tbuckley/cabot-search huggingface dataset:
The predictive role of plasma mutant allele fraction to antiangiogenic drugs in patients with mCRC: An expanded analysis of surrogate biomarkers of response to first-line treatment with bevacizumab.
Authors: Giulia Martini, Elena Elez, Francesco M Mancuso, Maria Auxiliadora Gomez, Ginevra Caratu, Judit Matito, Guillem Argiles, Nuria Mulet, Iosune Baraibar, Javier Ros, Ariadna Garcia, Raquel Comas, Marta Ligero, Cristina Santos, Paolo Nuciforo, Rodrigo Dienstmann, Josep Tabernero, Enrique Aranda, Raquel Perez-Lopez, Ana Vivancos
Journal: Journal of Clinical Oncology (2020)

3541 Background: So far, no biomarkers of response to anti-angiogenic drugs are available in colorectal cancer (CRC) treatment. Liquid biopsy tracks dynamic mutational changes in CRC patients (pts). RAS mutant allele fraction in plasma (plMAF) is an independent prognostic marker in metastatic CRC (mCRC). We explored the predictive value of plMAF in RAS mutant pts treated in 1st line with chemotherapy +/- bevacizumab (bev). Methods: A multicentric prospective/retrospective analysis was conducted. We collected data from 226 mCRC pts and selected the subset not eligible for metastasis resection with basal plMAF sample evaluable for RAS mutant MAF quantification with digital PCR (BEAMing). Pts were stratified as high (≥ 5.8%) or low ( &lt; 5.8%) plMAF. We investigated associations between clinicopathological variables and progression-free survival (PFS) stratified by plMAF RAS levels using Cox regression models and survival data were calculated by Kaplan-Meier method. Computational analysis of baseline CT scan data extracted 93 radiomics features of all the lesions per patient including 1) 1st class from density histogram distribution and texture analysis by 2) 2nd order and 3) higher order feature classes. The radiomic features distribution between pts with high and low pIMAF was assessed with Student’s t-test analysis. Results: From October 17 to May 19, 63 basal plasma samples were analysed with BEAMing. 42 pts (67.7%) were classified as high and 21 pts (32,3%) as low plMAF. In high plMAF subgroup, a statistically significant longer PFS favouring FOLFOX+bev was observed, compared to FOLFOX alone (10.7 vs 6.9 mts; HR: 0.30; p = 0.002). In low RAS plMAF subgroup, no differences in terms of PFS were observed in either arm (8.9 vs 8.7 mts; HR: 0.7; p = 0.6). Multivariate PFS model showed no association between RAS plMAF and clinicopathological variables, except for high RAS plMAF and treatment benefit with FOLFOX+bev. The CT-radiomics signature, that may translate tumor vascularization, differentiated patients with high vs low pIMAF (p = 0.002). 58 patients (92%) had similar radiomic score; 5 patients with high plMAF (8%) presented very heterogeneous radiomic score distribution. Conclusions: Tumor-borne RAS plMAFs may constitute a potential predictive biomarker of efficacy for anti-angiogenic drugs in mCRC. Next steps will include the identification of -histological, transcriptomic and radiomic- surrogate biomarkers of response that reflect tumor irrigational status.
Use of oncology electronic learning resources to learn about geriatric oncology.
Authors: Tina Hsu, Kori LaDonna, Claire Touchie
Journal: Journal of Clinical Oncology (2020)

