tbuckley/cabot-search huggingface dataset:
Surgical effect of dysphagia in patients with bulbar myasthenia gravis
Authors: Yun-feng Zhang, Jian-ye Li, Shan Ma, Lei Yu
Journal: BMJ (2013)

To retrospectively analyze the clinical data of 42 patients at our department with bulbar myasthenia gravis. They underwent video-assisted thoracoscopic extended thymectomy (VATET) from May 2003 to August 2010. Another 42 patients treated with medications alone were selected as controls. Compared with the control group(4.32±0.23), postoperative dysphagia scores improved significantly in patients undergoing VATET(9.21±0.41). And so did the dysphagia assessment classification (P<0.05). Thus VATET could effectively and definitely relieve dysphagia in patients with bulbar myasthenia gravis.


Key words: 
Myasthenia gravis; Deglutition disorders
Progress on relationship between renin-angiotensin system and skeletal muscle insulin resistance
Authors: Qi Huang, Wenjun Wu
Journal: BMJ (2016)

Skeletal muscle is essential for the glucose disposal in organism, which is one of the major sites of insulin resistance. The over-activity of classical renin-angiotensin system (RAS) induces the oxidative stress, leads to the impairment of insulin signaling and glucose transport, resulting in insulin resistance of skeleton muscle. The activation of non-classical RAS by inhibiting classical RAS activity, can ameliorate insulin resistance in skeletal muscle tissue.


Key words: 
Renin-angiotensin system; Insulin resistance
A prospective trial of <sup>68</sup>Ga-PSMA and <sup>18</sup>F-FDG PET/CT in nonmetastatic prostate cancer patients with an early PSA progression during castration.
Authors: Beihe Wang, Liu Chang, Yu Wei, Jin Meng, Yingjian Zhang, Hualei Gan, Xiaoping Xu, Fangning Wan, Jian Pan, Xuejun Ma, Silong Hu, Stephen J. Freedland, Shaoli Song, Dingwei Ye, Yao Zhu
Journal: Journal of Clinical Oncology (2020)

e17579 Background: To evaluate tumor heterogeneity and burden in nonmetastatic prostate cancer patients with an early PSA progression during castration by 68 Ga-PSMA and 18 F-FDG PET/CT. Methods: The trial prospectively included 37 patients who had an early PSA progression (≤2ng/ml) during castration, and high-risk (PSADT ≤10 months) nonmetastatic disease by conventional imaging. All patients underwent both 68 Ga-PSMA and 18 F-FDG PET/CT. Lesions were classified into PSMA-dominant lesions (PSMA+/FDG- and PSMA+/FDG+) and PSMA-/FDG+ lesions according to the tracer uptake status. The primary endpoint was the prevalence of PSMA-/FDG+ disease. Results: All patients were treated with RP (median duration of castration = 23 months). The median PSA at imaging was 0.57ng/ml. Overall, 114 lesions were detected in 29 of the 37 patients. A high prevalence (73%) of N+/M+ disease was observed. Of the 114 lesions, 81 were PSMA-dominant and 33 were PSMA-/FDG+. Per patient level, 9 men (24%, 95%CI: 10%-39%) showed at least one new PSMA-/FDG+ lesions. A short PSADT ( P= 0.009, OR = 8.000) were associated with PSMA-dominant disease, while a high Gleason grade group ( P= 0.022, OR = 13.091) with PSMA-/FDG+ disease. 19 patients (51%) with 51 lesions could be enrolled for oligometastases-directed therapy including 10 PSMA-/FDG+ lesions. Among different disease stages, PSMA-/FDG+ disease was rarely detected in the hormone-sensitive cohort, but frequently found in the castration-resistant cohort. Conclusions: Using 68 Ga-PSMA and 18 F-FDG PET, we observed a high prevalence of N+/M+ disease and a significant proportion of PSMA-/FDG+ disease in patients with an early PSA progression during castration. (ChiCTR 1900022634). Clinical trial information: 1900022634 . [Table: see text]
Phase II trial of lenvatinib (LEN) plus pembrolizumab (PEMBRO) for disease progression after PD-1/PD-L1 immune checkpoint inhibitor (ICI) in metastatic clear cell renal cell carcinoma (mccRCC).
Authors: Chung-Han Lee, Amishi Yogesh Shah, James J Hsieh, Arpit Rao, Alvaro Pinto, Mehmet Asim Bilen, Allen Lee Cohn, Christopher Di Simone, David R. Shaffer, Regina Girones Sarrio, Sara Gunnestad Ribe, Jane Wu, Emmett V. Schmidt, Rodolfo F. Perini, Peter Kubiak, Alan D. Smith, Robert J. Motzer
Journal: Journal of Clinical Oncology (2020)

