tbuckley/cabot-search huggingface dataset:
Clinical features of dyslipidemia in patients with primary biliary cholangitis
Authors: Tihong Shao, Ran Tian, Jinlei Sun, Shuo Zhang, Yihan Cao, Zhilei Chen, Li Wang
Journal: BMJ (2018)

Objective
To analyze the clinical features of dyslipidemia in patients with primary biliary cholangitis (PBC).


Methods
The clinical and laboratory data of 136 PBC patients in Peking Union Medical College Hospital from 2010 to 2016 were retrospectively analyzed.The liver function was compared between patients with normal and abnormal blood lipids.


Results
Among 136 PBC patients, 100(74%)had abnormal serum lipids. The incidence of increased cholesterol, low-density lipoprotein and triglyceride was 61%(59/96), 58%(48/83) and 47%(46/97), respectively; while that of reduced HDL-C was 26%(21/82). The incidences of pruritus [26%(26/100) vs. 8%(3/36), χ2=4.93, P=0.032], serum total bilirubin (TBIL) [17.3(12.2, 28.2) μmol/L vs. 14.5 (9.4, 21.1) μmol/L, Z=2.25, P=0.024], direct bilirubin (DBIL)[5. 5 (3.4, 12.4) μmol/L vs. 4.4(2.9, 7.1) μmol/L, Z=2.00, P=0.045], and glutamyl aminotransferase (GGT)[193.0(64.3, 454.8)U/L vs. 105.5(53.5, 179.5)U/L, Z=2.02, P=0.043], alkaline phosphatase(ALP)[183(86, 351)U/L vs. 135(85, 188) U/L, Z=1.98, P=0.048] in PBC patients with dyslipidemia were significantly higher than thosein patients with normal serum lipids.Pearson regression analysis showed that in PBC patients with dyslipidemia, the ALT was positively corrected with TG and TC(r=0.248 and 0.272, P=0.015 and 0.008); ALB was positively correlated with LDL-C(r=0.335, P=0.002); DBIL was positively corrected with HDL-C(r=0.252, P=0.022); TC was positively correlated with ALP and GGT(r=0.313 and 0.346, P=0.002 and 0.001); GGT was positively correlated with LDL-C(r=0.251, P=0.022).


Conslusion
Increased TC and LDL-C were more common in PBC patients. PBC patients with dyslipidemia have more severe liver damage than the patients with normal serum lipids.


Key words: 
Cholangitis; Liver cirrhosis, biliary; Dyslipidemia; Hyperlipidemia
Real-world outcomes of patients with metastatic breast cancer (BC) treated with osteoclast inhibitors (OIs).
Authors: Yasmin Karimi, Natasha Purington, Mina Liu, Allison W. Kurian, George W. Sledge, Douglas W. Blayney
Journal: Journal of Clinical Oncology (2020)

e19314 Background: Patients with metastatic BC have a high incidence of bone metastasis with associated morbidity and mortality. OIs including denosumab and zoledronic acid reduce the rate of skeletal-related events (SREs). Since denosumab was approved in 2011, there have been no analyses about the comparative effectiveness and safety of denosumab versus zoledronic acid. Methods: Patients with BC treated with three or more doses of either denosumab or zoledronic acid after 2011 were identified in Stanford’s BC research database, Oncoshare. SREs were defined as a composite measure of spinal cord compression, pathologic fracture, surgery or radiation to bone. Unadjusted Cox proportional hazard models were fit to time to: first SRE, subsequent SRE, overall survival (OS) and BC-specific survival. Results: 515 patients were identified: 388 and 127 treated with denosumab and zoledronic acid per oncologist’s discretion, respectively. Groups were well balanced for age at diagnosis, race/ethnicity, tumor grade, prior chemotherapy use and median time from first OI therapy to last follow-up. More patients with triple-negative BC (TNBC) received zoledronic acid. Median follow-up time from first OI dose was 28 months. 42% of patients experienced at least one SRE and there were no differences in incidence of first or subsequent SREs between groups (Table). Median OS was 91 months with no statistically significant difference between groups. Median BC-specific survival was not reached (78% of patients survived), however, patients in the zoledronic acid group had over twice the risk of BC-specific mortality, a difference that remained significant after adjustment for TNBC status. There was no difference in adverse events including osteonecrosis of the jaw, vertebral fracture or hypocalcemia. Conclusions: In a contemporary, real-world care setting, we observed no difference in the incidence of SREs or OS between metastatic BC patients treated with denosumab or zoledronic acid. [Table: see text]
Association between obesity and the clinical stage of newly diagnosed breast cancer: Experience with 2212 patients.
Authors: Bader I Alshamsan, Kausar Suleman, Naela Agha, Marwa Ismail Abdelgawad, Mashari J Alzahrani, Taher Al-Tweigeri, Dahish Saed Ajarim, Tusneem Elhassan, Adher Alsayed
Journal: Journal of Clinical Oncology (2020)

