tbuckley/cabot-search huggingface dataset:
Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for advanced breast cancer patients with high risk for Hereditary Breast and Ovarian Cancer Syndrome (HBOC).
Authors: Rosane Oliveira Sant'Ana, Isabelle Joyce de Lima Silva-Fernandes, Maria Claudia dos Santos Luciano, Paulo Goberlanio de Barros Silva, Marcos Venício Alves Lima
Journal: Journal of Clinical Oncology (2020)

e13549 Background: Local Advanced Breast Cancer (LABC) is associated with high risk of death. NAC is a safe and effective approach for these populations. pCR is a proven prognostic factor in several studies of NAC. HBOC is associated to high risk of breast cancer usually in young age and especially for BRCA1 mutations with a basal phenotype. The aim of this study was to evaluate the influence of BRCA mutational status on frequence of pCR. Methods: this is part of a retrospective, observational study of prevalence of HBOC among patients admitted for cancer therapy in our institution. Since August, 2018 over 300 pte suspected for HBOC (by NCCN criteria) have been screened for NGS with a 31-gene painel. Statistical analysis performed Person X 2 /Fisher and logistic regression ( p&lt; 0.05; SPSS 20.0). Results: Most pte were women (80%), with median age of 38y (22-72y), most tumors were (80%) stage III, Luminal B (23%) and TNBC (36%). Pathogenic mutations were identified in 34%(n = 28) of the sample ( BRCA1 50%, BRCA2 16.7%, PALB2 16.7%, follow by TP53, PMS2, XRCC2, MUTYH, BARD1 and ATM with 2.8% each).The majority of patients had more than 1 NCCN criteria: age &lt; 45y (83%), family member with BC &lt; 50y (24%) or TNBC (33%) the most common. TNBC tumors had stronger association with germline mutation ( p&lt; 0.001). Regarding response rate there were 13 stable disease (SD), 5 progressive disease (PD), 43 pCR and 39 pathological partial response (pPR). There were no differences in pRC among mutated or no mutated pte, p= 0,170. However, among mutated TNBC there were strong correlation with more pCR, p&lt; 0,006. There was no difference on pCR rate related to mutation status (BRCA vs Non-BRCA), p = 0,84. Conclusions: the present study corroborates other data about the impact of germline mutation status over pCR after NAC for LABC, except for mutated TNBC population, whose seems to be more NAC sensitive.
Interaction between diabetes mellitus and liver disease
Authors: 蔡晓波, 范建高
Journal: BMJ (2007)

1906年肝源性糖尿病的出现第一次将肝病与糖尿病联系了起来.如今,肝病导致糖尿病的观点已经被广泛接受.在现代社会中,随着生活条件的改善及生活方式的西化,糖尿病的患病率不断升高,这可能与肥胖患病率的日益升高有关,因为肥胖与胰岛素抵抗、糖尿病有着明确的关系[1].糖尿病的并发症有冠状动脉疾病、肾脏和视网膜疾病,然而其肝脏并发症的重要性也在逐渐地被认识到。
Incidence and trends of skin cancer in the United States, 1999-2016.
Authors: Hoa Van Le, CHI HUU HONG LE, Phuong HUU UYEN LE, CHI THI LE Truong
Journal: Journal of Clinical Oncology (2020)

