tbuckley/cabot-search huggingface dataset:
18F-FDG PET scan and liquid biopsy as tools to assess the pace of tumor progression and to predict overall survival (OS) in refractory colorectal cancer (rCRC): The CORIOLAN trial.
Authors: Silvia Camera, Tugba Akin Telli, Erwin Woff, Pashalina Kehagias, Thomas Guiot, Gabriela Critchi, Giacomo Bregni, Elena Trevisi, Andrea Pretta, Amélie Deleruelle, Chiara Senti, Sophia Leduc, Leila Shaza, Frédéric Hoerner, Caroline Vandeputte, Francesco Sclafani, Patrick Flamen, Alain Hendlisz, Amélie Deleporte, Francoise Rothe
Journal: Journal of Clinical Oncology (2020)

e16012 Background: Decision making in rCRC patients (pts) who have exhausted all available therapies is challenging. Clinical trials, treatment re-challenge and best supportive care are possible options. There are limited data, however, to predict pt outcome and guide treatment choices. Methods: CORIOLAN was a prospective, single-centre, single-arm trial. Eligible pts had to have an ECOG PS of ≤1, a life expectancy of ≥12 weeks (wks) and had to have received prior standard chemotherapy and targeted agents. No cancer treatment was allowed within 4 wks prior to study entry. 18 F-FDG PET scan and blood sample collection were carried out at baseline and after 2 wks. No treatment was given between these timepoints, while further management was left to the treating physician. The primary objective was to evaluate the association between tumour metabolic progression index as defined by changes of the whole-body metabolically active tumour volume (WB-MATV) and OS. Exploratory objectives included evaluation of the prognostic value of circulating biomarkers such as cell-free DNA (cfDNA), circulating tumour cells (CTCs, CellTracks Analyzer II, CellSearch) and CEA. Validated cut-off values, Kaplan-Meier method, Cox proportional hazards model and logrank tests were used (R version 3.5.1). Results: From 2012 to 2018, 47 eligible pts were enrolled. Median age: 65 years (38-82). ECOG PS 1: 64%. Males: 53%. Left-sided tumours: 71%. Metastases: lung (83%), liver (66%), lymph-nodes (45%), peritoneum (30%), bone (21%). Known RAS/BRAF mutations: 57%/0%. Median number of prior treatments: 5 (2-8). At the time of analysis, 45 deaths had occurred, with 26% of pts dying within 12 wks. The median relative delta between WB-MATV at baseline and after 2 wks was +21%. Changes of WB-MATV, however, failed to predict OS (p≥0.383). Similarly, no association was observed between changes of any of the circulating biomarkers investigated and prognosis. By contrast, low WB-MATV (9.4 vs 4.2 months, HR 0.65, p = 0.003), low cfDNA (7.0 vs 4.7 months, HR 0.58, p = 0.015), low CTC count (7.5 vs 3.3 months, HR 0.67, p &lt; 0.001) and low CEA (7.0 vs 4.4 months, HR 0.58, p = 0.053) at baseline were associated with longer OS. Conclusions: This study confirms the inaccuracy of life expectancy estimation for rCRC pts based on a physician judgement largely relying on conventional criteria. Baseline assessment of WB-MATV, cfDNA, CTCs and CEA, but not early change evaluation of the same, may help to refine pt prognostication and guide management decisions. Clinical trial information: NCT01591590 .
Outcomes and prognostic factors of patients (pts) with metastatic colorectal cancer (mCRC) who underwent pulmonary metastasectomy (PM) with curative intent.
Authors: Gustavo Cartaxo de Lima Gössling, Fernando de Souza Pereira, Rafaela Kathrine da Silva, Leonardo de Brittes Andrade, Nicolas Peruzzo, Maurício Guidi Saueressig, Márcio Fernandes Chedid, Gilberto Schwartsmann, Aparna Raj Parikh
Journal: Journal of Clinical Oncology (2020)

