tbuckley/cabot-search huggingface dataset:
Regorafinib outcomes from the population-based South Australian mCRC registry (SAmCRCR).
Authors: Timothy Jay Price, Cynthia Piantadosi, Amanda Rose Townsend, Rob Padbury, Amitesh Chandra Roy, Guy Maddern, James Moore, Christos Stelios Karapetis
Journal: Journal of Clinical Oncology (2020)

e19344 Background: Regorafinib has been shown to improve survival over BSC alone in large randomized trials. The median survival in the CORRECT study was 6.4 months and 12 month survival 24.3%. In Australia regulators have limited the use of regorafenib and patients are required to self-fund. Understanding the potential benefit of regorafenib in a real world non trial setting would be informative for consumers when considering self funding. Methods: The SAmCRCR collects all mCRC patients prospectively. The Registry was analysed for patients who had received regorafinib between February 2006 and December 2018. Survival was analysed using Kaplan Meier method. Results: Only 53 patients have received regorafenib therapy since February 2006. The median age was 66 (range 34-82). 66% were male, 66% had stage IV at diagnosis, 53% had liver only, 13% liver and lung and 6% lung only involvement. 75% were left sided. K/RAS was available in 35/53 patients, 49% WT. BRAF in 8/53, 25% MT. MSI measured in 14, and MSI-H 21%. Prior lines of treatment received: one 4%, two 9%, three 23%, four 26%, &gt; four 37%. Prior biological use: bevacizumab 72%, anti-EGFR 100% (for RAS WT). Median survival from diagnosis was 3.3 years (95% CI 2.8-3.8 years). From start of regorafinib median survival was 7.1 months (95% CI 4.8-9.4 months) and12 month survival 28%. Conclusions: The outcome for those patients who do access regorafinib is in keeping with that reported from large randomized trials and thus clinicians can quote these outcomes when discussing access to regorafinib in the community.
Perimenopausal syndrome and advance in hormone treatment
Authors: 张绍芬
Journal: BMJ (2008)

随着人口的老龄化,女性一生将有1/3或以上的时间在围绝经期与绝经后期渡过.绝经期卵巢功能衰退造成的雌激素不足,是促成老龄阶段慢性疾病的因素之一,这已是不争的事实,因此,绝经及其治疗应被看作公共健康的重要问题。
Concise interpretation and application of clinical practice guidelines for general practitioners
Authors: Yaolong Chen, Xiaoxia Peng
Journal: BMJ (2017)

临床实践指南的应用有利于规范诊疗行为，缩小不同医疗机构和临床医生间的诊疗水平差异，对降低患者就医成本和改善医疗保健质量具有重要意义。文章阐述了指南的定义与类型、我国指南制订的现状与质量、指南在基层医务人员中的使用现状以及基层医务人员如何正确解读和应用指南，并提出指南制订团队应该邀请基层医务人员参与到指南的制订与推广中来。
Independent validation of paige prostate: Assessing clinical benefit of an artificial intelligence tool within a digital diagnostic pathology laboratory workflow.
Authors: Christopher Kanan, Jillian Sue, Leo Grady, Thomas J. Fuchs, Sarat Chandarlapaty, Jorge S. Reis-Filho, Paulo G O Salles, Leonard Medeiros da Silva, Carlos Gil Ferreira, Emilio Marcelo Pereira
Journal: Journal of Clinical Oncology (2020)

