tbuckley/cabot-search huggingface dataset:
Telemedicine visits reduce time to biopsy, travel time and costs for interventional radiology patients.
Authors: Suken Shah, Joseph Erinjeri, Qiu Xia Guan, Christian Otto, Stephen Barnett Solomon
Journal: Journal of Clinical Oncology (2020)

2082 Background: Telemedicine has been utilized to increase access to care for patients in primary care practices and more recently, specialty practices. The purpose of the study was to test the hypothesis that adding a telemedicine clinic practice could decrease the time to biopsy, travel time and cost for interventional radiology (IR) clinic patients. Methods: Telemedicine visits were performed by a physician or advanced practice provider (PA or NP) at a single institution, academic medical center to patients at 3 MSK regional locations in NY and NJ. Total patient encounters and data from November 2017 to October 2019 were analyzed. Primary outcome measures were wait time from the IR referral to biopsy procedure visits, patient travel time and travel cost, stratified by in-person vs telemedicine visit. Round-trip travel distance and costs for patients were calculated by determining the offset travel. Cost (economic) benefit was the sum of: Federal cost per mile for travel, toll and parking costs, and doctor visit lost wages. Results: There were 172 MSK Regional site telemedicine visits. There was a significant reduction in time from referral to biopsy for telemedicine visits compared to in-person visits (12 vs 17 days, p &lt; 0.0001). Additionally, there was a significant reduction in travel time for telemedicine visits vs travel time to Manhattan for an in-person visit (p &lt; 0.0001). Telemedicine visit patients had to travel 367 less hours than an in-person visit and saved a total of 11,222 in miles that they did not have to travel. Telemedicine patients accrued $14,652 in economic benefits due to reduced travel costs and lost wages from work. Conclusions: Telemedicine significantly reduced the time to biopsy, travel time and cost for Interventional Radiology patients compared to in-person visits. Telemedicine for IR patients increases access to care for patients and allow for more efficient use of physician time and resources.
High intra-tumor heterogeneity observed in esophageal squamous cell carcinoma.
Authors: Jun Xue, Yingqiang Li, Tianhao Mu, Shifu Chen
Journal: Journal of Clinical Oncology (2020)

e16522 Background: Intra-tumor heterogeneity (ITH) is a critical factor in the metastasis of esophageal squamous cell carcinoma (ESCC). Analysis of ITH facilitates better diagnosis and medication. Cosine distance similarity reflects the directional relationship of each vector to analyze ITH better. Methods: Whole Exome Sequencing (WES) data of 185 tumor regions and 39 normal esophageal tissues from 39 patients were collected from NCBI database. We found highly variable SNPs in the East Asian populations from ExAC, GenomAD and other databases, and calculated the cosine distance of the SNPs between each tumor sample with the corresponding paracancerous sample. Sliding windows were incrementally advanced along the genome. Results: All 39 samples exhibited spatial ITH. Significant long distances were observed in patients with metastatic lymph nodes, and the homologous samples of the patients were roughly identical. In contrast, the sliding windows of different samples presented a distinctly heterogeneous scene. Conclusions: The cosine distance is suitable for the similarity calculation of high-dimensional vectors. The similarity of different samples can be calculated by using mutation sites as vectors. The cosine distance can be used to present further information and graph composition, compared with digital information. In the future, different samples can be clustered based on cosine distance by recruiting more samples and machine learning.
Randomized multicenter open-label trial of GT0918 (proxalutamide) in patients with mCRPC that progressed on abiraterone or enzalutamide.
Authors: Nicholas J. Vogelzang, Arash Rezazadeh Kalebasty, Richard Levin, Zulfiqar A. Malik, Ashley Ross, Britt Haley Bolemon, Nashat Y. Gabrail, Phoebe Zhang, Karl Zhou
Journal: Journal of Clinical Oncology (2020)

