV pre-operative signature (number, cellular origin, procoagulant phenotype) could predict midterm graft failure and to investigate potential functional role of MVs in graft occlusion. This was a nested case-control substudy of the CAGE (CoronAry bypass grafting: factors related to late events and Graft patency) study that enrolled 330 patients undergoing elective CABG. Of these, 179 underwent coronary computed tomography angiography 18 months post-surgery showing 24% graft occlusion. Flow cytometry MV analysis was performed in 60 patients (30 per group with occluded [cases] and patent [control subjects] grafts) on plasma samples collected the day before surgery and at follow-up. Before surgery, cases had 2- and 4-fold more activated platelet-derived and tissue-factor positive MVs respectively than control subjects. The MV procoagulant capacity was also significantly greater. Altogether this MV signature properly classified graft occlusion (area under the curve 0.897 [95% confidence interval: 0.81 to 0.98]; p < 0.0001). By using an MV score (0 to 6), the odds ratio for occlusion for a score above 3 was 16.3 (95% confidence interval: 4.1 to 65.3; p < 0.0001). The pre-operative signature of MVs is independently associated with midterm graft occlusion in CABG patients and a cumulative MV score stratifies patients' risk. Because the MV signature mirrors platelet activation, patients with a high MV score could benefit from a personalized antiplatelet therapy.
综合医院应设置全科医疗专科
Authors: 吴春容
Journal: BMJ (2004)

1969年2月,家庭医疗作为第20个医学专科得到美国医学会的批准.此后,在许多国家和地区,全科医疗(家庭医疗)专科逐渐得到医学界和公众的广泛认同和赞扬.各国纷纷成立全科医疗(家庭医疗)专科委员会,大力开展全科医生的资格考试和认定,并为全科医生颁发专科医生证书,使全科医生具有与其他专科医生相同的学术地位和社会地位,这为全科医疗专科立足于综合医院并取得其他专科医生的认同创造了条件。
Brazilian medical waste program as an intent to reduce costs and air release of carcinogens.
Authors: Fabiane Kellem Oliveira Cesario, Renata Pereira Fontoura, Amanda Cruz, Edivaldo Bazilio dos Santos, Amarildo Conceição Junior, Nidah Said, Poliana Morais, Brenda Omena, Gabriel Cotrim, Gabriel Antero, Anderson Silvestrini, Rosangela Andrade
Journal: Journal of Clinical Oncology (2020)

e19128 Background: Hospital waste management is a current sustainability challenge. The proper waste separation is principally recommended in most protocols, despite not always performed. Potentially infectious, sharp and chemical residues must be properly incinerated. Incineration increases the cost of waste management and releases hazardous gases into the atmosphere, such as dioxins. Dioxins are extremely stable compounds with an estimated half-life of 7 to 9 years in humans. As an important compound of air pollution, they have been classified as a class I human carcinogen by the International Agency for Research on Cancer. The dioxin carcinogenicity evolves action on transcriptional activation and inhibition of apoptosis. A higher serum concentration of dioxins is found in individuals who live near incinerators or who consume food produced near them.Furthermore, studies showed a 3 to 4 times higher risk of developing cancer in inhabitants of the neighborhood of waste incinerators and an association of serum concentration of dioxins and mortality from different types of cancer. Some neoplasms related to this exposure are lung cancer, soft tissue sarcomas and Non-Hodgkin Lymphoma. Methods: We present the impact of adequate division of medical waste from an institution in the Federal District - Brazil with data collected for 8 years. The residues were separated into two groups, the first being formed of residues that should be incinerated (potentially infectious, sharps and chemicals); and the second for regular garbage, which could be recyclable or non-recyclable. Results: By training the team and establishing appropriate protocols for proper segregation of materials, we achieved a saving of 66% from what would have been incinerated waste, equivalent to 76 tons, of which 71.9 tons correspond to recyclable waste. Also, the incineration cost was five times higher than the adequate disposal of regular waste. If the waste separation protocol had not been implemented, the biohazardous and chemical material would have contaminated the rest of the residues, making incineration as a final destination mandatory for all the waste, resulting in the release of more gases after incineration and a 64% higher cost. Conclusions: Despite the barriers to the classification of residues such as non-standardization and inadequate training of hospital teams, this low-cost implementation procedures significantly reduces the cost of waste management and the air release of human carcinogens.
System design of comprehensive reform of community health service in Changning district
Authors: Ping Jiang
Journal: BMJ (2017)