e14076 Background: The most common approach to diagnose prostate cancer is the “whole gland biopsy procedure,” in which numerous cores (≥12) are taken from different regions of the gland to maximize the chances of detecting small cancers; the presence of cancer in any of these cores is significant to the patient. If concerning features that are not fully diagnostic of cancer are identified, the pathologist may defer the final diagnosis until additional studies (e.g. immunohistochemistry) have been performed. We recently developed an artificial intelligence (AI)-based system for the assessment of cancer in prostate biopsies. Here, we investigated the performance of this test in an independent dataset of prostate cancers consecutively accrued. Methods: Two board-certified pathologists retrospectively reviewed 600 digitized hematoxylin-and-eosin (H&amp;E) stained diagnostic prostate core needle biopsy slides from 100 consecutive patients, originally diagnosed at an independent hospital. Pathologists’ assessments were based on the H&amp;E image alone; if further testing would be preferred, it was noted in the review notes. All images were assessed by Paige Prostate 1.0, an AI-based diagnostic tool; based on its outputs (either suspicious for cancer or not), the discordant images were re-reviewed by the pathologists and, in parallel, adjudicated with additional testing (e.g. ancillary immunohistochemical markers). Results: Paige Prostate's slide-level sensitivity was 98.9% and its specificity was 93.3% (100% and 78.0%, respectively, at the subject-level). The pathologists' average slide-level sensitivity and specificity without Paige Prostate was 90.9% and 98.6%, respectively. The sensitivity with their consensus read and Paige Prostate increased by 5.7% to 96.6% with only 0.8% decrease in specificity. In addition to new slide-level findings, benefits were also observed at the subject-level; with Paige, three new prostate cancer cases were discovered that were initially missed. Conclusions: The study reflects the potential benefits of the Paige Prostate system in the hands of experienced pathologists and validates the algorithm in a completely independent dataset. Paige Prostate can improve pathologists' sensitivity when reviewing digitized H&amp;E prostate needle biopsy images with a minor impact on specificity.
Tentonin 3 as a baroreceptor mechanosensor: not a stretch
Authors: Jianguo G. Gu, Dan E. Berkowitz
Journal: Journal of Clinical Investigation (2020)

Mechanical stretch of baroreceptors in the wall of the aortic arch and carotid sinus initiates autonomic reflexes to change heart rate and blood pressure for cardiovascular homeostasis. In this issue of the JCI, Lu et al. show that tentonin 3 (TTN3), a recently identified stretch-sensitive ion channel, was present at the vagus afferent nerve endings innervating the aortic arch to function as a baroreceptor. This study expands the molecular profiles of baroreceptors and provides new insights into molecular mechanisms underlying the regulation of cardiovascular functions through baroreceptor function.
Investigation of triple negative breast cancer rates in women diagnosed with breast cancer in Trinidad and Tobago.
Authors: Gerneiva Parkinson, Arianne Cooper, Kellie Alleyne-Mike
Journal: Journal of Clinical Oncology (2020)

e19005 Background: According to the WHO/PAHO, Trinidad and Tobago (T&amp;T) has the 2nd highest breast cancer mortality rate in the Caribbean region. In T&amp;T, citizens of African descent make up about 36.8% of the T&amp;T population, with 24.8% being of East Indian ancestry, and 32.4% identifying as having mixed heritage. In the United States, it has been showed that African American women, despite being diagnosed less often, have an earlier onset of breast cancer with less favorable clinical outcomes. One of the factors studied has been the higher frequency of triple negative breast cancer (TNBC) in African American women particularly when these patients are diagnosed at a younger age. Notably, a large proportion of breast cancer cases in T&amp;T appear to occur at a young age, with nearly 36% of them being diagnosed under the age of 50. However, breast cancer tumor phenotypes have not been well studied. Therefore, we sought to investigate the distribution of tumor hormone receptor markers in the T&amp;T breast cancer population. Methods: At the National Radiotherapy Center, T&amp;T’s main oncology unit, we investigated breast cancer patients born in T&amp;T using paper chart reviews. We collected information about their demographics, personal breast cancer diagnosis, tumor hormone receptor status and germline genetic testing results. Results: So far, we reviewed 90 patient charts, and in our sample, 33.3% (30/90) had TNBC. This is higher than the rates in the US where TNBC accounts for 10-20% of breast cancer patients, and of those TNBC cases, 10.6% have BRCA 1 or BRCA 2 mutations. In our T&amp;T sample, of those with TNBC, 23.3% (7/30) had a HBOC mutation (5 BRCA, 1 TP53 and 1 PTEN). Average diagnosis age of TNBC cases reported in our sample was 45.7 years. In our sample, 52.2% (47/90) identified as having African ancestry, 37.8% (34/90) identified as having East Indian ancestry and 10% (9/90) identified as Mixed. Of the patients with TNBC, 63.3% (19/30) were of African ancestry, 30.0% (9/30) were of East Indian ancestry and 6.7% (2/30) identified as Mixed. Conclusions: Therefore, our sample results suggest that there is a significant portion of the breast cancer cases being TNBC in the T&amp;T population, particularly in citizens with African ancestry. As we continue to finalize the incoming data, we hope to draw associations between tumor pathology, clinical presentation and genetic profiles. However, these initial results demonstrate the need to study tumor pathology within the T&amp;T population, as this could lead to improved clinical and screening guidelines specific to T&amp;T citizens.
Enhancing safety of exercise for individuals with bone metastases: Screening recommendations developed through Delphi consensus process.
Authors: Kristin L. Campbell, Sarah Weller, Prue Cormie, Kirstin N. Lane, Jennifer Marie Rauw, Jennifer Goulart
Journal: Journal of Clinical Oncology (2020)

