tbuckley/cabot-search huggingface dataset:
Is scalp cooling system effective in chemotherapy induced alopecia? A real-world experience in Asian patients.
Authors: Shruti Kate, Roshan Patil, Sonal Chandrakant Dhande, Dina Shaikh, Rohini Vyavahare, Sheela Joseph, Yasam Venkata Ramesh, Rajnish Vasant Nagarkar
Journal: Journal of Clinical Oncology (2020)

e19334 Background: Chemotherapy induced alopecia(CIA) is the most common and afflicting chemotherapy side effect. Data on the use of scalp cooling (SC) to prevent CIA is limited and debatable due to lack of experience. This study analyzed the effectiveness and tolerability of SC in clinical practice. Methods: We prospectively analysed 100 consecutive patients who opted for Paxman scalp cooling. The assessment of alopecia was done by WHO grading system. The extent of alopecia was analyzed at baseline, during each session, and 4 weeks from the last SC session. Results: A total of 100 (94 females, 6 males) patients were enrolled. Amongst them, 69% had breast cancer, 18% had ovarian cancer and 26% had various other cancers. Majority of patients were treated with a curative intent (69%) and had a good performance status (ECOG PS 0-1). Overall 40% patients received anthracyclines, 45% received taxanes, 9% received both and 6% patient received other chemotherapeutic agents. Hair preservation rate was in 31% (Grade 0 alopecia 12%, Grade 1 alopecia 19%). After a single SC session, 30% of patients discontinued due to grade 2 alopecia. On cox regression analysis, onset of grade 2 alopecia on SC was significantly longer in patients on taxanes compared to anthracyclines (1.357 HR, 0.98-1.87 CI, p= .05). One out of 100 patients developed scalp metastases. Majority of the patients experienced mild side effects [chills (30%), headache (12%)]. One out of 100 patients discontinued SC due to intolerable side effects. None of the other predetermined factors (age, menopausal status, ECOG performance status, body mass index), were found to delay the onset of grade 2 alopecia amongst the male patients, hair preservation rate was 100% . Conclusions: Scalp cooling is very effective for hair preservation for some chemotherapy patients. In our study, we found that it is more effective in reducing alopecia in taxane chemotherapy. Scalp metastasis and SC discontinuation were observed to be very rare.
Comparison of ultrasonographic findings between parotid glands and submandibular glands in primary Sjögren′s syndrome
Authors: Qin Xue, Jixuan Miao, Jing Hu, Qiongsong Zhou, Ke Zhao, Dazhong Zou
Journal: BMJ (2020)

A total of 87 patients with primary Sjogren′s syndrome (pSS) admitted in Jiangyin Hospital affiliated to South-East University Medical College from August 2014 to September 2018 were enrolled. According to severity, the ultrasonographic images of salivary glands were analyzed and graded to 0-4 scores, it is defined as positive if the scores ≥ 2. The ultrasonographic positive rate of submandibular glands and parotid glands were 94.3% (164/174) and 71.3% (124/174), respectively (χ2=32.22, P 0.05). The result indicates that the damage of submandibular glands is more severe than that of parotid glands in patients with pSS.


Key words: 
Sjogren′s syndrome, primary; Ultrasonography; Diagnosis
Objective and subjective vulvovaginal symptoms in breast cancer patients.
Authors: Shari Beth Goldfarb, Sally Saban, Ashley Arkema, Sujata Patil, Jessica Flynn, Deborah J. Goldfrank, Larry Norton, Jeanne Carter
Journal: Journal of Clinical Oncology (2020)

