tbuckley/cabot-search huggingface dataset:
SBRT versus nephrectomy in the treatment of renal cell carcinoma.
Authors: Mausam Patel, Thomas Kim, Chenghui Li, Ahmed Safar, Sanjay Maraboyina
Journal: Journal of Clinical Oncology (2020)

5059 Background: Stereotactic body radiotherapy (SBRT) is being increasingly used for renal cell carcinoma (RCC) treatment in non-surgical candidates. However, no studies have compared survival between nephrectomy and SBRT. The National Cancer Database (NCDB) database was used to assess overall survival in patients undergoing SBRT vs nephrectomy. Methods: All cases of T1-T4, N0, M0 RCC diagnosed between 2004 and 2016 were extracted from the NCDB. Only patients undergoing either nephrectomy or SBRT, but not both, were included in the final analysis. Primary outcome was overall survival, defined as time in months from diagnosis to death due to any cause. Descriptive statistics were calculated for all variables. Univariate survival analysis was performed using the Kaplan Meier method and log rank test. Multivariate Cox proportional hazards regression models were performed to determine the predictive performance of covariates with respect to overall survival, reported as hazard ratio [HR] with 95% CIs. Nephrectomy patients were propensity score matched to SBRT patients for sub-cohort survival analysis. Comparisons were considered statistically significant at P &lt; 0.05. Results: There were 243,754 patients meeting inclusion criteria with 243,488 undergoing nephrectomy and 266 undergoing SBRT. Five year OS rates were 53% and 80% for SBRT and nephrectomy, respectively (P &lt; 0.001). On multivariate Cox regression, SBRT was associated with an increased risk of death as compared to nephrectomy (HR, 2.05; 95% CI, 1.72 – 2.44; P &lt; 0.001). Sex, race, insurance coverage, comorbidity index, tumor grade, lymphovascular invasion status, T-stage, tumor size, and academic status of treatment facility were also independent predictors of survival. After propensity score matching of 266 SBRT patients to 266 nephrectomy patients, there were no significant differences in baseline characteristics between the groups. However, SBRT continued to demonstrate worse survival and an increased risk of death as compared to nephrectomy (HR, 1.85; 95% CI, 1.41 – 2.44; P &lt; 0.001). Conclusions: Among node-negative, non-metastatic RCC patients, SBRT is associated with inferior survival outcomes as compared to nephrectomy, even after correcting for underlying differences in demographics, tumor characteristics, socioeconomic status, and comorbidities. These results indicate that nephrectomy should remain the standard of care for RCC patients, with SBRT reserved for non-surgical candidates.
Regional Disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States
Authors: Kathleen A. McManus, Samuel Powers, Amy Killelea, Sebastian Tello-Trillo, Elizabeth Rogawski McQuade
Journal: JAMA Network Open (2020)

<h3>Importance</h3> With the goal of ending the HIV epidemic in the United States, access to HIV pre-exposure prophylaxis (PrEP) is essential to help curb new HIV infections. There has been differential uptake of PrEP by region, with the South lagging behind other regions. Discriminatory benefit design (benefit design that prevents or delays people with complex or expensive conditions from obtaining appropriate treatment) through prior authorization requirements could be a systemic barrier that contributes to the decreased PrEP uptake in the South. <h3>Objectives</h3> To investigate whether there are regional disparities in prior authorization requirements for combined tenofovir disoproxil fumarate and emtricitabine for qualified health plans (QHPs) and to assess whether any QHP characteristics explain the disparities. <h3>Design, Setting, and Participants</h3> This design was a cross-sectional study of QHPs offered in the 2019 Affordable Care Act Marketplace. The QHPs studied included all Affordable Care Act–compliant individual and small-group market plans in the United States. <h3>Exposures</h3> The primary exposure was the 4 census regions (Northeast, West, Midwest, and South). Additional covariates included other plan characteristics. <h3>Main Outcomes and Measures</h3> Prior authorization requirement for combined tenofovir disoproxil fumarate and emtricitabine at the QHP level. <h3>Results</h3> In total, 16 853 QHPs were analyzed (18.2% in the Northeast, 19.5% in the West, 25.0% in the Midwest, and 37.3% in the South). Overall, 18.9% of QHPs required prior authorization for combined tenofovir disoproxil fumarate and emtricitabine. This percentage varied by region, with 2.3%, 6.2%, 13.3%, and 37.3% of plans requiring prior authorization in the Northeast, West, Midwest, and South, respectively. Compared with QHPs in the Northeast, QHPs in the South were 15.89 (95% CI, 12.57-20.09) times as likely to require prior authorization, whereas the Midwest and West were 5.69 (95% CI, 4.45-7.27) and 2.65 (95% CI, 2.02-3.47) times as likely, respectively. Other plan characteristics did not account for the regional variation. <h3>Conclusions and Relevance</h3> Compared with QHPs in the Northeast, QHPs in the South were almost 16 times as likely to require prior authorization for PrEP, and the reasons for these disparities are unknown. The prior authorization requirement is a possible barrier to PrEP access in the South, which is the region of the United States with the most annual new HIV diagnoses. There is limited regulation of QHPs' prior authorization requirements. Federal- or state-level health policy laws may be necessary to remove this system-level barrier to ending the HIV epidemic in the United States.
Prenatal screening and diagnosis of fetal abnormal chromosome and nervous tube defect: report of 7698 cases
Authors: Rui-ping Huang, Hong Zhou, Zhi-ying Di, Ya-ying Zhang, Da-cheng Sun
Journal: BMJ (2008)

