tbuckley/cabot-search huggingface dataset:
Application of clinical pathway in management of patients with bronchial asthma in a Beijing community
Authors: Yun Xia, Ping Zheng, Lijuan Wei
Journal: BMJ (2018)

Objective
To evaluate the application of clinical pathway in management of patients with bronchial asthma in the community.


Methods
One hundred and ten patients with bronchial asthma were enrolled from Xinzhong community in Beijing Dongcheng district during January 2015 to December 2016. Patients were randomly assigned in two groups: 53 patients were managed with conventional method (control group) and 57 patients received clinical pathway management (study group). The asthma control test (ACT), degree of airflow limitation (FEV1%), annual acute attack times and annual medical expenses were compared between the two groups.


Results
There was no significant difference in the ACT(16.72±3.90 vs.16.82±4.81 points, t=-0.13) and FEV1%(66.8±17.43 vs. 68.57±19.79, t=-0.44)between two groups before management (P>0.05). After treatments, the ACT(16.72±3.90 vs. 17.23±3.47 points, t=-1.19)and FEV1%(66.8±17.43 vs. 70.35±9.78, t=-1.84)in control group were unchanged (P>0.05) , while the ACT(16.82±4.81 vs.19.40±3.64 points, t=-6.10)and FEV1%(68.57±19.79 vs. 77.03±14.04, t=-4.83)in study group were improved significantly (P<0.05). After one year of clinical pathway management, the ACT(19.40±3.64 vs. 17.23±3.47 points, t=-3.20)and FEV1%(77.03±14.04 vs. 70.35±9.78, t=-2.88)in study group were significantly higher than those in control group (P<0.05) . The annual acute attack times (1.23±0.42 vs.1.85±1.39 times, t=3.21) and annual medical expenses [16 966(3 130, 61 869)vs. 23 400(7 864, 237 028) Yuan, Z=-3.47] of study group were significantly lower than those of control group (P<0.05).


Conclusions
Clinical pathway management can improve ACT and FEV1% in patients with bronchial asthma, and reduce the risk of acute attack and medical expenses.


Key words: 
Clinical pathway; Asthma; Treatment outcome; Community health centers
Long-term outcomes of preoperative radiotherapy in locally advanced breast cancer: Analysis of Surveillance, Epidemiology, and End Results (SEER) database.
Authors: Zhe Pan, Zhiyuan Yao, Mingkai Huang, Junfeng Huang, Xiang Ao
Journal: Journal of Clinical Oncology (2020)

e12600 Background: Currently the treatment paradigm for locally advanced breast cancer (LABC) is multimodality therapy with neoadjuvant systematic treatment, surgery and postoperative radiation therapy (RT). However, with improving outcomes from systematic therapy, the survival rates remain unpromising, which leads to the investigation of the concept of preoperative RT in LABC due to the potential advantages including a possible tumor downstaging and better cosmetic outcomes. We evaluated the overall survival (OS) and breast cancer specific survival (BCSS) of preoperative versus postoperative RT in LABC patients. Methods: Patients diagnosed with non-inflammatory LABC (defined as T3 N1, T4 N0, any N2 or N3, and M0) who received RT before or after surgery between 2010 and 2015 were identified using the SEER database. OS and BCSS were analyzed using Kaplan-Meier method and multivariate Cox proportional hazards model. Results: Among 19249 patients with LABC, 140 (0.7%) received preoperative RT and 19109 (99.3%) received postoperative RT. Overall, 5-year survival and BCSS are 59% and 63% in the preoperative RT group while 77% and 80% in the postoperative RT group. In all patients, treatment with preoperative RT was significantly associated with poor OS (HR 1.82, 95%CI 1.25 to 2.45, P &lt; 0.001) and BCSS (HR 2.00, 95%CI 1.46 to 2.73, P &lt; 0.001) after adjustment for other clinically relevant factors. However, there were no significant difference in terms of both OS and BCSS in ER+ (OS: HR 1.44, 95%CI 0.91 to 2.27, P = 0.12; BCSS: HR 1.55, 95%CI 0.94 to 2.54, P = 0.08) and HER2+ patients (OS: HR 1.33, 95%CI 0.55 to 3.22, P = 0.53; BCSS: HR 1.64, 95%CI 0.67 to 3.97, P = 0.28). Conclusions: Overall, preoperative RT in LABC may reduce overall survival and breast cancer specific survival. However, OS and BCSS were independent of radiation sequence for ER+ and HER2+ patients. This finding warrants further exploration of potential mechanisms of the disparity and the definitive role of preoperative RT in the multimodality therapy of LABC patients.
Laparoscopy compared with laparotomy for comprehensive surgical staging of early ovarian cancer: Results of a retrospective multicenter case-control study.
Authors: Julia Caroline Radosa, Marc P Radosa, Pauline Mertke, Marie-Luise Hugo, Christoph Georg Radosa, Sara Brucker, Florin Andrei Taran, Stefan Kommoss, Uwe Andreas Ulrich, Andreas Hackethal, Benjamin Tuschy, Marc Suetterlin, Martin Deeken, Erich-Franz Solomayer
Journal: Journal of Clinical Oncology (2020)