5008 Background: LEN, a multikinase VEGFR inhibitor, plus everolimus is approved for advanced RCC after prior VEGF-targeted therapy. PEMBRO, an anti-PD-1 antibody, plus axitinib is approved as first-line therapy of advanced RCC. We report phase 2 results of the RCC cohort of a phase 1b/2 trial (Study 111/KEYNOTE-146) of LEN + PEMBRO in patients (pts) who progressed after ICI therapy. Methods: We performed a multicenter, open-label study of pts with mccRCC, who previously had disease progression by RECIST (confirmed ≥ 4 weeks later) during or following ICI therapy. Pts had measurable disease by immune-related RECIST, and ≥ 1 prior therapy. Pts received LEN 20 mg orally once daily plus PEMBRO 200 mg IV every 3 weeks until disease progression or toxicity. Tumor assessments were performed every 6 weeks (until week 24), then every 9 weeks. The primary endpoint was objective response rate (ORR) at Week 24 by irRECIST. Results: 104 pts were enrolled. At data cutoff (January 12, 2020), 71 (69%) pts were still on study treatment. Most pts had ≥2 prior anticancer regimens (58%). 91 of 104 pts were evaluable for response at Week 12 (13 pts NE at Week 12); 46 of 91 pts achieved a confirmed partial response for an ORR of 51% (Table). Median progression-free survival (PFS) was 11.7 months and median duration of response (DOR) was 9.9 months. The most common treatment-related adverse events (TRAEs) were fatigue (49%), diarrhea (44%), proteinuria (37%), hypertension (31%), nausea (31%), dysphonia (29%), stomatitis (29%), and arthralgia (27%). There was 1 grade 5 TRAE (upper gastrointestinal hemorrhage). 43% of pts required dose reduction and 12% of pts discontinued treatment due to TRAEs. Response and safety data will be updated to include all pts evaluable at an April 9, 2020 cut-off. Conclusions: LEN + PEMBRO demonstrated promising antitumor activity in pts with mccRCC with disease progression following ICI therapy. No new safety signals were detected. Efficacy outcomes by investigator review per irRECIST. Clinical trial information: NCT02501096 . [Table: see text]
Ectopic twin pregnancy in right fallopian tube: a case report and literature review
Authors: Xin Xu, Baigong Xue, Rui Xin, Dandan Li, Xueying Zhang, Ying Xu
Journal: BMJ (2017)

One case of ectopic twin pregnancy in right fallopian tube after in vitro fertilization embryo transfer (IVF-ET) was admitted in our hospital. The development was in synchrony and the mainly manifestation was vaginal bleeding after menopause and abdominal pain. After surgery, the patient recovered well. Six cases reported in domestic literature occurred after assisted reproductive technology, including 4 cases after IVF-ET and 2 cases after artificial insemination. Two cases developed synchronously with the main manifestation of menopausal vaginal bleeding and recovered well after treatment. In 4 cases of non-synchronous embryos, after medical or surgical treatment irregular vaginal bleeding occurred, adnexal mass on the other side was found by gynecological ultrasound and blood hCG level increased significantly. Three cases recovered well after drug and/or surgical treatment and 1 case lost follow-up.


Key words: 
Reproductive techniques, assisted; Pregnancy, ectopic; Pregnancy, multiple
由病例分析看白塞病的诊断和治疗
Authors: 吴东海
Journal: BMJ (2006)

1937年土耳其皮肤科医师Bechet首先报道了一组口腔溃疡、生殖器溃疡和眼色素膜炎病变的三联征,后人称之为白塞综合征.自Bechet后,陆续发现本病也可累及皮肤、心血管、神经系统、消化道、关节、肺、肾、附睾等多系统.目前多数学者将此病称为白塞病.本病在东亚、中东和地中海地区发病率较高,被称为丝绸之路病.我国发病率无确切资料,任何年龄均可患病,好发年龄为16～40岁.我国以女性居多.白塞病的病因不明,病理基础为血管炎.临床表现复杂多样,缺乏实验室特异诊断标准,无有效根治方法.大部分患者预后良好,眼、中枢神经及大血管受累者预后不佳。
超声定位切除乳腺隐匿型肿块临床研究
Authors: 王琼
Journal: BMJ (2009)

