tbuckley/cabot-search huggingface dataset:
Association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy: a systematic review and meta-analysis
Authors: Wufuer Alimu, Dengfeng Han, Yalikun Xiatiguli, Jiamaliding Halidan, Jianhua Ma
Journal: BMJ (2018)

Objective
To evaluate the association between short-term outcomes and collateral circulation status in patients with acute ischemic stroke receiving thrombolysis therapy.


Methods
Full-text articles published from January 2000 to November 2016 in Cochrane Library, Medline, Embase and Web of Science electronic database were retrieved and their quality was assessed. The association between short-term outcomes and collateral circulation status were analyzed by random-effects models.


Results
Twenty three studies involving 2 849 patients were included in quantitative synthesis. The results showed that good collateral circulations had a beneficial effect on favorable outcomes at 3 or 6 months (RR=2.26, 95%CI: 1.85-2.77, P=0.00), and were also associated with a lower rate of symptomatic intracranial hemorrhage (RR=0.56, 95%CI: 0.47-0.67, P<0.01) and a lower rate of mortality (RR=0.30, 95%CI: 0.22-0.40, P<0.01).


Conclusion
The baseline collateral circulation status is associated with the short-term outcomes in patients with acute ischemic stroke receiving thrombolysis therapy.


Key words: 
Thrombolytic therapy; Collateral circulation; Intracranial embolism and thrombosis, acute; Meta-analysis
Immunofocus-PD-L1 high throughput quantitative next generation sequencing assay.
Authors: Gareth Haydn Williams, Robert Paul Thatcher, Tiffany Eira Haddow, Keeda-Marie Hardisty, Marco Loddo
Journal: Journal of Clinical Oncology (2020)

e13521 Background: Immunohistochemical (IHC) assays are presently used as the gold standard predictive tests for immunotherapy but are compromised due to a number of potential variables. Comparative studies have demonstrated differing levels of PD-L1 staining between assays which appears independent of the antibody binding epitope. Secondly, inter-reader reliability even between expert pathologists is problematic particularly for assessment of PD-L1 positive immune cell populations. Methods: To improve predictive testing for anti PD-L1/PD1 immunotherapies we have developed and validated a Next Generation Sequencing Platform, Immunofocus, able to perform high-throughput quantitative PD-L1 gene expression levels in routine diagnostic PWET biopsies. We applied Immunofocus to a cohort of 130 NSCLCs and compared PD-L1 gene expression levels with PD-L1 IHC scores generated using the VENTANA PD-L1 (SP142) Assay. The PD-L1 IHC assessment was carried out double blinded by an independent laboratory. PD-L1 IHC scores were calculated using an algorithm combining tumour proportion score (TPS) with a PD-L1 positive immune cell (IC) score and immune cell area. Results: An exceptionally high degree of correlation was observed between the NGS PD-L1 levels with the combined PD-L1 IHC scores (P &lt; 0.001). Therapeutic cut points for NGS PD-L1 levels were identified corresponding to PD-L1 IHC defined clinical cut points. Notably, ~20% of patients with negative PD-L1 IHC scores showed high NGS PD-L1 expression levels. We hypothesize that these cases represent false negatives and identify a cohort of patients who have shown significant response rates to anti-PD-L1/PD-directed immunotherapies. Conclusions: The Immunofocus NGS PD-L1 assay has potential to greatly improve patient selection for immunotherapy by removing the IHC assay variables and inter-reader variability which compromise current PD-L1 IHC tests while also providing standardized high throughput in the clinical setting. Immunofocus is able to integrate gene expression with somatic mutation analysis allowing capture of networks regulating the immune-checkpoint including for example adaptive and innate resistance pathways, JAK1/2 pathways, differential MHC expression, TEFF gene signature, neoantigen surrogates such as DDR defects and TMB. The integration of NGS PD-L1 expression with other putative biomarkers of response is presently ongoing to further improve prediction of response.
Factors associated with the use of adjuvant neratinib in stage I-III HER2-positive breast cancer.
Authors: Ericson Stoen, Jodi Kagihara, Peter Kabos, Christine M. Fisher, Jennifer Robinson Diamond
Journal: Journal of Clinical Oncology (2020)