e17578 Background: Both abiraterone and enzalutamide have been approved for the treatment of mCRPC. GT0918 (proxalutamide) is a novel second-generation androgen receptor (AR) antagonist binding directly to the androgen receptor, impairing nuclear translocation and decreasing AR protein expression. This phase II portion of the Ph I/II study is being conducted to further evaluate safety and tolerability of GT0918 at 400 mg or 500 mg daily dosing. Methods: All eligible mCRPC pts with progressive disease based on rising prostate-specific antigen (PSA) or/and imaging while on either abiraterone or enzalutamide, but not both. One line of prior chemotherapy was allowed. Pts (n = 60) will be randomized to GT0918 either 400 mg or 500 mg po once daily for 6 months. The primary endpoint is safety and tolerability. Secondary endpoints are PSA reduction at 12 weeks, % radiographic progression at 6-month, time to imaging progression, and exploratory biomarker CTC &amp; cf-DNA/RNA. PSA is assessed every 4 wks and tumor imaging is done every 12 wks. Results: 56 pts were screened June 2019 to January 15, 2020 and 40 pts were randomized to receive GT0918 either 400 mg or 500 mg po daily. 22 pts (55%) had enzalutamide as prior therapy and 18 pts (45%) had abiraterone as prior therapy. 17 pts (43%) had one or more lines of chemotherapy. The median age was 72 years (range 53-89) and median baseline PSA was 162 ng/mL (0.3-4195). 10 pts had 1 cycle or less of study drug due to rapid PSA progression, AEs and/or withdrawal of consent. The most common treatment-related AEs were fatigue (48%), loss of appetite/anorexia (25%), nausea (20%), lower leg extremity edema (18%), constipation (15%), weight loss (13%), vomiting (10%), and headache (8%). 8 pts (6 in 500 mg vs. 2 in 400 mg) required dose reduction due to AE. No seizures have been observed. As Jan 30, 2020, 3 pts (8%) and 8 pts (20%) had PSA reduction at 12 weeks and 4 weeks, respectively, but no 50% PSA reduction was observed. 2 pts (5%) received study drug treatment over 24 weeks and 10 pts (25%) received study drug over 16 weeks based on stable disease (SD) on imaging. Conclusions: GT0918 administrated orally once a day is well tolerated and first 40-pts taking GT0918 show some anti-tumor activities. Dose of 400 mg po daily is recommended for GT 0918 for further clinical trials. Clinical trial information: NCT03899467 .
儿童血行播散型肺结核致感染性休克和呼吸窘迫综合征一例
Authors: 梁金鑫, 张琪, 李颖, 曹静, 钟笛箫, 王天有
Journal: BMJ (2012)

报道分析一例儿童急性血行播散型肺结核致感染性休克及呼吸窘迫综合征病例,显示其诊断难点在于虽然影像学存在典型双肺粟粒影,但缺乏细菌学阳性指标；治疗的重点是积极抗结核治疗及呼吸机辅助改善通气的同时,加强对全身其他脏器功能的评估及保护。
碳纤维敷料在II度烧伤创面换药中应用方法的改进
Authors: 王腊梅
Journal: BMJ (2008)

烧烫伤为常见的突发性意外伤害,其损伤程度多以Ⅱ度为主.据报道,90%的烧、烫伤患者要在门诊进行治疗[1].伤安素是一种新型碳纤维敷料,具有强力吸收渗液、减轻水肿、防治创面感染、减轻疼痛、促进创面愈合等作用[2]。
Localized testicular germ cell tumor surveillance: A Delphi consensus study.
Authors: Angélique DA Silva, Aude Flechon, Stephane Culine, François Planchamp, Thibaut Murez, Arnaud Mejean, David Pasquier, Karim Fizazi, Florence Joly
Journal: Journal of Clinical Oncology (2020)

