tbuckley/cabot-search huggingface dataset:
The potential cost-effectiveness of a risk-based pancreatic cancer screening strategy in new-onset diabetes.
Authors: Naomi RM Schwartz, Lynn McCormick Matrisian, Eva Shrader, Ziding Feng, Suresh Chari, Joshua A. Roth
Journal: Journal of Clinical Oncology (2020)

7017 Background: There are no established methods for pancreatic cancer (PC) screening, but the National Cancer Institute and the Pancreatic Cancer Action Network (PanCAN) are investigating risk-based screening strategies in new-onset diabetes (NOD)—a group with elevated PC risk. Preliminary estimates of the cost-effectiveness of these strategies can provide insights about potential value and inform supplemental data collection. Using data from the Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) risk model validation study, we assessed the potential value of CT screening for PC in those determined to be at elevated PC risk, as is being done in a planned PanCAN Early Detection Initiative (EDI) trial. Methods: We created an integrated decision tree and Markov state-transition model to assess the cost-effectiveness of screening those age ≥50 and with NOD for PC using CT imaging vs. no screening. PC prevalence, sensitivity, and specificity were derived from the ENDPAC validation study. PC stage distribution in the no screening strategy and PC survival were derived from SEER. Background mortality for diabetics, screening and cancer care expenditure, and health state utilities were derived from the literature. The base case assumed 40% of screen-detected PC cases were resectable, and a threshold analysis explored the fraction required for screening to be &lt;$100,000 per QALY gained. Life years (LYs), quality-adjusted life years (QALYs), and costs were tracked over a lifetime horizon and discounted at 3% per year. Results are presented in 2019 USD, and we took a U.S. payer perspective. Results: In the base case, screening resulted in 0.0055 more LYs, 0.0045 more QALYs, and $305 in additional expenditure for a cost per QALY gained of $68,059 (Table). Among PC cases, screening resulted in 0.67 more LYs, 0.55 more QALYs, and $22,691 in additional expenditure. In probabilistic analyses, screening resulted in a cost per QALY gained of &lt;$50,000 and &lt;$100,000 in 34% and 99% of simulations, respectively. In the threshold analysis, &gt;25% of screen-detected cases needed to be resectable for the cost per QALY gained with screening to be &lt;$100,000. Conclusions: We found that risk-based pancreatic cancer screening in NOD is likely to be cost-effective in the U.S. if even a modest fraction (&gt;25%) of screen-detected cases are resectable. Future studies should reassess the value of this intervention once PanCAN EDI data become available. [Table: see text]
Abstract 12846: Age-specific Difference in the Prognostic Significance of Conversion From Nonshockable to Shockable Rhythm in Out-of-hospital Cardiac Arrest: a Prospective Nationwide Population-based Cohort Study in Japan
Authors: Akira Funada, Yoshikazu Goto, Tetsuo Maeda, Hayato Tada, Ryota Teramoto, Masaya Shimojima, Kenshi Hayashi, Masakazu Yamagishi
Journal: Circulation (2016)

Introduction: Early defibrillation in out-of-hospital cardiac arrest (OHCA) patients with conversion from nonshockable to shockable rhythms is associated with favorable neurological outcomes. Hypothesis: We hypothesized that the prognostic significance of subsequent shock delivery would differ according to age and the time from initiation of cardiopulmonary resuscitation by emergency medical service providers to the first defibrillation (shock delivery time). Methods: We analyzed the records of 219,528 adult OHCA patients with initial nonshockable rhythm. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2011 to 2012. The primary end point was 1-month survival with favorable neurological outcomes (cerebral performance category scale, category 1 or 2; CPC 1-2). Results: The rates of 1 month CPC 1-2 were 1.7% (127 of 7391) in patients with subsequent shock and 0.7% (1530 of 212,137) in those without subsequent shock (p &lt; 0.001). When sorted by age, the rates of subsequent shock delivery were 4.4% (1945 of 44,602), 4.1% (1514 of 36,584), 3.1% (2137 of 69,278), 2.6% (1550 of 58,614), and 2.3% (245 of 10,450), and the rates of 1 month CPC 1-2 in patients with subsequently shocked OHCA were 3.7% (71 of 1945), 2.1% (32 of 1514), 0.8% (18 of 2137), 0.4% (6 of 1550), and 0% (0 of 245), for patients aged 18-64, 65-74, 75-84, 85-94, and ≥95 years, respectively (p for trend &lt;0.001, respectively). Multivariate logistic regression analysis revealed that subsequent shock delivery was positively associated with 1-month CPC 1-2: adjusted odds ratio (aOR) 6.9 (95% confidence interval, CI: 3.5-12.6) for shock delivery times &lt;10 min and 3.4 (2.4-4.7) for 10-19 min in patients aged 18-64 years, and 4.0 (1.4-9.4) for &lt;10 min in patients aged 65-74 years. However, subsequent shock delivery was negatively associated with 1-month CPC 1-2 in patients aged 85-94 years for 20-59 min: aOR 0.2 (95% CI 0.0-0.7). Moreover, subsequent shock delivery was not associated with the 1-month outcomes in OHCA patients aged 75-84 years. Conclusions: After rhythm conversion from initial nonshockable to shockable rhythms, early defibrillation was associated with increased odds of 1-month CPC 1-2 in OHCA patients not aged ≥75 years but aged 18-74 years.
Association of lymphocyte to monocyte ratio with clinical response and survival in patients with relapsed, aggressive non-Hodgkin lymphoma treated with axicabtagene ciloleucel CAR-T.
Authors: Abdullah S. Al Saleh, Sangeetha Gandhi, Tuan Truong, Arushi Khurana, Eva Brandes, Breanna Estby, Gina Lange, Stephen M. Ansell, N. Nora Bennani, Patrick B. Johnston, Jonas Paludo, Jose Caetano Villasboas, Luis F. Porrata, Yi Lin
Journal: Journal of Clinical Oncology (2020)