e12602 Background: Excess weight is currently recognized as a risk factor for several cancer types, including breast cancer. The primary goal of this study was to evaluate the impact of overweight and obesity in newly diagnosed breast cancer patients at the time of presentation. Methods: A retrospective analysis of breast cancer from a prospective database of all newly diagnosed non-metastatic breast cancer patients seen at King Faisal Specialist Hospital and Research Center between 2002 and 2014 was performed. The clinical stages were divided into early stage breast cancer and locally advanced breast cancer. The body mass index (BMI) groups were underweight, normal, overweight, and obese based on the World Health Organization classifications of BMI. The patient characteristics are presented as medians with interquartile ranges (IQRs) and frequencies for continuous and categorical variables, respectively. The association between BMI groups and clinical stage at presentation was evaluated using the logistic regression model. Survival probabilities were calculated using the Kaplan-Meier estimator. Results: In total, 2212 patients were eligible for the study. The median age at diagnosis was 45 (IQR = 39-52) years; 62% patients were pre-menopausal, and 31% were post-menopausal. The median BMI was 30 (IQR = 26-34) kg/m 2 . In this population, 53% patients were obese; 31%, overweight; and 14.7%, in the normal range at diagnosis. Regression analysis revealed a significant association between clinical stage and BMI at the time of presentation (p = 0.006). Obese patients showed a 40% higher chance of having locally advanced presentation than the normal BMI group (OR = 1.41, 95% confidence interval = 1.06-1.86, p = 0.02). However, overweight had no significant association with clinical stage (OR = 1.03, 95% confidence interval = 0.76-1.8). The median follow-up duration was 39 (IQR = 22-66.6) months. Overall survival showed no significant association with different BMI groups and breast cancer subtypes. Conclusions: The prevalence of overweight and obesity was found to be high (85%) in newly diagnosed breast cancer patients in Saudi Arabia. Obesity is associated with a more advanced clinical stage at the time of diagnosis of breast cancer and may be a contributing factor for more locally advanced presentations in the region.
Referral-to-treatment attrition and its impact on outcomes of patients with advanced gastroesophageal cancers.
Authors: Jenny Peng, Atul Batra, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2020)

