tbuckley/cabot-search huggingface dataset:
Knowledge requested by patients with coronary artery disease after stent implantation
Authors: Zhaoxia Yin, Tao Xiao, Zuoxia Shi, Jing Yan
Journal: BMJ (2014)

Objective
To survey the knowledge requested by patients with coronary artery disease (CAD) after stent implantation.


Methods
A survey on CAD and stent-related knowledge requested by CAD patients with stent implantation was conducted with a self-designed questionnaire from September 2013 to November 2013. Total 362 patients (235 males and 127 females) aged (67±12) years participated in the survey in Yuetan Community Health Service Center and Fuxing Hospital in Beijing. Open questions and heuristic questions were used together during the survey.


Results
The knowledge requested by patients were: diet management(255, 70.4%), side effects of medication(241, 66.6%), management of physical activity (221, 61.0%), prevention of CAD(181, 50.0%), withdrawal of medication(176, 48.6%), the life of stents (168, 46.4%), post-operation check-up items(162, 44.8%), the causes of CAD(156, 43.1%)and drug mechanisms(134, 37.0%). Patients with stent implantation less than one year requested more knowledge about the cause of CAD (χ2=37.4, P  70 years. Patients with education higher than junior high school requested more knowledge about the cause of CAD (χ2=26.6, P<0.001), prevention of CAD (χ2=14.4, P=0.001) and life-time of stents (χ2=7.82, P=0.02) than those with education lower than junior high school. Patients with education higher than junior college requested more knowledge about the cause of CAD (χ2=26.6, P<0.001) and post-operation check-up items (χ2=10.7, P=0.005) than those with education lower than junior college.


Conclusion
Some factors affect the knowledge requested by patients with coronary artery disease (CAD) after stent implantation, which should be considered in health education for CAD patients.


Key words: 
Coronary disease; Questionnaires; Health education; Stents
Fatigue in long-term survivors with ovarian cancer: Results of Expression VI – Carolin meets HANNA – Holistic analysis of Long-term survival with ovarian cancer—The international NOGGO, ENGOT and GCIG survey.
Authors: Hannah Woopen, Maren Keller, Elena Ioana Braicu, Dario Zocholl, Petra Krabisch, Tamara Boxler, Maria Pilar Barretina-Ginesta, Cesar Mendiola, Judith Lafleur, Daniel Uwe Reimer, Viola A. Heinzelmann-Schwarz, Eleftherios Pierre Samartzis, Mehmet Ali Vardar, Cagatay Taskiran, Ignace Vergote, Els Van Nieuwenhuysen, Jalid Sehouli
Journal: Journal of Clinical Oncology (2020)

12065 Background: Long-term survivors (LTS) with ovarian cancer may be cured from cancer but frequently experience long-term toxicities such as fatigue with a huge impact on quality of life. Aim of this study was to evaluate factors associated with fatigue in LTS. Methods: Within the study “Carolin meets HANNA” ( www.carolinmeetshanna.com ) long-term survivors with ovarian cancer (LTS) were recruited since 11/2016. Long-term survival was defined as an ovarian cancer diagnosis more than eight years ago. Results: Until 12/2019 473 LTS could be recruited. 211 LTS (44.5%) have experienced fatigue. At the time point of recruitment in 23.4% (111 LTS) fatigue was still present. LTS with fatigue were not more frequently under current treatment compared to LTS without fatigue (p = 0.348). LTS with fatigue were not younger at initial diagnosis (50.4 vs. 51.9 years, p = 0.228). 58.6% of LTS with fatigue compared to 41.5% without fatigue have developed recurrent disease (p = 0.002) and LTS had more frequently more than one recurrence (66.1% vs. 51.7%, p = 0.055). Fatigue was associated with worse health status (2.9 vs. 2.2 on a scale from 1-5, p &lt; 0.001). Fatigue was associated with medical complaints in general (82.0% vs. 43.0%, p &lt; 0.001). Symptoms such as nausea and vomiting (p &lt; 0.001), loss of appetite (p &lt; 0.001), constipation (p &lt; 0.001), diarrhea (p &lt; 0.001), weight loss (p = 0.001) and bloating (p &lt; 0.001) were more frequent in LTS with fatigue. This also accounts for cognitive disorders (39.6% vs. 10.5%, p &lt; 0.001), depression (23.4% vs. 7.4%, p &lt; 0.001), polyneuropathy (39.6% vs. 13.2%, p &lt; 0.001) and cardiovascular disease (11.7% vs. 3.6%, p = 0.002). LTS with fatigue regard themselves more frequently as cancer patient (73.9% vs. 40.8%), p &lt; 0.001). Conclusions: Fatigue is still very common in LTS despite the long survival time. Fatigue is associated with worsened health status and other long-term side effects underlining the impact on LTS. There is a high need for survivorship clinics that should ask for and, if necessary, should address still existing side effects such as fatigue.
Human epidermal growth factor 2 (HER2) in early stage uterine serous carcinoma: A multi-institutional cohort.
Authors: Britt Kristina Erickson, Omar Najjar, Molly Klein, Maryam Shahi, Michelle Dolan, Ashley Cimino-Mathews, Anthony Grandelis, Natalia Buza, Paris Delaney, Joan Tymon-Rosario, Alessandro Santin, James Stuart Ferriss, Rebecca Lynn Stone, Amanda Nickles Fader
Journal: Journal of Clinical Oncology (2020)

