tbuckley/cabot-search huggingface dataset:
TeleTriage at a high-volume specialty cancer center: Aligning patient volume and need with available resource.
Authors: Stutman E Robin, Jason Napoli, Erika Duggan, Danny Joseph, Eoin Dawson, Rennie Mohabir, Lee Erickson, Christian Otto, Jeffrey S. Groeger
Journal: Journal of Clinical Oncology (2020)

2085 Background: The Memorial Sloan Kettering (MSK) Urgent Care Center (UCC) functions as the emergency room for MSK. With 23,000+ visits annually, increasing volume and acuity means more days over capacity. Patients experience increased wait times to see clinicians, complete evaluation, and transfer to an inpatient bed. The UCC TeleTriage Program is a remote triage program which aims to align patient volume and need with available resources, improve patient experience, and streamline flow through the UCC. By managing resources more efficiently and expediting initial evaluation, the program promotes timely patient access to care, while maintaining MSK's standard of care. Methods: UCC TeleTriage began July 2018 with the Gastrointestinal Medical Oncology service. The Service Nurse refers patients to TeleTriage on weekdays, from 9a.m.- 4:30p.m. The TeleTriage clinician contacts each patient within 30 minutes of referral, takes the history, and determines the initial plan. Patients are directed to a local ER, clinic, or UCC based on level of acuity, real-time GPS, and specific need. For stable patients coming to UCC, TeleTriage focuses on initiating testing prior to registration in UCC. Results: TeleTriage patients have (virtual) contact with a UCC clinician within 30 minutes of referral, whereas non-TeleTriage patients wait 110 minutes or more. TeleTriage patients are discharged from UCC up to 42 minutes more rapidly. TeleTriage patients who receive imaging prior to registration in UCC receive a final disposition up to 93 minutes sooner. About 4% of TeleTriage patients are managed at home. In a small number of TeleTriage patients with severe complications of cancer-treatment, significant morbidity was avoided due to early intervention and coordination of care. Conclusions: TeleTriage patients have contact with a UCC clinician measurably faster than non-TeleTriage patients. Their evaluation is also started earlier. By managing less acute patients at remote sites or at home, TeleTriage can help patients avoid unnecessary travel, (time) expenditure, and hospital contact. TeleTriage patients who come to UCC, spend less time in UCC than non-TeleTriage patients and they discharge faster. By utilizing cancer care expertise, TeleTriage can significantly impact patient outcomes and utilize resources more effectively.
The impact of genetic mutations on response to radium-223 treatment for castration-resistant prostate cancer with bone metastases.
Authors: Alex John Liu, Heidi E. Kosiorek, Benjamin Edward Ueberroth, Ayse T. Kendi, Katherine S. Tzou, Fernando Quevedo, Richard Choo, Cassandra N. Moore, Thai Huu Ho, Parminder Singh, Sameer R. Keole, William Wong, Alan Haruo Bryce
Journal: Journal of Clinical Oncology (2020)