e17060 Background: Stage I testicular germ cell tumor (TGCT) has excellent cure rates and surveillance is fully included in patient’s management, particularly during the first years of follow-up. Surveillance guidelines differ between the scientific societies, with different recommendations concerning clinical and imaging frequency de-escalation and long term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. Methods: An online survey on surveillance practice of stage I TGCT based on clinical-cases was conducted among urologists, radiotherapists and oncologists. Results were compared to AFU, ESMO and EAU guidelines. Then a panel of experts assessed surveillance proposals following a formal consensus method (DELPHI method). Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. Results: Survey and DELPHI method were conducted between July 2018 and May 2019. 61 participated to the survey (69% oncologists, 15% urologists, 16% radiotherapists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, only 25% discontinued surveillance after the 5th year, as recommended. No physician followed the ESMO guidelines of de-escalation chest imaging. A panel of 32 experts (78% oncologists, 16% urologists, 6% radiotherapists) was asked about 38 statements. Consensus was reached for 26 statements concerning clinico-biological surveillance modalities and end of surveillance after the 5th year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th year of follow-up. No consensus was reached regarding de-escalation of chest imaging. Conclusions: The survey proved that French TGCT specialists do not follow current guidelines. With DELPHI method, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th year and discontinuation of AP scan on the 4th year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.
Progress in prenatal ultrasound diagnosis of fetal vertebral deformity
Authors: Qinghong Zhao
Journal: BMJ (2019)

Congenital vertebral malformation refers to the developmental anomaly of vertebral body during the embryonic stage. Congenital vertebral malformation can cause vertebral kyphosis, scoliosis, spine shortening and other spinal abnormalities as well as thoracic deformities, affecting the quality of life, even threatening the life of the affected children, bringing heavy burden to the family and society. This article reviews the progress in fetal vertebral deformity and its prenatal ultrasound diagnosis.


Key words: 
Campomelic dysplasia; Spine; Ultrasonography, prenatal
青年脑血管病20例病因分析
Authors: 张勤, 刘生华
Journal: BMJ (2005)

脑血管病通常发生于中老年人,近年临床上青年脑血管病亦不少见,其原因不同于中老年人,现将我院近年收治的20例40岁以下的脑血管病例报告如下. 1.临床资料:全部病例均为我院1997年至2004年间收治的40岁以下的急性脑血管病患者,男13例,女7例,年龄15～39岁,平均31.2岁;所有病例均符合1995年全国第4次脑血管病会议制定的诊断标准,且均经CT或MRI证实.占同期住院脑血管病患者的6.8%(20/294)。
Immune-mediated adverse events following concomitant radiotherapy and immunotherapy in patients with melanoma and Merkel cell carcinoma: A preliminary report from an evolving retrospective registry.
Authors: Nikolaos Andreatos, Joanna Roopkumar, Alok A. Khorana, Pauline Funchain
Journal: Journal of Clinical Oncology (2020)

3144 Background: Radiotherapy (RT) potentiates immune-mediated responses against tumor antigens, an effect that is enhanced by checkpoint inhibitors (CPIs) and may hold therapeutic promise. However, the mechanisms underlying this abscopal effect can theoretically increase the rate of immune-mediated adverse events (irAEs). We estimated the incidence of irAEs in a single-institution cohort treated with concomitant RT and immunotherapy. Methods: We retrospectively screened 731 patients that received RT and CPIs at our institution. Patients diagnosed with melanoma or Merkel cell carcinoma (MCC) who underwent RT concurrently or within 30 days of CPI administration were eligible. A radiation period (RP) comprised the interval between the first and last treatment days (≤90 days); a patient could contribute multiple RPs. Data on new irAEs diagnosed within 3 months after RT and relevant demographic and clinicopathologic variables were collected; univariate analysis was performed with the chi-squared test. Results: 35 patients (23 male, 12 female) contributed 43 RPs; mean age was 65.5 years (range: 39-90). Five had MCC, and 30 had melanoma (24 cutaneous, 1 uveal and 5 urogenital melanomas). PD-1 inhibitors were most commonly employed (22 RPs), followed by ipilimumab-nivolumab (14 RPs), ipilimumab (4 RPs), and avelumab (3 RPs). CPIs were administered concurrently with RT in 32 RPs and sequentially in 11 RPs. Fourteen RPs comprised intracranial radiation. Importantly, 45.7% of patients (16/35) experienced irAEs, which manifested within a month of RT in 25.7% (9/35). Four patients experienced grade ≥3 irAEs leading to hospitalization; one died of respiratory failure after developing pneumonitis. On univariate analysis, no significant association between tumor type, CPI regimen, concurrent RT, intracranial vs. extracranial RT, and irAE incidence was noted. A trend for increased irAEs within the ipilimumab-nivolumab group was observed (p = 0.27). Conclusions: Almost half of patients developed new irAEs following RT, with 25% (4/16) of cases warranting hospitalization; these incidence rates appear to exceed rates from historical data and raise concerns about the additive toxicity of CPIs and RT. Comparison to non-RT cohorts and survival analyses are ongoing.
Trajectories of sexual dysfunction and its risk factors in women with gynecologic cancer across radiation therapy and healthy controls.
Authors: Jinbing Bai, Despina Tsementzi, Pretesh R. Patel, Joseph W Shelton, Mary Dolan, Jessica Arluck, Deborah Bruner
Journal: Journal of Clinical Oncology (2020)