6067 Background: The objective of this study was to compare laparoscopy and laparotomy for comprehensive surgical staging of early ovarian cancer in terms of efficacy and oncologic safety. Methods: Patients who had laparoscopic staging for early stage (I/II) ovarian cancer between 01/2000 and 10/2018 at the participating sites (Gynecologic comprehensive cancer centers with respective expertise in minimal invasive surgery) were included in this retrospective case-control study. The control group consisted of all patients treated via laparotomy during the study period. Clinical data were abstracted from medical record and recent follow up information were obtained. Comparisons were made between patients regarding surgical parameters and oncologic outcome and multivariate models were used to identify factors independently associated with disease recurrence. Results: Among 313 patients, staging was performed via laparoscopy in 208 (66 %) patients and via laparotomy in 105 (34 %) patients. Patients staged laparoscopically were younger (median 52 (15-86) vs. 59 (17-92) vears, p≤0.01) and had a lower BMI (24.4 (16.5-46.8) vs. 26 (15.5-53.8), p≤0.01). Regarding surgical parameters, duration of surgery was longer (291 (159-778) vs. 277 (159-690) minutes, p≤0.01), postoperative hospitalization was shorter (7 (0-27) vs. 9 (0-92) days, p≤0.01) and postoperative complications were lower in the laparoscopy group. On univariate analysis there were no differences in rates of tumor stage according to FIGO, intraoperative rupture of ovarian cysts (14 % vs. 13 %, p=0.87), number of lymph nodes removed (24 (0-89) vs. 22 (0-96), p=0.81) or any recurrence of disease (14 % vs. 16 %, p=0.52). At a median follow-up of 46 months (0-227), there were no differences in DFS and OS by surgical technique (5yr DFS 82 % (SE 0.04) vs. 83 % (SE 0.05), p=0.43; OS 91 % (SE 0.03) vs. 87 % (SE 0.04), p=0.87). On multivariate analysis route of surgery was not associated with an increased risk of recurrence. Conclusions: According to this preliminary analysis, laparoscopic surgical staging in patients with early ovarian cancer seems to be adequate and safe, but a longer follow-up and prospective data are needed to enhance evidence on oncologic outcomes.
肾原发性淋巴瘤一例
Authors: 李尚明, 马丰庆
Journal: BMJ (2011)

患者男性,63岁,因左腰部阵发性酸痛1个月,明显加重1 d,于2008年1月7日入院,自觉疼痛难忍,向左腰背部放射,无发热、恶心及呕吐,无腹胀,无膀胱刺激征,无肉眼血尿.体检:一般情况可,全身浅表淋巴结无肿大,肝脾未触及,双肾区未触及包块,左肾区叩痛明显,双输尿管行经区无压痛。
可待因中毒致脑干梗死一例
Authors: 徐晶, 肖丽君, 韩静艳
Journal: BMJ (2007)