临床不可触及、但具有手术活检指征的小病灶,常规手术难度大,如何准确定位成为活检手术成功的关键.我院在2007年5月至2008年2月对18例21个临床触诊阴性的乳腺微小肿块在高频彩色多普勒超声引导下行双锁定乳腺定位导丝定位活检切除。
Randomized trial of web-based genetic education versus usual care in advanced cancer patients undergoing tumor genetic testing: Results from the ECOG-ACRIN NCI Community Oncology Research Program (NCORP; EAQ152) COMET trial.
Authors: Angela R. Bradbury, Ju-Whei Lee, Jill B Gaieski, Shuli Li, Ilana F Gareen, Keith Flaherty, Benjamin A. Herman, Angela DeMichele, Susan M. Domchek, Kara Noelle Maxwell, Adedayo A. Onitilo, Shamsuddin Virani, Sujung Park, Bryan A. Faller, Stefan C. Grant, Ryan C. Ramaekers, Robert J. Behrens, Gopakumar S. Nambudiri, Ruth Carlos, Lynne I. Wagner
Journal: Journal of Clinical Oncology (2020)

2008 Background: Enthusiasm for precision oncology may obscure the complex psychosocial and ethical considerations for tumor genetic testing. Low patient genetic knowledge has been documented and heightens the risk for adverse experiences. We developed a web-based intervention to increase genetic knowledge and decrease distress among advanced cancer patients undergoing tumor genetic testing. Methods: 594 patients (80% from NCORP Community Sites) were recruited and randomized to web-intervention (n = 293) or usual care (n = 301), prior to receipt of tumor genetic test results. Primary outcomes were genetic knowledge, anxiety, depression, and cancer-specific distress measured at T0 (prior to intervention), T1 (post-intervention), T2 (after receipt of tumor results) and T3 (3 months post receipt of tumor results). Secondary outcomes included satisfaction, regret and disappointment. The effect of web-intervention was evaluated using t-test, multiple linear regression and logistic regression, with an intent-to-treat approach. Results: Patients randomized to web-intervention had better knowledge improvement than those randomized to usual care (T1-T0, p &lt; 0.0001; T2-T0, p = 0.003). No difference was observed in change scores for anxiety, depression or cancer-specific distress. To find the moderators of intervention effect (including sex, age, education, and literacy) two 2-way interactions were noted with statistical significance: higher depression among those in the intervention arm versus the control arm for patients with lower literacy (p = 0.03); and lower cancer-specific distress among women in the intervention arm than with usual care but no such effect noted in men (p = 0.01). 71% of patients reported receiving tumor test results and this did not differ by arm. Only 20% of patients reported regret and disappointment at T2, which was more likely for those without a mutation of interest (MOI) detected vs those with a MOI detected (OR = 2.08, 95% CI, 1.13 to 3.83, p = 0.02). Conclusions: Web-based education prior to receipt of tumor genetic test results increases patient understanding of tumor genetic testing. While the intervention did not significantly reduce distress, results suggest that women who received the intervention had lower cancer-specific distress than those with usual care. Future refinements to the web-intervention are needed to address low literacy groups, men and patients with no actionable results. Clinical trial information: NCT02823652.
A comprehensive analysis of the demographics and citation-based productivity of radiation oncologists practicing at comprehensive cancer centers.
Authors: Shearwood McClelland, Christina C Huang, Emma Brey Holliday, Reshma Jagsi, Richard C. Zellars
Journal: Journal of Clinical Oncology (2020)