Changning district is a pilot site for community health reform of China as well as of Shanghai municipality. According to the requirement of comprehensive reform, the system is designed on the problem-oriented basis focusing on solving the capability, vitality and attraction problems of the community health service system. The reform fully uses the internal capacity and external medical resources, and implements the policies of outsourcing services, rational salary and performance appraisal system, convenient drug dispensing and quick referral. The comprehensive reform has gained preliminary achievements in enhancing grass-root capacity, implementing tiered referral and playing double gatekeeper role of family doctors.


Key words: 
Community health service; System design
Efficacy and biomarker analysis of nivolumab plus gemcitabine and cisplatin in patients with unresectable or metastatic biliary tract cancers: results from a phase II study
Authors: Kaichao Feng, Yang Liu, Yongtian Zhao, Qingming Yang, Liang Dong, Jiejie Liu, Xiang Li, Zhikun Zhao, Qian Mei, Weidong Han
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background The prognosis of patients with unresectable or metastatic biliary tract cancer (BTC) is unacceptably low. This study aimed to determine the efficacy, safety and predictive biomarkers of the immune checkpoint inhibitor nivolumab in combination with chemotherapy in advanced BTCs. Methods In this open-label, single-arm, phase II trial, a chemotherapy and immunotherapy combination consisting of gemcitabine 1000 mg/m 2 , cisplatin 75 mg/m 2 and nivolumab 3 mg/kg was administered every 3 weeks for up to six cycles. Maintenance treatment with gemcitabine plus nivolumab was administered to patients achieving disease control following the combination therapy. The primary outcome was the objective response rate. Secondary outcomes included safety, disease control rate (DCR), progression-free survival (PFS) and overall survival (OS). The exploratory objective was to assess biomarkers for predicting clinical response and prognosis. Results Thirty-two patients with a median age of 60 (range 27–69) years were enrolled. As of September 31, 2019, the median follow-up was 12.8 (95% CI 10.8 to 14.8) months. Twenty-seven response-evaluable patients received a median of 4 (IQR, 3–6) cycles of combination therapy, of whom 15 (55.6%) patients achieved an objective response, including 5 (18.6%) with a complete response (CR), and the DCR was 92.6%. Of the six patients in cohort A who were resistant to gemcitabine-based or cisplatin-based chemotherapy, one achieved CR and one achieved partial response. Thirteen of 21 chemotherapy-naive patients (61.9%) in cohort B achieved an objective response. The median PFS of all patients in cohorts A+B was 6.1 months. The median OS was 8.5 months, with a 33.3% 12-month OS rate. The most frequent grade 3 or higher adverse events were thrombocytopenia (56%) and neutropenia (22%). Fitness might be a biomarker for predicting clinical response. On-therapy changes in serum soluble FasL, MCP-1 and interferon-γ were correlated with prognosis. Conclusions Nivolumab in combination with gemcitabine and cisplatin offers promising efficacy and a manageable safety profile for patients with advanced BTCs. Trial registration number NCT03311789
Endoscopic ultrasonography in assessment of invasive risk and selection of therapeutic modalities for gastric stromal tumor
Authors: Xiaofan Wang, Shiyun Tan, Ming Li, Li Yang, Yingchun Liu
Journal: BMJ (2014)

Objectives
To evaluate the application of preoperative endoscopic ultrasonography (EUS) in assessment of invasive risk and selection of therapeutic modalities for gastric stromal tumors (GST).


Methods
The clinical data of 135 patients with GST admitted in our hospital from January 2011 to January 2012 were retrospectively analyzed. The invasion extent of GST was assessed by image of EUS before surgery, and compared with pathological results after surgery; the Fletcher 4-tier system was used for predicting the aggressiveness of GST. The selection of therapeutic modalities in 38 patients, who underwent surgical treatment was analyzed.