e16504 Background: Advanced gastroesophageal cancers (AGCs) are aggressive tumors. Prior research has demonstrated that patients with poor prognostic cancers are inconsistently or infrequently referred to oncology specialists because of misperceptions that oncologic treatments are futile and do not alter overall outcomes. The aim of this real-world study was to characterize the attrition of patients with AGCs as they proceed through the diagnostic-therapeutic pathway and to assess its impact on survival. Methods: A retrospective population-based analysis was performed using data from the cancer registry and electronic medical records in a large province (Alberta, Canada). Patients diagnosed with AGCs from 2010 to 2017 were included. Details on demographics, setting of referral (outpatient or inpatient), time from referral to consultation to treatment, and modality of treatment (best supportive care, systemic therapy, and/or radiation) were collected. Logistic regression was used to determine factors associated with referral. Cox regression models were constructed to determine factors associated with overall survival (OS). Results: We identified 1,244 patients, of whom 633 (51%) had gastric and 611 (49%) had esophageal cancer. Median age was 67 years (IQR 58-78 years) and 72% were men. In this cohort, 87% were referred to a cancer center, 80% were seen by an oncologist, and only 44% received first-line treatment. Median time from referral to consultation was 13 days and consultation to treatment was 12 days. In logistic regression, advanced age (OR 0.274; 95% CI 0.183-0.412, p&lt;0.0001) and those with a gastric primary (OR 0.437; 95% CI 0.303-0.628, p&lt;0.0001) were less likely to be referred. In Cox regression, receipt of chemotherapy (HR 0.79; 95% CI 0.76-0.83, p&lt;0.0001) and shorter time from consultation to treatment (HR 0.994; 95% CI 0.991-0.997, p&lt;0.0001) were predictive of better OS. The setting of referral (inpatient vs. outpatient) was not significantly associated with OS (HR 1.11; 95% CI 0.85-1.45, p=0.414). Conclusions: Attrition was most significant as patients proceeded from consultation to treatment. Streamlining processes to narrow the consultation to treatment window may increase the number of patients with AGCs who may be eligible for potentially effective therapies or new clinical trials, which can improve their overall outcomes.
Safety of immunotherapy in Peruvian patients with diverse type of malignancies: Experience at a private center.
Authors: Alfredo Aguilar, Michelle Mariñas, Leny Bravo, Jenny Zavaleta, Joseph Pinto, Rossana Ruiz, Luis Schwarz
Journal: Journal of Clinical Oncology (2020)

e19258 Background: Immunotherapy has changed the landscape of cancer treatment. The aim of this work was to describe the adverse events related to immunotherapy treatment in diverse type of malignant tumors using real-world data. Methods: This is a retrospective review of patients with diverse type of advanced malignancies treated with immunotherapy at Oncosalud-AUNA (Lima-Peru) during the period 2016-2018. We present a descriptive analysis of the clinicopathological and treatment features of the patients, as well as data of safety of immunotherapeutic agents. Results: In total, 37 patients were included in the study. The median age was 67 years (38 to 84 years); 64.9% of patients were male; 54.1% were smoker/former smoker and 45.9% non-smokers. Regarding to the primary tumor, 75.7% were lung cancers (82.1%, adenocarcinomas and 17.9%, squamous cell carcinomas), 16.2% were melanomas, 5.4, head and neck cancers and 2.7%, were bladder cancers. Central nervous system metastases were present in 29.7% of patients. Immunotherapy was given after a first line in 43.2% of cases, 40.5% after the second line and 16.2%, after the third line of treatment. The types of immunotherapy were prembrolizumab in 54.1%, nivolumab in 40.5%, atezolizumab in 2.7% and avelumab in 2.7%. 27% of cases had combination of immuno with chemotherapy. Finally, regarding to adverse events, 94.6% had any adverse event; 48.6% fatigue and asthenia; 35.1%, nausea; 32.4, pruritus/rash; 27.7%, decreased appetite; 18.9%, hypo/hyperthyroidism; 13.5%, diarrhea/colitis; 10.8%, pneumonitis and 5.4%, infusion-related reactions. Conclusions: During the study period we had a slightly higher incidence of adverse events than reported by other works. It could be probably due to the age of patients and several prior lines of treatment.
综合医院与社区卫生服务机构合作模式设计方案研究构想
Authors: 沙悦, 黄晓明, 陈嘉林, 方卫纲, 黄程锦, 王玉, 朱卫国, 曾学军
Journal: BMJ (2010)

高效的医疗服务系统应该建立在社区卫生服务机构与综合医院合作的基础上,这是全世界各国卫生事业发展的共同经验.我国国务院 中明确提出,协调推进社区卫生服务发展,建立分级医疗和双向转诊制度等是重点内容之一。
Evaluation of community rehabilitation program for stroke patients
Authors: Jie Xu, Yi Wu, Ying-qi Gao, Feng Zhang
Journal: BMJ (2011)

One hundred and twenty stroke patients were randomly divided into rehabilitation group (n =60) and control group (n =60).Patients were assessed with National Institute of Health Stroke Scale (NIHSS) ,Fugl-Meyer Assessment (FMA),Bathel Index (BI) and World Health Organization Quality of Life Assessment Instrument Brief Version(WHOQOL-BREF) before and 6 weeks after treatment by the same doctor.The scores of NIHSS,FMA,BI and WHOQOL-BREF were improved significantly in rehabilitation group after treatment; while those of control group were no improved.The scores after treatment of rehabilitation group were significantly higher than those of control group ( P ＜ 0.05 ).