6084 Background: Uterine serous carcinoma (USC) is a rare and aggressive malignancy, accounting for 40% of all endometrial cancer deaths. Human Epidermal Growth Factor Receptor 2 (HER2) has emerged as an important prognostic and therapeutic target in USC. Given recent randomized trial results, HER2-directed therapy is now recommended in advanced-stage or recurrent, HER2-positive disease. The significance of tumoral HER2 expression in early-stage disease has not yet been established. Methods: In this IRB-approved, retrospective, multi-institutional cohort, women diagnosed with stage I USC from 2000-2018 were identified. Patient demographic, treatment, and survival data were collected. Immunohistochemistry (IHC) was performed for HER2 and scored 0-3+. Equivocal IHC results (2+) were further tested with in-situ hybridization (ISH) per the 2007 ASCO-CAP HER2 breast cancer guidelines. HER2 overexpression (“positive”) was defined as 3+ IHC or ISH positive. Kaplan-Meier analyses and Cox-proportional hazards were used to compare survival between the cohorts. Results: In total, 173 patients with stage I USC were tested for HER2; 25% were HER2-positive, 77.4% had stage IA and 22.6% had stage IB disease. Adequate clinical follow up was available for 168 patients. There were no significant differences in age, race/ethnicity, body mass index, surgical management, sub-stage, tumor size, adjuvant therapy, or follow-up duration between the HER2-positive and negative cohorts. On univarite analysis, presence of lymph-vascular space invasion was correlated with HER2-positive tumors (p=0.003). After a median follow-up of 50 months, there were 41 (24.4%) recurrences. Significantly more recurrences were observed in the HER2-positive cohort (47.6% vs. 16.7%, p&lt;0.001). HER2 overexpression was also associated with poorer progression-free (PFS) and overall survival (OS) (p&lt;0.001 and p=0.012). After adjusting for prognostic factors including sub-stage and adjuvant treatment, those with HER2-positive tumors experienced inferior PFS (aHR 3.67, 95%CI 1.92-6.98; p&lt;0.001) and OS (aHR 2.03, 95%CI 1.03-4.01; p=0.042) compared to HER2-negative tumors. Conclusions: Uterine serous carcinoma is a poor prognostic tumor, even in patients with early-stage disease. Given its significant association with worse survival outcomes, tumoral HER2 overexpression appears to be a prognostic biomarker in women with stage I disease. These data provide rationale for clinical trials with HER2-directed therapy in early-stage uterine serous carcinoma.
The prognostic significance of the advanced lung cancer inflammation index(ALI) in patients with advanced biliary tract cancer: A retrospective study.
Authors: Jung Hoon Kim, Sung Yong Oh, Jung Hun Kang, Myoung-Hee Kang, Chi-Young Jeong, Jun Ho Ji
Journal: Journal of Clinical Oncology (2020)