e12517 Background: HER2-positive breast cancers have a higher risk of recurrence, though systemic chemotherapy in combination with HER2-targeted agents significantly reduces this risk. Neratinib (N) is a small molecule inhibitor of HER2 that was shown in the ExteNET trial to improve invasive disease-free survival in patients with stage II-III breast cancer. The purpose of this study was to investigate factors associated with the use of adjuvant N in patients with HER2-positive breast cancer treated in the University of Colorado Health system (UCH). Methods: We performed a retrospective chart review of women diagnosed with stage I-III breast cancer who received adjuvant trastuzumab (T) between July 2016 and April 2019 at UCH to coincide with the approval of N in July 2017. We collected patient demographics, baseline characteristics, and cancer treatments. Results: A total of 350 patients were identified who received adjuvant T for treatment of stage I-III HER2-positive breast cancer within the inclusion timeframe. 234 patients (74.1%) were either ≥ T2 and/or node-positive at diagnosis as in the inclusion criteria of ExteNET. Of these, only 31 (13.3%) were prescribed adjuvant N within 2 months of completing adjuvant T. 81 (34.6%) received adjuvant pertuzumab (P) in addition to T. Of those who received N, 78.8% were ≥ T2 and 78.8% were node-positive. The average age of those receiving N was 49.3 versus 54.9 years in those not receiving N. Hormone receptor (HR)-positive disease was noted in 72.7% of those receiving N and 68.6% in those who did not (P = 0.624). The vast majority (97.0%) of patients were prescribed diarrheal prophylaxis with N. Patients receiving adjuvant N were less likely to have had a pathologic complete response (pCR) following neoadjuvant chemotherapy than those who did not receive N (23.1% versus 51.0%, P = 0.008). Of those who received N, 18 (54.5%) were treated at an academic hospital, where 34.2% of the total studied patient population was treated. Conclusions: The use of adjuvant N in patients with ≥ T2 or node-positive HER2-positive breast cancer in our patient population was low. Patients who did receive adjuvant N were more likely to have residual disease following adjuvant chemotherapy and be treated at an academic hospital. Despite the greater benefit of adjuvant N in HR-positive HER2-positive breast cancer in ExteNET, HR status did not correlate with the use of adjuvant N in our study. Trials assessing the additional benefit of adjuvant N in patients receiving adjuvant P or trastuzumab emtansine will likely be required prior to widespread use of adjuvant N.
妊娠期阴道炎的治疗
Authors: 李娟清, 石一复
Journal: BMJ (2006)

妊娠期阴道炎除表现为外阴阴道不适外,还可引起绒毛膜羊膜炎、胎膜早破、早产、低体重儿、产褥感染、母婴垂直传播等一系列母儿并发症,故应重视其诊断,及时予以治疗. 一、妊娠合并外阴阴道假丝酵母菌病 假丝酵母菌(念珠菌)属胃肠道和女性下生殖道的正常共栖菌,白色念珠菌是大多数念珠菌感染的致病菌,在妊娠期妇女中检出率约为10%,其中白色念珠菌占68.2%～83.0%,大约比非孕妇多30%,该趋势在孕36周以后更加明显.其次为光滑、平滑、克柔、热带念珠菌等.同一宿主的相同或不同部位可以感染多种念珠菌或存在同一菌属的多种不同基因型,这一现象说明女性念珠菌感染是一个动态的过程.有报道妊娠末期25%～30%的孕妇可在阴道分泌物中找到白色念珠菌,其中70%～85%可传染给新生儿。
Implementation science of district cancer care delivery model (Pendharkar model).
Authors: Dinesh Pendharkar, Chandramauli Tripathi
Journal: Journal of Clinical Oncology (2020)