e24097 Background: Women with gynecological cancer (GynCa) reported an increased risk for acute and long-term sexual dysfunction across cancer treatments, especially radiation therapy (RT). However, limited data exist on the course of sexual dysfunction across RT and its risk factors are unknown. This study sought to characterize women’s sexual dysfunction trajectories and identified risk factors of persistent sexual dysfunction. Methods: Using a longitudinal study design, patient-reported sexual dysfunction, demographic and clinical data were collected. Women receiving RT for GynCa older than 18 years or age, race, and BMI matched healthy controls were enrolled. Female Sexual Function Index (FSFI) was used to assess women’s sexual dysfunction. Patients completed all the questionnaires pre-RT, at the end of RT, 6- and 12-month post-RT. Group-based trajectory modeling was used to identify trajectories of sexual dysfunction and risk factors of persistent sexual dysfunction. Results: Eighty-two patients were analyzed, including 36 GynCa patients receiving RT and 46 healthy post-menopausal women, comprising of 33 Blacks, 44 Whites, and 5 others. Three trajectory groups of sexual dysfunction (total FSFI score) were identified: low risk (17.4%), moderate risk (12.3%), and high risk (70.4%). All three trajectory groups were significantly different from each other (p&lt;0.01). Similarly, three trajectories were identified for each of six FSFI domains: desire (low [6.3%], moderate [62.5%], high [31.2%], p&lt;0.01); arousal (low [38.1%], moderate [46.4%], high [15.4%], p&lt;0.01); lubrication (low [49.7%], moderate [44.6%], high [5.7%], p&lt;0.01); orgasm (low [43.8%], moderate [31.3%], high [24.9%], p&lt;0.01); pain (low [25.5%], moderate [64.2%], high [10.3%], p&lt;0.01); and satisfaction (low [8.3%], moderate [61.4%], high [30.3%], p&lt;0.01). Risk factors of sexual dysfunction were high pH (p=0.007) and without chemotherapy (p=0.019). Young women had more arousal (p=0.011); high education level was associated with high arousal (p=0.039); low pH was associated with high arousal (p=0.018) and orgasm (p=0.036). No risk factors were found for desire and satisfaction domains. BMI, surgery, and study cohort (cancer vs healthy) were not predictors of sexual dysfunction trajectories. Conclusions: This study identified three trajectories of sexual dysfunction. Low education, high pH, no chemotherapy, and elder women were risk factors of severe sexual dysfunction. Sexual dysfunction interventions should address these risk factors.
Prescribing preferences for hormone sensitive (HR+) metastatic breast cancer (mBC) in the CDK 4/6 inhibitor (CDK 4/6i) era.
Authors: Bruce A. Feinberg, Jeffrey Wojtynek, Igoni Dokubo, Yolaine Jeune-Smith, Jonathan Kish, Ajeet Gajra
Journal: Journal of Clinical Oncology (2020)