Key words: 
Cerebrovascular accident; Rehabililation
Liquid biopsies to enable non-invasive real-time functional chemoresistance profiling in solid organ cancers.
Authors: Dadasaheb B Akolkar, Timothy Crook, Raymond Page, Darshana Patil, Sewanti Limaye, Vineet Datta, Stefan Schuster, Cynthe Sims, Sanket Patil, Sachin Apurwa, Vishakha Mhase, Sushant Pawar, Ashok Gawai, Harshal Bodke, Ajay Srinivasan, Rajan Datar
Journal: Journal of Clinical Oncology (2020)

3525 Background: Despite the development of targeted therapy agents and immune checkpoint inhibitors (ICI), cytotoxic anticancer agents remain the mainstay of treatment in several solid organ cancers. However, instances of innate and acquired resistance towards these anticancer agents can lead to treatment failures, which remain undetectable until clinical or radiological manifestation of symptoms suggestive of disease progression. There are presently no viable means or markers to detect or monitor for chemoresistance in real time. Owing to this unmet need, cancer treatment strategies face risks of failure and poor outcomes. Methods: We obtained 15 mL blood from 3,662 patients with various solid organ cancers, of various states and including treatment-naïve and pretreated patients. Circulating Tumor Associated Cells (C-TACs) were enriched and harvested from PBMCs using an epigenetically activating medium that is cytotoxic towards non-malignant epithelial and hematolymphoid cells in blood, but confers survival benefit on apoptosis resistant cells of tumorigenic origin (Circulating Tumor Associated Cells, C-TACs). In a subset of patients, fresh tumor tissue was also obtained from which viable tumor derived cells (TDCs) were obtained. Viable TDCs and C-TACs were treated with a panel of anticancer agents and the surviving cell fraction estimated to determine chemoresistance. Results: Among the 1,325 therapy naïve patients, resistance towards treatment agents was observed in C-TACs from 56.3 % of samples. Among 2,201 pretreated patients’ samples, resistance towards treatment agents was observed in C-TACs from 77.8% of samples. The increased resistance in C-TACs from pretreated patients indicated that the C-TACs had been resistance-educated by prior therapies. In a subset of patients, Chemoresistance profile of C-TACs was observed to be 96.9% concordant with that of tumor derived cells (TDCs) which were concurrently obtained from tumor tissue indicating that C-TACs accurately represent chemo-antecedents of the tumor. Conclusions: Non-invasive chemoresistance profiling of C-TACs is a viable strategy to monitor treatment efficacy in real time. Adoption of this strategy in the clinic will not only guide treatment selection with reduced risk of failure, but will also enable timely therapeutic course correction upon detection of acquired chemoresistance.
Clinical effect of intracuronary infusion of autologous bone marrow-derived stem cells transplantation in patients with acute myocardial infarction: a recta-analysis
Authors: Yi-gang Qiu, Jing Li, Yu-xing Fei
Journal: BMJ (2011)

Full text of literatures on randomized clinical trials (RCTs) of intracoronary infusion of autologous bone marrow-derived stem cells (BMSCs) transplantation in patients with acute myocardial infarction (AMI) published at home and abroad were systematically retrieved and reviewed from PubMed database and the China Full Text Journal database to assess its efficacy and safety. Fifteen RCTs were included in a recta-analysis with RevMan version 5. 0 software after strict and standard screening. Results showed that global left ventricular ejection fraction (LVEF) in the patients with BMSCs transplantation improved significantly ( P < 0. 01 ), but no obvious change in their left ventricular end-diastolic volume (LVESV) was observed. Occurrence of end-stage cardiovascular events also decreases significantly ( OR =0. 51, 95% CI =0. 36-0. 72) in patients with AMI.