e24042 Background: Exercise has been shown to improve physical function and quality of life in individuals with bone metastases. To facilitate better integration of exercise services into clinical care for these more complex patients, the purpose was to understand the current views of an expert panel on the appropriate exercise screening approach for adults with bone metastases. Methods: Physicians, physical therapists and exercise physiologists with clinical or research expertise in providing medical and/or exercise advice to individuals with bone metastases were identified. A 3-round modified online Delphi survey was used to establish a consensus, with a priori consensus set to 70%. Results: Response rates were 68% (73/107), 81% (59/73) and 97% (57/59) for each Delphi round. Key consensus points were: a) medical guidance (i.e. communication and medical information from a physician) is recommended prior to commencing structured exercise for all individuals with bone lesions (90% consensus) and is required when individuals present with bone pain, have received past medical treatment for bone pain, or have a history of disease-related fractures (90% consensus); b) the primary objective of exercise professionals for seeking medical guidance is to obtain medical information (e.g., bone scan reports) to guide clinical decision making for exercise prescription (93% consensus) and for bi-directional communication (i.e., for overall patient care and safety) (75% consensus) versus requiring a direct referral from a physician for liability coverage (39% consensus); c) the physician group that exercise professionals most commonly approach for medical guidance are medical oncologists (84% consensus) or radiation oncologists (63% consensus) compared to primary care providers (33% consensus), orthopedic surgeons (40% consensus) or physiatrists (16%); d) as part of pre-exercise screening by an exercise professional, information should be collected on the number, location and type of bone lesion(s), level of bone pain and any other bone-related symptom (100% consensus). Conclusions: This represents the current views of a range of physicians, physical therapists, exercise physiologists and researchers who provide medical and/or exercise advice to adults with bone metastases. These findings will inform the work of the International Bone Metastases Exercise Working Group to establish the first exercise guidelines for adults with bone metatases.
Analysis of Overall Survival Benefit of Abemaciclib Plus Fulvestrant in Hormone Receptor–Positive, ERBB2-Negative Breast Cancer—Reply
Authors: George W. Sledge, Martin Frenzel
Journal: JAMA Oncology (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Oncology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Oncology journal
Bifidobacterium triple viable combined with mesalazine in treatment of patients with ulcerative colitis
Authors: Xi Chen, Xingzhou Xia, Xia Sun, Haitao Lan
Journal: BMJ (2014)