11033 Background: Despite the aging population driving cancer growth, oncology trainees receive little training in geriatrics. While electronic resources, such as ASCO University, may help meet this gap, use of available geriatric oncology (GO) modules is low. We sought to understand why by exploring how oncology trainees currently learn about GO, their preferred methods for learning about GO, and their attitudes towards e-learning and geriatrics. Methods: Canadian medical oncology residents and recent graduates were electronically surveyed about the following domains: demographics, self-directed learning practices, use of electronic resources, perceived facilitators and barriers to e-learning, and geriatric oncology teaching. Descriptive statistics were used to analyze the data. Results: Respondents (n = 47) were mostly aged &lt; 35 (66%). Respondents felt that learning about older adults was important (mean 4.3±1.0 out of 5) and generally felt comfortable caring for them (mean 3.9±0.9 out of 5) despite minimal training in geriatrics.Almost half (48.9%) received 0-2 hours of teaching in GO during residency, with the majority (59.6%) receiving teaching in clinic, 36.2% through lectures and 21.3% via seminars. Respondents also learned about GO through reading journal articles (42.6%), modelling in clinic (36.2%), reading a textbook (19.2%) or attending a conference (19.2%). Respondents preferred to learn about GO through on-site lectures (46.8%), dinner meetings (42.6%), case discussion (42.6%) and attending conferences (38.3%). Although overall respondents highly valued electronic learning (mean 4.3±0.75 out of 5), only a minority (8.5%) had received GO teaching electronically using e-modules and only 23.4% respondents were aware of e-learning resources in GO. In contrast most respondents (83%) had used an e-learning resource to learn about oncology. The most common oncology e-resources used were ASCO University (61.7%), Oncology Education (61.7%), and ASCO meeting videos (44.7%). Conclusions: Although oncology trainees value and commonly use e-learning resources, e-learning is not a common or preferred way to learn about GO, potentially due to lack of awareness about these resources. Future research will explore whether the current methods of educating oncology learners about older adults are appropriate and sufficient, as well as how trainees value and prioritize learning about topics that are not included in the formal curricula.
Influencing factors for health-related quality of life in patients with chronic liver disease
Authors: Feng Gao, Ru Gao, Guang Li, Yu Wang, Jian-yu Hao
Journal: BMJ (2013)

Objective
To investigate the factors affecting health-related quality of life (HRQOL) in patients with chronic liver disease (CLD).


Methods
HRQOL was measured with SF-36v2 Chinese version. All patients with CLD diagnosed between December 2009 and May 2011 in Liver Research Center, Beijing Friendship Hospital and Digestive Department, Beijing Chaoyang Hospital were enrolled in this study. Patients with CLD were divided into 4 groups according to their Child-Turcotte-Pugh scores: no cirrhosis, Child's classes A, B, and C. Demographic and clinical data were collected in each group.


Results
A total of 392 patients with CLD and 91 healthy controls were included. HRQOL in patients with CLD was lower than that in healthy controls. Physical component score (PCS) in healthy controls was 54.6±5.5, and in CLD was 47.8±8.8 (t=9.343, P<0.01). Mental component score (MCS) in healthy controls was 56.4±8.1, and in CLD was 51.7±7.4 (t=5.302, P<0.01). Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on HRQOL, PCS scores were 53.1±5.9, 48.7±6.6, 42.4±7.1 and 37.2±8.9 (F=93.353, P<0.01);MCS scores were 53.2±4.8, 52.7±6.5, 51.8±7.5, and 46.8± 7.5 (F=11.325, P<0.01), for no patients with cirrhosis, Child's classes A, B and C respectively. Stepwise linear regression analysis showed that severity of disease, age, present ascites, present varices, and prothrombin time had significant effects on physical health area (F=100.893, P<0.010). Severity of disease, female gender, present varices, total bilirubin, prothrombin time and hemoglobin had significant effects on mental health area (F=19.237, P<0.010).


Conclusions
Patients with CLD have reduced HRQOL. Increasing severity of CLD is associated with a decreasing HRQOL. Old age, female gender, advanced stage of CLD, present ascites, hyperbilirubinemia and prolonging prothrombin time are risk factors for reducing HRQOL.


Key words: 
Liver disease; Quality of life; Sickness impact profile
妊娠期糖尿病的胰岛素治疗
Authors: 徐先明
Journal: BMJ (2012)

妊娠期糖尿病的胰岛素治疗需掌握适应证,经规范饮食治疗血糖仍不达标时才需用胰岛素治疗,胰岛素治疗无论是使用剂量还是使用频次都强调个体化原则,治疗期间应密切监测血糖变化,使用时应注意低血糖的发生。
晕厥的现场判断、危险性评估和院前急救原则
Authors: 冯庚
Journal: BMJ (2005)