Key words: 
Myocardial infarction;  Stem cell transplantation
Analysis of the efficacy of CIK therapy in adjuvant treatment of colorectal cancer.
Authors: Rui Guo, Haiyan Piao, Gang Shi, Guirong Zhang, Rui Zhang
Journal: Journal of Clinical Oncology (2020)

e15022 Background: In the past decade, cell-based immunotherapy has been reported to improve the clinical outcomes by altering tumor immune responses, improving prognosis and overall survival rates in cancer patients.This retrospective study aimed to evaluate the efficacy of cytokine-induced killer (CIK) cell infusion as an adjuvant therapy in patients with colorectal cancer. Methods: A total of 370 patients with colorectal cancer admitted to Cancer Hospital of China Medical University, Liaoning Cancer Hospital &amp; Insititute from March 2013 to April 2015 were retrospectively analyzed.All patients were treated with surgery for primary lesions, and then adjuvant chemotherapy was determined according to the guidelines. Among these patients, 201 patients received CIK therapy (CIK group),while the other 169 patients who had similar demographic and clinical characteristics did not receive a CIK cell infusion therapy (non-CIK group). Then we followed up these patients. Data were analyzed by Kaplan-Meier. Results: Our results showed that the 1,3,5-year overall survival (OS) rate for the CIK group versus the non-CIK group was 98.46 versus 93.61%, 85.4 versus 71.61%, 79.39 versus 67.9%, respectively. The OS was significantly longer in CIK group than in non-CIK group (P = 0.009). Meanwell, the OS of stage II and III colorectal cancer was significant in CIK group than in non-CIK group (P = 0.02 and 0.02). But the OS was not significant in Stage I and IV colorectal cancer (P = 0.347 and 0.285). We analyzed the patients between chemotherapy plus CIK therapy group and chemotherapy only group. We find that the OS has significant difference in two groups (P &lt; 0.001). Conclusions: CIK therapy can improve the efficacy of adjuvant therapy in patients with colorectal cancer. But multicenter, large-sample randomized controlled trials are still needed to confirm it.
Comparison of efficacy and quality of life in type 2 diabetics treated with controlled-release-gliclazide and ordinary gliclazide tablets
Authors: 余丹菁, 姚君厘, 殳雪怡, 吴丹, 姜林娣, 高鑫
Journal: BMJ (2006)

目的 对Ⅱ期随机对照临床试验中应用格列齐特控释片和格列齐特普通片治疗2型糖尿病的临床疗效和生存质量进行比较.方法48例符合入组标准的2型糖尿病患者随机分为两组各24例,A组予格列齐特控释片(30 mg)2片早餐前服用,安慰剂2片晚餐前服用;B组予格列齐特普通片(80 mg)和安慰剂各1片,每日2次(早餐前和晚餐前)服用.共治疗12周.所有患者均测定相关临床指标,并完成糖尿病患者生存质量特异性量表和简明健康状况调查表(SF36).结果两组患者的空腹及餐后2 h静脉血糖和糖化血红蛋白均较治疗前显著降低(P＜0.01),C肽水平明显升高(P＜0.01),所有临床参数和生存质量参数组间比较差异均无统计学意义.两组患者SF36评分中躯体疼痛和社会功能治疗后均较治疗前显著改善(P＜0.01).A组和B组不良反应发生率分别为20.8%和8.3%,差异有统计学意义(P＜0.05),均为轻度.结论格列齐特控释片治疗2型糖尿病的临床疗效和对生存质量的影响与格列齐特普通片相似。
Prevention and management of skin burn in endoscopic thyroidectomy via upper anterior thoracic approach
Authors: Haibo Chen
Journal: BMJ (2018)

Total 268 patients underwent endoscopic thyroidectomy via upper anterior thoracic approach in Wenling First People′s Hospital from June 2005 to July 2015, and skin burn occurred in 21 cases (7.8%). The causes of skin burns were shallower level of built space in 9 cases (43%), mismanagement for skin bleeding in 11 cases (52%), and improper separation of sternocleidomastoid region in 1 case (5%). After management 12 cases of subcutaneous ecchymosis or blisters (57%) were healed without pigmentation, 3 cases of skin necrosis (14%) were healed with scars, 4 cases of burned skin rupture treated with intradermal suture (19%) were healed by first intension and with minor scars, 2 cases of burned skin rupture treated with catheter drainage (10%) were healed with obvious scars. The results show that correct level of puncture and proper management of skin bleeding can prevent skin burn, and proper treatments of skin burn can reduce the skin scars.