Results
No specific clinical manifestations were noticed, but some patients with enormous GST had symptoms of ulcer, hematemesis, and melena. Among 135 patients 97 cases received conservative treatment and followed up; in remaining 38 cases, according to invasion risk assessed by EUS, there were 9 cases in low risk, 18 in intermediate risk and 11 in high risk. The surgical modalities were selected based on the risk assessment: endoscopic therapy was performed in 15 cases, laparoscopic with gastroscopic surgery in 17 cases and laparotomy in 6 cases. The coincidence rate of diagnosis between preoperative EUS and postoperative pathological examination was 79.0%.


Conclusions
Preoperative endoscopic ultrasonography is of value in assessment of invasion risk and selection of appropriate therapeutic modalities for gastric stromal tumors.


Key words: 
Gastrointestinal stromal tumor; Endosonography; Diagnosis
Quality of life of cervical cancer patients after specialized treatment in Kazakhstan.
Authors: Dilyara Kaidarova, Roza Pak, Zhanna Chingissova
Journal: Journal of Clinical Oncology (2020)

e18024 Background: In Kazakhstan cervical cancer (CC) ranks 2nd in morbidity and mortality among women with malignant neoplasms. 88% of women are diagnosed in stages 1-2. Age range of patients with cervical cancer is becoming younger with women age 35-55 years old. This urges implementation of an effective system for assessing and maintaining the quality of life of people with CC who undergo special treatment. Methods: During study we used The EORTC quality of life questionnaire (QLQ C-30) Version 3.0 on 157 patients with stage 1-2 CC, 1+ year after chemoradiotherapy (CRT, n = 65) and surgical treatment (ST, n = 92). For statistical analysis, we used the Wilcoxon rank-sum test and the chi-square test using SPSS version 22.0. Results: When analyzing limitations in everyday activities (work etc) (sign 1), 13.8% -18.5% of patients with cervical cancer noted “significant” and “very strong” impact on quality of life after CRT compared with 1.1% - 3.3% of patients after ST (p &lt; 0.001). Study showed that there is a strong correlation between treatment method and quality of life (table 1). 35.4% of patients after CRT have noted “significant” difficulties in carrying out work requiring a higher level of physical effort (sign 2). In contrast, only 16.3% of patients after ST noted “significant” difficulties, which is 2.2 times less (p &lt; 0.006). Assessment revealed a moderate quantitative correlation (table 1). 16.9% of patients after CRT noted severe pain (sign 3) compared with 2.2% of patients who received ST (p &lt; 0.001). Assessment revealed a moderate quantitative correlation (table 1). Absence of feeling of weakness (sign 4) was greater among patients from the ST group - 21.7% compared with CRT - 9.2% (p &lt; 0.03). Assessment revealed a strong quantitative correlation (table). 15.4% of patients after CRT, compared with 2.2% of patients who received ST (p &lt; 0.001) have noted that their physical condition and treatment had a “very strong” impact on their personal life (sign 5). Conclusions: Assessment revealed that CC patients who received CRT showed lower physical and social indicators of quality of life. [Table: see text]
Impact of flu vaccine on survival after immunotherapy for metastatic castration resistant prostate cancer (mCRPC): Analysis of Medicare claims data.
Authors: Russell Kent Pachynski, Rana R. McKay, Jason Hafron, Kate Fitch, Scott Flanders, Nicholas J. Vogelzang
Journal: Journal of Clinical Oncology (2020)