3028 Background: Chimeric antigen receptor T-cell (CAR-T) therapy induces complete remission (CR) in 30-40% of patients with non-Hodgkin lymphoma (NHL). However, for patients who do not achieve CR as their first response, predictors for achieving CR as best response can guide management between careful observation or early intervention. Increased absolute lymphocyte count to absolute monocyte count ratio (ALC/AMC) predicts better response rates and survival in NHL patients receiving chemotherapy and/or autologous stem cell transplant. We evaluated the prognostic impact of ALC/AMC in CAR-T therapy for NHL. Methods: This was a retrospective review of patients who received CAR-T for NHL from June 2016-August 2019. ALC/AMC was assessed at the start of lymphodepletion (LD) chemotherapy. The receiver operator curve (ROC) was used to determine the best cutoff for ALC/AMC in predicting CR at 3 months. Event-free survival (EFS) was defined from time of CAR-T infusion to relapse or death, whichever occurred first. Overall survival (OS) was defined from time of infusion to death of any cause. Results: Forty-seven patients received axicabtagene ciloleucel, with a median follow-up of 14 months. By ROC, ALC/AMC &gt; 0.8 before LD chemotherapy was predictive of achieving CR at 3 months. Baseline characteristics were similar between the high (n = 30) and low (n = 17) ALC/AMC groups. Patients with an ALC/AMC &gt; 0.8 at the time of LD chemotherapy were more likely to achieve CR at 3 months (46% vs. 12%, p = 0.01), 6 months (52% vs. 0%, p &lt; 0.0005), and 12 months (42% vs. 0%, p = 0.01). Correspondingly, the EFS and OS were significantly shorter in patients with ALC/AMC≤0.8 vs. those &gt; 0.8 (median EFS: 2 vs. 13 months, P &lt; 0.0001) and (median OS: 15 months vs. not reached, P = 0.03), respectively. Association between ALC/AMC ratio and EFS and OS remained consistent in multivariate Cox models after adjusting for other prognostic variables, including abnormal lactate dehydrogenase and increased ferritin level at infusion day. Conclusions: ALC/AMC &gt; 0.8 before lymphodepletion chemotherapy is a strong predictor for complete remission as well as improved event-free and overall survival for axicabtagene ciloleucel in NHL.
颌面部海绵状血管瘤的超声诊断
Authors: 王伟, 刘磊, 孙娟, 刘源, 刘海燕
Journal: BMJ (2005)

随着超声技术的发展,二维超声特别是彩色多普勒血流显像在软组织肿瘤中的应用日益受到重视,在临床诊断中发挥着重要作用[1].本文总结了我院自2000年9月至2004年6月就诊的40例颌面部海绵状血管瘤患者的超声特点,现报告如下。
成功救治重度盐酸曲马多中毒并发多脏器功能衰竭一例
Authors: 何新华, 李春盛, 殷文朋
Journal: BMJ (2009)

