tbuckley/cabot-search huggingface dataset:
The role of ALBI and IGF-CTP score in refining prognostication of HCC.
Authors: Sunyoung S. Lee, Yehia I. Mohamed, Aliya Qayyum, Manal Hassan, Lianchun Xiao, Dan G. Duda, Rikita Hatia, Robert A. Wolff, Jeffrey Morris, Lina Altameemi, James C. Yao, Hesham M. Amin, Ahmed Omar Kaseb
Journal: Journal of Clinical Oncology (2020)

e16659 Background: Child-Turcotte-Pugh (CTP) score is widely used in the assessment of prognosis of HCC and CTP-A is the standard criterion for active therapy and clinical trials entry. Recently, ALBI and insulin-like growth factor-1 (IGF)-CTP scores have been reported to improve survival prediction over CTP score. However, comparative studies to compare both scores and to integrate IGF into Albi score are lacking. Methods: After institutional board approval, data and samples were prospectively collected. 299 HCC patients who had data to generate both IGF-CPG and Albi index were used. The ALBI index, and IGF score were calculated, Cox proportional hazards models were fitted to evaluation the association between overall survival (OS) and CTP, IGF-CTP, Albi and IGF, albumin, bilirubin. Harrell’s Concordance index (C-index) was calculated to evaluate the ability of the three score system to predict overall survival. And the U-statistics was used to compare the performance of prediction of OS between the score system. Results: OS association with CTP, IGF-CTP and Albi was performed (Table). IGF-CTP B was associated with a higher risk of death than A (HR = 1.6087, 95% CI: 1.2039, 2.1497, p = 0.0013), ALBI grade 2 was also associated with a higher risk of death than 1 (HR = 2.2817, 95% CI: 1.7255, 3.0172, p &lt; 0.0001). IGF-1(analyzed as categorical variable) was independently associated with OS after adjusting for the effects of ALBI grade. Which showed IGF-1 ≤26 was significantly associated with poor OS, P = 0.001. Conclusions: Although ALBI grade and IGF-CTP score in this analysis had similar prognostic values in most cases, their benefits might be heterogenous in some specific conditions. We looked into corporation of IGF-1 into ALBI grade, IGF score with cutoff ≤26 which clearly refined OS prediction and better OS stratification of ALBI-grade.
A population-based study on gender differences in tumor and treatment characteristics and survival of curable gastroesophageal cancer.
Authors: Marianne C. Kalff, Willemieke P.M. Dijksterhuis, Rob H.A. Verhoeven, Anna Dorothea Wagner, Valery E.P.P. Lemmens, Hanneke W.M. Van Laarhoven, Suzanne S. Gisbertz, Mark I. van Berge Henegouwen
Journal: Journal of Clinical Oncology (2020)

4550 Background: Although curative treatment options for gastroesophageal cancer are identical for men and women, outcomes may vary. This study examined differences in tumor and treatment characteristics and survival between men and women with potentially curable gastroesophageal cancer. Methods: Nationwide data was acquired from the Netherlands Cancer Registry. Patients with a potentially curable gastroesophageal carcinoma (cT1-T4a or cTx, any cN, cM0 or cMx) diagnosed between 2006 and 2017 were selected. Patient stratification was performed for tumor location and histology. The primary endpoint, relative survival, was compared between men and women with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma (GAC), adjusted for the normal life expectancy for men and women separately. Results: In total, 13,391 patients with an EAC (79.1% men), 5,103 patients with an ESCC (54.7% men), and 8,149 patients with a GAC (60.1% men) were included. Women with gastroesophageal cancer were older than men. Lower cT-stages were observed in women with EAC and ESCC (both p &lt; 0.001) and lower cN-stages were observed in women in all groups, although clinical T- and N-stage were more frequently graded as cTx and cNx in women. In women, EAC tumors were less frequently located in the distal esophagus (70.4% vs. 58.6%, p &lt; 0.001), ESCC tumors had a more proximal tumor location (p &lt; 0.001), and GAC tumors were more frequently located at the antrum (32.3% vs. 37.2%, p &lt; 0.001). For EAC and GAC, but not for ESCC, men were more frequently allocated to a potentially curative treatment; endoscopic resection, surgical resection or definitive chemoradiotherapy (EAC: 74.6% vs. 60.1%, p &lt; 0.001; GAC: 69.0% vs. 65.4%, p 0.001; ESCC: p 0.117). An inferior 5-year relative survival was observed in women with EAC (34.3% vs. 30.1%, p &lt; 0.001) and GAC (36.1% vs. 33.2%, p 0.016). In women with ESCC a superior 5-year relative survival was observed (24.4% vs 28.5%, p 0.001). Conclusions: Remarkable differences in 5-year relative survival were observed between men and women with gastroesophageal cancer, in addition to important differences in tumor stage, tumor location and treatment. Strikingly, men with esophageal and gastric adenocarcinoma were more frequently allocated to a potentially curative treatment compared to women. These findings illustrate the need for further exploration and consideration of gender differences in gastroesophageal cancer treatment.
Organ index of immunological and anti-tumor effect of intratumor injection of penicillin sodium combined with chemotherapy drug for tumor-bearing mice.
Authors: Qiang Fu, Yan Han, Bian Li, Jian Zhang, Dong Chen, Ming Zhao, Guoqin Zheng, Baofa Yu
Journal: Journal of Clinical Oncology (2020)