患者男,23岁.5 d前一次性服下复方可待因口服溶液240 ml(2瓶),服后5 min即出现出汗、头晕、头痛,继而进入睡眠状态.6 h后醒来,出现不能说话、站立不稳、烦躁不安,不久后又进入嗜睡状态,被送到当地综合医院救治.入院时患者时睡时醒,醒时即出现烦躁不安、双臂乱动、口干,吞咽困难,不能进食水。
Primary cutaneous diffuse large B-cell lymphoma, leg-type: The Mayo Clinic experience.
Authors: Muhamad Alhaj Moustafa, Ricardo Daniel Parrondo, Nicole Gannon, Jacquelyn Hastings, Karan Seegobin, Bradford Hoppe, David M Menke, Mohamed Kharfan-Dabaja, Ernesto Ayala, Liuyan Jiang, Han W. Tun
Journal: Journal of Clinical Oncology (2020)

e20044 Background: Primary Cutaneous Diffuse Large B-cell Lymphoma, Leg-type (PCDLBCL) is a rare lymphoma comprising 4% of all cutaneous lymphomas with an aggressive clinical course. We investigated disease characteristics and outcomes among patients PCDLBCL. Methods: Following IRB approval, we identified patients retrospectively with PCDLBCL treated at the Mayo Clinic Cancer Center 1998-2019. Results: 45 pts were identified with a median age of 71 years (Range- 48-95) and 28 (62%) were female. Disease locations were legs (62%), arms (22%), head (11%), trunk (2%) and multiple sites (2%). At diagnosis, (51%) had a single lesion, (29%) had multiple lesions in 1-2 contiguous regions, (16%) had multiple lesions in non-contiguous regions or &gt; 2 regions and data was not available (4%). Immunohistochemistry showed positive staining for BCL-2 (92%), BCL-6 (76%), c-MYC (62%), MUM1 (95%), CD10 (11%), and cytoplasmic IgM (8/9- 89%). By Han’s criteria, (95%) had activated B cell lymphoma (ABC). Median Ki-67 was 90% (range, 50,100%). 9/12 (75%) were positive for MYD88 L265P mutation. 13/21 (62%) were double expressor and 3/22 (14%) had double hit lymphoma. 37/45 (82%) had ECOG &lt; 2. LDH was elevated in 13/37 (35%). The median number of therapies was 1 (range; 1-11). The initial treatments were chemo-radiation (30%), chemo alone (38%), rituximab alone (11%), radiation (RT) alone (16%), rituximab-RT (2.5%), and surgical (2.5%). The median follow-up time for the whole cohort was 80 months (95% CI; 32, 169). The median progression free survival and overall survival (OS) were 20 months (95% CI; 12, 34) and 80 months (95% CI; 48, 119). 22/45 (49%) are alive. The cause of death was disease-related in 11/23 (48%). The median number of relapses was 1 (range; 0, 11) with (60%) relapsed after first line. 4/45 pts had autologous stem cell transplant after relapse. 7/45 (16%) had a systemic relapse at a median time of 35 months from diagnosis (range; 16, 112). Age above 60 years was associated with worse OS; 70 months (95% CI; 30, 99) vs NR (95% CI; 135, NR), p = 0.025. ECOG performance status &lt; 2 was associated with better OS, NR months (95% CI; 80, NR) vs 48 months (95% CI; 3.3, 88),p = 0.0003. 1 pt received Ibrutinib on 11 th relapse and had 3 years of PFS. Conclusions: PCDLBCL is predominantly ABC type, affects elderly pts and is characterized by multiple cutaneous relapses followed in some cases by systemic relapses. Increased age and poor performance status had a negative impact on OS. High incidence of MYD88 L265P mutation is observed in PCDLBCL similar to immune-privileged site lymphomas.
Effectiveness evaluation ofapplyingan intelligent voice callsystem on the popular science knowledge of Corona Virus Disease 2019 for the patients with chronic diseases in the community
Authors: Xuejuan Wei, Ying Chen, Hao Wu, Caiying Ge, Li Wang, Wenjuan Gao
Journal: BMJ (2020)

Objective
To improve the contracted patients’cognitive level and self-protection ability ofCorona Virus Disease 2019 (COVID-19)through the popularizationeducation with the application of an intelligent voice outbound system.