e17587 Background: Radium (Ra)-223 has become the cornerstone treatment in patients with metastatic castrate-resistant prostate cancer (mCRPC) with bone metastases. Ra-223 has been shown to suppress abnormal bone formation by inducing DNA double-strand breaks in tumor cells. This can reduce skeletal-related events, as well as improve survival and quality of life. Studies have indicated mutations that regulate DNA damage response in prostate cancer as susceptible to PARP inhibitors and platinum-based therapies. This study aims to evaluate mCRPC response to Ra-223 stratified by tumor genomics. Methods: This is a retrospective study of mCRPC patients who received Ra-223 and genetic testing within the Mayo Clinic database (Arizona, Florida, and Minnesota). Patient demographics, genetic mutations, treatment responses in terms of alkaline phosphatase (ALP) and prostate-specific antigen (PSA), and survival were assessed. Primary end points were progression-free survival (PFS) and overall survival (OS) from time of first radium treatment. Results: 239 mCRPC patients treated with Ra-223 were identified. Germline and/or somatic genetic sequencing was available in 50 patients, who had a median age of 61 years at time of diagnosis and 68 years at time of Ra-223 treatment. Median Gleason score at time of diagnosis was 8.0. 100% of patients received prior androgen deprivation therapy. 72% received prior docetaxel, and 18% received prior cabazitaxel. Notable mutations included TP53 (45.2%), TMPRSS2-ERG (28.6%), PTEN (26.2%), BRCA1/2 (14.3%), ATM (9.3%), CDK12 (7.1%), and Rb (4.9%). TMPRSS2-ERG was the second most commonly found mutation, with median OS 12.7 mo versus 15.4 mo in patients without TMPRSS2-ERG mutations (p = 0.099). In patients with CDK12 mutations (2 of 28 tested positive), PFS was 10.4 mo versus 5.6 mo in patients without CDK12 mutations (p = 0.157). The assessment of ALP and PSA response to radium treatment stratified by genetic mutation did not reach statistical significance. Conclusions: Among mCRPC patients treated with Ra-223 at Mayo Clinic, TMPRSS2-ERG was the second most commonly found genetic mutation and had observed worse survival outcomes that approached statistical significance. Prospective studies and increased sample sizes are needed to determine the impact of genetic mutations in response to Ra-223.
Value-based estimate of market size and opportunity for economic benefit through innovative pancreatic cancer (PC) therapies.
Authors: Vincent J. Picozzi, Victoria G. Manax, Semmie Kim, Zachary Wintrob, Margaret T. Mandelson, Michele Korfin, Giuseppe Del Priore, Robert Goldberg
Journal: Journal of Clinical Oncology (2020)

e16790 Background: Over the past 20 years, cancer drugs have contributed to increased life expectancy, reduced mortality, decreased hospitalization and decreased use of medical services. The economic value of these improvements is about as large as the value of the increase in the US gross domestic product during that time period. Recently, a health economic study presented at ASCO GI 2020 cited that every $1 (adjusted for inflation) spent on innovative PC treatments reduced non-drug expenditures by $9, thereby lowering the total cost of care for PC patients. Accordingly, the commercial opportunity of a new therapy should be measured by some combination of the clinical, economic and social value generated. We demonstrate the value of a novel PC drug from this perspective. Methods: Analysis of SEER survival and incidence data between 2008 and 2016 shows the introduction of new medicines for PC of all stages was associated with a cumulative increase of 26,456 life years, or 2.52 life years per patient. It was also associated with quality of life improvements, measured by a decline in hospitalizations rates and emergency room visits that can also lead to more days at work, at school and with family. Several studies have suggested the average value of an additional year of life, for the age of a typical patient diagnosed with PC, is at least $250,000. Using this figure, the value of 26,456 life years gained from 2008-2016 is $6.61 billion (26,456*$250,000) to patients, the healthcare system and society, as a result of advancing medical innovation for patients with PC. Results: The median annual list price of a life-enhancing cancer therapy is $150,000 per patient. Using the NCI treatment prevalence estimator (holding incidence constant), we estimate that between 2020-2025, there will be an additional 10,728 advanced PC patients requiring treatment who could benefit from innovative drugs. The total cost of these drugs for these patients would be $1.61 billion. However, the economic value of the life years saved would be $6.76 billion (10,728*2.52 life years*$250,000 = $6.76 billion). A review of cancer medicine payor coverage suggests a new PC therapy that produces such value would be able to obtain coverage from US payors given this value-based price. Conclusions: A value-based approach to estimating the opportunity for clinical and economic benefit reveals significant potential for new PC medicines.
Comparison of clinicopathological features between gastric polyps and colorectal polyps
Authors: Endian Zheng, Liang Zheng, Xizhou Lin, Ying Wang, Qiaoli Lan, Qiang Cai
Journal: BMJ (2016)

Objective
To compare of clinical and pathological features between gastric polyps and colorectal polyps. 