e16134 Background: To observe the antitumor mechanism of penicillin combined with chemotherapy drugs in tumor-bearing mice. Methods: The H22 experimental tumors were randomly divided into groups when the longest diameter of the tumor reached about 4 to 7 mm. First and the second administration was performed every 7 days. Perform a skin test and observe the local response. There were 22 mice in each group, male and female. The No. 1 to No. 3 of each group of male and female are used for pharmacodynamic experiments and executed by cervical dislocation on the 13th day. The tumor tissue is removed, weighed, and the tumor growth inhibition rate is calculated. Thymus and spleen, calculate the thymus and spleen coefficients. The male and female Nos. 4 to 8 of each group was used for survival experiments. The death time of the mice was observed and recorded. And 9 to 11 mice from the male and female mice in each dose group of penicillin were taken for skin test, and the skin test response was recorded; the 4th day after the second administration (the 12th day of the experiment) the 9th to 11th of each group No. is used for the tumor formation time experiment of the contralateral tumor. The tumor formation time of the mice is observed and recorded. Results: (1) Comparison with body weight. Sustained-release chemotherapeutic agents of penicillin sustained-release medicines by hydrogen peroxide can cause less damage to mice. (2) Compared with tumor volume and tumor inhibition rate, the compound group (I-Ⅵ) could significantly inhibit tumor growth in mice after intratumoral injection, but penicillin and DNP had no obvious tumor inhibition after intratumoral injection. (3) The comparison of thymus coefficients shows that the adjuvant can obviously prevent the damage to the thymus caused by the drug and has a certain protective effect on the thymus which is very important organ for immune systems. Comparison of survival time, the survival rate and average survival time of the compound Ⅱ group were higher than those of other compound groups. Conclusions: Based on the efficacy and survival results, this intratumoral injection with penicillin could increase organ index for spleen and thymus and indicated it could increase immunological response to against whole body cancer cell.
Immune subtype of mismatch repair deficient colorectal carcinoma.
Authors: Ning He, Qingzhu Jia, Ge Jin, Bo Zhu
Journal: Journal of Clinical Oncology (2020)

e15194 Background: Half of microsatellite instability-high (MSI-H) colorectal carcinoma (CRCs) patients do not response to checkpoint blockade (ICB) immunotherapy. We aimed to unleash the underlying mechanism of distinct efficacy to ICB by sophisticated depicting the immune microenvironment of MSI-H CRC. Methods: Public omics and clinical data of patients with MSI labels were collected from TCGA data portal (364 samples) and Gene Expression Omnibus (GSE39582, GSE13294, GSE13067, GSE35896, GSE24514, GSE25071, GSE79959, GSE103340, GSE29638, GSE33113 cohorts, 1119 samples). GEO datasets were used as discovering sets, and TCGA dataset was used as validating sets. The immune cell infiltrations and signaling pathways in the tumor microenvironment were quantified by single sample Gene Set Enrichment Analysis (ssGSEA), and the bio-similarities were estimated by t-Distributed Stochastic Neighbor Embedding (tSNE). Clustering was identified by k-mean unsupervised strategy with optimal k. Statistical analysis and data visualization were all carried out using the R. Results: Based on the whole transcriptome and immune cell infiltration profiling, both GEO and TCGA cohorts showed that MSI-H patients harbored unique pattern which significantly differed from the MSS counterpart. Unsupervised clustering further classified the MSI-H patients into “Hot” and “Cold” subgroups with remarkable different IFNG-related signatures, inflammatory response score, interferon-γ signaling score, and survival outcome. Screening assay identified 23 genes ( ADAMTSL3, DLGAP4, DNAH11, FFAR3, GABRA4, KCNA6, KCTD9, KIAA1033, KLHL6, LARGE, MORC1, NDST3, OR5H14, PAX5, PHF3, PIK3R5, RNF25, SPATA20, STAT4, TLR9, TMC3, TTC12, ZNF790) enriched and 5 genes ( CELSR3, DGKD, HECTD4, RECQL4, SLC9A4) spared in immune “hot” tumors. Moreover, “hot” tumor showed less WNT signaling pathway score, which was negatively correlated with the IFNG signaling and inflammatory response within the MSI-H CRC tumors. Conclusions: We firstly identified immune hot and cold groups from MSI-H CRCs, which may be related to different immunotherapy response. This result may help further understanding the anti-immunotherapy of MSI-H CRCs.
Patterns of self-reported symptom distress among survivors of head and neck cancers.
Authors: Guadalupe R. Palos, Katherine Ramsey Gilmore, Kate A. Hutcheson, Kristen B Pytynia, Stephen K. Gruschkus, Patricia Hansberry Chapman, Weiqi Bi, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2020)