e24056 Background: Breast cancer and its treatment adversely impact sexual function and QoL. As more women become survivors, information is needed about vulvovaginal symptoms, sexual concerns and treatment options. Methods: An IRB Limited Waiver of Authorization was obtained to evaluate the medical records of 650 breast cancer patients with initial sexual medicine consults between 7/19/12 &amp; 3/5/19. All women completed the Clinic Assessment form including a pelvic exam checklist, vulvovaginal tissue quality assessment (Vaginal Assessment Scale (VAS)/Vulvar Assessment Scale (VuAS) and sexual function measures (FSFI, PROMIS-SF) at initial visit and 56% (366/650) completed it at follow-up visits. R v3.6.1 was used to perform statistical analysis. Results: Women were categorized at initial consult as either postmenopausal (PM), pre/perimenopausal or menopausal from ovarian suppression (OS). Median age at initial consult was 52 (range 26 to 83) and median endocrine exposure ranged from 12 months on Tamoxifen only to 52 months on Tamoxifen followed by an AI. Of the total sample, 60% reported no confidence in future sexual activity and 68% reported pelvic pain with exam at initial consult. Improvements were seen at the first follow-up in confidence about intimacy and sexual health concerns (p &lt; .001). Vulvovaginal symptoms (VAS/VuAS) and dilator and vulvovaginal moisturizer use (p &lt; .001) also improved from baseline to follow-up 1. The women most likely to attend first follow-up appointments were OS (70%) and PM women on AIs (64%) who also reported worse symptoms at baseline compared to pre/perimenopausal women on Tamoxifen. At initial presentation, PM on AIs and OS had poor exam outcomes respectively: pH &gt; 5 (92%; 83%), poor vaginal elasticity (19%; 13%), vaginal dryness (88%; 68%), decreased rugosity (36%; 30%) and poor vascularity (33%; 21%). At initial consult, exam findings for pH, moisture, vulvar and vestibular irritation each correlated significantly with patient reported vaginal (VAS total score) and vulvar (VuAS total score) symptoms (p≤ .05). Conclusions: Breast cancer patients can benefit from coordinated multidisciplinary care addressing the long-term effects of premature menopause and endocrine therapy. Patient characteristics such as menopausal status and type/duration of endocrine therapy should be considered when assessing sexual health since aromatase inhibitors and ovarian suppression appear to worsen clinical exam and patient reported outcomes. Sexual health counseling and treatment can help women cope with sexual concerns during and after breast cancer therapy.
Abstract P122: Racial/Ethnic Variation in Incidence and Progression of Coronary Artery Calcification: Implications for Understanding the Hispanic Paradox
Authors: Sandra S Albrecht, Pamela L Lutsey, Matthew Allison, Teresa Seeman, Martha L Daviglus, Karol Watson, Joseph F Polak, Carlos J Rodriguez
Journal: Circulation (2018)

Background: Previous studies show that Hispanic persons have similar or lower levels of coronary artery calcium (CAC) and slower progression than non-Hispanic whites (NHW), even after adjustment for traditional risk factors. We examined whether this health advantage in CAC incidence and progression among Hispanic adults extends across all levels of risk factor (RF) burden, and whether associations vary by nativity (foreign-born, US-born) and by heritage group (Mexican, non-Mexican). Methods: We analyzed data on Hispanic and NHW participants aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis (MESA). Follow-up CAC measurements and complete covariate data were available for 3694 participants with an average of 6.6 years between the follow-up and baseline scans (2000-2002). Baseline measures of the following traditional RFs were considered: current cigarette smoking, high total cholesterol, hypertension, diabetes, and obesity, with RF burden scores ranging from 0-5. Outcomes were incident CAC (any follow-up CAC &gt;0 Agatston units) among individuals without detectable CAC at baseline, and CAC progression (any positive increase in CAC) among all participants estimated using relative risk regression. All models were adjusted for age, sex, RF burden, race/ethnicity, education, income, and time between scans Results: Although a higher proportion of Hispanics had RF burden scores ≥3 compared to NHW (14.6% vs 8.9%, p&lt;0.0001), Hispanics had a lower adjusted incidence (risk ratio (RR) = 0.83, 95% CI: 0.72-0.96) and less progression of CAC (RR=0.90, 95% CI: 0.86-0.95) than NHW. However, there was evidence of heterogeneity in this pattern. For example, among individuals with no detectable baseline CAC, a Hispanic health advantage was only seen among individuals with RF burden scores of 0 (RR=0.66, 95% CI: 0.48-0.91 for Hispanics vs. NHW at RF=0), with race/ethnic differences getting progressively smaller with increasing RF burden (for RF ≥3: RR=1.01, 95% CI: 0.69-1.48). Compared to NHW, lower adjusted incidence and progression of CAC was evident to an even greater extent among foreign-born Hispanics, but a health advantage was still present for US-born Hispanics, and for both Hispanic heritage groups. However, these patterns also only remained among individuals with lower RF burden scores. Conclusions: The Hispanic health advantage in CAC incidence and progression was primarily evident among individuals with fewer traditional risk factors for CVD, but was present among different Hispanics groups. Future research is necessary to identify the factors underlying this advantage, and the dynamics that erode it as RF burden increases.
Influence of obstructive sleep apnea syndrome on diabetes and strategies
Authors: 陈宝元
Journal: BMJ (2010)