e17591 Background: Sipuleucel-T (sip-T) is a cellular immunotherapy that activates a patient’s own immune system to target prostate cancer cells. Flu vaccine contains inactivated virus that stimulates the immune system to induce a response. Hypothetically, influenza vaccines may impact sip-T effectiveness by affecting the apheresis procedure, ex vivo production of sip-T, and/or CD 54+ upregulation. We explored the effect of receiving the flu vaccine on outcomes in men who received first line treatment with sip-T. Methods: Claims data from the 2013-2017 CMS Fee for Service 100% Medicare Identifiable Database for Parts A, B and D Data were examined. Among men with dates of first sip-T doses in 2014 and 2015 (ie, index dates), we identified whether or not they received flu vaccine 30 days before or after based on healthcare common procedure coding system (HCPCS) codes and National Drug Codes (NDCs). Kaplan-Meier methodology was used to assess survival with Cox proportional hazards regression model used to calculate hazard ratios (HR). Three years of follow-up (F/U) were available for men with 2014 index dates; 2 years were available for men with 2014 and 2015 index dates. Results: Approximately 8% of men received the flu vaccine (102 of 1279 with 2 years of F/U; 50 of 656 with 3 years of F/U). Overall, mean age was 76 years. Most ( &gt; 86%) were white. Receipt of flu vaccine did not impact the overall survival of men who received sip-T (HR [95% CI], 0.93 [0.64, 1.35] at 2 years and 0.90 [0.60, 1.37] at 3 years). The resultant Kaplan-Meier curves overlapped (not shown). Conclusions: Based on these claims analyses, concomitant use of flu vaccine did not appear to impact survival outcomes after sip-T administration in men with mCRPC. These data have practical application for clinicians and patients given limited prospective data evaluating the role of flu vaccination in patients receiving immunotherapy. [Table: see text]
The characterization of <i>IDH1</i> mutations in Chinese biliary tract cancers.
Authors: Kui Wang, Feng Xie, Mingtai Hu, Yuting Zheng, Zhengang Yuan, Lei Zhang, Hui Xue, Jianwei Liu, Zhao Yang, Chengjun Sui, Yanting Xie, Dan Liu, Junping Shi, Qing Hao, Xiaoliang Shi, Angen Liu, Lin Zhang
Journal: Journal of Clinical Oncology (2020)

e16674 Background: Next-generation sequencing (NGS) has been used to identify actionable mutations in biliary tract cancers (BTCs). IDH1 is an enzyme that catalyzes the conversion of isocitrate to alpha-ketoglutarate, and is involved in the tricarboxylic acid cycle. Mutations in IDH1 are associated with aberrant conversion of alpha- ketoglutarate to 2-hydroxyglutarate, which is an oncogenic metabolite. In addition, IDH1 showed an effective biomarker for cholangiocarcinoma targeted therapy in the ClarIDHy study. Therefore, the detection of IDH1 mutations is essential for predicting sensitivity to targeted therapy. Methods: Deep sequencing targeting 450 cancer genes was performed on formalin-fixed, paraffin-embedded (FFPE) tumor tissues and matching blood samples that collected from a cohort of 926 Chinese BTC patients, including 469 intrahepatic (ICC), 203 extrahepatic (ECC), 195 gallbladder cancers (GC), and 59 hilar (HCCA) cholangiocarcinoma. Single nucleotide variations (SNV), short and long insertions/deletions (Indels), copy number variations, gene rearrangements, and fusions, were analyzed. The testing was carried out by a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Results: IDH1 mutations were detected in 3.9% patients, with a median age of 59 years old. The rate of IDH1 mutations was 7% in ICC, 1% in ECC, 0.5% in GC, and 0% in HCCA. IDH1 R132C (75.8%) substitution was the most common type of IDH1 mutation in ICC. In BTC patients, ARID1A (25%), TP53 (22%), and PBRM1 (22%) were the top-ranked co-mutation genes with IDH1. Compared with the IDH1 wild-type cohort, the frequencies of KRAS and TP53 mutations were significantly lower in the IDH1 mutated cohort (29.3% vs. 2.8%, p = 0.001; 56.6% vs. 22.2%, p &lt; 0.001). In addition, IDH1 mutations were associated with a significantly lower TMB value compared to the wild-type cases (average TMB: 3.2 vs. 5.8 muts/Mb, p &lt; 0.001). Conclusions: To date, this was the largest cohort used to study the characterization of IDH1 mutations in Chinese BTCs. The mutation frequency of IDH1 was lower in Chinese ICCs compared with non-Asian populations (7.0% vs. 16.5%). Consistent with the results from previous reports, IDH1 R132C substitution was the most common type of IDH1 mutation in ICCs (PMID: 31392056). TMB value and the frequency of TP53 and KRAS mutations were lower in patients with IDH1 mutation, which may provide clues for sensitivity to targeted therapy and prognosis.
慢性阻塞性肺疾病患者的康复治疗
Authors: 林江涛
Journal: BMJ (2004)

慢性阻塞性肺疾病(COPD)患者稳定期康复治疗的根本目的在于预防急性发作,改善日常活动能力,尽可能恢复受损的心肺功能,防止或减缓心肺功能的继续减退,预防或减轻慢性缺氧和二氧化碳潴留所引起的各种并发症。