4034 Background: Indications for PM in pts with mCRC are often based on the presence of favorable prognostic factors. We aimed to analyze the prognostic factors and outcomes of pts treated with PM for mCRC. Methods: We retrospectively identified pts with mCRC who underwent PM with curative intent between Jan 1985 and Dec 2019 at Hospital de Clínicas de Porto Alegre. Demographics, clinicopathological features and previously described prognostic factors were collected. Univariate Cox regression was performed and followed by Kaplan-Meier (KM) curves with log-rank test when significant. Results: Fifty-eight pts underwent PM. Demographics are described in Table. Wedge resection was performed in 87.9% and margins were negative in 89.1%. Mean number of lesions was 2.4 ± 1.7, with the largest measuring 1.7 ± 0.9 cm. Two or more resections were performed in 36.2%, nodal sampling in 27.3%, and nodal disease was found in 5.2%.Thirty-day readmission rate was 5.2%. One pt had a Clavien-Dindo grade IIIb complication. RAS/RAF/MMR and CK20/CDX2 were available for 13.8% and 58.6% of the sample. Median PFS 14 months (m) (95% CI 10.4 - 17.5), median OS 58 m (95% CI 33.5 - 82.4) and 5-year survival 49.8%. Unfavorable prognostic factors for OS included disease-free interval (DFI) &lt; 24 m (40 m, 95% CI 31.8 - 48.1 vs 85 m, 95% CI 75.7 -96.2; P &lt; 0.005), synchronous presentation (33 m, 95% CI 23.9 - 42.0 vs 77 m, 95% CI 50.7 - 103.2; P &lt; 0.001), largest lesion size ≥ 2cm (37 m, 95% CI 22.9 - 51.0 m vs 81 m, 95% CI - 33.7 - 128.2, P = 0.019) and lack of CK20 expression (19 m, 95% CI 12.1 - 27.2 vs. 83 m, 95% CI 46.9 - 119.0; P &lt; 0.001). More than one lesion at presentation was prognostic for PFS (11 m, 95% CI 7.6 - 14.3 vs 23 m, 95% CI 0.1 - 59.2; P = 0.003) but not OS (P = 0.11). Grade was significant at Cox regression but showed no effect in further analysis. Neither CEA at baseline or relapse, resection margins, Charlson comorbidity index (CCI) or adjuvant chemotherapy were prognostic. Conclusions: Our results suggest a benefit for select pts and PM. Lack of CK20 expression may be associated with more aggressive disease and shorter OS. Additional molecular prognostic factors after PM should be further explored. [Table: see text]
Current status of antibiotic use for common cold and related factors
Authors: Jiatang Zheng, Yuxia Kong, Xiuwen Fei, Aimei Dong
Journal: BMJ (2018)

Common cold is the most common upper respiratory tract infection. No antibiotic use for common cold has been international consensus, while the irrational antibiotic use and subsequent antibiotic resistance become an important issue of public health security. This article reviews the current status of antibiotic use for common cold and its related factors.


Key words: 
Common cold; Anti-bacterial agents; Drug prescriptions
Genomic profiles and clinical outcomes to distinguish primary from secondary metastatic hormone-sensitive prostate cancer (mHSPC).
Authors: Emily Nizialek, Su Jin Lim, Hao Wang, Pedro Isaacsson Velho, Emmanuel S. Antonarakis
Journal: Journal of Clinical Oncology (2020)