患者男,18岁.2007年11月7日13:00时被发现瘫倒在床,呼之不应,大小便失禁,无呕吐,身旁发现5个盐酸曲马多药盒(100 mg/片,12片/盒).急送当地医院,给予输液等治疗。
Progression free survival (PFS) in Asian vs non-Asian patients (pts) with EGFR mutant non-small cell lung cancer (NSCLC) receiving osimertinib.
Authors: Samuel Cytryn, Salman Rafi Punekar, Megan Tenet, Tasfiq Ullah, Bin Wang, Judith D. Goldberg, Vamsidhar Velcheti, Kwok-Kin Wong, Abraham Chachoua, Elaine Shum, Joshua K. Sabari
Journal: Journal of Clinical Oncology (2020)

e21679 Background: Third generation EGFR tyrosine kinase inhibitor (TKI) osimertinib demonstrated superior PFS and OS compared to earlier generation TKIs in pts with EGFR+ NSCLC. These pts are disproportionately Asian, female, and never-smokers. Contradictory data has been reported regarding the PFS and OS to osimertinib in Asian pts as compared to 1 st and 2 nd generation EGFR TKI. These inconsistencies warrant further investigation. The purpose of this study is to evaluate the PFS in Asian vs non-Asian pts with EGFR+ NSCLC receiving osimertinib. Methods: We conducted a single institution IRB approved retrospective study of pts with EGFR+ NSCLC. PFS was evaluated in pts treated from 1/2013 – 12/2019. Disease and treatment characteristics were summarized using frequency distributions and Kaplan-Meier curves for comparison of subgroups. Results: Of 190 EGFR+ pts: 52 (27%) Asian, 108 (57%) Caucasian, 125 (66%) female, 172 (91%) advanced disease, 107 (56%) never-smokers. Baseline characteristics in Asian and non-Asian pts were similar in regards to de-novo stage IV disease (71% vs 65%, p = 0.80), brain metastases (42% vs 54%, p = 0.48), and differed with regards to ever-smoking (29% vs 56%, p = 0.04). Treatment: 126/172 (73%) pts with advanced disease received TKI across all lines of therapy; 92/126 received osimertinib (22 (24%) 1 st line; 45 (49%) 2 nd line; 18 (19%) 3 rd line; 7 (8%) ≥4 th line). There were insufficient number of pts who received osimertinib in the 1 st line to comment on differences in PFS between Asian and non-Asian pts. In the 2 nd line, 19 Asian pts and 26 non-Asian pts received osimertinib, with no observed difference in PFS (median 15.4 v 13.8 months, p = 0.20). Moreover, Asian pts who received osimertinib as second line therapy had superior PFS (median 15.4 vs 9.6 months, p &lt; 0.01) compared to Asian pts who received earlier generation TKIs, likely due to T790M resistance. Conclusions: Among second line advanced EGFR+ NSCLC, we did not observe a difference in PFS between Asian and non-Asian pts treated with osimertinib. Median PFS in Asian pts treated with osimertinib was longer compared to those treated with 1 st or 2 nd generation TKIs in the 2 nd line setting. Our study highlights the the role of ethnic background in response to EGFR therapies and may warrant further study.
Using multiple perspectives analysis to propose state cancer control policy in Abia State, Nigeria.
Authors: Kelechi Ngozi Eguzo, Uwemedimbuk Smart Ekanem, Oluoha Chukwuemeka, Kingsley Kelechi Nnah, Olufemi Olatunbosun, Andries Muller, Vivian Walker, Chris Mpofu, Vivian R Ramsden
Journal: Journal of Clinical Oncology (2020)