e24073 Background: Head and neck cancer (HNC) survivors are known to experience debilitating disease-related symptoms and late effects. Patterns of symptoms among HNC survivors who have transitioned care to survivorship clinics could inform supportive care needs. We sought to assess patterns of self-reported symptoms in HNC survivors and to describe the level to which these symptoms interfered with their function. Methods: Symptoms and their interference were assessed using the MD Anderson Symptom Inventory Head and Neck (MDASI–HN). This validated patient-reported outcome (PRO) instrument consists of 28 questions grouped into 3 subscales; 1) 13 “core” or general symptoms, 2) 9 symptoms specific to HN and 3) 6 daily life interference items. Symptom severity is measured using a 0 to 10 scale, 0 = not present, 10 = as bad as can be imagined. Patients completed the MDASI-HN during a visit to the HNC Survivorship Clinic. Three databases a) MDASI HN, b) institutional, and c) the HNC survivorship provided data. We defined the primary outcome, symptom distress, as the combination of severity and interference rated ≥5 (0-10). Descriptive statistics were used to characterize the sample. Results: The sample included 1390 HNC survivors, majority were male (77%), Caucasian (83%) with a median age of 63 years (range 22- 95 years). The median years since diagnosis was five (range 2-37 years). The top disease sites were oropharynx (37%), oral cavity (35%), and larynx/hypopharynx (15%). The table summarizes the patterns of symptom distress. Conclusions: These results highlight the variation in symptom distress reported by long-term HNC survivors. Understanding the clinical implications of these patterns is important to ensure the well-being of those with head and neck cancers. [Table: see text]
Treatment of metastatic castration sensitive prostate cancer (mCSPC) by disease volume: A systematic review and a meta-analysis.
Authors: Qurat Ul Ain Riaz Sipra, Irbaz Bin Riaz, Noureen Asghar, Rabbia Siddiqi, Steven R Hwang, Muhammad Husnain, Shahroz Adil, Ammad Raina, Deepa Maheswari, Hani M. Babiker, M. Hassan Murad, Parminder Singh, Alan Haruo Bryce
Journal: Journal of Clinical Oncology (2020)

e17539 Background: Chemotherapy with Docetaxel (D) or androgen pathway inhibition (API) with Abiraterone Acetate plus prednisone (AAP), Aplautamide(APA) and Enzalutamide(E) are acceptable, FDA approved treatment options for mCSPC. It is not clear whether the magnitude of benefit varies by the choice of initial agent [chemotherapy vs API] or by volume of disease [High vs Low]. Data is now available from all registration trials by volume status and motivated this analysis to inform initial treatment choice in mCSPC. Methods: We systematically searched MEDLINE(Ovid), Embase, and Scopus for randomized controlled trials of chemotherapy(D) or APIs (AAP, APA, ENZ) that had available hazard ratios (HRs) for overall survival (OS) and Progression Free Survival (PFS) according to patient’s volume of disease. We also reviewed abstracts and presentations from all major conference proceedings. We calculated the pooled overall survival HR and 95% CI by chemotherapy and APIs and by high volume(HVD) and low volume(LVD) using a random effect model, and tested for heterogeneity to assess the null hypothesis that no difference in the survival advantage exists by choice of initial agent and volume of disease. Results: Of 4456 studies identified in our search, there were 8 eligible randomized controlled trials that were included in the analysis. Both D and APIs significantly improved PFS [HR 0.48; 0.45-0.51] and OS [0.72; 0.64-0.81] when added to ADT, however the latter was associated with significantly higher improvement in PFS( P &lt; 0.01) and OS (P = 0.03). In patients treated with D, patients with HVD derive significantly more benefit as compared to LVD( P = 0.046) and patients treated with APIs both HVD and LVD patients derive similar benefit( P = 0.80) (Table). Conclusions: mCSPC patients derive higher magnitude of survival benefit when treated with APIs as compared to D; however, D may be preferred in HVD patients. [Table: see text]
以晕厥为首发症状的大面积肺动脉栓塞一例
Authors: 江爱桂, 卢慧宇, 高小燕
Journal: BMJ (2012)