e17558 Background: Clinical outcomes may differ among pts with primary (de novo) mHSPC vs. secondary (relapsed) mHSPC occurring after previous local therapy. However, it is unknown what molecular features distinguish these potentially distinct presentations. Methods: A single-center retrospective study was performed using pts with mHSPC and available somatic genomic data. Clinicopathologic characteristics were collected, and pts were classified as primary mHSPC (n = 118) or secondary mHSPC (n = 104). A targeted set of genes suspected to influence disease severity and response to systemic therapy was analyzed: BRCA2, PTEN, RB1, TP53, SPOP, CDK12, combined PTEN/RB1/TP53 alterations (2 out of 3), and a composite of any homologous recombination deficiency (HRD) mutation. Hazard ratios for PFS and OS were compared between groups using the log-rank test. Differences in genomic features and baseline characteristics between groups were compared using Fischer exact and chi-squared tests. Results: Median PFS from initiation of first-line ADT was 16.0 mo and 28.9 mo for men with primary and secondary mHSPC, respectively (HR 0.59, 95% CI 0.43–0.83; P= 0.002). OS did not differ between groups (HR 0.92, 95% CI 0.56–1.52; P= 0.7) There were more men with Gleason 8-10 disease in the primary vs. secondary mHSPC groups (91% vs. 67%, P= &lt; 0.01). In terms of molecular alterations, there were more PTEN and CDK12 mutations in the primary mHSPC group ( PTEN: 27% vs 19%, CDK12: 7% vs 3%), but more BRCA2 mutations in the secondary mHSPC group (5% vs 10%, respectively). In univariate analysis, PTEN mutations (HR 1.39, P= 0.08) and combined PTEN/RB1/TP53 mutations (HR 1.46, P= 0.09) predicted worse PFS; PTEN mutations (HR 1.63, P= 0.09) and combined PTEN/RB1/TP53 mutations (HR 2.38, P= 0.01) also predicted worse OS. In multivariable models adjusting for age at first metastasis and Gleason sum, only combined PTEN/RB1/TP53 mutations were predictive of worse OS (adjusted HR 2.32, 95% CI 1.14–4.71; P= 0.02). Conclusions: Compared to secondary mHSPC, primary mHSPC pts had higher Gleason scores, more frequent PTEN and CDK12 mutations, and less frequent BRCA2 mutations. In our study, such pts demonstrated worse PFS but not OS. While the strongest negative predictor of OS was the presence of combined PTEN/RB1/TP53 mutations, other contributors such as CDK12 and BRCA2 may also partially explain differences in outcomes. Thus, primary mHSPC appears to be clinically and genomically distinct from secondary mHSPC, and may require unique treatment paradigms.
Short-term effects of combinant intraperitoneal hyperthermal chemotherapy with general chemotherapy in malignant ascites
Authors: Zong-lan Hu, Jun-li Cao, Zhan-zhao Fu, Tao Gu, Shao-hui Cheng, Hai-xia Hua, Sen Yang, Li-jiao Zhang, Yan-hong Yang, Li-xin Dong
Journal: BMJ (2008)

Sixty-one patients with moderate to severe malignant ascites were enrolled and randomly assigned to receive intraperitoneal hyperthermal chemotherapy+intravenous chemical injection (treatment group; n=31) or routine intravenous chemical injection (control group; n=30). Short-term response and reverse effects were observed. Our results indicated that the complete remission rate, part remission rate,and clinical benefit rate in the treatment group was significantly higher than those in the control group (38.71% vs 13.33% ,41.94% vs 16. 67%, and 90.32% vs 66.67%, respectively). No difference in reverse effects was found between the two groups. Our data suggest that intraperitoneal hyperthermal chemotherapy plus general chemotherapy may effectively control the malignant ascites, and the reverse effects might be well tolerated.

Key words: 
Chemotherapy,cancer, regional perfusion;  Ascites
Effect of temozolomide chronotherapy in patients with high-grade glioma.
Authors: Himachandana Atluri, Jian Li Campian, Grayson Talcott, Melissa Meyer, Emily Slat, Joshua Rubin, Jiayi Huang, Milan G Chheda, Tanner Michael Johanns, Yu Tao, Ashwin Govindan
Journal: Journal of Clinical Oncology (2020)