One hundred and eight patients with early onset mild or moderate active ulcerative colitis (UC) were randomly divided into combination group and control group. Patients in combination group were treated with postprandial oral mesalazine (1.0 g, q. i.d) and bifidobacterium triple viable capsule (420 mg, t. i.d) for 2 months, and those in control group were treated with postprandial oral mesalazine alone (1.0 g, q. i.d) for 2 months. Results showed that the Mayo index in combination group was significantly lower than that in control group (P=0.028) after treatment; and the clinical efficacy was significantly better than that of control group (P=0.024). After treatment, serum TNF-α, IL-6, IL-8 levels in both groups were significantly lower and IL-10 level was significantly higher (P<0.05) than those before treatment. There were significant differences in serum TNF-α, IL-6, IL-8, IL-10 levels after treatment between combination group and control group (P<0.05). After treatment, serum SOD levels were significantly reduced and MDA levels were significantly increased compared to those before treatment (both P<0.05). There were significant differences in serum SOD and MDA levels after treatment between two groups (P<0.05). Bifidobacterium triple viable combined with mesalazine shows more effective in inhibition of UC-inflammatory response and oxidative stress, resulting in reduction of UC activity and improvement of therapeutic effect.


Key words: 
Colitis, ulcerative; Treatment
治疗急性肠梗阻181例体会
Authors: 王尚才, 潘正东, 尹春元
Journal: BMJ (2005)

回顾分析我院1994年10月至2004年10月收治的181例急性肠梗阻病例,治愈出院177例,死亡4例.其中出现多器官功能衰竭 2例,肾功能衰竭 1例,严重电解质紊乱4例,应激性溃疡 1例.结果表明,在急性肠梗阻诊疗过程中,严密观察病情变化,重视非手术治疗,掌握中转手术指征及时手术,重视围手术期处理,可提高疗效、降低死亡率。
Clinical, sociodemographic, and pathological characteristics of breast cancer in the United States: A cross-sectional analysis from the National Cancer Database (NCDB).
Authors: Zeina A. Nahleh, Nadeem Bilani, Leah Elson, Elizabeth Blessing Elimimian, Emily Craig Zabor
Journal: Journal of Clinical Oncology (2020)

e13623 Background: Breast cancer (BC) remains the most commonly-diagnosed malignancy in women. BC encompasses great heterogeneity in patient pathologic and clinical characteristics, as well as treatment approaches and outcome by stage and subtype. This study aims to explore recent differences in characteristics and overall survival (OS) of BC across different facility types. Methods: We conducted a retrospective analysis of patients with BC, diagnosed between 2004-2016, based on the NCDB. Categorical variables were summarized using frequencies/percentages, whereas continuous variables were summarized using the median/interquartile range (IQR). OS was explored using the Kaplan-Meier method. Results: A total of 2,671,549 patients with BC were captured in this dataset. The median age at diagnosis was 61 (range 18-90 years). The majority n = 1,986,450 (75%) were non-Hispanic (NH) white; 286,176 (11%) were NH-black; 124,877 (4.7%) were Hispanic-white; 2,977 (0.1%) were Hispanic-black and 90,484 (6.1%) were Asian. The most common BC subtype was hormone receptor-positive (HR+)/HER2- (58%), followed by HR+/HER2+ (26%), HR-/HER2-negative (10%) and HR-/HER2+ (6.4%). 73% of cases were ductal; 15% lobular; the remaining histological subtypes included 0.9% epithelial-myoepithelial, 0.1% fibroepithelial, 0.4% metaplastic, &lt; 0.1% mesenchymal, 1.6% rare breast carcinomas and 7% other carcinomas. The majority of patients received therapy at comprehensive community cancer programs (CPs) (45%), followed by academic/research CPs (30%), integrated network CPs (15%) and community CPs (9.5%). OS was best at academic (72% 10-year OS), followed by integrated network (69% 10-year OS), comprehensive community (68% 10-year OS) and community (63% 10-year OS) CPs. Significant differences in OS according to facility type remained when stratified by stage of disease (all p &lt; 0.0001). OS was also significantly better for white (69% 10-year OS) versus black (63% 10-year OS) patients. Conclusions: This large database from the NCDB provides a comprehensive, recent overview of BC over the last 12 years. Facility type appears to be significantly associated with OS, such that academically designated centers have superior OS across all stages.
Four distinct patient-reported outcome (PRO) trajectories in longitudinal responses collected before, during, and after chemotherapy.
Authors: Douglas W. Blayney, Amee Azad, Melih Yilmaz, Selen Bozkurt, James D. Brooks, Tina Hernandez-Boussard
Journal: Journal of Clinical Oncology (2020)