This study was to explore the value of maternal serum screen in identification of fetal abnormal chromosome and neural tube defect(NTD). By using time-distinguished fluorescence immunoassay, serum levels of free-β-HCG and alpha fetal protein(AFP)were obtained in 7698 pregnant women at 15～20 +6weeks. and 483 were found at a higher risk of fetal abnormal chromosome. Based on amniotic fluid examination or cord blood testing on 344 high. Risk participants. Fetal abnormal chromosome was found in 18 women with a positive rate of 5. 2%. Twenty-five pregnant women were NTD high-risk, and their positive rate was 0. 3%. B-mode ultrasound identified 6 fetal malformations and 2 fetal deaths ( positive rate of 32. 0%). In high-risk or low-risk group, there were 25. 6%and 7. 7%subjects developed adverse outcome, respectively(P＜0. 05). Our findings suggested that maternal serum screen is an effective prediction factor for fetal abnormal chromosome and NTD. 

Key words: 
Prenatal diagnosis; Pregnancy outcome
Variation of lipid profile in patients with acute myocardial infarction of different age groups
Authors: Yong Wei, Shao-wen Liu, Gen-qing Zhou, Ping Ou-Yang
Journal: BMJ (2013)

Objective
To investigate the variation of lipid profile in patients with acute myocardial infarction (AMI) of different age groups.


Methods
Total 1214 patients of AMI were admitted to our hospital from May 2007 to July 2011. The age of patients ranged 40-89 years, and patients were divided into 5 age groups with 10-years step. Differences in lipid levels were observed by using pair-wise comparison among different age groups.


Results
Pair-wise comparisons among different age groups indicated that TC levels were higher in 40-69 years age groups [(4.71±1.08), (4.80±1.30), (4.69±1.03) mmol/L, respectively] than those in the 70-89 age groups [(4.41±0.96), (4.38±1.03) mmol/L], all P<0.05 (t values were 2.381, 2.323, 4.382, 3.965, 3.317, 3.096). TG levels among three age groups < 59 years had no significant difference, which were higher than those in groups over 60 years. Among 50-89 years age groups, TG gradually reduced with increase of age. HDL levels were lower in 40-59 years age groups [(1.03±0.23), (1.05±0.26) mmol/L, respectively] than those in 60-89 years age groups [(1.11±0.28), (1.11±0.28), (1.16±0.34) mmol/L, respectively], all P<0.05 (t values were -2.777, -2.789, -3.731, -2.543, -2.566, -3.644). Total cholesterol (TC) (r=-0.123, P<0.01), low-density lipoprotein cholesterol (LDL) (r=-0.139, P<0.01) and triglyceride (TG) (r=-0.287, P<0.01) were negatively but high-density lipoprotein cholesterol (HDL) (r=0.125, P<0.01) was positively correlated with age of patients. TC levels in female patients were higher than those in male patients in 50-89 years age groups; LDL levels in female patients were higher than those in male patients in 50-69 years age groups and HDL levels in female patients were higher than those in male patients in 40-79 years age groups (all P<0.05, t values were -2.878, -3.007, -3.352, -3.333).


Conclusions
show that the non-elderly AMI patients (<60 years) have higher levels of TC, LDL and TG, and lower level of HDL than the elderly patients; the TC, LDL and HDL levels are higher in female AMI patients than those in male patients at the same age groups.