e14525 Background: High grade gliomas (HGG) (the most common being glioblastoma) are the most common primary CNS malignancy in adults. Mainstay of therapy is surgical resection followed by concurrent radiation and temozolomide (TMZ) followed by adjuvant TMZ. Unfortunately, prognosis remains poor and optimization of current therapy is critical. Chronotherapy is defined as improvement in treatment outcomes by maximizing treatment efficacy and minimizing toxicity by administering medications in accordance with biological rhythms of the patient. In a mouse model, there was greater anti-tumor efficacy during morning administration of TMZ. This trial was designed to determine the feasibility and potential clinical impact of chrono-therapeutically administering TMZ in patients with HGG. Methods: Adult patients ( &gt; 18 years) with HGG (WHO Grade III/IV) were eligible. Patients were screened and consented prior to initiation of monthly TMZ therapy. Eligible patients were randomized to TMZ in the morning (AM) before 10AM or in the evening (PM) after 8PM. Pill diaries were recorded for drug administration time and compliance. Fact-Br Quality of Life (QoL) surveys were administered to patients at the time of enrollment in the trial and at the end of treatment to measure differences in QoL in both groups. Circadian rhythm was recorded by Actiwatch. Adverse events (AE), overall survival (OS) and progression free survival (PFS) were measured for each group. Results: At the time of submission, a total of 28 patients were evaluated. 15 patients were in AM group and 13 in PM group. It is feasible for participants to take TMZ per study assignment. There was no significant difference in the QoL based on the Fact-Br dataset in the four main categories of physical well-being, social/family well-being, functional well-being and emotional well-being. The Friedman’s two-way nonparametric ANOVA tests were used to analyze the differences across time points. Cytopenias are a known adverse effect of TMZ. There was a trend towards worsening lymphocyte counts in the AM group compared to PM group, although not statistically significant. There was no statistical significance in PFS or OS in patients with newly diagnosed glioblastoma. Conclusions: Chronotherapy with TMZ is feasible. A trend of worsening lymphocyte counts is noted in AM treatment group compared to PM group but was not statistically significant. No difference in OS or PFS was noted, although sample size was too small to effectively assess this. A larger study will need to be conducted to effectively assess the effect of chronotherapy on survival. Clinical trial information: NCT02781792.
Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15‐year prospective longitudinal trajectories in survivors
Authors: Evelyn Santiago‐Vacas, Josep Lupón, Giovana Gavidia‐Bovadilla, Francisco Gual‐Capllonch, Marta de Antonio, Mar Domingo, Julio Núñez, Elisabet Zamora, Albert Teis, Pedro Moliner, Pau Codina, Javier Santesmases, Antoni Bayes‐Genis
Journal: European Journal of Heart Failure (2020)
Impact of tumor histology and socioeconomic factors on survival of patients suffering from malignant vascular tumors of liver and hepatocellular carcinomas: A SEER database analysis.
Authors: Aditya Varnam Shreenivas, Guru Subramanian Guru Murthy, Ben George, James P. Thomas, Sakti Chakrabarti, Mandana Kamgar, Paul S. Ritch
Journal: Journal of Clinical Oncology (2020)

e16612 Background: Primary malignant vascular tumors of the liver are rare, aggressive and poorly understood subtypes of liver cancers. In this analysis, we aim to determine the impact of tumor histology and other socio economic factors on survival of these tumors and hepatocellular carcinomas. Methods: Patients with malignant histopathological diagnoses of hepatocellular carcinoma not otherwise specified (HCC NOS), hepatocellular carcinoma with spindle cell (HCC SP), fibrolamellar (HCC F), clear cell (HCC CL), scirrhous (HCC SC) and pleomorphic variants ( HCC PL), combined hepatocellular carcinoma and cholangiocarcinoma (Mixed), hepatic angiosarcoma (AS), hemangioendothelioma (HE), its epithelioid variant (EHE) and hemangiopericytoma (HP) were identified using the SEER (version 2018) database. Overall survival was studied with Kaplan–Meier with the log rank method. Multivariable analysis was performed to assess the impact of race, ethnicity, marital and insurance status on survival of these patients. Results: We analyzed de-identified data of 104502 patients from the year 1973 to 2016 with hepatocellular carcinomas and malignant vascular tumors of liver (including 101851 patients with HCCNOS, 70 with HCC SP, 378 with HCC F, 104 with HCC SC, 593 with HCC CL, 23 with HCC PL, 950 with Mixed, 367 with AS, 36 with HE, 120 with EHE and 10 with HP ) respectively. Median overall survival (OS) of HCC NOS was calculated to be 7 months. Among hepatocellular carcinoma patients HCC F had the longest median OS of 29 months and HCC SP had the shortest median OS of 3months (P &lt; 0.001). Additionally, among patients with malignant vascular tumors, AS had the shortest median OS (1 month) while patients with EHE had the longest median OS of 81 months (P &lt; 0.001). Overall, married and insured patients had a better overall survival than unmarried and uninsured patients (P &lt; 0.04). Conclusions: Malignant vascular tumors of liver are rare in comparison to hepatocellular carcinomas. Spindle cell variant of HCC and liver angiosarcomas carry the worst prognosis and fibrolamellar variant of HCC, hemangioendothelioma (HE) and its epithelioid variant (EHE) have the best prognosis. Insurance and marital status has a positive impact on overall survival of liver cancer patients.
Efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome
Authors: Lina Sun, Ningfu Wang, Lan Kang, Wei Gao, Hong Li, Lei Lai, Hao Pan, Xianhua Ye, Liang Zhou, Guoxin Tong, Jianmin Yang, Peng Xu
Journal: BMJ (2014)