10077 Background: Cutaneous skin cancer is among the most common malignancies in US. While Surveillance, Epidemiology and End Results (SEER) data are vital to estimate its incidence, delays and under-reporting remained major limitations. Surveillance is hindered due to exclusion from states’ reportable diseases and possible outpatient diagnoses’ omission from registries. Thus, exact incidence has not been known. This study determined skin cancer incidence and trends from 1999 to 2016 in a nationally representative sample. Methods: New melanoma, non-melanoma and other skin cancer cases among adults aged ≥20 years were identified in the National Health and Nutrition Examination Survey (NHANES), 1999-2016. Crude and age-adjusted incidences and 95% CIs were estimated by survey year cohorts (1999-2008 and 2009-2016) based on the 2000 US standard population. Sex and age-stratified longitudinal trends were examined in age and sex-adjusted regression models. Statistical analyses accounted for complex survey design with examination sample weight and adjusted for nonresponse. Sensitivity analyses included unadjusted, sex- and age- adjusted modeling. Statistical significance was determined by 2-sided p-value of .05. Results: Among 47,172 adults and 21,192 non-Hispanic whites from 1999-2016, the overall age-standardized incidences of skin cancer per 100000 persons were 390.9 (95% CI: 312-469.7) and 519 (95% CI: 413.8-624.3), respectively. The median age at first diagnosis was 72.2 (mean = 69.8, IQR = 57.5-79.5 years). The incidence was higher in men than women (474.7 vs 313.8 per 100000 persons, p&lt; .001) and increased with older age ( p&lt; .001). Between 1999-2008 and 2009-2016, the incidence was significantly higher in those older than 70, 75 and 80 ( p ≤.01). Rising incidence was also observed in overall population, women, and by approximately 90% among those older than 70. Sensitivity analyses showed similar trends. Conclusions: Our incidence rates for skin cancer were high, particularly in the elderly. From 1999 to 2016, the incidence increased in women and those 70 and older, a concerning observation given the aging population. As understanding susceptible groups has public health implications, our study provided an updated depiction of skin cancer incidence and trends in US. [Table: see text]
Prostate cancer relative survival by stage and race/ethnicity, United States, 2001 to 2015.
Authors: David A Siegel, Mary Elizabeth O'Neil, Thomas B Richards, Nicole F Dowling, Hannah K Weir
Journal: Journal of Clinical Oncology (2020)

5509 Background: Prostate cancer is the most common cancer diagnosed and the second leading cause of cancer-related deaths among U.S. men. Incidence rates for distant stage cancer increased during 2010–2014, and survival at all stages was lower for black men than white men. We examined temporal changes in survival by race/ethnicity. Methods: Five-year relative survival (RS) (cancer survival in the absence of other causes of death) was calculated for men with prostate cancer aged ≥40 years using National Program of Cancer Registries data (93% U.S. population coverage). Cancers were diagnosed during 2001–2015 with follow-up through 2015. RS was estimated by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), stage, and year (2001–2007 and 2008–2015). Differences were determined by non-overlapping 95% confidence intervals (CI). Results: During 2001–2015, 2,234,233 cases were recorded. Five-year RS was 100% for localized disease in all race/ethnicities and time periods. Overall, RS improved from 29.0% (95% CI, 28.5–29.5) to 31.3% (30.8–31.9) for distant stage and 83.4% (83.0–83.8) to 84.7% (84.2–85.1) for unknown stage. For regional stage, RS improved for white men (table). For distant stage, RS was highest for black and Hispanic men. For unknown stage, RS was highest for white and Hispanic men. Conclusions: RS improved for regional, distant, and unknown stage, but disparities by race/ethnicity persist. The disparity between black and white men for distant stage reversed compared to past studies. Further investigation of diagnosis patterns and clinical characteristics of men with distant and unknown stage cancer could inform interventions to address disparities in outcomes. [Table: see text]
A fungal pneumonia patient with liver failure effectively treated by voriconazole with plasma drug concentration monitoring
Authors: Xiaoyan Liu, Haibin Su, Jingjing Tong, Jing Chen, Long Xiao, Chongdan Guan, Lilong Yan
Journal: BMJ (2017)

伏立康唑是侵袭性曲霉菌感染时的首选用药。目前在肝衰竭患者的具体用药剂量无统一标准。本文报道1例监测伏立康唑血药浓度变化及调整剂量治疗肝功能衰竭并肺部真菌感染患者的临床资料，提示监测血药浓度情况下应用伏立康唑治疗肝功能衰竭患者是安全的。
Combined structural and perfusion MRI enhanced by machine learning may outperform standalone modalities and radiological expertise in high-grade glioma surveillance: A proof-of-concept study.
Authors: Diana Roettger, Loizos Siakallis, Carole Sudre, Jasmina Panovska-Griffiths, Paul Mulholland, Lewis Thorne, Faiq Shaikh, Sotirios Bisdas
Journal: Journal of Clinical Oncology (2020)