Methods
The clinical characteristics and pathological features of 2 125 patients with gastric polyps and 4 924 patients with colorectal polyps admitted in Wenzhou People's Hospital from 2004 to 2013 were compared. The detection rates, the indication of endoscopy, distribution, number, size and pathological type of gastric polyps and colorectal polyps were analyzed. 


Results
The detection rate of gastric polyps was 3.1%(2 125/69 575)and that of colorectal polyps was 24.5%(4 924/20 124)(χ2=9 886.401, P<0.01). The detection rates of gastric polyps in age groups<20, 20-39, 40-59 and ≥60 were 1.8%(23/1 302), 1.8%(399/22 600), 3.4%(1 137/33 087)and 4.5%(566/12 586), respectively (χ2=238.867, P<0.01); and those for colorectal polyps were 6.6%(14/211), 11.6%(623/5 385), 26.0%(2 622/10 070)and 37.3%(1 665/4 458), respectively (χ2=934.724, P<0.01). The detection rates of gastric polyps in age groups 20-39, 40-59 and ≥60 were lower than those in colorectal polyps(all P<0.01). The detection rate of gastric polyps in males was lower than that in females(2.3%, 848/36 447 vs. 3.9%, 1 277/33 128, χ2=273.807, P<0.01), while the detection rate of colorectal polyps in males was higher than that in females (28.8%, 3 239/11 230 vs. 18.9%, 1 685/8 894, χ2=262.518, P<0.01). Diarrhea and gastrointestinal bleeding in patients with colorectal polyps was more common than those in patients with gastric polyps (23.5%, 1 156/4 924 vs. 2.5%, 54/2 125, χ2=558.080, P<0.01; 12.1%, 597/4 924 vs. 2.4%, 51/2 125, χ2=168.150, P<0.01). Single polyps were more common in gastric polyps than colorectal polyps(80.7%, 1 714/2 125 vs. 67.6%, 3 331/4 924, χ2=186.337, P<0.01). Polyps with size ≥1.0 cm were more common in colorectal polyps than those in gastric polyps (24.3%, 1 197/4 924 vs. 13.6%, 289/2 125, χ2=102.333, P<0.01). The proportion of inflammatory and hyperplastic types in gastric polyps was higher than that in colorectal polyps (67.1%, 1 378/2 125 vs. 27.5%, 1 273/4 924, χ2=934.394, P<0.01; 26.9%, 552/2 125 vs. 9.9%, 459/4 924, χ2=319.588, P<0.01); while the proportion of adenoma and canceration in gastric polyps was lower than that in colorectal polyps (1.7%, 34/2 125 vs. 62.4%, 2 893/4 924, χ2=2 135.743, P<0.01; 0.4%, 9/2 125 vs. 4.8%, 221/4 924, χ2=80.362, P<0.01). 


Conclusions
In comparison with gastric polyps, the detection rate of colorectal polyps is higher. The detection rate of gastric polyps is higher in females, while that of colorectal polyps is higher in males. The detection rates of gastric polyps and colorectal polyps increase with the age. The main pathological type of gastric polyps is inflammatory, while that of colorectal polyps is adenoma.The canceration of colorectal polyps is more common than that of gastric polyps.


Key words: 
Polyps; Stomach; Intestine, large; Disease attributes
Progress in use of macrolides
Authors: 王忠山, 李霞, 刘红, 韩向阳
Journal: BMJ (2004)