Methods
12 popular science education modules ware designed according to the knowledge and protective measures ofCOVID-19, and3-6 core points were extracted from each module. From Wuhan city blocked 2020.1.23 to 2020.1.29, the intelligent voice outbound system was applied toperform batch voice call calls and send text messages to all contracted patients with chronic diseases in different period of time for popular science education.Using equidistant sampling method, 400 cases were successfully selectedfrom the patients of successful voice outbound calls.The intelligent voice outbound system was used to investigatepatients' mastery, the main sources ofCOVID-19knowledge, and satisfaction with popular science education conducted in this study. The outbound results of the above indicators were queried from the database of the intelligent voice outbound system.


Results
A total of 98,487 voice outbound calls were effectively connected,the average call duration per person was 2.24 minutes, and the total call durationwas equivalent to 488.5 workdays. 141,201 messages were sent, with a read rate of 97.8% (141 201/144 405) . The patients’scoreto answer the popular science knowledge questionnaire was 86.8±16.7.94.8% (235/248) of patients’knowledge of COVID-19mainly came from voice call.In addition, the patient's overall satisfaction with the application of the intelligent voice call system for popular science education was90.8%(225/248).


Conclusion
The patients’cognitive levelofCOVID-19knowledge and its prevention and control measureseffectively improved with the application of an intelligent voice outbound system. Moreover, this mode was highly acceptable to patients, whichshould be referenced by other urban communities in China.


Key words: 
Corona Virus Disease 2019 (COVID-19); Community; Intelligence; Voice callsystem; Healthy education
Single-institutional analysis of clinicopathologic features and overall survival (OS) in melanoma patients (pts).
Authors: Ding Wang, Jonathan Wang, Richard Krajenta, Liping Zhu
Journal: Journal of Clinical Oncology (2020)

e14023 Background: Melanoma is ranked 5th commonest malignancy in United States and SEER has projected 3,290 new skin melanoma cases in Michigan in 2020. Diagnosis of recurrent &amp; metastatic melanoma has associated with poor prognosis and survival. Henry Ford Cancer Institute (HFCI) is a tertiary cancer care facility serves cancer patients from communities throughout metropolitan Detroit tri-county areas where a higher melanoma presentation (1.56%) in black pts than this group at national database (0.6%). A subgroup of white Michiganders travel to Southern sunshine states in winter months known as “snowbirds” have contributed to melanoma incidences in Michigan. We aim to review our institute tumor registry data to analyze the clinicopathological features, care pattern and correlated survival outcomes. Methods: We have identified adult melanoma pts through institute tumor registry between 2007 – 2017, who had demographics, initial diagnosis, recurrence, then death or last follow-up for overall survival (OS) outcome. Data were analyzed using IBM SPSS, R-statistical and log-rank test. Results: Of 1327 eligible pts, median age was 63, and 874 (65.86%) pts were invasive at onset diagnosis. 1298 (97.81%) pts were white, 23 (1.73%) pts were black. Slightly more females (55.54%) over males and overall 301 deaths (22.68%) were observed. 1277 pts with cutaneous melanoma had better 5- and 10-year (yr) OS at 78.14%, and 68.32% compared to 50 (3.77%) non-cutaneous pts at 13.31% and 8.87%, respectively. Black pts carried a poor 5-yr OS at 34.68% vs white at 76.4%. 116 (17.9%) pts presented with recurrences, had 5-yr OS at 34.58%. Of 121 (9.1%) pts who never had been disease-free, showed worse 5-yr OS at 15.87%, with trend of improvement since FDA-approval of immune checkpoint inhibitor therapies. Conclusions: We have analyzed our melanoma care pattern, experience and survival outcomes at 5-yr and/or 10-yr from a tertiary community cancer care facility. We have assessed our current practice benchmarks with plan to improve our care delivery by having built a multidisciplinary team, and launched Melanoma &amp; Skin Cancer Clinical Care Pathway through Tumor Board to improve care access, to decrease care disparity, then to standardize quality of care including encouraging clinical trial enrollments which will enhance quality of melanoma care and survival outcomes of advanced and metastatic cases.
Streamlining the genetics pipeline to increase testing for patients at risk for hereditary prostate cancer.
Authors: Barry Tong, Hala Borno, Eric Jay Small, Fern Alagala, Amie Blanco, Mallika Sachdev Dhawan
Journal: Journal of Clinical Oncology (2020)