e13058 Background: CDK 4/6i is a category 1 guideline-recommended therapy for HR+/HER2- mBC in both first-line (1L) with an aromatase inhibitor and second-line (2L) with fulvestrant and without prior CDK 4/6i. We sought to understand community oncologists’ (c-oncs) prescribing preferences and sequencing for 1L, 2L, and third-line (3L) HR+/HER2- mBC patients across several common clinical scenarios (CS). Methods: C-oncs were presented 4 hypothetical HR+/HER2- mBC clinical scenarios (CS 1-4) via web-based survey. CS differed by menopausal status, prior adjuvant therapy and nature of metastases (mets) (i.e., bulky liver, lung, bone), but otherwise uniform: asymptomatic presentation, PI3K negative, identical response extent and duration in 1L, 2L, and 3L. Treatment preferences: hormonal (H), single agent (SA) or combination chemotherapy (CC) for 1L, 2L, and 3L in each CS were queried. We describe these preference patterns. Results: 47 U.S. c-oncs participated: mean years in practice was 22.7 and mean mBC patients under active treatment was 23.3. Preference for treatment and sequence, regardless of CS, per LOT were: 1L = 71% H, 14% SA, 16% CC; 2L = 51% H, 31% SA, 16% CC; and 3L = 35% H, 59% SA, 6% CC (Table). Of the 71% who preferred 1L H, the CDK4/6i % were: 73% overall, 58% when mets described as bulky liver, 94% when described as bone and or lung. The preference for pre-planned sequential chemo-hormonal therapy in 1L resulted in 63% of initial chemotherapy followed immediately by H; of which CDK 4/6i was preferred in 47%. In total, the initial and post-chemo CDK4/6i 1L preference was 80%. 2L hormonal preferences by frequency were: everolimus + exemestane = 38%, CDK 4/6i + fulvestrant = 20%, fulvestrant = 19%. SA preferences: 2L = capecitabine 46%, taxane 25%; 3L = capecitabine 40%, eribulin 32%. CC preferences included atezolizumab + nab-paclitaxel 24% in 1L and 16% in 2L. Conclusions: 1L HR+/HER2- mBC treatment is highly variable and preferences that warrant further research include: the role of CC, specifically atezolizumab + nab-paclitaxel; repeated CDK4/6i line of therapy; H therapy post CDK4/6i progression; and optimal SA sequencing. [Table: see text]
Influence of insulin in all-in-one parenteral nutrition on blood glucose level in infants of very low birth weight
Authors: Xiang-yu Gao, Yang Chen, Ying-jun Sun, Li-da Li, Shen-ying Qu, Zhao-jun Wei, Guang-ling Zhou, Ying Zhou, Bo Yang, Pei-zhi Hao
Journal: BMJ (2010)

Objective To investigate influence of exogenous insulin in all-in-one parenteral nutrition on blood glucose in infants with very low birth weight (VLBW). Methods Forty-two infants with VLBWI admitted to the department of pediatrics of Xuzhou Hospital affiliated to Southeast University during September 2005 to March 2009 were randomly assigned to Group Ⅰ ( n = 13 ) with exogenous insulin added to all-in-one parenteral nutrition at infusion rate of 0.4 U·kg-1·h-1,GroupⅡ(n = 13) with exogenous insulin at infusion rate of 0.1U·kg-1·h-1 and Group Ⅲ (n = 16) with no exogenous insulin added.Their blood glucose was monitored every two hours. Chi-square test was used for comparing difference in blood glucose abnormality between the three groups and association between blood glucose levels at admission and during hospitalization was analyzed with Spearman correlation. Results Incidence of hyperglycemia and hypoglycemia was 10. 9 percent (29/265) and 18. 1 percent (48/265) in Group Ⅰ, 20. 8 percent (59/284) and 14. 1 percent (40/284) in Group Ⅱ , and 20. 5 percent (61/298) and 11.7 percent (35/298) in Group Ⅲ, respectively. There was significant difference in incidence of hyperglycemia between Groups Ⅰ and Ⅱ ( x2 = 9. 844, P = 0. 002 ) and between Groups Ⅰ and Ⅲ ( x2 = 9. 478, P = 0. 002 ), but no significant difference in it between Groups Ⅱ and Ⅲ ( x2 = 0. 008, P = 0. 928 ). There was significant difference in incidence of hypoglycemia between Groups Ⅰ and Ⅲ ( x2 = 4. 526, P =0. 033 ), but no significant difference in it between Groups Ⅰ and Ⅱ (x2 =1.653, P=0. 199) or between Groups Ⅱ and Ⅲ (x2 =0.709, P =0.400).No significant correlation between endogenous blood insulin level at admission and during hospitalization( r = 0. 082, P = 0. 661 ) was found. Conclusions Blood glucose in infants with VLBW can not be regulated timely by their endogenous insulin itseff. Exogenous insulin added to all-in-one parenteral nutrition at infusion rate of 0. 1 U · kg-1 · h-1 may not significantly reduce incidence of hyperglycemia,while incidence of hypoglycemia can be reduced by exogenous insulin at infusion rate of 0. 4 U · kg- 1 · h -1 that can increase incidence of hypoglycemia Therefore, exogenous insulin is not recommended to be prophylactically added to all-in-one parenteral nutrition for infants with VLBW.