大环内酯类(macrolides)是一类具有十四到十六元碳内酯环化学结构的抗生素,主要用于治疗需氧革兰阳性球菌和阴性球菌、某些厌氧菌以及军团菌、支原体、衣原体等感染.但最近的研究表明大环内酯类抗生素除了抗菌作用外,还具有其他广泛的药理作用,现综述其临床应用情况。
Usefulness of Charlson comorbidity index (CCI) to predict early mortality and overall survival (OS) in acute myeloid leukemia (AML).
Authors: Prajwal Dhakal, Valerie Shostrom, Zaid Al-Kadhimi, Lori J. Maness, Krishna Gundabolu, Vijaya Raj Bhatt
Journal: Journal of Clinical Oncology (2020)

e19129 Background: Increasing age is associated with greater comorbidity burden. We hypothesized that comorbidity burden predicts 1-month mortality and OS in patients (pts) aged ≥60 y with AML. Methods: We utilized the National Cancer Data Base to identify pts aged≥60 y with AML diagnosed between 2004-2014. Pts were divided into 3 groups with CCI scores of 0, 1 and ≥2. Chi-square tests were used to examine the association between CCI and different variables. Logistic regression and cox proportional hazard models were used to determine predictors of 1-month mortality and OS, respectively. Results: Of 50,668 pts, 65% had CCI of 0, 24% CCI of 1 and 11% CCI of ≥2. 34% did not receive chemotherapy. 4% underwent upfront hematopoietic cell transplant (HCT). Pts with CCI of 0 were more likely to receive chemotherapy, especially multiagent chemotherapy (42% vs 39% vs 28%) and undergo HCT (4% vs 3% vs 1%). 1-month mortality was 24%, 34% and 45% for pts with CCI of 0, 1 and ≥2, respectively. In a multivariable analysis, 1-month mortality was worse with CCI of 1 (OR 1.5, 95% CI 1.4-1.6) or CCI of ≥2 (OR 2.3, 95% CI 2.2-2.5) vs CCI of 0. Lower CCI, younger age, male sex, white race, higher annual income, private insurance, multiagent chemotherapy, receipt of HCT, acute promyelocytic leukemia (APL) and diagnosis after 2009 were associated with improved OS (Table). Conclusions: In one of the largest real-world studies, we demonstrated that 1/3 rd of newly diagnosed AML did not receive chemotherapy. Greater comorbidity, measured by higher CCI, was more common with increasing age, and correlated with lower likelihood of receiving chemotherapy. Higher CCI independently predicted worse early mortality and OS in older pts with AML. Trials are warranted to determine the effect of optimized comorbidity management and supportive care to reduce early mortality and improve OS. [Table: see text]
Primary analysis of the randomized phase II trial of bortezomib, lenalidomide, dexamthasone with/without elotuzumab for newly diagnosed, high-risk multiple myeloma (SWOG-1211).
Authors: Saad Zafar Usmani, Sikander Ailawadhi, Rachael Sexton, Antje Hoering, Brea Lipe, Sandi Hita, Brian G. Durie, Jeffrey A. Zonder, Madhav V. Dhodapkar, Natalie Scott Callander, S. Vincent Rajkumar, Peter Michael Voorhees, Paul G. Richardson, Robert Z. Orlowski
Journal: Journal of Clinical Oncology (2020)