1590 Background: Metastatic prostate Cancer (mPCa) is increasingly recognized as a heritable disease and germline genetic testing has increasingly become a part of standard of care. At the University of California at San Francisco (UCSF) Genitourinary (GU) Medical Oncology clinic, approximately 850 new patients with mPCa are seen annually. A feasibility pilot Genetic Testing Station (GTS) was developed to expand access to genetic testing among this high-risk population. GTS is facilitated by Genetic Counselor Assistants (GCA) under the supervision of genetic counselors. Methods: This is a feasibility pilot of a GTS model among patients with mPCa. In this model, all patients with mPCa are offered a same day GTS visit with a GCA. At the GTS, the patient receives pre-test education via videos developed by genetic counselors. The patient provides informed consent, a family history, and a saliva sample for Invitae’s 87-gene panel. All positive results trigger a genetic counselor visit while non-positive results either receive a letter or a genetic counselor visit (in person or via telehealth). To evaluate the model, testing frequency and laboratory turnaround time (TAT) was assessed before and after the pilot. Results: In the first four months of the GTS pilot (10/14/2019 – 02/10/2020), 94 patients were referred and received genetic testing. Eight germline positives were identified (BRCA2, CHEK2, HOXB13 MSH6, RECQL4). The average TAT was 8 days. 9.3% of patients were found to have pathogenic mutations through the prostate GTS which is comparable to previously published rates of germline mutations in metastatic prostate cancer patients. In a 4-month time frame the prior to the intervention (10/01/2018-1/31/2019), 26 genetic testing orders were placed. The average laboratory TAT in this prior process was 17 days. Rates of positive germline mutations in the prior model was 8.6%. Conclusions: The GTS is a feasible method to increase access to germline genetic testing among a high-risk population. It may reduce barriers to testing and facilitate real-time discussion of treatment and prevention strategies with patients and family members. As a result, we will continue to operate the GTS. This model provides a framework for scaling access for and cascade testing in other high-risk patient groups.
Phase I study of 9-ing-41, a small molecule selective glycogen synthase kinase-3 beta (GSK-3β) inhibitor, as a single agent and combined with chemotherapy, in patients with refractory tumors.
Authors: Benedito A. Carneiro, Ludimila Cavalcante, Bruno R. Bastos, Steven Francis Powell, Wen Wee Ma, Solmaz Sahebjam, Donald Harvey, Andre Luiz De Souza, Mallika Sachdev Dhawan, Howard Safran, Francis J. Giles, Pamela N. Munster
Journal: Journal of Clinical Oncology (2020)