e19024 Background: Health care systems are fighting with issues related to multiple elements of access to care. The problems include non availability of physical facilities and qualified human resource. Here we report successful intervention results of a scalable, replicable, cancer care model starting with two and expanding to nearly 198 districts, using standard processes. This has brought specialised cancer care to government run general district hospitals using existing human resource, through empowerment of alternate oncology workforce, capacity building, decentralisation, and task sharing with impactful outcome. Methods: Government run general district hospitals were involved to train one physician and nurse in principles of oncology care over one month period, followed by constant 24 x7 support and continued training etc. (techno-mentoring). Administrative changes enabled creation of identity of nodal cancer units and organised process of cancer drug delivery. Results: The implementation process was experimented in two hospitals and later on extended to nearly 198 hospitals, over a period of six years (Table). Majority of states have formulated the innovation as state run district cancer care program with published operational guidelines. The state governments designated physicians as nodal cancer officers and created their identity with physical allocation of space and providing cancer drug formulary. The physicians are assisting cancer patients from diagnosis up to end of life care including chemotherapy, palliative care. More then 45000 patients have availed services. Few thousand chemotherapy sessions have been performed by alternate oncology workforce. Drug availability is maintained through routine government supplies by adding anticancer drugs to list of essential medicines. Satisfaction survey conducted amongst patients, has proved its usefulness, acceptability. Conclusions: Impactful implementation at scale is feasible for cancer care delivery, using existing physical infrastructure and empowerment of alternate oncology workforce, through this model. It can ideally serve areas with no access to cancer care, including LMIC. [Table: see text]
Moxifloxacin-based triple therapy combined with rebamipide for Helicobacter pylori eradication in type 2 diabetic patients
Authors: Yan-guang Xu, Yue Guan, Xin-li Wang, Da Pan, Yun Xie, Shao-zhen Wang
Journal: BMJ (2012)

Objective To evaluate the efficacy of moxifloxacin-based triple therapy combined with rebamipide for Helicobacter pylori (Hp) eradication in type 2 diabetic patients.Methods Two-hundred age and sex matched type 2 diabetic patients with Hp infection and accompanied by gastrointestinal symptoms were assigned into rebamipide group (n =100) and placebo group (n =100).Both groups received moxifloxacin-based triple therapy for 10 d to eradicate Hp.Rebamipide was administrated in rebamipide group and placebo was administrated in placebo group for 30 d.All patients proceeded 14C-urea breath test (14C-UBT) hefore and 7-8 weeks after eradication therapy.The blood sugar indices,gastrointestinal symptom scores and Hp eradication rates were measured and compared.Those who had gained successful Hp eradication in both groups proceeded 14 C-UBT again 12 months after eradication therapy,and the re-infection rates of both groups were compared.Results There were no significant differences in the average fasting glucose,postprandial glucose and HbAlc levels between the rebamipide group and the placebo group before and after therapy (P ＞ 0.05),the gastrointestinal symptoms of the rebamipide group were improved more markedly than those of the placebo group after therapy (Rome Ⅲ Criteria,2.1 ± 0.9 vs.4.4 ± 0.7,P ＜ 0.01).The Hp eradication rate with both intention-to-treat (ITT) and per protocol (PP) analysis of the rebamipide group were higher than that of the placebo group [86.0％ (86/100) vs.73.0％ (73/100),P ＜ 0.05 and 92.5％ (86/93) vs.76.8％ (73/95),P ＜ 0.01].The re-infection rates with both ITT and PP analysis of those who had successful eradication in rebamipide group were lower than that in placebo group [19.8％ (17/86) vs.35.6％ (26/73),P＜0.05and20.5％ (17/83) vs.36.6％ (26/71),P＜0.05].Conclusions Moxifloxacin-based triple therapy combined with rebamipide has a more beneficial effect on Hp related symptoms,a higher Hp eradication rate and a lower Hp re-infection rate for type 2 diabetic patients.

Key words: 
Diabetes mellitus, type 2;  Helicobacter pylori;  Therapy
LAG-3 overexpression in pediatric Hodgkin lymphoma.
Authors: Scott Moerdler, Michelle Ewart, Mou Peng, Xingxing Zang, Peter D. Cole
Journal: Journal of Clinical Oncology (2020)