晕厥(syncope or faint)是意识障碍的常见类型之一,它指患者因脑缺血而发生的自限性短暂意识丧失,是院前急救时经常遇到的一组症候群.晕厥是内科临床中的一大难题,首先其病因诊断困难,涉及面广,误诊率高,根据文献报道大约40%～60%的晕厥患者经过各种检查找不到病因.第二其发病率及复发率均较高,在全部人群中有20%～23%的人至少发生过一次晕厥,其发病率占综合性医院急诊科患者的3%～5%,住院患者的6%.有不少患者发生晕厥后并未就医,因此该病的实际发生率可能更高.第三晕厥导致的并发症多,轻度损伤(如皮肤破损)占晕厥患者的29%,反复晕厥者骨折和软组织损伤占12%.晕厥的发生率多与患者的年龄成正比,根据欧洲2001年晕厥诊疗指南提供的数据,晕厥的发生率在 70岁的人群中为23%。
Biomarkers for predicting cancer in women with a suspicious mammogram.
Authors: Virginia A. Espina, Ngoc Vuong, Alessandra Luchini, Claudius Mueller, Denitra S Mack, Michael Smith, Jennifer May, Lance A. Liotta, Richard A. Hoefer
Journal: Journal of Clinical Oncology (2020)

e15533 Background: Biomarker identification for early breast cancer diagnosis is confounded by comparing healthy control patients to patients undergoing surgical procedures and stress of a potential cancer diagnosis. We implemented a clinical research protocol that combines biomarker harvesting and identification with Breast Imaging-Reporting and Data System (BIRADS) results, within a cohort of women with a suspicious mammogram who donated samples prior to biopsy. The primary goals were to discover candidate novel plasma markers for stage I breast cancer versus benign lesions, and validate the markers by mass spectrometry and immunohistochemistry. Methods: 150 women found on screening mammography to have a BIRADS IV or V mammographic abnormality were enrolled in the IRB approved study, with one year follow-up. After informed consent, serum, plasma, and saliva specimens were obtained and frozen. The patient underwent image guided biopsy of the mammographic abnormality. Hydrogel nanoparticles were used to harvest and concentrate low abundance protein biomarkers from plasma. Proteins were identified by mass spectrometry. The BIRADS score and biopsy outcome were blinded to the laboratory researchers. Results: 37/150 women (median age 64, 73% ER+, 70% PR+) were diagnosed with biopsy-proven breast cancer. 15/37 had a family history of breast cancer. Within the context of stress of an abnormal mammogram and invasive biopsy, we identified 5478 plasma peptides. A model to predict endpoints that discriminate cancer vs no cancer was developed using cross-validation and lasso shrinkage method. The best fit multi-analyte ROC/AUC model of peptide spectral matches revealed 10 candidate peptides, including PLAA, TRAPPC9, PROS1, DDX41, ANKRD63, EGFLAM (AUC = 0.81), that discriminated cancer versus no cancer. The functional mechanisms of these proteins are calcium metabolism, GPI anchor biosynthesis, neural-immune crosstalk, DNA repair, and ubiquitin-mediated protein trafficking. Conclusions: Molecular profiling of blood can potentially complement imaging to improve diagnostic specificity in the setting of a suspicious mammogram. This unique trial design, enhanced by nanotechnology protein harvesting, identified potential novel cancer biomarkers in the presence of a suspicious mammogram. A confirmation trial is underway.
RB1 mutation had influenced on bone metastases in advanced treatment-naïve lung cancer.
Authors: Chengzhi Zhou, Ying Xu, Xinqing Lin, Fei Wang, Huojin Deng, Xiaohong Xie, Ming Liu, Zhanhong Xie, Jiexia Zhang, Ming Ouyang, Shiyue Li, Rongchang Chen, Yinyin Qin, Rongrong Chen, Xuefeng Xia
Journal: Journal of Clinical Oncology (2020)