报道一例以晕厥为首发症状的大面积肺动脉栓塞病例,患者经胸部增强CT证实右侧肺动脉主干及左下肺动脉栓塞,心脏彩超显示右心增大,右心负荷过重,三尖瓣重度反流,肺动脉重度高压.经介入机械性血栓清除术联合局部及全身小剂量尿激酶溶栓治疗,得到成功救治。
Preoperative frailty assessment with Robinson Frailty Score (RFS) and Edmonton Frail Scale (EFS) in older surgical patients with cancer.
Authors: Tomohiro F. Nishijima, Taito Esaki, Masaru Morita, Yasushi Toh
Journal: Journal of Clinical Oncology (2020)

e24033 Background: In general geriatric surgical patients, frailty has been shown to predict higher rates of postoperative adverse outcomes. A little is known about how to optimally assess older adults with cancer for preoperative frailty. We evaluated the potential utility of the RFS [Robinson Am J Surg. 2013], EFS [Rolfson Age Ageing. 2006] and Geriatric 8 (G8) for prediction of postoperative adverse events. Methods: This cohort study included older adults who were prospectively evaluated by geriatric oncology service at Kyushu Cancer Center in Japan before undergoing oncological surgery between September 2018 and December 2019. The RFS measures cognition, function (activities of daily living (ADLs) and Timed Up &amp; GO (TUG)), history of falls, comorbidity, albumin and hematocrit (score 0 to 1: fit (n = 71), 2 to 3: prefrail (n = 30) and 4 to 7: frail (n = 13)). The EFS evaluates cognition, function (IADLs and TUG), incontinence, self-perceived health, mood, nutrition, polypharmacy and social support (score 0 to 3: fit, 4 to 7: prefrail and 8 to 17: frail). G8 was dichotomized at previously studied cut-off value of 14. The primary outcome was composite adverse events (AEs), including 30-day postoperative complications (Clavien-Dindo grade ≥ 2) and discharge to an institutional care facility. Severity of surgery was assessed using the Operative Stress Score (OSS) [Shinall JAMA Surg. 2019]. Results: Of 114 patients (median age 80 years, range 72-96), surgery type was GI in 62%, HEENT in 20%, GYN in 8%, and other in 10%. 100 patients had ECOG PS 0 to 1. Using the OSS, surgical procedures were classified as very low to low stress (9%), moderate stress (31%), high stress (46%) and very high stress (15%). 45 patients had AEs. After adjusting for the OSS, preoperative frailty based on the RFS was associated with the occurrence of AEs (fit: 25%, prefrail: 49%, frail: 77%; p &lt; 0.01). However, neither the EFS (fit: 30%, prefrail: 37%, frail: 60%; p = 0.14) nor G8 was significantly associated with a risk of AEs (score &gt; 14: 17%, score ≤ 14: 41%; p = 0.07). Conclusions: Preoperative frailty status defined by the RFS is predictive of postoperative adverse outcomes in older adults undergoing elective surgery for cancer.
新诊断的糖尿病患者如何应用胰岛素进行短期强化治疗
Authors: 傅汉菁
Journal: BMJ (2011)

随着我围糖尿病患病率的增高,在内科门诊患者中经常会遇到新诊断的糖尿病患者.对于一些血糖较高的新诊断糖尿病患者,近年来提出胰岛素短期强化治疗.胰岛素是作用最强的降糖药物,可较快并有效地降低血糖,最大程度地解除糖毒性对胰岛β细胞的影响,所以2型糖尿病患者应尽快行外源性胰岛素替代治疗,使血糖迅速恢复正常,解除糖毒性,从而促使胰岛β细胞的功能恢复以延缓糖尿病的自然病程进展.下面通过一门诊病例的治疗过程来介绍新诊断糖尿病患者的胰岛素短期强化治疗。
Randomized phase II study of nivolumab (N) alone versus with pegilodecakin (PEG) in combination with N in patients (pts) with post-platinum immunotherapy-naive stage IV non-small cell lung cancer (NSCLC) and no or low PD-L1 expression (CYPRESS 2).
Authors: Robert M. Jotte, Jerome H. Goldschmidt, Jeffrey Gary Schneider, Merrill Kingman Shum, David Berz, Lasika C. Seneviratne, Matei P. Socoteanu, Annie Hung, Rebecca R. Hozak, Bo H. Chao, John J. Nemunaitis
Journal: Journal of Clinical Oncology (2020)