Key words: 
Dyslipidemia; Myocardial infarction; Age distribution
Cardiopulmonary resuscitation knowledge among urban and rural residents in Tiaocheng area of Hebei Province
Authors: Ya-qin Li, Yan-qiao Ye, Gui-lan Zhang, Wei-zhan Wang, Lan Wang, Guo-ying Ma
Journal: BMJ (2008)

A total of 11 200 subjects from urban and rural areas of Taocheng of Hebei Province were surveyed for cardiopulmonary resuscitation (CPR) knowledge with self-made questionnaire. Our results showed that of the 11200 participants, there were 3708 subjects (33.11%) knew CPR; 6105 subjects (54.51%) knew but couldnt put it into practice; and 1387 subjects (12.38%) didn't know CPR. There was a significant difference in CPR awareness rate among people with different education level and profession (P <0.01). Awareness of emergency treatment and therapeutic technique was proved to be low among urban and rural residents, especially those living at poor-educated small towns. We suggest that more attention should be paid to increased awareness of CPR and its technique to improve to outcome of the treatment.

Key words: 
Cardiopulmonary resuscitation;  Questionnaires
Perioperative trastuzumab and pertuzumab in combination with FLOT versus FLOT alone for HER2-positive resectable esophagogastric adenocarcinoma: Final results of the PETRARCA multicenter randomized phase II trial of the AIO.
Authors: Ralf Dieter Hofheinz, Georg Martin Haag, Thomas Jens Ettrich, Kersten Borchert, Albrecht Kretzschmar, Christian Teschendorf, Gabriele Margareta Siegler, Matthias Philip Ebert, Eray Goekkurt, Manfred Welslau, Rolf Mahlberg, Nils Homann, Daniel Pink, Wolf Otto Bechstein, Peter Reichardt, Timo Gaiser, Disorn Sookthai, Claudia Pauligk, Thorsten Oliver Goetze, Salah-Eddin Al-Batran
Journal: Journal of Clinical Oncology (2020)

4502 Background: Perioperative FLOT is a standard of care for resectable, esophagogastric adenocarcinoma (EGA). This trial evaluates the addition of trastuzumab (tras) and pertuzumab (per) to FLOT for HER2-positive resectable patients (pts). Methods: PETRARCA is a prospective, multicenter, randomized, investigator initiated trial planned as a phase II/III investigation. We report the phase II part of this trial. Pts with HER2+ resectable EGA (≥ cT2 or cN+) were enrolled. Pts were randomized 1:1 to 4 pre- and post-operative cycles of FLOT (Docetaxel 50 mg/m²; Oxaliplatin 85 mg/m²; Leucovorin 200 mg/m²; 5-FU 2600 mg/m², q2w) (Arm A) or the same regimen with tras 8/6 mg/kg and per 840 mg q3w, followed by 9 cycles tras/per (arm B). Primary endpoint for the phase II part was the rate of pathological complete remission (pCR). Main secondary endpoints were DFS, OS and safety. Results: The trial closed prematurely and did not proceed to phase III. In total, 81 pts were randomized (A, 41; B, 40). Baseline characteristics were balanced (overall, male 79%; median age 60; cT3/T4 86%; cN+ 85%; GEJ 75%). 93% in arm A and 90% in arm B completed pre-OP treatment as planned. More pts had at least one dose modification in arm B (A, 44%; B, 70%). The pCR rate was significantly improved with tras/per (A, 12%; B, 35%; p = 0.02). Likewise, the rate of pathological lymph node negativity was higher with tras/per (A, 39%; B, 68%). R0-resection rate (A, 90%; B, 93%) and surgical morbidity (A: 43%; B, 44%) were comparable. Moreover, in-house mortality was equal in both arms (overall 2.5%). Median DFS was 26 months in arm A and not yet reached in arm B (HR 0.58, p = 0.14). After a median follow-up of 22 months median OS was not yet reached. DFS and OS rates [with 95% CI] at 24 months were 54% [38-71%] and 77% [63-90%] in arm A and 70% [55-85%] and 84% [72-96%] in arm B, respectively. In terms of toxicity more ≥ grade 3 adverse events were reported with tras/per (75% vs. 85%), especially diarrhea (5% vs. 41%) and leukopenia (13% vs 23%). Conclusions: The addition of tras/per to perioperative FLOT significantly improved pCR and nodal negativity rates in pts with Her2+ resectable esophagogastric adenocarcinoma at the price of higher rates of diarrhea and leukopenia. Clinical trial information: NCT02581462 .
腰痛的治疗方法
Authors: 杨诚, 彭宝淦
Journal: BMJ (2011)

腰痛是一种腰部疼痛综合征,涉及到腰部肌肉、筋膜、韧带、关节以及椎间盘等结构的病损,它以反复腰部疼痛为主要表现,伴有或不伴有下肢放射痛,一般呈现持续性钝痛或隐痛,剧烈疼痛者比较少见.疼痛也可因为咳嗽、喷嚏等增加腹部压力的动作而诱发或加重。
香港家庭医学学院与澳洲皇家全科医学院联合院士考试的介绍
Authors: 潘丽恩, 邢丽, 吕少丽, 顾湲
Journal: BMJ (2008)