[编者按] 在 ( )见刊之前,编辑部征集到部分社区医生的读后提问,并邀请陈宝元、高雪梅和何权瀛教授分别对 做了更具针对性的解读和答疑.阻塞性睡眠呼吸暂停和糖尿病均是常见病,社区医生应该做些什么、能够做些什么?全科专家张晓林结合社区医生的工作特点做了分析。
Quality assessment of online hepatocellular carcinoma patient education materials.
Authors: Jim (Zhang Hao) Li, Jane McLeod, Paris-Ann Ingledew
Journal: Journal of Clinical Oncology (2020)

e24184 Background: Hepatocellular carcinoma (HCC) is the fourth-leading cause of cancer-associated death in the world, claiming nearly 800,000 lives each year globally. Concurrently, an increasing number of patients are using the Internet as a source of health information. However, limited research has been done on assessing the quality of HCC websites. Therefore, we aim to systematically evaluate the quality of online HCC information to illuminate its current strengths and limitations. Methods: The term “hepatocellular carcinoma” was searched using Google, Dogpile, and Yippy. The overall highest-ranked 100 (“top 100”) websites were extracted based on pre-specified inclusion and exclusion criteria. A validated, evidence-based tool was used to evaluate their quality based on several benchmarks such as website affiliation, accountability, interactivity, structure &amp; organization, readability, and content quality. Results were evaluated using descriptive and inferential statistics. Results: The search yielded over 1,100 websites. Of the top 100 websites, 53% were commercial in nature. Although 95% disclosed ownership, other measures of accountability were poor – only 30% identified their author(s), 42% cited sources, and 33% were updated within the past two years. Average readability was judged to be at a grade 11.8 level using the Flesch-Kincaid grading system, and 10.4 using the SMOG index. Both estimates were significantly higher than the traditionally recommended grade-six level ( p &lt; 0.0001 for both). Prognosis, prevention, and incidence were the least commonly covered topics (33%, 46%, and 50% respectively). All other topics were covered with “mostly accurate” or “completely accurate” information by over 70% of websites (Table). Overall, non-commercial websites were higher in quality compared to their commercial counterparts ( p &lt; 0.002). Conclusions: Content accuracy is generally high. However, authorship disclosure, attribution, currency, and coverage in certain topics are deficient among many HCC websites. Additionally, difficult readability may pose a barrier for patient comprehension. Healthcare professionals should be aware of the limitations of online HCC information, in order to proactively guide patients to suitable resources and advocate for improvements in patient education materials. [Table: see text]
Lower gastrointestinal symptoms are associated with worse glycemic control and quality of life in type 1 diabetes mellitus
Authors: Leeds John S, Hadjivassiliou Marios, Tesfaye Solomon, Sanders David S, 宋艳宁, 巩纯秀
Journal: BMJ (2018)