Key words: 
Endoscope; Thyroidectomy; Burn, electric; Skin
以家庭为中心治疗和护理在小儿肾病综合征治疗中的应用
Authors: 付作昌, 朱国栋
Journal: BMJ (2007)

作者从1995年开始运用中西医结合疗法在家庭中治疗小儿肾病综合征(nephrotic syndrome,NS),并对48例NS患儿家庭治疗和护理实施者进行护理指导,取得了较满意的疗效。
Multiple myeloma (MM) therapy within a Medicare insured patient population: Role of initial care setting and socioeconomic status.
Authors: Amy J. Davidoff, Jessica B. Long, Jan Philipp Bewersdorf, Rory Shallis, Amer Methqal Zeidan, Nikolai Alexandrovich Podoltsev, Rong Wang, Steven Gore, Smith Giri, Natalia Neparidze, Scott F. Huntington
Journal: Journal of Clinical Oncology (2020)

e19057 Background: Approval of MM therapies including immunomodulatory agents (IMiDs), and proteasome inhibitors (PIs), coupled with increasing evidence supporting PI-IMiD combinations, maintenance (MT), and autologous stem cell transplant (ASCT) among fit patients, have expanded options, complexity and duration of active therapy. Prior research reported race disparities in initial therapy receipt and survival differences based on provider characteristics. It is unknown whether these effects extend to longer-term management. Methods: We selected adults with MM diagnosis (dx) between 07/07-12/15 from the SEER-Medicare linked database. We required continuous Medicare Parts A, B, and D enrollment and no HMO/PPO coverage from 12 months prior to dx through death or end of study (12/16) and MM therapy initiation w/in 12 months post dx. Outcomes including line of therapy (LOT) 1 PI-IMiD combination, LOT1 length, ASCT, MT, any LOT2, and any LOT4, were constructed using claims indicators for oral and IV drugs and receipt dates. Initial provider setting was assigned as academic &amp;/or NCI cancer center, non-teaching hospital, or community (non-hospital) based on 1 st oncologist E &amp; M visit w/in 2 months pre- or post-MM dx. We also examined race (white, black, other), Hispanic ethnicity, Part D Low Income Subsidy (LIS) receipt and linked area poverty rate. Multivariable logistic and Cox proportional hazard regressions controlled for demographics, health status, and diagnosis year. Results: The cohort (n = 5678) was 51% male, 14% Black, and 51% age ≥75 years. Initial care setting was 50% academic/NCI, 32% non-teaching hospital, and 19% community; 22%, 53%, and 19% received LOT1 PI-IMiD, LOT 2, and LOT 4, respectively. Median LOT1 length was 165 days. Relative to academic/NCI, community care was associated with lower adjusted odds of all outcomes (e.g. LOT2, aOR: .56, 95% confidence interval (CI) .48 -.65, p &lt; .001; LOT4, aOR: .74, 95% CI .58-.95, p = .02) except LOT1 PI-IMiD. Care at non-teaching hospitals was associated with reduced odds of LOT2. Part D LIS was associated with lower odds of LOT1 PI-IMiD, while increasing % poverty was associated with lower odds of LOT1 PI-IMiD combinations, LOT1 ASCT, LOT2 and LOT4. No associations were observed with race or ethnicity and any outcome. Conclusions: In Medicare insured adults treated for MM, initial care in a community setting was associated with shorter and less complex therapy. Socioeconomic status (Part D LIS, area poverty rates), but not race or ethnicity, was a consistent predictor of MM treatment.