全科医学即家庭医学是20世纪60年代末在北美兴起的一门综合性的临床医学分支学科.经过加余年的发展,形成了一套独特的学科理论,呈现出特有的临床工作方式,弥补了生物医学发展带来的医疗高度专科化的不足,促进了医学模式的转变和卫生服务的发展.然而,在我国尚缺乏适应社区卫生工作的高素质全科医生,对现行全科医生的培训也缺乏有效的考核[1],探讨和完善全科医生职业与考核标准是迫切需要的. `
Biodynamic response prediction in breast cancer patients receiving neoadjuvant chemotherapy.
Authors: Travis Morgan, Eric Whitacre, William Burak, Eric Manahan, Timothy Goedde, Andrew Greenspan, John Woods, David Nolte, John Turek, David M. Loesch, Ran An
Journal: Journal of Clinical Oncology (2020)

e12643 Background: Biodynamic signatures (temporal patterns of microscopic motion within a three-dimensional tumor explant) offer a phenomic biomarker that is highly predictive for therapeutic response. The purpose of this study is to evaluate predictive accuracy of a biodynamic drug response classifier in breast cancer patients receiving neoadjuvant chemotherapy (NAC). Methods: Consecutive breast cancer patients from 4 institutions were screened for enrollment in a prospective observational study (NCT03164863). Treatment-naïve needle biopsies were delivered to a central laboratory where biodynamic signatures were measured in living tumor fragments challenged by standard-of-care cytotoxins. Patients received NAC per institutional guidelines and were followed through surgical intervention. A four-point classifier was trained to predict pathologic complete response (CR) then prospectively validated. Results: Among patients completing neoadjuvant treatment and surgical intervention, 33% (24 of 72) achieved CR. The biodynamic classifier predicted CR with 96% sensitivity and 97% negative predictive value. Biodynamically “favored” (scoring ≥ 3) and “strongly favored” (scoring 4) regimens produced CR at rates of 56% (23 of 41) and 73% (19 of 26), respectively. Only 3% of patients (1 of 31) achieved CR from regimens scoring 1 or 2. Area under the receiver operating curve (AUC) was 87% (95% CI: 75% to 93%, p &lt; .0001), with similar performance across all subtypes and therapy cohorts (range: 84% to 89%). Performance of the classifier on training and validation patients was statistically equivalent. Conclusions: Biodynamic scoring accurately predicts response in breast cancer patients receiving NAC and holds promise to substantially improve management of these patients. [Table: see text]
Expanding criteria for prognostic stage IA disease in HR+ breast cancer.
Authors: Olga Kantor, Tari A. King, Steven Shak, Christy Ann Russell, Armando E. Giuliano, Gabriel N. Hortobagyi, Harold J. Burstein, Eric P. Winer, Joseph A. Sparano, Elizabeth A. Mittendorf
Journal: Journal of Clinical Oncology (2020)

550 Background: The 8 th ed AJCC staging system incorporated grade, receptor status and the Oncotype DX Recurrence Score (RS) result into staging. Based on TAILORx trial data and evidence of utility for RS results in node positive disease, this study was undertaken to determine if staging should incorporate expanded RS criteria. Methods: Patients (pts) with T1-3N0-3 HR+HER2- disease undergoing surgery 2010-15 were identified in the SEER database. 5yr DSS was estimated based on T and N category, grade and RS result; differences were compared between pts with path prognostic stage IA disease and all other groups. Results: 154,054 pts were identified; median follow up was 49 mo (range 0-83). RS results were obtained in 60,886 (39.5%); RS &lt;11 in 13,570 (22.3%) and RS 11-25 in 39,240 (64.5%). The table details 5yr DSS rates. 5yr DSS for path prognostic stage IA pts (n=114,675, 73.4%) was 98.2%. Among all pts with RS &lt;11, 5yr DSS was excellent and not significantly different than for path prognostic stage IA pts. For those with RS 11-25 not receiving chemo, 5yr DSS was inferior to path prognostic stage IA disease for T1-2N1 pts and for those with T2-3N0 disease although among N0 pts the differences were numerically small (1.4%-2.5% vs overall path prognostic stage IA). Conclusions: Pts with Recurrence Score &lt;11 have excellent 5yr DSS regardless of T and N category or grade suggesting further modification of the AJCC staging system using this cutoff. Additional study is required to optimize staging for patients with Recurrence Score 11-25. [Table: see text]
Effect of daratumumab based four drug combinations on surrogate endpoints and high-risk features in newly diagnosed multiple myeloma: A systematic review.
Authors: Mohammad Ammad Ud Din, Syed Ather Hussain, Leela Krishna Teja Boppana, Hania Liaqat, Arafat Ali Farooqui, Faryal Razzaq, Zahoor Ahmed, Faiz Anwer
Journal: Journal of Clinical Oncology (2020)