e14132 Background: Beyond the National Cancer Control Plan, most States in Nigeria do not have State cancer control policies. Using the multiple perspectives analysis framework, this research sought to explore the perspectives of patients diagnosed with cancer, healthcare providers and health policymakers regarding cancer policy in Abia State. Methods: A concurrent mixed methods action research design was used. Sample included individuals aged ≥18 years who were diagnosed with cancer (patients), provided cancer treatment (providers) or made health policy (policymakers) in the State. Data were collected using surveys and key informant interviews. Data analysis involved descriptive statistics, chi-square test and a deductive thematic analysis. Results: Participants were 29 patients, 50 providers and 33 policymakers (n = 122), with an average age of 45 (±11) years. Challenges identified by ≥60% of participants were: low public awareness (75.9%); limited availability of treatment options (62.6%); lack of treatment pathways (92.8%); lack of local cancer data (95.2%); and, absence of support groups for patients (88.0%). Each group of participants (n = 3) rated cancer 9 out of 10 as a public health priority. Some qualitative themes were: low cancer awareness, delays in cancer treatment and financial burden on patients. “One thing I’d like to include in the policy is to make cancer a reportable disease in the State.” -Policymaker. Most participants (80%, 90/112) recommended that health insurance should fund ≥16% of cancer control activities, although policymakers were more likely to make quarterly insurance contributions than patients (7 out of 10 vs. 5 out of 10). Conclusions: Cancer control was an important issue for people in the State. Inadequate prevention services with a background of &gt; 3-month diagnostic delays, characterized cancer control in Abia State. Future cancer control policy should emphasize cancer prevention, the creation of local clinical pathways and a blended financing model. [Table: see text]
Impact of oligometastatic disease on survival in ER positive breast cancer: A population-based analysis.
Authors: Nathalie LeVasseur, Kaylie Willemsma, Caroline A. Lohrisch, Nafisha Lalani, Stephen K. L. Chia, Mitchell Liu, Karen A. Gelmon
Journal: Journal of Clinical Oncology (2020)

e19109 Background: Estrogen positive (ER) advanced breast cancers (ABC) are associated with a longer survival compared to other subtypes. However, clinical equipoise remains for the management of oligometastatic disease. While recent phase I and II data support the use of metastasis-directed therapy, breast cancer patients remain underrepresented and real-world outcomes for breast cancer patients with directed treatment for oligometastases is lacking. Methods: The BC Cancer Breast Cancer Outcomes Unit (BCOU) database was utilized to identify patients with ER positive breast cancer referred to BC Cancer from 2005-2014 with documented metastases. Baseline clinical, pathological and treatment data were compiled. Overall survival (OS) was compared between the group with oligometastatic disease(OM) (defined as &lt; = 5 foci of metastases) and the group with non-oligometastatic disease (defined as &gt; = 6 foci of metastases) using Kaplan-Meier survival curves. Key secondary endpoints included metastasis-directed treatment impact, based on the site of metastasis, local control (LC) and distant failure (DF) rate. Results: A total of 938 patients met the inclusion criteria. Of these, 191 (20.4%) had OM and 747 (79.6%) had widespread disease at 1st diagnosis of ABC. The groups were well balanced for clinical characteristics (all p &gt; 0.05), with a median age of 59yrs (23-99). 84% were ductal carcinomas, 14% were also HER2 positive. Sites of oligometastases were bone (66.5%), liver (12.0%), brain (8.4%) and lung (5.8%). Median follow-up was 7.4 yrs. Median OS was 24 mo (95% CI 20.2, 27.8) for patients with OM and 11 mo (9.5, 12.5) for those with widespread disease (p &lt; 0.0001). In the OM group, 114 (59.7%) of patients received metastasis-directed treatment, whereas 77 (40.3%) did not. Treatment modalities included radiation in 53.4% of patients, surgery in 8.9% of patients and stereotactic body radiotherapy (SBRT) in 3.7%. Median OS was 24 mo (18.3, 29.7) for patients who received metastasis-directed treatment and 23 mo (17.5, 28.5) for those who did not (p = 0.954). Patients with bone-only metastases had a median OS of 27mo with directed treatment and 25mo without directed-treatment (p = 0.334). Conclusions: Oligometastatic state was associated with a significantly better OS. Metastasis-directed treatment was associated with a non-significant OS difference in patients with bone-only metastases in a real world cohort. However, the impact of modern systemic treatment and SBRT methods are evolving. Large prospective randomized studies of this approach merit further study.
Assessment of patient knowledge and completion of advance directives in oncodermatology
Authors: E. Melgar, G.F. Escobar, F. Granel‐Brocard, T. Remen, A. Marzouki‐Zerouali, L. Geoffrois, H. Martin, A. Schoeffler, J.L. Schmutz, A.C. Bursztejn
Journal: British Journal of Dermatology (2020)
Application of machine learning algorithms for the diagnosis of primary brain tumors.
Authors: Vasilii Khammad, Jose Javier Otero, Yolanda Cabello Izquierdo, Francisco Garagorry Guerra, Aline P. Becker, Nataliy Kharchenko, Gadzhimurad Zapirov
Journal: Journal of Clinical Oncology (2020)