2012 Background: Cancer chemotherapy, whether given with curative or palliative intent, is toxic. Toxicity is routinely captured in clinical trials by investigator observation and increasingly by PRO. The ability to capture PRO in the routine treatment workflow has been standard at Stanford since 2015 (Roy et al ASCO 2020). Analysis of longitudinally captured, real world PRO and prospectively identifying patients (pts) whose quality of life (QOL) is at risk of deteriorating either permanently or temporarily is needed. Routine serial PRO measurement should enhance precision care delivery, precision toxicity detection and management. Methods: We identified patients undergoing chemotherapy at Stanford and analyzed PROMIS (PRO Measurement Information System) responses. Pts with PROMIS survey information at three intervals—pre-treatment, during chemotherapy and post chemotherapy—were identified. We evaluated global physical health (GPH) and global mental health (GMH). Pts with a clinically significant decrease (CSD) in GPH or GMH scores were identified. A k-median cluster analysis was used to identify patient trajectory clusters and a machine-learning model was applied to identify risk factors for CSD and predict CSD. Results: We identified 670 adult oncology patients undergoing chemotherapy who completed at least one PROMIS survey in each interval. GPH scores were 48.4 ± 9.1 before, 47.1 ± 8.5 during, and 48.5 ± 8.9 after chemotherapy and GMH scores were 50.5 ± 8.2, 49.1 ± 8.5, and 50.7 ± 9.0, respectively. The majority of patients did not have a CSD in GPH or GMH post treatment compared to pretreatment scores. Pretreatment scores were the strongest predictor of a CSD in GPH and GMH. Trajectory clustering identified four distinct trajectories: Temporary Improver, Temporary Deteriorator, Improver, Inexorable Deteriorators. We were not able to predict any cluster based on pre-treatment features. Conclusions: Using routinely collected PROMIS surveys in a real-world setting, we are able to predict patients with post-treatment decreases in their physical and mental well-being. We further defined four novel patient trajectories during chemotherapy, which could guide personalized supportive interventions to improve patient’s chemotherapy experience. Identification of patients at risk for deterioration and the patterns of deterioration could help guide efficient deployment of toxicity mitigating and supportive care interventions to patients most in need.
Interaction of sleep quality and sleep duration on impaired fasting glucose: a population-based cross-sectional survey in China
Authors: 娄培安, 陈培培, 张雷, 张盼, 常桂秋, 张宁, 李婷, 乔程
Journal: BMJ (2014)

目的
探讨睡眠时间和睡眠质量对中国成年人空腹血糖受损的影响及交互作用。


设计
横断面调查。


地点
中国徐州社区人群。


研究对象
15 145名符合调查要求的18～75岁的当地居民。


主要和次要结果的测量
用匹兹堡睡眠质量指数将睡眠质量分为好、中、差；以空腹血糖水平评估空腹血糖受损程度；每晚平均睡眠时间分为 8 h。运用非条件Logistic回归模型分析睡眠时间和睡眠质量与2型糖尿病的关系，通过Bootstrap法计算相对超额危险度比(RERI)、归因比(AP)和交互作用指数(S)及其95%可信区间来评价睡眠时间和睡眠质量之间的交互作用。