e20561 Background: Daratumumab (DARA) has shown benefit in combination with standard of care regimens in newly diagnosed multiple myeloma (NDMM). Methods: A literature search of PubMed, EmCare, clinicaltrials.gov, and Cochrane Library was performed on January 27, 2020 for DARA in NDMM. Six phase I/II and III trials met inclusion criteria out of 696 studies per PRISMA guidelines (n = 2146). Results: The median age was 58.5 – 71 years. DARA based quadruplet regimens were evaluated by Moreau et al (2019) and Mateos et al (2018) in stem cell transplant (SCT) eligible and ineligible patients respectively. These trials along with Voorhees et al (2019), Yimer et al (2019), Kapoor et al (2019) and Jakubowiak (2017) all reported improved surrogate endpoints (Table). African Americans were underrepresented and Hazard Ratio for disease progression in high-risk MM did not significantly improve by adding DARA. Conclusions: Combining DARA in the treatment of NDMM with/without SCT achieved improved surrogate endpoints without increased toxicity. With limited data, improvement is not noted in high-risk cytogenetics NDMM. Long term data is awaited. [Table: see text]
心房扑动的心电图表现
Authors: 朱天刚
Journal: BMJ (2009)

心房扑动(atrial flutter,AF)是指快速、规则的心房电活动.在心电图上表现为大小相等、频率快而规则(心房率一般在240～340次/min)、无等电位线的心房扑动波.心房扑动的频率是介于阵发性房性心动过速与心房颤动之间的中间型,三者可相互转换.心房扑动的发生常提示合并有器质性心脏病,很少见于正常人.由于频率快常可引起血流动力学障碍,应积极处理。
Cutaneous melanoma mutation pathways and driver mutations as racially biased.
Authors: Margaret I Sanchez, James Michael Grichnik
Journal: Journal of Clinical Oncology (2020)

e22066 Background: Cutaneous melanoma (CM) demonstrates differences in its clinical prevalence in different racial groups. CM generally exhibits a high tumor mutational burden (TMB) and mutually exclusive driving mutations in NRAS, BRAF or KIT. TMB may be driven by different pathways including ultraviolet radiation (UVR), oxidation and deamination. UVR is the most common mutational signature found in CMs, but deamination and oxidation are also present. Methods: We analyzed 321 CMs exome data from The Cancer Genome Atlas network. BRAF, NRAS, KIT and those without (WT) were used to divide the melanomas. Germline SNPs with racial information (Caucasian, African and Asian) that were enriched in melanomas with a particular driving mutation were identified. Results: We compared the 3 racial groups across the 4 driving mutation types, Asian SNPs were significantly higher in KIT, African in WT and Caucasian in BRAF and NRAS. The melanomas were also evaluated by the type of substitution mutations including CC &gt; TT for UV, G &gt; T for oxidative damage and (G/A)C (G) &gt; (G/A)T(G) for deamination. UV and deamination appeared inversely proportional, while oxidative damage appeared to be independent. UV signal was more prominent in BRAF and NRAS groups. KIT had a greater percentage of deamination while WT revealed more oxidative damage. We further compared UV and non-UV (CC &gt; TT absence) KIT subgroups for racial differences. Asian SNPs were greatly increased in non-UV subgroup whereas Caucasian SNPs were in UV subgroup. Further, the non-UV KIT subgroup was divided into deamination and oxidative damage subgroups to compare racial differences. Deamination was significantly increased in Asians whereas oxidative damage was higher in Caucasians. In the case of the WT group, African SNPs were significantly higher in the non UV subgroup and were primarily correlated with oxidative damage. Conclusions: This study suggests that racial genetic background may predispose the distinctive mutational and genetic environments of melanoma development.
Chinese guideline is the best criterion of clinical practice in China
Authors: Yifang Guo
Journal: BMJ (2017)

中国指南性文件在制订过程中充分考虑到了本国的具体情况以及以本国人群为基础的临床研究，因而是最适合中国血脂异常防治工作的指南。以我国指南为基础开展血脂异常以及ASCVD防治工作，有助于为患者提供安全有效且效价比高的诊疗方案，最大程度降低血脂异常的致死致残风险。