e21668 Background: RB1 is one of the most vital cancer suppressor genes in various cancer types. RB1 mutation always occurs in treatment-naïve small cell lung cancer (SCLC) patients or in resistance to EGFR TKI therapy of non-small cell lung cancer (NSCLC) patients. However, we observed a group of clinical NSCLC patients, and found that RB1 mutations also occurred in treatment-naïve patients. Methods: RB1 is one of the most vital cancer suppressor genes in various cancer types. RB1 mutation always occurs in treatment-naïve small cell lung cancer (SCLC) patients or in resistance to EGFR TKI therapy of non-small cell lung cancer (NSCLC) patients. However, we observed a group of clinical NSCLC patients, and found that RB1 mutations also occurred in treatment-naïve patients. Results: Nonsense and frame-shift mutations were the major pathogenic mutations found in RB1 gene, which predicted RB1 protein-deficient in these mutational patients. Furthermore, we found these RB1 mutation patients had TP53 mutations at the same time. Patients with RB1 mutation had a higher smoking prevalence than patients who had wildtype RB1 genes (P &lt; 0.0001). Gene testing showed RB1 mutations patients also developed EGFR driver mutations, while the mutation frequency was significantly lower than RB1 wildtype patients ( P = 0.0368). Eight RB1 mutated patients diagnosed with actionable EGFR mutations, including exon 19 del, L858R, L861Q, G719S and S768I, while no patients diagnosed with EGFR exon 20 insertion. 10 (62.5%, 10/16) patients in RB1 mutated group, and 25(32.1%, 25/78) patients with RB1 wildtype had bone metastases. The proportion of bone metastases in patients with RB1 mutation was significantly increased than others ( P = 0.0216). Conclusions: This study demonstrates that the function of tumor suppressor gene RB1 in advanced stage of NSCLC. From the results, we considered RB1 mutation had influence on bone metastases. Although loss-of-function mutations in tumor suppressor gene (TSG) RB1 always had no targets therapeutic drugs, it also suggested that some other clinically treatment can be performed as soon as possible.
Small cell bladder cancer: Treatment patterns and clinical outcomes.
Authors: Rishi Robert Sekar, Leonidas Nikolaos Diamantopoulos, Funda Vakar-Lopez, MD, Petros Grivas, Sarah P. Psutka, George R. Schade, Daniel W. Lin, John L. Gore, Robert B. Montgomery, Jonathan L. Wright
Journal: Journal of Clinical Oncology (2020)

e17014 Background: Small cell bladder cancer (SCBC) is a rare histologic variant associated with poor oncologic outcomes and propensity for metastasis, however, there remains a paucity of data regarding the role of chemoradiation. We review our institutional experience of patients with small cell bladder cancer (SCBC) treated with radical cystectomy (RC) versus concurrent chemoradiotherapy (CCRT). Methods: We retrospectively reviewed our institutional database for pts with SCBC treated with RC or CCRT and compared them to pts with conventional urothelial carcinoma (CUC) treated with RC. Clinicopathologic data and outcomes were captured and compared between treatment groups. Overall (OS) and recurrence-free survival (RFS) were estimated utilizing the Kaplan Meier method. T test, χ2 test and log-rank test were used for group comparisons. Factors significant in the univariate analysis for OS were included in multivariable Cox models. Results: We identified 38 consecutive pts with SCBC, of whom 24 (63%) had SC predominant ( &gt; 50%) histology. At presentation, 31 (82%) had muscle invasion, 8 (22%) had nodal involvement, and 7 (18%) had distant metastasis. Twenty-eight (73%) pts proceeded to definitive therapy, with RC in 20 (53%) and CCRT in 8 (21%). Among pts treated with CCRT, 4 (50%) had complete response on cystoscopy, 2 (25%) had residual disease with 1 (12.5%) proceeding to salvage cystectomy, and 2 (25%) progressed with metastasis. Among pts treated with RC, 15 (75%) received neoadjuvant chemotherapy (NAC) with platinum/etoposide, of whom 3 (20%) experienced a pathologic complete response (pCR, ypT0N0), 3 (20%) had residual UC but no SCBC, and 9 (60%) had residual SCBC. Median OS was comparable between RC and CCRT groups (30.4 vs. 26.2 months, p = 0.633). Compared to pts with CUC treated with RC (n = 457), those with SCBC treated with RC had similar clinical stage, rates of carcinoma in situ, lymphovascular invasion, and positive surgical margins (all p &gt; 0.05). Median OS and RFS were inferior for SCBC treated with RC (30.4 vs 109.7 months, p = .001; 13.1 vs 86.1 months, p = .002). On multivariable analysis among pts treated with RC, SCBC was significantly associated with shorter OS adjusting for pT and pN stage, performance status, and age. Conclusions: Pts with SCBC undergoing RC had significantly worse oncologic outcomes compared to pts with CUC, however RC and CCRT had comparable outcomes in pts with SCBC. The pCR rate to NAC was unexpectedly low. Larger sample size, assessment of other confounders and longer follow-up are needed for validation.
2型糖尿病患者社区综合干预效果的评价
Authors: 刘立群, 赵伟波
Journal: BMJ (2007)