e16613 Background: Intrahepatic cholangiocarcinoma is the second most common primary cancer, but the prognosis is poor and aggressive therapies provide only limited benefit when it is in advanced stage. Many studies were conducted to find significant prognostic factors to predict clinical outcomes, but there is no definitive parameter or scoring model yet in this disease. This study is a retrospective analysis to test various kinds of prognostic scoring systems including the advanced lung cancer inflammation (ALI) index, a new prognostic model, for patients treated for advanced intrahepatic cholangiocarcinoma. Methods: We retrospectively searched medical records of patients who were diagnosed with advanced intrahepatic cholangiocarcinoma between January 2012 and December 2017 and actively treated at a single tertiary regional cancer center. Patients who received only supportive care, or had active infection concomitantly were excluded. 60 patients were identified, and we reviewed and analyzed their baseline characteristics and clinical outcomes. Various types of inflammation or nutritional scoring systems, neutrophil to lymphocyte ratio (NLR), Onodera’s prognostic nutritional index (OPNI), the advanced lung cancer inflammation (ALI) index were concurrently calculated and significance for patients’ survival was evaluated. Results: In 50 patients with metastatic stage and 10 patients with locally advanced disease, the median overall survival was 13.97 months (95% confidence interval (CI) 7.99 – 19.95). ALI of 28.5 was determined as the optimal cut-off value for prediction of 1-year survival by receiver operating characteristics (ROC) curve with an AUC value of 0.671 (sensitivity and specificity were 77.8% and 60.6%, respectively). 26 patients with ALI &gt; 28.5 had significantly better overall survival compared with 34 patients with ALI≤28.5 (19.2 months vs. 8.73 months, p= .007). NLR above 2.8 only showed mildly significant difference for overall survival (OS), and the OPNI failed to predict prognosis of these patients. In multivariate analysis, there was no independent prognostic factor observed to have association with overall survival. Conclusions: The advanced lung cancer inflammation (ALI) index showed a potential to be a new prognostic model for advanced intrahepatic cholangiocarcinoma. Further cohort studies to expand population size may be worth.
PROMIS-10 scores at six months post-baseline among breast and gynecologic oncology patients participating in a text-based symptom monitoring program with patient navigation.
Authors: Michelle Joy Naughton, Ritu Salani, Maryam B. Lustberg, Juan Peng, Jennifer Moon, Hibaq Loyan, Electra D. Paskett
Journal: Journal of Clinical Oncology (2020)

e19173 Background: Unreported symptoms during cancer treatment can lead to poorer patient care and quality of life. eHealth technologies enable effective means to track patients’ health in real time to provide assistance in meeting patients’ needs and facilitating symptom management. Methods: Gynecologic (endometrial and ovarian) and breast oncology patients were enrolled in a quality improvement program post-surgically to respond to 12-monthly, text-based symptom surveys assessing fatigue, sleep quality, pain, and depression (PHQ-9). At baseline, 6 and 12 months, patients also completed the PROMIS-10 to assess their physical and mental health functioning. All patient responses were captured in REDCap and monitored by program staff, with patients’ oncologists receiving monthly feedback for patient follow-up. Patient navigators were also engaged for patients needing assistance with non-medical concerns. We provide the interim results of this program on PROMIS-10 scores from baseline to 6 months. Results: 198 breast and 120 gynecologic oncology patients (ovarian [n = 70] and endometrial [n = 50]) were enrolled. Multiple regression examined the impact of demographic (age, race, education), clinical (stage, chemotherapy, radiation), and monitoring program variables (# of monthly surveys completed, navigation services [yes/no]) on PROMIS-10 physical and mental health subscale scores at 6 months, adjusting for baseline PROMIS scores. For the breast patients, the only significant predictor of worse PROMIS physical health scores was a cancer stage of 4 vs 1 (p = 0.049), whereas a higher number of symptom surveys completed was associated with worse mental health functioning (p = 0.033). For the gynecologic oncology patients, worse PROMIS physical health scores were only associated with higher age (p = 0.037), but higher PROMIS mental health was also associated with higher age (p = 0.029) and borderline significantly associated with not using navigation services (p = 0.07). Conclusions: These results indicate that greater adherence in completing monthly symptom surveys and using navigation services were more likely to be associated with patients reporting lower mental health. PROMIS physical health scores, however, were not significantly associated with adherence to monthly surveys or navigation services. These interim results suggest that monitoring programs, such as this, may assist in identifying and treating patients with lower mental health functioning during treatment.
Status of liver fibrosis evaluated by aspartate aminotransferase to platelet ratio in patients with non-alcoholic fatty liver disease
Authors: Annan Liu, Xiaolan Zhao, Zhiheng Chen, Qun Zhang, Hai'ou Hong, Yu Wang, Shouqing Huang, Qibin Wang, Yanni Xia, Ling Zhu
Journal: BMJ (2017)