e21744 Background: Nivolumab (N) is an immune checkpoint inhibitor (CPI) approved to treat post-platinum NSCLC as monotherapy. PEG in combination with N has demonstrated promising efficacy in NSCLC pts in a phase I trial (IVY; NCT02009449; Naing et al., 2019 Lancet Oncol), providing rationale for this randomized phase II trial (CYPRESS 2). Methods: CYPRESS 2 was an open label phase II trial, for ECOG 0-1, PD-L1 negative or low (TPS 0-49%), Stage IV NSCLC pts, without known EGFR/ALK mutations. Pts were randomized 1:1 to arm N (240 mg every 14-days or 480 mg every 28-days as decided by investigator) v. arm PEG+N (received N as above + PEG daily of 0.8 mg if weight ≤80kg and 1.6mg if weight &gt; 80 kg). Pts were stratified by tumor histology and smoking history and must have no prior history of cancer or CPI therapy. Primary endpoint was ORR (per RECIST v 1.1 per investigator). Secondary endpoints included PFS, OS, and safety. Exploratory endpoints included immune activation biomarkers (baseline and change from baseline), assessed by immunoassay. Results: As of Aug 28, 2019, 52 pts were randomized to PEG+N (n=27) or N (n=25). Median follow-up time was 11.6 months. The following results were found for PEG+N versus N: ORR 14.8% v. 12.0%, mPFS 1.9 v. 1.9 months with HR = 1.01 (95% CI [0.52, 1.95]), mOS 6.7 v. 10.7 months with HR = 1.87 (95% CI [0.77, 4.53]). Gr ≥3 treatment related adverse events (TRAEs) for PEG+N versus N were 70.4% vs. 16.7%. Gr 3 TRAEs of ≥10% incidence included anemia (40.7% v. 0%), fatigue (18.5% v. 0%), and thrombocytopenia (14.8% v. 0%). In PEG+N arm, increased circulating IL-18, Granzyme B, FasL, and IFNg levels and decreased TGFb levels were observed on treatment. Conclusions: Exploratory pharmacodynamic results were consistent with immunostimulatory signals of the IL-10R pathway. Despite evidence of biological effect, adding PEG to N did not lead to improvement in ORR, PFS, or OS in post-platinum advanced NSCLC with no or low PD-L1 expression. PEG+N arm demonstrated expected safety profile but overall higher toxicity compared to nivolumab alone. Clinical trial information: NCT03382912.
Application of e-health among patients visiting community healthcare centers in Shanghai
Authors: Wenyu Deng, Limin Lao
Journal: BMJ (2018)

Objective
To exmine the status and perspectives of e-health among patients in Shanghai community health center.


Methods
In November 2014, a semi-open and in-depth qualitative interview was conducted among 40 patients from two community health service centers in Shanghai. According to the results of the interview, a self-made questionnaire was designed and a cross-sectional survey was carried out from March 2015 to May 2015. Eight districts or counties of Shanghai were randomly selected, and one community health service center was randomly selected from each district or county. Total 480 patients who visited the selected center participated in the survey. The main contents of the interviews and questionnaires included: the current status of communication using information and communication technologies (ICT) in patient daily life; the status of the communication with medical personnel by using ICT; the attitudes and perspectives of patients in applying ICT for medical service; and views on e-health development.


Results
Among the participants, 25.0%(10/40) of the interviewees and 16.7%(62/371)of the quesitionnaire surveyees had experience of using e-health. Among the questionaired patients, telephone-call was the most common method for communication with doctors (90.3%, 335/371), followed by short message (16.1%, 60/371) and wechat (12.9%, 48/371). Illness consulting is the most common perpurse for communication(64.5%, 40/62), followed by medicine advice(40.3%, 25/62) and sudden physical help(24.2%, 15/62). Among the participants, 56.3%(209/371)of whom thought that e-health should be promoted in the community, 69.4% (145/209) of whom thought that it could save time and effort; among the patients not using or considering unnecessary to use e-health, 87.6% (142/162) of whom thought they lived closer to the hospital and easy to access.


Conclusion
At present, less patients have the experience of using e-health, but more than half of them believe that it is necessary to use e-health and it should be promoted in the community healthcare.


Key words: 
Community healthcare center; Questionnaire; Medical consult