为了探索适合本地区的糖尿病防治模式,2004年3月至2006年3月我院以所属4个社区卫生服务站为平台,开展对糖尿病患者综合干预效果的研究. 一、对象与方法 1.一般资料:2004年3月开始将就诊于我院所属4个社区卫生服务站的2型糖尿病患者共284例作为研究对象,全部符合WHO糖尿病诊断和分型标准。
The over-the-scope grasper (OTSG)
Authors: Markus Brand, Nico Hofmann, Chi-Nghia Ho, Alexander Meining
Journal: Endoscopy (2020)

Abstract Background Endoscopic removal of foreign bodies, coagulated blood, or necrotic debris is sometimes challenging and time-consuming, partly because of inadequate endoscopic instruments. Therefore, new devices are needed to overcome the current limitations. Methods The over-the-scope grasper (OTSG) is a new grasping tool that can be attached to any standard gastroscope. It has been developed for endoscopic removal of larger particles. We present retrospective data on five patients who were treated using the device for various indications, including necrosectomy, bolus impaction, and removal of blood clots. Results In two patients, the OTSG was used through a lumen-apposing metal stent for direct endoscopic necrosectomy after severe pancreatitis. The other patients had a massive blood clot in the esophagus after endoscopic submucosal dissection, or aphagia due to large meat chunks clogging the esophagus. The OTSG was used with technical success in all of the patients and without any procedure-associated complications. Conclusion The OTSG appears to be a useful device for endoscopic removal of larger particles, blood clots, or necrotic debris. Preliminary experience shows that the device is effective and easy to use.
Repealed embryo aspiration for reduction of multifetal cervical pregnancy:clinical analysis of 3 cases
Authors: Qing-zhen Xie, Wang-ming Xu, Jing Yang, Wen Long, Hong Su
Journal: BMJ (2008)

Effect and safety of repeated embryo aspiration for reduction of muhifetal cervical pregnancy Was retrospectively evaluated.Three women with muhifetal cervical pregnancy successfully received conservative treatment of repeated embryo aspiration under the guidance of transvaginal ultrasound,and the gestational sac contents were aspirated completely.Local(2.5～5.0 mg injectable methotrexate,MTX) or systemic medication was used.Our findings showed that repeated embryo aspiration for reduction of cervical multifetal pregnancy could improve the coupe of disease,decrease systemic medication of MTX,and discontinue a cervical pregnancy within 8 weeks effectively and safely.However,the mminimum therapeutic dose of MTX remained to be explored.

Key words: 
Pregnancy,ectopie; Cervix uteri
Relationship between preschooler's primary tooth caries and parental knowledge-behavior-knowledge of oral health in Hudong community in Pudong new area
Authors: qi Xu, Zhizhen Yao, Honglan Tong, Gengsheng Li, Cunrong Li
Journal: BMJ (2014)

Objective
To explore the primary teeth caries status of preschoolers in Pudong community and its relevant factors of parental knowledge-belief-practice (KBP).


Methods
Using stratified random cluster sampling, a total of 1 179 children from 9 kindergartens in Hudong community in Pudong new area were examined. Oral cavity check-ups and parental questionnaire survey were conduced to understand the primary teeth caries rate of preschoolers and its related influencing factors.