3507 Background: Overexpression of GSK-3β, a serine/threonine kinase, is associated with advanced stage malignancies, aggressive tumor growth, and chemotherapy resistance. 9-ING-41 is a GSK-3β inhibitor with significant broad spectrum pre-clinical antitumor activity, including chemotherapy-resistant models. This first-in-human study (NCT03678883) is evaluating the safety, pharmacokinetics (PK), and efficacy of 9-ING-41 monotherapy and in combination with chemotherapy in patients (pts) with refractory malignancies. Methods: 9-ING-41 is given intravenously (IV) twice-weekly as a single-agent (21-day cycle) or combined with gemcitabine, gemcitabine/nab-paclitaxel, carboplatin, carboplatin/paclitaxel, doxorubicin, lomustine or irinotecan in patients previously treated with the same chemotherapy. Results: As of Jan 2020, 101 pts were enrolled. Tumor types: 25 pancreatic (PDAC), 14 colorectal (CRC), 10 non-small cell lung cancer (NSCLC), 8 GBM and other gliomas, 7 melanoma, 5 appendiceal, 4 breast (BC), 30 others. Seven single agent dose levels (DL) completed (1, 2, 3.3, 5, 7, 9.3, 12.4 mg/kg) without any 9-ING-41-attributable SAEs. 9-ING-41 attributable AEs include: transient visual change (color perception; n = 29), starting at DL 3 (3.3mg/kg), all G1/2; infusion reactions (n = 14), all G1/2, starting at DL 5 (7mg/kg). 9-ING-41’s mean terminal half-life is 12-20 hrs. C max and AUC 0-72 , are dose proportional with no accumulation. One BRAFV600K-mutated melanoma with &gt; 20 brain metastases, post checkpoint/BRAF/MEK failure has an ongoing CR starting at cycle 2 and sustained after 9 months on treatment. 32 (31%) pts had SD as best response (6 PDAC, 6 CRC, 3 appendiceal, 2 BC, 2 salivary gland, 2 melanoma, 1 Merkel cell, 2 GBM/glioma, 1 RCC, 1 HCC, 1 NSCLC, 1 esophageal, 1 parotid gland, 1 nasopharyngeal, 1 peritoneal, 1 T cell-ALL). 8 pts remained on study treatment &gt; 5 months (1 melanoma, 3 PDAC, 1 appendiceal, 1 GBM, 1 peritoneal, 1 salivary gland) with median treatment duration of 198 days (range 163-261). 32 pts continue to receive 9-ING-41. Conclusions: 9-ING-41 has dose-proportional PK, is well tolerated with significant antitumor activity as monotherapy and in combination with chemotherapy in pts with refractory tumors. 1 ongoing CR was observed in a refractory BRAF-mutated melanoma. A biologically active dose has been reached, although MTD has not been determined. Enrollment is ongoing. Clinical trial information: NCT03678883 .
Updated safety phase I trial of anti-LAG-3 alone and in combination with anti-PD-1 in patients with recurrent GBM.
Authors: Michael Lim, Xiaobu Ye, Anna F. Piotrowski, Arati Suvas Desai, Manmeet Singh Ahluwalia, Tobias Walbert, Joy D. Fisher, Serena Desideri, Louis B. Nabors, Patrick Y. Wen, Stuart A. Grossman
Journal: Journal of Clinical Oncology (2020)

2512 Background: Preclinical GBM data targeting the checkpoint molecule Lag-3 have shown promising anti-tumor immune response with resultant improved survival when combined with anti-PD-1. Here we report our experience from a multi-arm safety study in patients with recurrent GBM treated with anti-Lag-3 and in combination with anti-PD-1. Methods: A phase I, open label, multicenter, multi-arm dose-finding/safety study of anti-LAG-3 (BMS-986016) alone or in combination with anti-PD-1 in patients at first recurrence of GBM was carried out in The Adult Brain Tumor Consortium (ABTC) (1501). The primary objectives were safety and to define MTD (DLT rate &lt; 33%) for both the mono and combination arms. The major secondary objective was efficacy. The key inclusion criteria were: adults with first recurrence of GBM following RT+TMZ, TLC≥1000/ul, KPS≥ 60%, on a stable corticosteroid regimen, measurable disease, and written informed consent. Three pre specified dose levels of anti-Lag-3 at 80mg, 160mg, and 800mg were tested. Anti-PD-1was given at a flat dose of 240 mg in combination with anti-LAG-3 at 80 mg and 160 mg. Results: To date, the phase I portion of study completed its accrual and 33 patients were enrolled into the anti-LAG-3 alone or in combination with anti-PD-1 arms. The median age and KPS was 56 and 90 respectively. 39% tumors were MGMT methylated and the median treatment cycle was 3. The highest safe dose for Anti-LAG-3 alone is 800 mg without a DLT. Two DLT were observed in combination arms of Anti-LAG-3 +anti-PD-1 (80 mg/240mg), a grade 3 muscle weakness and a grade 4 edema. Three DLTs were observed in the higher Anti-LAG-3 + anti-PD-1 group (160 mg/240mg): grade 3 hypertension, syncope, and edema. 80% of the DLTs occurred after cycle 2 of the treatment. The estimated overall mOS was 8 months. Seven (44%) patients in the combination arm are still alive and 3 out of the 7 are living beyond 20 months suggesting a subset benefit. Conclusions: The phase I part of trial has completed enrollment. The MTD is 800mg for anti-LAG-3 as a monotherapy. For the combination arms, 160 mg of Anti-LAG-3 and 240 mg of anti-PD-1 was the MTD. DLTs were late onset events. Clinical trial information: NCT02658981 .