11001 Background: Academic radiation oncology represents a constantly changing landscape. We sought to determine the demographic makeup of the current academic radiation oncology workforce. Methods: Internet searches of the 51 National Cancer Institute-designated Comprehensive Cancer Centers were conducted in September 2019. The Scopus database was subsequently searched in December 2019 to ascertain the h-index for each radiation oncologist. H-indices were analyzed by faculty rank (junior faculty versus associate professor versus full professor) and gender. Variables were coalesced for statistical analysis using Fisher’s exact test and two-tailed t-tests. Results: Analysis of 993 radiation oncologists revealed that 53.6% are junior faculty, 24.8% are associate professors, and 21.7% are full professors. The average radiation oncologist has been an MD for 19.6 years; 32.5% (232/993) are women, and less than 5% (47/993) are underrepresented minorities (URM). Of the 51 department chairs, 11.8% are women and 5.6% are underrepresented minorities. Women are significantly underrepresented among full professors (odds ratio = 1.78; p = 0.010) and departmental chairs (odds ratio = 3.80; p = 0.0007); there was no significant difference for assistant professorship (p = 0.067) nor associate professorship (p = 0.348). The overall mean h-index for all faculty was 17.64. Mean h-index was 8.21 for junior faculty, 18.46 for associate professors, and 40.05 for full professors; these differences were statistically significant (p &lt; 0.0001). The overall mean h-index was 19.35 for men (n = 668) and 14.11 for women (n = 323); this difference was statistically significant (p &lt; 0.0001). Conclusions: The majority of academic radiation oncologists are assistant professors; fewer than 5% are underrepresented minorities. Men comprise more than two-thirds of the workforce, and are significantly overrepresented at the full professor (by 78%) and departmental chair (by 280%) levels in academic radiation oncology. The average radiation oncologist at a comprehensive cancer center has published more than 17 manuscripts cited at least 17 times. Contrary to previous findings comparing male and female residents, the difference in academic productivity by gender among faculty was statistically significant. These findings provide objective data to assess the radiation oncology academic workforce and provide a useful benchmark to measure change going forward.
Trial in progress: A phase II open-label, randomized study of PARP inhibition (olaparib) either alone or in combination with anti-PD-L1 therapy (atezolizumab) in homologous DNA repair (HDR) deficient, locally advanced or metastatic non-HER2-positive breast cancer.
Authors: Patricia LoRusso, Mary Josephine Paula Pilat, Cesar Augusto Santa-Maria, Roisin M. Connolly, Erin Elizabeth Roesch, Anosheh Afghahi, Hyo S. Han, Rita Nanda, Gerburg M. Wulf, Hadeel Assad, Haeseong Park, Elizabeth Claire Dees, Jeremy Meyer Force, Anne M. Noonan, Adam Brufsky, Vandana G Abramson, Barbara B. Haley, Saundra S. Buys, Elad Sharon, Kurt A. Schalper
Journal: Journal of Clinical Oncology (2020)

TPS1102 Background: While immunostimulatory therapies have shown great success, a major challenge remains identification of mechanisms to effectively treat the majority of patients with so-called "non-inflamed" tumors lacking marked lymphocyte infiltration and PD-L1 expression. The DNA repair proficiency of a tumor may impact its potential for immune recognition and sensitivity to immune checkpoint blockade. Preclinically, PARP inhibition in HDR-deficient tumors has been shown to trigger antitumor immunity through a STING-dependent antitumor immune response. Effects of PARP inhibitors were augmented when combined with PD-1 blockade. We hypothesize that enhanced DNA damage and cell death induced by PARP inhibition in tumors with homology directed repair (HDR) deficiency will enhance adaptive anti-tumor immune responses and increase sensitivity to PD-1 axis blockers. Methods: This is a randomized, open-label phase II clinical trial exploring the PARP inhibitor olaparib either alone or in combination with the anti-PD-L1 human monoclonal antibody atezolizumab in BRCA1/2 mutated locally advanced or metastatic non-HER2-positive breast cancer. HDR deficiency is defined as the presence of deleterious BRCA 1/2 mutations. Randomization occurs in a 1:1 fashion to two arms: (1) olaparib 300 mg PO bid continuously in 21-day cycles or (2) olaparib 300 mg PO bid continuously in combination with atezolizumab 1200 IV every 3 weeks in 21-day cycles. Patients undergo baseline evaluations and pre-treatment biopsy within 2 weeks of starting therapy. Repeat biopsies are required at the time of first tumor assessment scan (6 weeks from the start of treatment) and in the event of disease progression. Correlative studies, including detailed analysis of the genomic profile and tumor immune contexture, will be performed at each biopsy time point. The primary objective is to compare progression free survival between the study arms. If progression occurs on the olaparib monotherapy arm, cross-over to the combination arm is allowed. This study began enrolling in August 2018; 47 of the planned 72 patients have been registered. Clinical trial information: NCT02849496 .
A commentary on the new American hypertension guidelines
Authors: Dayi Hu
Journal: BMJ (2018)

简要评述美国新版高血压指南的主要依据及将高血压的诊断标准和治疗目标下移至130/80 mmHg(1 mmHg＝0.133 kPa)可能带来的连锁反应；指出中国的高血压防治指南是基于大量关于高血压的流行病学研究和临床干预试验，循序渐进、平稳而可操作地制定修改的；强调在中国临床实践中不能照搬照抄国外的指南，应坚持中国证据、中国指南、中国剂量。
First year outcomes of an initiative to increase <i>BRCA</i> testing among NCCN guideline-eligible breast cancer patients within a large community OCM practice.
Authors: David Michael Waterhouse, Andrew Guinigundo, Aimee Brown, Dan Davies, Lauren Jones, Molly Mendenhall
Journal: Journal of Clinical Oncology (2020)