2533 Background: Primary lesions of the CNS refer to a heterogeneous group of benign or malignant tumors arising in different parts of the brain and spinal cord. According to the 2016 CNS WHO classification, the accurate diagnosis of primary brain tumors requires a layered approach of histologic, anatomic and molecular features to generate an integrated diagnosis with clinical and prognostic significance. However, in the US and worldwide, scarce resources are available to perform all the required tests routinely, so methods that improve pre-test probabilities and decrease false positive results have significant clinical and financial impact. Aims: 1) validate new diagnostic workflows with implementation of modern machine learning/artificial intelligence approaches; 2) design a reliable and interactive computational platform for primary CNS tumor diagnosis. Methods: To achieve these goals we have developed a population model in Rstudio, “La Tabla”, based on the articles from open resources of MEDLINE database and the latest version of WHO classification of CNS tumors. The data of “La Tabla” is comprised of more than 100,000 adult and pediatric cases, including rare brain tumor diagnoses, such as Gangliocytoma, Diffuse Midline Glioma and etc. Results: Boruta package and weights function in R have been used to distinguish the most important features for diagnosis prediction. To visualize correlation between these features (age, ki67 level, tumor location, presence of myxoid areas, calcifications, necrosis and etc.) and all diagnoses in two-dimensional space, we used a t-SNE algorithm. Models trained with decision tree algorithms (randomForest, XGBoost and C5.0) showed high overall accuracy in predicting diagnoses of “La Tabla” (95%, 94% and 92%) and 300 patients at OSUCCC-James (93%, 74% and 87%) in the absence of IHC and molecular data. Neural networks provided by keras and nnet packages predicted diagnoses using just clinical and histological findings with 94% and 88% accuracy on “La Tabla” and James patient databases respectively. Currently, we are building “Shiny” applications with R to deliver easily operated platform for pathologists and physicians. Conclusions: In conclusion, we managed to generate models that are able to diagnose primary brain lesions using basic clinical data (age, gender, tumor location), ki67 levels and distinct features of histological architecture. Most of the models distinguish brain tumors and associated molecular status with high accuracy and will serve as a reliable tool for second opinion in clinical neuro-oncology.
Safety and efficacy of lenvatinib in HCC beyond second-line treatment.
Authors: André Jefremow, Marco Wiesmüller, Rachel Amande Rouse, Peter Dietrich, Andreas Emanuel Kremer, Maximilian Josef Waldner, Markus Friedrich Neurath, Jurgen Siebler
Journal: Journal of Clinical Oncology (2020)

e16592 Background: Until 2018 sorafenib was the only first-line systemic treatment option for advanced hepatocellular carcinoma (HCC). Ten years later a new agent, called lenvatinib, showed equal efficiency in comparison to sorafenib. Currently sorafenib and lenvatinib are options for first line treatment with regorafenib, cabozantinib and ramucirumab (if alpha fetoprotein &gt; 400 ng / ml) as second-line treatment choices. The first published results from Imbrave150-trial shows promising effects regarding the combination of atezolizumab and bevacizumab for first line treatment in advanced HCC. This highlights the question for reasonable sequence therapies. Yet, it has so not been demonstrated, if lenvatinib is an option for a treatment line beyond the second. Methods: We identified 5 patients with advanced HCC from our hospital, who had been treated with local ablative procedures as well as at least three different systemic therapies with still excellent clinical performance status before receiving lenvatinib. Retrospective analysis was performed to examine clinical and radiologicresponse rates as well as side effects. Results: 3/5 patients achieved regression in at least third treatment lines. One patient showed stable disease, and only one of these five patients showed a mixed response. The toxicity profile was heterogeneous. One patient developed a mild hand-foot syndrome. Another one evolved hypertension. Developing of proteinuria led to stop treatment in one patient. One patient showed psychiatric disorder, which was possibly associated with lenvatinib. Response was independent of the underlying cause of HCC. Conclusions: Lenvatinib is a promising agent for treating advanced HCC in a later treatment line and revealed a tolerable toxicity profile.
Distribution of drug resistance Acinetobacter Baumannii in surgical ICU and its prevention
Authors: Bei Wang, Huan Yang
Journal: BMJ (2011)

Drug resistance of Acinetobacter baumannii ( Ab) in surgical ICU from January 2008 to December 2009 was investigated retrospectively. Total 114 clinical strains of Ab were isolated from surgical ICU and 92 strains were from respiratory tract (80.7% ). The prevalence rate of multiresistant Ab in 2009 was higher than that in 2008 (75. 7% vs 50. 0% , x2 = 7. 703, P = 0. 006). The results indicate that to monitor and control drug resistant of Ab constantly is important for the prevention of nosocomial infection.

Key words: 
Acinetobacter baumanii;  Drug resistance