e14528 Background: Treatment monitoring in patients with High-Grade Glioma (HGG) and identification of disease progression, remains a major challenge in clinical neurooncology. We aimed to develop a support vector machine (SVM) classifier utilising combined longitudinal conventional and Dynamic Susceptibility Contrast (DSC) perfusion MRI to classify between Stable Disease (SD), Pseudoprogression (PsP) and Progressive Disease (PD) in glioma patients under surveillance. Methods: Conventional (269) and perfusion (62) MRI studies of HGG patients acquired between 2012 and 2018 were prospectively analysed. Study participants were separated into two groups: Group I with a single DSC time point (64 participants) and Group II with multiple DSC time points (19 participants). The SVM classifier was trained using all available MRI for each group. Classification accuracy was assessed for the use of features extracted from different feature dataset and time point combinations and compared to the experienced radiologists’ predictions. Results: The study included 64 participants (mean age: 48.5 ± 12.8 yrs [standard deviation], 24 female). SVM classification based on combined perfusion and structural features outperformed standalone datasets across all groups. For the clinically relevant classification step (SD/PSP vs PD), both feature combination as well as the addition of multiple DSC time points, improved classification performance (lowest median error rate: 0.016). The SVM algorithm outperformed radiologists in predicting lesion destiny in both groups. Optimal performance was observed in Group II, in which SVM sensitivity/specificity/accuracy was 100/91.67/94.7% for analysis based on the first time point and 85.71/100/ 94.7% based on multiple time points compared to 60/78/68% and 70/90/84.2% for the respective radiologist classifications. In Group I, the SVM also exceeded radiologist predictions, albeit by a smaller margin and resulted in sensitivity/specificity of 86.49/75.00/81.53% (SVM) compared to 75.7/68.9/73.84% (radiologists). Conclusions: Our results indicate that the addition of multiple longitudinal perfusion time points as well as the combination of structural and perfusion features significantly enhance classification outcome in treatment monitoring of HGGs and machine-learning-assisted diagnosis has potentially superior accuracy than the radiologist's visual evaluation and expertise.
Retrospective study of the evaluation and management of febrile neutropenia in cancer patients in a tertiary center.
Authors: Megan Emmich, Prarthna V Bhardwaj, Jackson Clark, Arthi Sridhar, Fatima Ali, Ritika Walia, Alexander Knee, Tara Lagu, Kah Poh Loh
Journal: Journal of Clinical Oncology (2020)

e19100 Background: Febrile neutropenia is a medical emergency often managed by internists, but adherence to guidelines has not been well-described. We aimed to describe care and outcomes of a retrospective cohort of patients hospitalized with febrile neutropenia at a single tertiary care hospital. Methods: We included adults ≥18 years old who had a cancer diagnosis and required hospital admission for a principal diagnosis of fever and neutropenia (ANC &lt; 500) from October 2015 - April 2019. We reviewed records to identify demographics, cancer diagnosis and stage, and outcomes, including death. Results: We included 193 patients; all were cared for by hospitalists. About half (52%) were classified as high risk [ &lt; 21 Multinational Association of Supportive Care in Cancer (MASCC)score], but only 1 patient had a documented MASCC score in hospital progress notes. The majority of patients were female (55%) and white (84%). Twenty-three percent had a stage IV diagnosis. Most (89.1%) patients were within their first chemotherapy cycle, and 23% received GCSF. Approximately half (47%) had solid tumors; the remainder had hematologic malignancies. About one quarter (27%) had positive blood cultures (of these, 43.4 % were gram positive cocci (GPC); 49.1% were gram negative rods (GNR)). Most patients received empiric coverage for GPC and GNR: 82% received cefepime and 42% received empiric MRSA coverage. Few patients had cultures positive for resistant organisms such as MRSA (n = 3) or pseudomonas (n = 4). Hematology/Oncology was consulted for most (82%) cases. Inpatient mortality occurred in 12% of patients. Compared to those who survived, patients who died had lower MASCC score 13.9 (vs. 19.1) and were more likely to receive critical care therapies during hospitalization (70% vs. 14%). Few patients (n = 24, 12%) had documented goals of care (GOC) discussions. Conclusions: Although MASCC is predictive of outcomes, internists caring for patients with fever and neutropenia do not document this score. Hospitalist-focused education efforts about MASCC score could improve care. Few patients had documented GOC discussions. Oncologists should maintain good communication with internal medicine colleagues, who may be hesitant to address GOC in patients receiving chemotherapy.
Bone metastasis as an independent prognostic factor for survival in patients with advanced melanoma treated with immune checkpoint blockade.
Authors: Marcos Rezende Teixeira, Milton Jos De Barros E Silva, Natasha Carvalho Pandolfi, Vinicius Fernando Calsavara, Thiago Bueno Oliveira, Monique Celeste Tavares, José Augusto Rinck, Daniel Garcia, Joao Paulo SN Lima, Joao Duprat
Journal: Journal of Clinical Oncology (2020)