1540 Background: Pathogenic variants in BRCA1/BRCA2 can affect a breast CA pts care: preventative interventions, surgical decisions, medical treatments, screening, and family counseling. National data suggests significant non-adherence to NCCN testing guidelines, with only 1/3 of eligible pts referred for genetic services. In 2018, OHC (Cincinnati) launched an APP-centric genetics program. Specially trained APPs carry out genetic counseling and order NCCN-compliant testing. Early data suggested a significant deficit in physician-driven referrals. From 1/01/18 - 07/31/18, 138 new breast pts were estimated to be NCCN guideline-eligible. Only 28 (20%) pts received genetic services. Methods: In 2019, the OHC genetics team implemented a standardized screening process for every new breast CA pt. An EMR template (iKnowMed G2) that included NCCN guidelines was created for initial breast CA consultation and Oncology Care Model (OCM) treatment planning. All pts, not just OCM pts, are subject to OCM treatment planning. This automated screening method ensured all breast CA pts were screened, drastically increasing compliance. Through integration of genetics screening into the templates, pts meeting NCCN criteria for testing are reflexively referred for genetic counseling. With USON/McKesson, integrated data fields were developed in the EMR to automate data collection. Results: From 01/01/19 – 12/31/19, 717 new breast CA pts were seen at OHC. 676/717 (94%) were screened. Of those screened, 279 new breast CA pts met NCCN criteria for BRCA testing. 140 (50%) eligible new pts had appts with the genetics team. Another 50 (18%) had confirmed testing outside of OHC. 57 (20%) refused appts and/or testing. 32 (11%) did not have appts, representing screen fails. Referrals in non-breast CA pts also increased by 127%; 604 (2019) vs 264 (2018) suggesting a halo effect. Analyses suggest the program to be economically viable, with a financial growth rate of 127%. Conclusions: EMR templates embedded with the NCCN guidelines for reflex genetics referral can appropriately increase the utilization of genetic services. Breast genetics screening and resultant appt/testing rates increased significantly 2019 vs 2018. Success in BRCA testing in breast CA will lead to expansion to other cancers and genes. Implementation of structured EMR genetics data fields can automate data collection and measure compliance. Integration of genetics screening into universal OCM treatment planning is feasible, economically viable and scalable.
Nivolumab (NIVO) + low-dose ipilimumab (IPI) as first-line (1L) therapy in microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC): Two-year clinical update.
Authors: Heinz-Josef Lenz, Sara Lonardi, Vittorina Zagonel, Eric Van Cutsem, M. Luisa Limon, Mark Wong, Alain Hendlisz, Massimo Aglietta, Pilar Garcia-Alfonso, Bart Neyns, Fabio Gelsomino, Dana Backlund Cardin, Tomislav Dragovich, Usman Shah, Jing Yang, Jean-Marie Ledeine, Michael J. Overman
Journal: Journal of Clinical Oncology (2020)

4040 Background: In the phase 2 CheckMate 142 trial, NIVO + low-dose IPI had robust, durable clinical benefit and was well tolerated as 1L therapy for MSI-H/dMMR mCRC (median follow-up 13.8 months [mo; range, 9–19]; Lenz et al. Ann Oncol 2018;29:LBA18). Longer follow-up is presented here. Methods: Patients (pts) with MSI-H/dMMR mCRC and no prior treatment for metastatic disease received NIVO 3 mg/kg Q2W + low-dose IPI 1 mg/kg Q6W until disease progression or discontinuation. The primary endpoint was investigator-assessed (INV) objective response rate (ORR) per RECIST v1.1. Results: In 45 pts with median follow-up of 29.0 mo, ORR (95% CI) increased to 69% (53–82) (Table) from 60% (44.3–74.3); complete response (CR) rate increased to 13% from 7%. The concordance rate of INV and blinded independent central review was 89%. Median duration of response (DOR) was not reached (Table). Median progression-free survival (PFS) and overall survival (OS) were not reached, and 24-mo rates were 74% and 79%, respectively (Table). Nineteen pts discontinued study treatment without subsequent therapy. An analysis of tumor response post discontinuation will be presented. Ten (22%) pts had grade 3–4 treatment-related adverse events (TRAEs); 3 (7%) had grade 3–4 TRAEs leading to discontinuation. Conclusions: NIVO + low-dose IPI continued to show robust, durable clinical benefit with a deepening of response, and was well tolerated with no new safety signals identified with longer follow-up. NIVO + low-dose IPI may represent a new 1L therapy option for pts with MSI-H/dMMR mCRC. Clinical trial information: NTC02060188 . [Table: see text]