Objective
To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).


Methods
A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study. Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI). Subjects were divided into three groups according to diagnostic threshold of liver fibrosis: APRI<0.43 group, APRI 0.43-0.53 group and APRI≥0.54 group. The correlation between APRI and biochemical variables was analyzed, and the risk factors of progressive fibrosis were also analyzed.


Results
Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI≥0.98 (2.97%, progressive fibrosis), 318 with APRI≥0.54 (15.48%), 1 475 with APRI<0.43 (71.81%), 261 with APRI 0.43-0.53 (12.71%). Logistic stepwise regression analysis showed that TG(P=0.002, OR=1.095, 95%CI : 1.033-1.161), 2 hPG(P=0.000, OR=1.103, 95%CI : 1.058-1.151, BUN(P=0.034, OR=1.215, 95%CI: 1.014-1.454) were risk factors, and HDL-C(P=0.034, OR=0.353, 95%CI: 0.135-0.924) was a protective factor for the progression of fibrosis.


Conclusion
The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.


Key words: 
Fatty liver; Diagnosis; Aspartate aminotransferase-to-platelet ratio index; Fibrosis
因防中暑而诱发了房颤
Authors: 曾昭耆
Journal: BMJ (2007)

一位84岁的女干部,自诉1周前因天气酷热怕中暑,自己上街买清热解暑药.在途中出汗很多、非常口渴,回到家即连饮冷开水3杯.约半小时后即感心慌、无力,遂来院急诊. 当时查体:血压120/70 mm Hg(1 mm Hg=0.133 kPa),心率170次/min,节律完全不齐,无杂音.心电图证实为心房颤动(房颤).接诊医生给予地高辛0.125 mg/d,阿替洛尔12.5 mg每天2次,阿司匹林0.1 g/d。
Comparison between T1 with lymph node metastases and T3-4 without lymph node metastases in patients with non-small cell lung cancer.
Authors: Naixin Liang, Lei Cao, Zhili Cao, Zhongxing Bing, Chao Gao, Yanyu Wang, Yadong Wang, Ziqi Jia, Xiaoying Yang, Chengcheng Li, Fuyu Gong, Guoqiang Wang
Journal: Journal of Clinical Oncology (2020)