e22045 Background: Immune checkpoint blockade (ICB) has changed the natural history advanced melanoma (AM) with response rates about 40% and overall survival in 5 years of more than 30%. Interestingly, the site of metastasis may have impact on immune response due to the quantity and quality of immune infiltrate as we have seen in patients (pts) with liver metastasis treated with ICB. We have hypothesized that bone metastasis(BM) represents an immune less responsive site of disease Methods: We conducted a retrospective observational analysis of patients with AM treated with ICB at A.C. Camargo Cancer Center (AC) in São Paulo, Brazil. We analyze the impact of BM on progression-free (PFS) and overall survival (OS) using Kaplan Meier method, log-rank test and time-dependent COX regression model. Results: We analyzed 170 pts with AM treated with anti-PD1 (79%) or anti-PD1 + anti-CTLA4 (21%) between September 2013 and December 2019. Fifty-five percent in first-line, 22.4% second-line and the remaining in third or more lines of therapy. Ninety- four were male (55.3%), median age of 60.5 years (24.8 to 88.3) and 61 (35.9%) pts had BRAF mutation. Among stage IV patients (94%), 52 (32.4%) were M1c, 36 (22.4%) M1d and 46 (27%) had elevated LDH. Forty-two (26%) pts had BM. The overall response rate was 30.9% for pts with BM compared to 57.7% for pts without BM (p:0.004). In a median follow-up of 23.6 months (95% CI: 18.0-29.1), the median PFS and OS for pts with and without BM were 3.8 x 18.8 months (p 0.005) and 19.4months x not achieved (p 0.001), respectively. The 24-month analysis shows an overall survival rate of 38% for patients with BM compared to 62% for the rest of the cohort population. In a multivariate analysis for overall survival, acral melanoma, elevated LDH, ECOG performance status of 1 or 2 and BM were independent adverse prognostic factors (bone metastasis - HR: 2.3; 95%CI: 1.18-4.1; p:0.013). Conclusions: In this analysis, the presence of bone disease seems to be a worse independent prognostic factor for survival. A hypothesis would be the unfavorable bone microenvironment for the action of the immunotherapy.
Utilization and satisfaction of family doctor service among contract-signing residents in Beijing urban area and related influencing factors
Authors: Tong Wang, Dandan Zhang, Meirong Wang, Yingjie Liu, Juan Du
Journal: BMJ (2017)

Objective
To investigate the utilization and satisfaction of family doctor service among contract-signing residents in Beijing urban area, and the related influencing factors.


Methods
Total 740 contract-signing residents visiting community health service centers of two urban districts in Beijing from June to September of 2015 were selected with purposive sampling as study subjects. All participants completed a questionnaire survey on the utilization and satisfaction of the service provided by family doctors. The influencing factors related to satisfaction were analyzed by chi-square test and multivariate Logistic regression.


Results
The survey showed that 73.9% (547/740) of the participants would seek service in community health service centers first when their illness was mild; while 56.2% (416/740) of the participants would seek service in secondary or tertiary hospitals directly. Four out of 8 contracted services were mostly utilized: personalized health counseling (732/740, 98.9%), chronic disease management (721/740, 97.4%), health promotion guidance (626/740, 84.6%), and health education (614/740, 83.0%). The satisfaction rates for service attitude of family doctor, the contents of contracted service, the competence of family doctor and the environment of clinical setting were 82.7% (612/740), 75.4% (558/740), 72.8% (539/740) and 70.4% (521/740), respectively. The satisfaction rates of service contents were 85.4% (164/192) for home visit, 81.3% (248/305) for appointment of experts in tertiary hospital, 76.8% (562/732) for personalized health counseling, 76.3% (550/721) for chronic disease management, 75.2% (471/626) for health promotion guidance, 74.4% (457/614) for health education, 72.8% (302/415) for referral service, and 65.7% (305/464) for appointment of next visit. Logistic regression showed that the quality of family doctor service in the community health service institutions(OR=2.693, P=0.000)and education levels of residents (OR=0.680, P=0.008)were the factors related to the satisfaction of the patients.