Results
The prevalence rate of primary teeth caries was 53.2% and DMFT 2.79. The prevalence rate of primary teeth caries had statistical significance in different age groups (P<0.05). Multi-factor analysis showed that the influencing factors of primary teeth caries were age (P<0.05), parental education level (P<0.05), parental assistance of teeth brushing (P<0.05), children eating sweets before bedtime (P<0.05) and parental awareness for treating primary teeth (P<0.05).


Conclusions
The prevalence rate of primary teeth caries is high among the preschoolers of Pudong. And age, parental education level, parental preventive knowledge of teeth caries and poor eating habits are significant factors correlated with the incidence of dental caries in children.


Key words: 
Tooth, deciduous; Dental caries; Factor analysis, statistical
CheckMate 067: Long-term outcomes in patients with mucosal melanoma.
Authors: Alexander Noor Shoushtari, John Wagstaff, Paolo Antonio Ascierto, Marcus O. Butler, Christopher D. Lao, Ivan Marquez-Rodas, Vanna Chiarion-Sileni, Reinhard Dummer, Pier F. Ferrucci, Paul Lorigan, Michael Smylie, Wim van Dijck, Jasmine I. Rizzo, F. Stephen Hodi, James M. G. Larkin
Journal: Journal of Clinical Oncology (2020)

10019 Background: Mucosal melanoma is a rare but aggressive malignancy with a poor prognosis. Here we report 5-y outcomes in a subgroup of patients with mucosal melanoma treated in CheckMate 067 with nivolumab plus ipilimumab (NIVO+IPI), NIVO alone, or IPI alone. Methods: Patients with previously untreated stage III or IV melanoma were randomized 1:1:1 to receive NIVO 1 mg/kg + IPI 3 mg/kg for 4 doses Q3W followed by NIVO 3 mg/kg Q2W, NIVO 3 mg/kg Q2W + placebo, or IPI 3 mg/kg Q3W for 4 doses + placebo until progression or unacceptable toxicity. Mucosal histology was not a stratification factor, and patients with mucosal melanoma were identified by local investigators in the study. Descriptive subgroup analyses were performed to evaluate efficacy (objective response rate [ORR], progression-free survival [PFS], overall survival [OS]), and safety. Results: A total of 79 patients with mucosal melanoma were treated. With a minimum follow-up of 60 mo, NIVO+IPI treatment was associated with the highest 5-y ORR (43% [vs 30% with NIVO and 7% with IPI]), PFS (29% [vs 14% and 0%, respectively]), and OS (36% [vs 17% and 7%, respectively]; Table), consistent with trends in the intent-to-treat (ITT) population; however, efficacy outcomes were generally less favorable overall relative to the ITT population. Complete response rates were higher with NIVO+IPI (14%) relative to monotherapy (NIVO, 4%; IPI, 0%) in patients with mucosal melanoma. Safety outcomes, including the grade 3/4 treatment-related adverse event rates of 54%, 26%, and 25%, respectively, were similar to the ITT population. Conclusions: This 5-y analysis showed that patients with mucosal melanoma in CheckMate 067 had similar safety outcomes but poorer long-term efficacy vs the ITT population. Patients with mucosal melanoma treated with NIVO+IPI appeared to have more favorable survival outcomes than those treated with NIVO or IPI alone. Novel therapies are needed to further improve long-term benefit in patients with mucosal melanoma. Clinical trial information: NCT01844505. [Table: see text]
Extrapleural Nuss procedure for the correction of pectus excavatum under choledochoscope
Authors: Zhen-bing You, Wei Guo, DA-fu Xu, Jian Ji, Wei-guo Zhu, Hong-jun Chu
Journal: BMJ (2010)

From Oct 2006 to Dec 2008, 11 children (9 boys and 2 girls) aged 3 - 15 ( mean 6 yearyears) with pectus excavatum underwent extrapleural Nuss procedure under choledochoscope. No compcomplication was observed during and after operation. The blood loss during operation was 5-20 ml. Postoperative evaluation showed that the score of 10 cases was excellent and 1 was good. The results indicate that extrapleural Nuss procedure under choledochoscope, has advantages of low complication and minimal invasion,can be widely used in clinic practice.

Key words: 
Funnel chest; Thoraic surgery,vidio-assisted