e21074 Background: Patients with small tumor size but lymph node metastases (T1N1-N3, T1N1+) and patients with large tumor size but without lymph node metastases (T3-4N0, T3+N0) mainly belong to stage IIB to IIIA according to the 8 th version TNM staging. However, whether the contradictory between tumor size and lymph node may influence the survival and the underlying genomic differences have not been fully studied. Methods: Whole-exome sequencing and RNA sequencing data for 1001 patients with NSCLC including 514 lung adenocarcinoma (LUAD) and 487 lung squamous cell carcinoma (LUSC) were downloaded from TCGA. The prognosis between patients with T1N1+ and T3+N0 has been investigated. The DNA sequencing data and RNA sequencing data from TCGA were used to study the underlying mechanism. Results: Patients with T3N0+ consisted of 80.2% Stage IIB and 17.4% Stage IIIA and patients with T1N1+ consist of 66.7% Stage IIB and 25.9% Stage IIIA. There were no differences in race, age, staging or neoadjuvant history between T1N1+ and T3+N0 cases. T1N1+ patients were more frequent among females (P = 0.02) and were more likely to be adenocarcinomas (P = 0.01) compared to T3+N0. Patients with T1N1+ was associated with a prolonged disease-free survival (DFS) (HR, 0.47; 95% CI, 0.28-0.79; P &lt; 0.05) and progression-free survival (PFS) (HR, 0.31; 95% CI, 0.17-0.56; P &lt; 0.001) than patients with T3+N0. In the multivariable cox proportional hazards regression model including stage, patients with T1N1+ still had increased PFS (HR, 0.45; 95% CI, 0.26-0.82; P = 0.009) and DFS (HR, 0.38; 95% CI, 0.16-0.95; P = 0.04) compared to T3+N0 cases. Moreover, patients with T1N2, belong to Stage IIIA according to AJCC 8 th edition TNM staging, had a superior DFS (P = 0.01) and PFS (P = 0.04) compared with the patients with T3N0, who are in Stage IIB. Further investigation revealed that the tumor mutation burden was no significant difference between two groups (P &gt; 0.05). There was no difference in genomic alterations between groups in LUSC and LUAD. GSEA analysis revealed that gene expression involved in DNA repair signaling was enriched in T1N1+ patients in LUSC and LUAD. Conclusions: Patients with T1N1+ shows a longer DFS and PFS compared with patients with T3+N0, especially T1N2 cases who belong to Stage IIIA show a better prognosis compared with T3N0 patients who are in Stage IIB, indicating the AJCC 8 th edition TNM staging need to be refined. Moreover, the better prognosis in T1N1+ patients may be related with DNA repair signaling genes enrichment.
额窦巨大脓囊肿二例
Authors: 卞新浩
Journal: BMJ (2011)

例1患者女,60岁.因右眼视力减退伴复视、头痛半年于2009年7月4日入院.体检:眼内及鼻腔结构正常.国际标准视力表视力:右眼0.4,左眼0.8,右眼球外展受限(±),眼压:右眼17.75 mm Hg(1 mm Hg=0.133 kPa),左眼12.23 mm Hg.眼眶CT:右侧额窦及筛窦内肿块影,骨质压迫吸收。
Exercise Electrocardiography and Computed Tomography Coronary Angiography for Patients With Suspected Stable Angina Pectoris
Authors: Trisha Singh, Rong Bing, Marc R. Dweck, Edwin J. R. van Beek, Nicholas L. Mills, Michelle C. Williams, Todd C. Villines, David E. Newby, Philip D. Adamson
Journal: JAMA Cardiology (2020)

Recent European guidance supports a diminished role for exercise electrocardiography (ECG) in the assessment of suspected stable angina.To evaluate the utility of exercise ECG in contemporary practice and assess the value of combined functional and anatomical testing.This is a post hoc analysis of the Scottish Computed Tomography of the Heart (SCOT-HEART) open-label randomized clinical trial, conducted in 12 cardiology chest pain clinics across Scotland for patients with suspected angina secondary to coronary heart disease. Between November 18, 2010, and September 24, 2014, 4146 patients aged 18 to 75 years with stable angina underwent clinical evaluation and 1417 of 1651 (86%) underwent exercise ECG prior to randomization. Statistical analysis was conducted from October 10 to November 5, 2019.Patients were randomized in a 1:1 ratio to receive standard care plus coronary computed tomography (CT) angiography or to receive standard care alone. The present analysis was limited to the 3283 patients who underwent exercise ECG alone or in combination with coronary CT angiography.The primary clinical end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years.Among the 3283 patients (1889 men; median age, 57.0 years [interquartile range, 50.0-64.0 years]), exercise ECG had a sensitivity of 39% and a specificity of 91% for detecting any obstructive coronary artery disease in those who underwent subsequent invasive angiography. Abnormal results of exercise ECG were associated with a 14.47-fold (95% CI, 10.00-20.41; P < .001) increase in coronary revascularization at 1 year and a 2.57-fold (95% CI, 1.38-4.63; P < .001) increase in mortality from coronary heart disease death at 5 years or in cases of nonfatal myocardial infarction at 5 years. Compared with exercise ECG alone, results of coronary CT angiography had a stronger association with 5-year coronary heart disease death or nonfatal myocardial infarction (hazard ratio, 10.63; 95% CI, 2.32-48.70; P = .002). The greatest numerical difference in outcome with CT angiography compared with exercise ECG alone was observed for those with inconclusive results of exercise ECG (5 of 285 [2%] vs 13 of 283 [5%]), although this was not statistically significant (log-rank P = .05).This study suggests that abnormal results of exercise ECG are associated with coronary revascularization and the future risk of adverse coronary events. However, coronary CT angiography more accurately detects coronary artery disease and is more strongly associated with future risk compared with exercise ECG.ClinicalTrials.gov Identifier: NCT01149590.
Phase 1b study of BXCL701, a novel small molecule inhibitor of dipeptidyl peptidases (DPP), combined with pembrolizumab (pembro), in men with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Rahul Raj Aggarwal, Dan Costin, Vincent J. O'Neill, Stefani Corsi-Travali, Sreenivas Adurthi, Adedayo Adedoyin, Diane I. Healey, Johann S. De Bono, Paul Monk, Jingsong Zhang, Eric Jay Small
Journal: Journal of Clinical Oncology (2020)