目的
在1型糖尿病患者中，下消化道症状不常出现，而且血糖控制和生活质量对其影响尚不清楚。本研究的目的是确定血糖控制和生活质量对下消化道症状患病率的影响，并研究其潜在的病因。


研究设计和方法
次级治疗的前瞻性队列研究。1型糖尿病患者完成胃肠症状问卷，并填写36份V.2生活质量调查表，并进行血红蛋白A1c测定。腹泻患者按国家指南进行重新评估和调查。对照组为非糖尿病患者，比较消化道症状患病率和生活质量评分。


结果
有706例合并1型糖尿病患者（平均年龄41.9岁）和604例对照患者（平均年龄41.9岁）入组。与对照组相比，1型糖尿病患者的胃肠道症状频次显著增加，尤其是便秘[比值比（OR）2.4]、腹泻（OR 2.5）、排便习惯改变（OR 2.1）、腹痛（OR 1.4）、稀便（OR 2.7）、腹胀（OR 1.4）和胀气（OR 1.3）（均P<0.05）。曾经患胰腺炎在1型糖尿病患者中更为常见（OR 4.6），但其他胃肠道疾病则不常见。胃肠道症状与血糖控制较差（P<0.01）和生活质量差有关，尤其是腹泻患者。对腹泻，包括排便习惯改变患者（n=105）的研究表明，在随后的管理变化中确定了72.3%的病因。


结论
1型糖尿病患者胃肠道症状的患病率是非糖尿病人群的2倍，并与较差的生活质量和血糖控制有关。1型糖尿病患者腹泻，应给予治疗，且控制糖尿病可使四分之三症状得以缓解。
MET status and treatment outcomes in papillary renal cell carcinoma (PRCC): Pooled analysis of historical data.
Authors: Laurence Albiges, Daniel Yick Chin Heng, Jae-Lyun Lee, Stephen Walker, Anders Mellemgaard, Lone Ottesen, Melanie M. Frigault, Anne L'Hernault, Jonathan Wessen, Toni K. Choueiri, Mathilde Cancel, Sabina Signoretti
Journal: Journal of Clinical Oncology (2020)

e19321 Background: PRCC accounts for 10–15% of RCCs, but there are limited biomarker-based data to inform targeted treatment. Treatments for patients (pts) with advanced/metastatic PRCC include those approved for clear cell RCC such as sunitinib or everolimus, however their activity in PRCC can be limited. A subset of PRCCs are MET-driven, and it has been suggested that this may be a negative prognostic factor, although the role of MET activation in advanced/metastatic disease is unclear. We explored the prevalance of MET status in pts with advanced/metastatic PRCC treated with targeted therapies and impact on clinical outcomes. Methods: This large, international, retrospective, observational study included pts with previously treated, locally advanced/metastatic PRCC. MET status was determined retrospectively by NGS of archival tissue. MET-driven disease was defined as MET and/or HGF amplification, chromosome 7 gain (requiring &gt; 30% tumor content) and/or MET kinase domain mutations. Study objectives included progression-free survival (PFS), time to treatment failure (TTF) and overall survival (OS) by MET status. Results: 305/308 pts (International Metastatic RCC Database Consortium, n = 72; The Asan Genito-Urinary Cancer Center, n = 40; Groupe Français d’Etude des Tumeurs Uro-Génitales, n = 196) received first-line (1L) treatment; sunitinib was most common (68%). 214 (69%) pts received 2L therapy; everolimus was most common (20%). Of 179 pts with valid NGS results, 38%, 49% and 13% had MET-driven, MET-independent (ind) tumors and chromosome 7 ploidy unevaluable, respectively. Baseline demographics were mostly balanced among groups. In sunitinib-treated pts, PFS and TTF were numerically longer in pts with MET-driven tumors vs pts with MET-ind tumors, but OS was similar (Table). In everolimus-treated pts, PFS and TTF were similar for both MET groups; however the sample size was small. Conclusions: MET alterations are frequent in advanced/metastatic PRCC and have potential to impact PFS and TTF, although our results show limited effect on OS. These data show that MET-driven tumours may not predict for poorer outcome vs MET-ind tumours and there is a need for suitable therapies for MET-driven PRCC. [Table: see text]
Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020
Authors: Emma E. McGinty, Rachel Presskreischer, Hahrie Han, Colleen L. Barry
Journal: JAMA (2020)