Objective
To evaluate the clinical efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome (ACS).


Methods
A total of 218 ACS patients admitted in Hangzhou First People's Hospital from March 2013 to July 2013 were enrolled into this study. The patients were randomly assigned to receive atorvastatin 80 mg/d during hospitalization, and 40 mg/night after discharge for one month (intensive group, n=107); or receive atorvastin 20 mg during hospitalization and 20 mg/night after discharge for one month (control group, n=111). The biochemical indexes were measured on the admission and after one-month treatment.


Results
After one-month treatment, the total cholesterol, triglycerides and LDL cholesterol of intensive group were significantly lower, and the high density lipoprotein cholesterol was higher than baseline values (0.75±0.14)mmol/L vs. (1.52±0.88)mmol/L, P<0.05; (2.21±0.78)mmol/L vs.(4.55±1.12)mmol/L, P<0.05; (1.76±0.31)mmol/L vs.(2.23±0.77) mmol/L, P<0.05; (1.15±0.34) vs.(1.52±0.41)mmol/L, P<0.05. The liver enzymes creatine kinase in intensive group was not significantly changed, but the creatinine levels decreased (82.53±23.85)μmol/L vs.(57.81±15.27) μmol/L, P<0.05, and the blood homocysteine and ultra-sensitivity C-reactive protein levels also decreased compared with the baseline (10.52±4.66)mmol/L vs.(30.70±18.82) mmol/L, P<0.05; (8.06±2.68)mg/L vs.(19.75±11.91)mg/L, P<0.05.


Conclusions
Short-term intensive statin therapy can effectively reduce blood lipid, cholesterol and homocysteine levels and raise HDL cholesterol levels; also with its anti-inflammatory and renal protective effect the therapy can provide more clinical benefit for patients with ACS.


Key words: 
Coronary Disease; Antilipemic agents; Treatment outcome
内镜联合经皮肝穿刺胆管引流术对胆管梗阻的治疗作用
Authors: 陈幼祥, 吕农华, 郭贵海, 徐萍, 朱勇
Journal: BMJ (2006)

对12例内镜下逆行胰胆管造影术胆管造影失败或胆管深插管失败,且术前诊断胆管结石或胆管梗阻者,行内镜联合经皮肝穿刺胆管引流术治疗.结果7例采用该技术治疗胆管结石获成功,5例恶性肿瘤并转移胆管狭窄者放置胆道支架引流成功,均未出现与操作相关的并发症.提示该方法治疗胆道梗阻安全有效,可做为内镜下逆行胰胆管造影术失败后一种有效的补救方法。
Clinical analysis of 10 cases of idiopathic portal hypertension
Authors: Yijin Zhang, Xuesong Gao
Journal: BMJ (2015)

Objective
To review the clinical characteristics of idiopathic portal hypertension (IPH).


Methods
The clinical and pathological data of 10 patients with idiopathic portal hypertension admitted from December 2008 to December 2014 were retrospectively analyzed.