10531 Background: The role of the PD-1/PD-L1 axis in Hodgkin Lymphoma (HL) has led to FDA approval for use of inhibitors in chemotherapy-refractory HL. Numerous additional immune checkpoints may be useful targets, but have not yet been evaluated in HL. LAG-3, a related checkpoint, has been demonstrated to be overexpressed on tumor infiltrating lymphocytes (TILs) of a variety of cancers with associated poor outcomes. LAG-3 is known to inhibit T cell proliferation and activation, representing a possible therapeutic pathway for anti-tumor immunity. However, LAG-3 has yet to be evaluated in pediatric cancers. The purpose of this study is to characterize the expression pattern and clinical significance of LAG-3 in pediatric HL using immunohistochemistry. Methods: Patient tumor samples from prior Children’s Oncology Group clinical trials (AHOD0031) with matched patient outcome data containing 200 patient samples were obtained. 95% confidence intervals were calculated based on a range of observed prevalence of immune checkpoint expression. Using immunohistochemistry, paraffin embedded samples were tested for the expression of LAG-3 and PD-L1. Samples were stained for CD30 to better delineate Reed Sternberg cells from the remainder of the tumor microenvironment. Immune checkpoint staining was compared to positive controls of normal tonsil tissue, and negative controls of 3T3 cells. Expression intensity was scored by a Pediatric Pathologist. Results: 115 unique HL patient cases with evaluable HL tissue and correlating clinical outcome data were analyzed. Samples from 73/115 patients (63%) demonstrated positive LAG-3 staining, defined as over 10% of TILs expressing LAG-3. No demographic data including gender, race/ethnicity, age, or stage were significantly associated with LAG-3 expression. While not statistically significant there was a numerical difference in event free survival (EFS) and patients with LAG-3 expression demonstrated worse EFS. In terms of degree of LAG-3 expression, patients with the lowest positive expression were found to have the worst EFS, and those with highest expression demonstrated the best EFS. 97% of patient cases were found to be PD-L1 positive. 71/73 (97%) of patients who expressed LAG3 were also PDL1+, and 71/106 (67%) of PDL1+ cases were also LAG3+. LAG-3 and PD-L1 were found to be independent (p = 0.09). Conclusions: This project is innovative in its characterization of LAG-3 as an immune checkpoint target in pediatric HL. We hope that the information from this project will be used to support new clinical trials for pediatric patients with Hodgkin lymphoma.
Incorrect Spelling of Author’s Name
Authors: Kazumitsu Sugiura, Masaaki Teranishi, Yoshinari Matsumoto, Masashi Akiyama
Journal: JAMA Dermatology (2013)

Kazumitsu Sugiura, MD, PhD; Masaaki Teranishi, MD, PhD; Yoshinari Matsumoto, MD, PhD; Masashi Akiyama, MD, PhD
Case analysis of inappropriate prescription in elderly patients
Authors: Ping Zeng, Xuelian Yan, Xiaohong Liu
Journal: BMJ (2018)

老年人群用药数量多，不合理用药常见，可引起药物不良反应等严重后果。老年患者潜在不合理用药的Beers标准(Beers Criteria)是常用的药物核查工具，在识别潜在不合理用药问题、降低不合理用药引起的相关问题和治疗费用等方面发挥了积极作用。针对不合理用药的现状，采用Beers标准，分心血管系统、中枢神经系统、内分泌代谢系统、消化系统对一些常见的临床不合理用药情况结合病例进行分析，以期为临床提供合理用药参考。
Examining perceptions of financial toxicity among cancer patients: The Financial Toxicity 16 Questionnaire.
Authors: Roberto Bordonaro, Fabrizio Castagna, Dario Piazza, Stefano Sergio Cordio, Concetta Sergi, Giuseppina Emanuela Fassari, Concetta Martines, Oriana Commendatore, Daniela Sambataro, Luigia Carapezza, Marco Mattina, Alessia Erika Russo, Vittorio Gebbia
Journal: Journal of Clinical Oncology (2020)