结果
调整潜在的混杂因素后，相比睡眠质量好且睡眠时间在6～8 h者，睡眠质量差且睡眠时间短的人空腹血糖受损最严重(比值比＝6.37，95%CI：4.66～8.67，P<0.001)。调整潜在的混杂因素后，睡眠质量差和睡眠时间短的交互作用的RERI、AP和S及95%CI可信区间分别是1.69(0.31～3.76)、0.42(0.15～0.61)和2.85(2.14～3.92)，睡眠质量好和睡眠时间长的交互作用的RERI、AP和S及95%CI可信区间分别是0.78(0.12～1.43)、0.61(0.26～0.87)和–0.65(–0.94～–0.27)。


结论
结果提示睡眠质量差和睡眠时间短可能对空腹血糖受损存在交互作用。
Incidence and economic burden of infections in cancer patients receiving immune checkpoint inhibitors.
Authors: swarna sri nalluru, Paramarajan Piranavan, Anvesh Narimiti, Shanil Shah, Ahmad Daniyal Siddiqui, George Abraham
Journal: Journal of Clinical Oncology (2020)

e19365 Background: Along with antitumor effects, Immune Checkpoint Inhibitors (ICPI) have shown great potential in treating chronic infections such as HIV, Hepatitis B, and malaria, in ex-vivo studies. However, several case reports and case series suggested increased infection risk in cancer patients receiving ICPI. The purpose of our study is to assess the risk of infections in cancer patients receiving ICPI. We also attempted to evaluate the role of a multidisciplinary approach (Oncology and Infectious disease specialists) and the cost associated with treatment. Methods: Records on all cancer patients over age ≥18 years old who had received at least one dose of ICPI from 2015 to 2018 at two major community teaching hospitals in the Central Massachusetts region were reviewed. Several risk factors associated with infection were identified. Two-tailed unpaired t-test was used to analyze the association between risk factors and infection. We calculated the average length of stay (LOS) and cost per admission with a multidisciplinary vs. non-multidisciplinary approach. The calculated total average cost per admission was compared with a random set of non-oncologic population admitted with similar infections noted in our study to estimate the economic burden. Results: Thirty-seven (21.8%) patients developed sixty-two episodes of infection. Microbiological confirmation was available in 13 episodes. Risk factors like COPD (P = 0.01), prior chemotherapy (P = 0.03), and steroid use (P = 0.003) were significantly associated with infections. An infection-associated mortality rate was noted to be 2.3%. With the involvement of multidisciplinary team, the average LOS increased from 5.9 to 8.1 days. Yet, the average cost per admission approximately remained the same (52,047$ vs. 54,510$). Upon comparison with a non-oncologic patient, the average cost per admission for an infection in cancer patients receiving ICPI increased from 11,527$ to 35,484$. Conclusions: Surprisingly, a significant incidence of infections and associated health care resource utilization continue to prevail in cancer patients despite the utility of ICPI. Although the economic burden due to the infections in this set of patients is remarkably high when compared to the general population, the multidisciplinary approach did not increase the hospital costs.
肾病综合征并发心绞痛、心肌梗死二例
Authors: 吴恩亮, 白秀芝, 高广美, 谢冰
Journal: BMJ (2008)

例1 男,54岁,干部.因面部及双下肢水肿伴少尿5 d来诊.无发热、皮疹及关节痛等症状.查体:体温36.5 ℃,脉搏82次/min,呼吸22次/min,血压150/105 mm Hg(1 mm Hg=0.133 kPa),体重70 kg.双眼睑浮肿。
The newly progress of cervical cancer’ biological treatment
Authors: 王丽萍, 张友忠
Journal: BMJ (2009)

子宫颈癌(宫颈癌)是全球女性中仅次于乳腺癌列第二位的常见的恶性肿瘤[1].经过广泛开展妇科普查,几十年来我国宫颈癌的发病率及死亡率降低了近68%[2],但从全国范围来看,患病率仍居妇科恶性肿瘤之首,近年随着人乳头状瘤病毒(HPV)感染率的上升和社会生活的变化,发病率有增高趋势,且发病年龄渐趋年轻化.科学技术的不断进步为宫颈癌的治疗提供新的模式.下面对宫颈癌近年的基因治疗及分子靶向药物基础研究情况做一综述。