This study used national survey data to compare the prevalence symptoms of psychological distress and loneliness among US adults during the coronavirus disease 2019 (COVID-19) pandemic in April 2020 vs those reported in the National Health Interview Survey in 2018.
妊娠糖尿病的规范化治疗
Authors: 徐先明
Journal: BMJ (2005)

妊娠糖尿病(GDM)的治疗目标是使血糖控制在满意范围、防止代谢并发症及产科并发症、稳定已发生的并发症并尽量保证足月妊娠.大约80%以上的GDM孕妇都可单纯采用饮食指导的方法把血糖控制在满意范围,只有不到20%的GDM孕妇需进一步加用运动治疗或胰岛素治疗.所谓血糖控制在满意范围是指经治疗后空腹血糖控制在3.3～5.8 mmol/L(60～105 mg/dl),餐后1 h血糖<7.8 mmol/L(140 mg/dl)、餐后2 h血糖 4.0～6.7 mmol/L(70～120 mg/dl)。
The clinical application and evaluation of capsule endoscopy
Authors: 伞锕镅
Journal: BMJ (2006)

小肠远离口腔和肛门,且长度长(3.35～7.85 m),游离于腹膜内并被肠系膜束缚形成多发复合肠襻,是整个胃肠道中最难检测的部分.虽然小肠疾病可经X线钡餐、小肠镜、核素扫描及动脉造影等进行检查,但均存在着诊断阳性率低、定位及定性不准确、检查时患者痛苦大或属创伤性检查及伴有并发症等诸多缺点,从而使小肠疾病缺乏有效的诊断手段.
Cost implications of clinical trial (CT) participation in metastatic non-small cell lung cancer (NSCLC).
Authors: Cristina Merkhofer, Shasank Chennupati, Qin Sun, Keith D. Eaton, Renato G. Martins, Scott David Ramsey, Bernardo H. L. Goulart
Journal: Journal of Clinical Oncology (2020)

7084 Background: To assess the value of CTs in advanced NSCLC from the payer perspective, we compared insurance-related total direct medical costs for NSCLC patients who enrolled in CTs vs. those who did not. Methods: After linking electronic health records with tumor registry and claims data, we identified 101 patients with metastatic NSCLC diagnosed between 1/1/2007 and 12/31/2015 and treated at the Seattle Cancer Care Alliance. Eligibility criteria included 60-day minimum survival, claims for ≥ 1 anti-cancer drug within 180 days of diagnosis and insurance enrollment for the first 12 months after diagnosis. We abstracted patient sociodemographic, disease and treatment data, and obtained death dates from the Washington State Cancer Registry, censoring patients alive on 3/7/2019.We used the Kaplan-Meier sample-average (KMSA) estimator with bootstrapped 95% confidence intervals to describe direct medical costs and compared costs in CT enrollees vs. non-enrollees by applying a generalized linear model (Gamma distribution, log link) adjusted for confounding covariates. Results: Of 101 patients, 39 (39%) enrolled in CTs. Compared with non-enrollees, CT enrollees were younger (mean age 61.6 vs. 66.5 years), female (67% vs. 47%), Asian (18% vs. 11%), never smokers (41% vs.32%), had commercial insurance (44% vs. 35%), resided in metropolitan areas (90% vs. 79%) and had a higher median income ($81,149 vs. $76,844). Table shows KMSA estimates of total direct medical costs and adjusted mean lifetime total direct medical costs by CT participation. After adjusting for sex, smoking status, residence, income, insurance payer, ECOG and mutation status, CT enrollment was associated with an increase in lifetime total direct medical costs compared with no enrollment (adjusted cost ratio=1.39; 95% CI: 1.01, 1.90; p=0.043). Conclusions: CT participation is associated with increased total direct medical costs in patients with metastatic NSCLC. Our results may inform partnerships between trial sponsors, oncology centers and payers to sustain treatment innovation through CTs. [Table: see text]
Validation of the Van Nuys Prognostic Index in 737 patients with ductal carcinoma in situ (DCIS) treated at Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Authors: Michal Kunkiel, Anna Niwinska, Agnieszka I. Jagiello-Gruszfeld, Wojciech Michalski
Journal: Journal of Clinical Oncology (2020)