8507 Background: The introduction of immunomodulatory agents, proteasome inhibitors, and autologous stem cell transplantation (ASCT) has improved outcomes for patients with multiple myeloma (MM), but those with high risk MM (HRMM) have a poor long-term prognosis. To date, no trials have addressed optimal treatment for these patients. Methods: S1211 is a randomized phase II trial (NCT01668719) comparing 8 cycles of lenalidomide, bortezomib and dexamethasone (RVd) induction followed by dose-attenuated RVd maintenance until disease progression with or without elotuzumab. Stem cell collection was allowed, but ASCT was deferred until progression. HRMM was defined by one of the following: gene expression profiling high-risk (GEP hi ), t(14; 16), t(14; 20), del(17p) or amplification 1q21, primary plasma cell leukemia (pPCL) and elevated serum LDH (&gt; 2X ULN). Median progression-free survival (PFS) was the primary end-point, using a one-sided stratified log-rank test at a one-sided significance level of 0.1. Secondary endpoints included overall response rate (ORR), adverse events (AE), serious adverse events (SAE) and OS. Response was assessed using the IMWG 2009 criteria. Results: S1211 enrolled 103 evaluable patients, RVd n = 54, RVd-Elo n = 49. 75% had ISS II/III, 47% amp1q21, 38% del17p, 12% t(14; 16), 9% GEP hi , 7% pPCL, 5% t(14; 20) and 4% elevated serum LDH (18.5% &gt; 1 feature). With median follow-up of 53 months (mos.), no difference in median PFS was observed [RVd-Elo = 31 mos., RVd = 34 mos.,HR = 0.968 (80% CI = 0.697-1.344), p = 0.449]. No difference in OS was observed [RVd-Elo = 68 mos, RVd = not reached, HR = 1.279 (80% CI: 0.819, 2.000), p-value = 0.478]. 72% pts had &gt; Grade 3 AEs, no differences in the safety profile were observed except &gt;Grade 3 infections (RVd 8%, RVd-Elo 16%), &gt;Grade 3 sensory neuropathy (RVd 8%, RVd-Elo 13%). Conclusions: In the first randomized HRMM study reported to date, the addition of elotuzumab to RVd induction and maintenance did not improve patient outcomes. However, the PFS and OS seen in both arms of the study exceeded the original statistical assumptions and support the role for PI/IMiD combination maintenance therapy for this patient population. The S1211 data will serve as an important benchmark for future HRMM clinical trials. Clinical trial information: NCT01668719 .
Characterizing the landscape of genomic variants in high-risk pediatric osteosarcoma.
Authors: Amanda Marinoff, Liam F. Spurr, Duong Doan, Laura Corson, Abigail Ward, Yvonne Y. Li, Andrew D. Cherniack, Katherine A. Janeway
Journal: Journal of Clinical Oncology (2020)

11530 Background: Survival rates for patients with metastatic and/or recurrent osteosarcoma are poor, and treatment strategies have remained unchanged for more than three decades. Genomic characterization can identify new treatment strategies and improve risk stratification. To date, sequencing studies of osteosarcoma have focused on newly diagnosed patients. We present one of the first reports of osteosarcoma genomics in a high-risk cohort. Methods: 92 samples from 92 patients were sequenced in a CLIA/CAP laboratory with a targeted NGS panel test. Patients were enrolled in one of two studies. The PROFILE study enrolls all patients seen at Dana-Farber Cancer Institute, and the GAIN study enrolls patients with metastatic and/or recurrent cancer at 11 institutions. Sequencing was performed using primary tumor samples at biopsy and/or from sites of metastasis when available. Results: 33 patients were enrolled on the PROFILE study, and 59 were enrolled on GAIN. Diagnostic stage was available for 65 (67%) of patients. 37% had metastatic disease at diagnosis. The 3-year overall survival (OS) was 71% for the entire study population, 56% for patients with metastatic disease at diagnosis, and 81% for patients with initially localized disease. The presence of metastases at diagnosis was significantly associated with poor outcome (p &lt; 0.0087) and was the only independent clinical prognostic factor identified. Genomic analysis revealed frequent alterations in TP53 (37%), RB1 (15%), CDKN2A (13%), MYC (12%), CDKN1A (12%), ATRX (10%), and CCND3 (8%). Patients whose tumors had MYC amplification (defined as ≥ 6 copies) had a 3-year OS of 39% compared with a 3-year OS of 76% in the absence of MYC amplification, a difference with borderline statistical significance (p = 0.051). Conclusions: In the first study to examine genomic alterations detected by targeted gene panel sequencing in a CAP-certified laboratory in a large population of pediatric patients with higher risk osteosarcoma, the most frequently occurring events were similar to those found in prior reports. MYC amplification, reported as a possible poor prognostic factor in other studies, was present in 12% of patients and was associated with a worse OS, though this finding did not reach statistical significance.
Chronic conditions of type 2 diabetes in a community:262 case analyses
Authors: jie Du, Liang-pu Peng, Yu-hua Zuo, Su-ying Jiang, Wei-ke Xin, Wen Xu, Lan-hua Liu, Nai-zhen Zhen, Rong Fang
Journal: BMJ (2008)