Key words: 
Infant, very low birth weight;  Parenteral nutrition;  Insulin;  Blood glucose
Validation of the ARIA items to assess allergic rhinitis control (ARIA‐C)
Authors: Antonio Valero, Alfonso del Cuvillo, Ana M. Navarro, Carlos Colás, Joaquín Sastre, Joaquim Mullol
Journal: Allergy (2020)

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Relationship of serum uric acid with carotid atherosclerosis in the elderly
Authors: 宝辉, 苗懿德, 张颖
Journal: BMJ (2005)

目的 探讨老年人血尿酸水平与颈动脉粥样硬化程度的相关性.方法应用高频多普勒超声检测老年患者的颈动脉内膜中层厚度(IMT)及斑块程度,测定血尿酸、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖、肌酐、24 h尿白蛋白.分析血尿酸与颈动脉IMT及斑块的关系.结果血尿酸四分位组分析显示,随分位数增加,老年人颈动脉IMT及斑块严重程度增加.血尿酸与颈动脉IMT的相关性独立于年龄、性别、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐,血尿酸与斑块严重程度的相关性独立于年龄、性别、患有原发性高血压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐、空腹血糖及24 h尿白蛋白的自然对数.结论老年人血尿酸水平与颈动脉IMT正相关,血尿酸升高是颈动脉斑块的危险因素,独立于年龄、性别、患有原发性高血压病、血脂、血肌酐等心血管危险因素和肾损伤指标。
Transvaginal vs transabdominal hysterectomy for cicatricial non-prolapsed uterus
Authors: Li-qiong Huang, Wei Zhang, Lu Tao, Yang Yang
Journal: BMJ (2009)

One hundred and ninety-three patients undergoing transvaginal hysterectomy for cicatrix uterus (study group), 200 patients receiving transabdominal hysterectomy for cicatrix uterus (control group Ⅰ), and 200 patients having transvaginal hysterectomy for non-prolapsed uterus (control group Ⅱ) were retrospectively analyzed. In comparison with the control group Ⅰ, the study group showed a significantly reduced operation time and the average volume of blood loss (P < 0.01). Moreover, patients in the study group had shorter postoperative recovery time (P < 0.01) . The incidence of postoperative fever was decreased in the study group. There was no significant difference in complications of the vaginal wound between the three groups (P 0.05). This investigation demonstrates that transvaginal hysterectomy might be feasible and safe in removing cicatrix non-prolapsed uterus. 

Key words: 
Uterus;  Hysterectomy, vaginal
Abstract 14948: Diastolic Blood Pressure Relates to Incipient Lv Systolic Dysfunction by Speckle Tracking Myocardial Imaging: A 25-Year Follow-Up Study of the Cardia Cohort
Authors: Gisela Teixido-Tura, Andre Almeida, Eui-Young Choi, Ola Gjesdal, Anderson Armstrong, Hongyan Ning, David Jacobs, Pamela Schreiner, Kiang Liu, Samuel Gidding, Joao A Lima
Journal: Circulation (2012)

Background Hypertension is a well known risk factor for incident heart failure. Early recognition of subclinical left ventricular (LV) systolic dysfunction is crucial for preventive efforts. Recent...