e12603 Background: To assess the value of the Van Nuys Prognostic Index (VNPI) used in Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO) to select the most adequate method of the treatment of DCIS patients. Methods: The database covered 737 subsequent DCIS patients treated in MSCNRIO in the years 1996 -2011. The results of the treatment with and without compliance with the VNPI index were compared. Results: In the group of 737 patients 66 (9%) failures were reported. There were 4 (0.5%) deaths due to DCIS progression. After 15 years of observation of patients treated in compliance with VNPI, the percentage of failures after local excision (4-6 VNPI points), breast conserving treatment (7-9 VNPI points) and mastectomy (10-12 VNPI points) was 29%, 21% and 9%, respectively. No differences in the overall survival was observed. In patients with 4-6 VNPI points the percentage of recurrences in the group treated in compliance with the VNPI (without radiotherapy) was 29% while in the group treated without compliance with the VNPI (with radiotherapy) - 2%. Conclusions: The Van Nuys prognostic index (VNPI) does not seem to be an ideal tool in patients with DCIS. It shows too high percentage of recurrences in the low risk group (VNPI of 4, 5 or 6 points), treated exclusively with a sparing surgery. Almost all patients after surgical excision should be irradiated.
Machine learning imputation of Eastern Cooperative Oncology Group performance status (ECOG PS) scores from data in CancerLinQ discovery.
Authors: Smita Agrawal, Babu Narayanan, Prajwal Chandrashekaraiah, Sai Vinod M, Sourav Nandi, Vivek Vaidya, Ping Sun, Claudia Cabrera, David Svensson, Sajan Khosla, Edward Stepanski, George Anthony Komatsoulis
Journal: Journal of Clinical Oncology (2020)

e19318 Background: ECOG PS is a prognostic indicator of outcomes, and scores of 0-1 (good ECOG PS) are often required for clinical trial enrollment. Patients treated in non-trial settings often lack ECOG PS scores limiting the ability of Real World Data from these patients to be used in external control arms (ECAs) or to provide optimal specificity for clinical effectiveness research. Machine Learning can be used to impute ECOG PS scores from other clinical data at various points during treatment. Methods: We developed a series of models using logistic regression (LR) or XGBoost (XGB) that impute ECOG PS at initial diagnosis, metastatic diagnosis and final evaluation using a curated Non-Small Cell Lung Cancer cohort of 31,425 patients with at least one ECOG PS score. Results: AUC-ROC values of up to 0.81 could be obtained for imputing a patient’s final ECOG PS, with lower AUC values when imputing ECOG PS at initial and metastatic diagnosis using large numbers (i.e. thousands) of features. We developed more interpretable models with 110 or 40 features with reduced but still satisfactory AUC, with accuracy of predicting good ECOG PS scores of around 80%. Key features were obtained from lab tests, physical exams, comorbidities, medications, age and metastatic status. The table below shows the results of several of these models. Where the models misclassify ECOG PS, the error was rarely greater than 1 grade. Conclusions: ECOG PS is subjective, suggesting that ML based cohort assignment will be sufficiently accurate to support their use in research. Further work will be required to assess if the ML predicted cohorts have different outcomes. [Table: see text]