e17581 Background: BXCL701 (talabostat previously PT100) is an oral small molecule inhibitor of DPP4, DPP8 and DPP9, which trigger macrophage cell death via pyroptosis resulting in proinflammatory stimulation of the innate immunity pathway. Expression of PD-L1 correlates with amplification of DPP8 and DPP9. In syngeneic animal models, significant tumor responses were observed when BXCL701 was used with checkpoint inhibition. In a prior clinical study, BXCL701 at a total daily dose of 0.6mg (as 0.3mg BID) demonstrated single agent activity in 2 pts with Stage IV melanoma (unpublished). Methods: In this multi-center study, eligible patients (pts) had progressing mCRPC (PCWG3), at least 1 line of systemic therapy and ≤ 2 lines of cytotoxic chemotherapy for mCRPC, no prior anti-PD-1/PD-L1 or other T-cell directed anti-cancer therapy, and an ECOG PS of ≤ 2. Pts received fixed dose pembro (200mg IV q21 days) with escalating doses of BXCL701 (0.4mg and 0.6mg PO QD days 1-14 of 21-day cycles) using a 3X3 design. The key endpoints were safety and identification of the recommended phase 2 dose (RP2D) for the combination. Composite response (RECIST, PSA, CTC), plasma drug concentration and change in relevant immune effector cytokines were also evaluated. Results: Six pts were treated at 2 BXCL701 dose levels of 0.4mg qd (n = 3) and 0.6mg qd (n = 3), with 5 pts having adeno, 1 pt having mixed adeno and SC-NEPC. Prior tx included ADT (n = 6), 2 nd generation androgen signaling inhibitors (n = 4), chemo (n = 4), RT (n = 5). Among 3 pts at the BXCL701 dose level of 0.6mg, 1 pt had a DLT of Grade 3 syncope (C1D6) and 1 pt had fatal acidosis (C3D8). A dose-dependent increase in pts with low-grade on-target clinical effects was observed. In the 0.4mg qd cohort 1 pt had lower extremity (LE) edema. Whereas in the 0.6mg qd cohort, all pts had events consistent with cytokine release: 3 had hypotension and 2 pts each had dizziness and LE edema. The 0.6mg/day dose level was expanded using a split dose strategy to improve tolerability while maintaining the daily dose previously associated with objective responses. BXCL701 was quantifiable in plasma. Conclusions: BXCL701 0.4 mg QD on days 1 to 14 of 21-day cycle plus pembrolizumab 200 mg IV on day 1 every 21 days was well tolerated in pts with mCRPC. A dose-dependent increase in on-target clinical effects expected with cytokine upregulation was seen. The final dose expansion using the split dose for the RP2D, plasma drug concentrations and relevant biomarkers will be presented. Clinical trial information: NCT03910660 .