Conclusion
The contract-signing residents in Beijing urban area are willing to go to the community health service institutions, and generally satisfied with the service. But the service contents and service quality need to be further improved.


Key words: 
Questionnaires; Patient satisfaction; Family doctor service system
Diagnosis and treatment of respiratory distress syndrome in full-term newborns
Authors: Jing Liu, Xiao-feng Wang, Hua-wei Wang, Ying Liu, Jing-ya Li, Tao Hang, Jing Liang
Journal: BMJ (2013)

To explore the pathogenesis, clinical characteristics and management strategies of respiratory distress syndrome (RDS) in full-term neonates. A total of 316 full-term infants with RDS were enrolled. The main characteristics of term ineonatal RDS are as following: Term neonatal RDS was more common in boys than in girls. 70.9% of the patients had an onset within 3 hours after birth, 90.2% of them within 6 hours after birth and 99.4% of them within 12 hours after birth. The main causes of ARDS was selective cesarean section, followed by males; while severe infection was the most common cause of secondary RDS, followed by severe birth asphyxia and meconium aspiration syndrome. Illness state was more severe and evolved more rapidly. And it was more likely to develop into persistent pulmonary hypertension of newborn (PPHN) and multiple organ system failure (MOSF), especially myocardial injuries and acute renal failure. Most patients required prolonged mechanical ventilation. The mortality was relatively higher and the major mortality cause was severe infection with MOSF. But their prognosis improved after comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were implemented.


Key words: 
Respiratory distress syndrome, newborn; Signs and symptoms
Study progress on non-adherence to drug therapy in patients with systemic lupus erythematosus and its influencing factors
Authors: Junxia Wang
Journal: BMJ (2018)

In order to avoid persistent disease activity, relapse and unnecessary treatment escalation, patients with systemic lupus erythematosis (SLE) need long-term adherence to prescribed medication.However, in the clinical practice, a considerable number of SLE patients have poor medication adherence, which may be related to disease cognition, medication types, economical status, education level and depressive state.This review summarizes several related factors affecting medication adherence in SLE patients to provide reference for clinicians.


Key words: 
Lupus erythematosus, systemic; Medication adherence; Related factors
Elective open nephron-sparing surgery for renal masses: Single-center experience with 223 consecutive patients
Authors: F. Francesca, G. Pomara, G. Campo, P. Casale
Journal: Journal of Clinical Oncology (2009)

e16139 Background: To present our experience with elective, open, nephron-sparing surgery for renal masses in a contemporary, consecutive series. Methods: In this retrospective study, records of all patients who underwent elective nephron-sparing surgery (E-NSS) between March 1997 and December 2007 at our institution were reviewed. The preoperative workup included laboratory analysis, renal ultrasonography and abdominal computed tomography. The histological findings, complications, and oncologic outcome were studied. Results: A total of 231 E-NSS were performed in 223 patients (82 females,141males; mean age 64 years). 62 “hot ischemia” procedures and 169 “cold ischemia”. The mean tumor size was 4.6 cm (1.1–12cm). 52 patients presented renal masses &gt; 4cm. Renal cell carcinoma was present in 177 patients (76.6%), benign renal masses were diagnosed in in 54 pazienti (23.3%): angiomyolipoma (35%), oncocytoma (40%), complicated cyst (25%). Worthy of note among these 54 patients, pre-operative diagnosis was present in 12 patients. Moreover, 17 benign lesions (31%) were &gt; 4 cm. Complication rate was 5.3% (12 pts): splenectomy (2.2%), nephrectomy because of postoperative bleeding (0.8%), urinary fistulas (0.8%). After a median follow-up of 84 months (range 5 to 120), no patient had developed local recurrence, 19 (8.9%) died for other causes, 2 (0.9%) died for other tumor. Conclusions: The results of this contemporary, monocenter experience underline the role of open, elective, nephron-sparing surgery for patients with renal masses, confirming good results even for renal masses &gt; 4cm. These conclusions are particularly important considering that benign histologic findings were present in almost one forth of patients. No significant financial relationships to disclose.