Results
Among 10 patients 5 were males and 5 females with averaged age of (38.6±16.1) years. There were splenomegaly and esophageal varices in all 10 cases, upper gastrointestinal bleeding in 3 cases, thrombocytopenia in 9 cases and anemia in 6 cases. Liver function was normal in 7 cases, mild abnormality in 3 cases. Ten cases underwent ultrasound examination and 7 cases had CT scan, cirrhosis was suggested with ultrasound/CT scan in 6 cases. Liver histology showed lobular architecture in existence, no false flocculus to form, variable degree of portal fibrosis appeared. Eight cases were misdiagnosed as liver cirrhosis, the duration of misdiagnosis varied from 1 month to 15 years.


Conclusions
The clinical manifestation of IPH is similar as cirrhosis caused portal hypertension. Liver histopathological examination can exclude liver cirrhosis, and portal fibrosis and liver terminal portal branch occlusion in histopathology is helpful to the diagnosis of IPH.


Key words: 
Hypertension, portal; Diseases attributes; Diagnosis
Progress on application of dexmedetomidine in regional block anesthesia
Authors: Qingren Liu, Yunhui Zhang
Journal: BMJ (2016)

Dexmedetomidine (Dex) is a novel and highly selective α2-adrenoceptor agonist, it has anxiolytic, antisympathetic and certain analgesic effects, its sedative effect can lead to mimic natural sleep. Dex is widely applied in mechanical ventilation, invasive procedures and perianesthesia with other drugs by intravenous route. Recent basic and clinical researches show that Dex can be applied safely and effectively with local anesthetics in regional block, to improve anesthetic effect, promote stable hemodynamics and optimize postoperative analgesia.


Key words: 
Dexmedetomidine; Nerve block
White coat hypertension in non-hypertensive patients
Authors: 刘勇
Journal: BMJ (2004)

近20年来,国外关于白大衣高血压(white coat hypertension,WCH)在成人高血压病中的流行病学和临床意义已有较多研究报道,但有关WCH在非高血压病患者中的状况的研究于近几年才有了较好的开端。
Impact of augmented intelligence (AI) on identification and management of depression in oncology.
Authors: John Frownfelter, Sibel Blau, Marjorie Zettler, Kelly Miller, Jonathan Kish, Amy W. Valley, Ajeet Gajra
Journal: Journal of Clinical Oncology (2020)

e14059 Background: Depression is common in patients with cancer and is associated with worse cancer treatment outcomes. Depression is often underdiagnosed/treated as cancer clinicians are focused on the complex aspects of therapy and care coordination. AI has a potential application in the identification of patients at high risk for depression. Jvion has developed a prescriptive analytics solution (the Machine), which uses AI algorithms and machine learning techniques applied to combined clinical and exogenous datasets to identify patients with a propensity for poor clinical outcomes. The Machine was applied to depression risk (within next 6 months), and recommended patient-specific, dynamic, and actionable insights. While the Machine requires no additional documentation within the electronic health record (EHR) to generate its insights, those insights can be integrated back in to any EHR. Herein, we report the results of a pilot study evaluating the impact of AI-driven insights on depression screening and management at a single oncology practice. Methods: All patients were scored weekly using the Machine depression vector. The Machine risk-stratified the patients and generated recommendations for the provider to consider as they developed a care plan. Patients identified as “at risk” by the Machine were assessed for depression (PHQ-9) by the clinical team regardless of prior screening results. The rate per 1000 unique patients per month (PPM) of depression screenings, case management evaluations, and antidepressant prescriptions were calculated for the 5 months prior to and 17 months post deployment of the Machine in the practice. Results: The oncology practice has 21 providers managing an average of 4329 unique PPM. The mean rate of depression screenings increased from 6.0 per 1000 PPM pre- deployment to 16.2 per 1000 PPM post deployment (+271%). The downstream workflow outcomes of case management evaluations increased from 11.6 to 21.4 per 1000 PPM (+184%) and antidepressant prescriptions increased from 9.2 to 15.5 per 1000 PPM (+168%) pre and post-implementation respectively. The providers reported high satisfaction with the use of the AI solution in depression screening. Conclusions: This oncology practice found deployment of the Jvion AI solution to be feasible. The Machine-generated insights for depression risk were actionable, could be incorporated into workflow, and increased the number of patients identified. If confirmed in larger studies, AI-driven insights may improve the identification and management of depression in patients with cancer.