e19389 Background: Financial toxicity (FT) among cancer patients (CP) is multifactorial, arising from both disease-related and non- disease related factors, including socio-cultural, environmental, and psychological attributes. It derives both from costs related to assistance and borne on the patients and its caregivers, and reduction of income capacity also in this case borne on the patients and on the caregivers. Stress levels may escalate to significant proportions in some patient, to present with symptoms of anxiety especially during therapy administration periods. Methods: In order to highlight financial toxicity related to the diagnosis of metastatic pancreatic and lung cancer and to measure its evolution over time and any correlation with the prognosis, we developed a questionnaire called FT16 and we conducted a validation study on a sample of 31 patients. The design of the study involved the development and the psychometric assessment of a scale to measure the perceived sources of FT among CP. Following extensive literature review, a table of specification with the initial items was created to guide item construction for developing the scale. The items related to these FT were converted into an 16-item, multipoint questionnaire, resulting in the FT16. We also monitored quality of life of the patients, using the QlQ C-30 questionnaire, in the aim to capture correlation between FT onset and quality of life deterioration; clinical characteristics of the patients, response to therapy and outcome parameters also have been recorded in the aim to evaluate eventual correlation with FT. Results: The questionnaire was administered to 31 adult patients with lung and pancreatic metastatic cancer, both men and women, who were newly diagnosed and will undergo cancer treatment. Each of them has been informed about the research and written informed consent has been obtained. The internal consistency reliability (Cronbach’s alpha) was 0.77 for the 16 items of the FT16. Analyses of variance (ANOVAs) indicated that there were no significant differences in the mean FT16 score, between sexes, and age groups in the severity score. Conclusions: FT16 questionnaire seems to be an useful tool to capture FT onset in this poor-prognosis subset of patients; the analysis of the data recorded will continue to assess the capability of the FT16 to capture correlations with clinical characteristics at diagnosis and correlations with the prognosis.
Giant coronary aneurysm presenting as a cardiac mass on transthoracic echocardiogram.
Authors: Vivek Mutha, Muhammad Asrar ul Haq, Nagesh S Anavekar, Peter Barlis
Journal: BMJ (2014)

A 69-year-old man with a history of ischaemic heart disease and previous stent implantation in the right coronary artery (RCA) was found to have a large well-encapsulated mass attached to the right atrium on a routine transthoracic echocardiogram. Subsequent investigations including transoesophageal echocardiography and CT coronary angiogram suggested an RCA aneurysm formation in relation to the prior stented segment, further confirming on coronary angiogram a large ectatic vessel with a giant aneurysm measuring 2.4×2.7 cm. Giant coronary artery aneurysms are rare and here we present interesting images of a case initially picked up on transthoracic echocardiography.
Clinical characteristics, treatment modalities, and oncological outcomes in patients with gastrointestinal stromal tumors in Mexico.
Authors: Luis Guillermo Anaya Sanchez, Pamela Denisse Soberanis Piña, Mónica Isabel Meneses Medina, Alberto Cedro-Tanda, Vanessa Rosas Camargo, Fidel David Huitzil Melendez
Journal: Journal of Clinical Oncology (2020)

e23514 Background: In Mexico there is scarce information regarding treatment and outcomes of patients with gastrointestinal stromal tumors (GIST). Access to medical therapy in a country with limited resources may impact survival. We aim to report clinical characteristics, treatment modalities, and oncological outcomes in patients with GIST treated at our institution. Methods: Single-center retrospective review of patients with histologically confirmed diagnosis of GIST evaluated between Jan 2005 to Dec 2018. Overall survival (OS) was estimated by Kaplan-Meier curves and compared with log-rank rest. A p value &lt; 0.05 was significant. Results: 90 cases were included with a median age of 57 years, 61% were women. Most common symptoms were gastrointestinal bleeding (68%), abdominal pain (58%) and anemic syndrome (54%). Primary tumor location was stomach (51%), small intestine (43%) and other locations (6%). 89% (n 80) were localized and 11% (n 10) metastatic. For localized tumors, Fletcher risk stratification was used to predict prognosis. We found 44% low, 29% intermediate and 27% high-risk. Treatment for localized patients was: initial surgery (95%, n76), neoadjuvant imatinib (5%, n4). Adjuvant imatinib was given to only 69% of patients that required it (31 of 45 patients with intermediate or high-risk), 12.5% (n12) of patients with localized disease had recurrence (2 of them did not receive adjuvant treatment). In the advanced seating (n10), most common site of metastasis was liver 70%. Initial treatment was surgery in 6 patients. Only 5 patients received imatinib (50% of those who required it). Only one patient had second line sunitinib. None had access to regorafenib, none had a molecular analysis performed. Survival outcomes are shown in table. Conclusions: Patients with localized GIST treated at our institution have good oncological outcomes and similar to those reported by other series. On the other hand, patients with advanced disease have inferior outcomes compared to those reported by other series possibly related to limited access to treatment. [Table: see text]