This study was to assess the chronic morbidity and metabolic disordelters in 262 patients with type 2 diabetes.Of all participants,64(24.4%)coexisted with peripheral neuropathy,34(13.0%)combined with peripheral vascular disease.41(15.6%)were diagnosed as diabetic retinopathy,and 46 (17.6%)had concurrent diabetic nephropathy.In comparison with diabetic patients without these complications,those with the chronic conditions generally had higher plasma glucose,blood pressure or body mass index.

Key words: 
Diabetes mellitus,type 2; Diabetes complications
急性脑损伤的心脏并发症
Authors: 刘斌, 吴承远
Journal: BMJ (2012)

急性脑损伤的心脏并发症是其最常见的早期并发症之一,也是急性脑损伤患者死亡的主要影响因素.本文总结急性脑损伤后心脏并发症的病理生理学特点、临床特征、检查方法及防治策略,为临床工作提供参考。
Chronic myeloid leukemia presenting with isolated thrombocytosis: a report of two cases
Authors: Yi Feng, Juan Lyu, Jiaping Fu
Journal: BMJ (2020)

孤立性血小板增高慢性粒细胞白血病（CML）是一类临床症状不典型的CML，易与原发性血小板增多症混淆。本文报道2例以孤立性血小板增高为表现的CML，通过巨核细胞形态、分子生物学及细胞遗传学检测等手段加以甄别。临床应重视这类变异型CML的存在，以免误诊误治。
PD-L1 status and efficacy of immune check-point inhibitors (ICIs) in advanced cancer patients: A pooled analysis of randomized trials.
Authors: Federica Biello, David James Pinato, Gloria Borra, Silvia Genestroni, Guido Siffredi, Ilaria Repetti, Veronica Martini, Feba mariam Varughese, Ajay Ram Vachanaram, Edoardo Mora, Simone Nardin, Paolo Bruzzi, Antonio Sica, Alessandra Gennari
Journal: Journal of Clinical Oncology (2020)

e15263 Background: The introduction of immune check-point inhibitors (ICIs) in the treatment of a broad range of tumor types has led to a significant and clinically meaningful improvement in overall survival (OS) in advanced disease stages. However, the efficacy of these agents is not consistent across trials and in routine practice. The role of PD-L1 expression as a tumour-agnostic predictive correlate of response to ICIs remains unclear. We performed a pooled analysis of the efficacy of PD-1/PD-L1-targeted ICI regimens as compared to standard of care (SoC) therapy according to PD-L1 expression, based on landmark clinical studies. Methods: We searched literature databases to identify phase III randomized controlled trials that compared anti-PD-1/PD-L1 antibodies alone or in combination with chemotherapy or targeted agents against SoC therapy in the treatment of different tumor types. We reported efficacy data, in terms of OS, according to PD-L1 status. Log hazard ratios (HRs) were pooled across the studies overall and by PD-L1 status by inverse variance weighting. All statistical tests were two-sided. Results: Twenty-four studies including 17687 randomised patients with advanced lung, renal, urothelial, liver, breast, head and neck cancers and melanoma, were eligible for analysis. Efficacy according to PD-L1 immunohistochemical expression, with a 1% cutoff ( &lt; 1% versus &gt; 1%), was reported in 11 studies (7126 patients). Overall, ICI-containing regimes were significantly superior in terms of OS to SoC regimens (pooled HR = 0.64; 95% CI 0.60 to 0.68). When OS data were pooled according to PD-L1 expression, HR was 0.66; 95% CI 0.61 to 0.71 in PD-L1 &lt; 1%, versus 0.62; 95% CI 0.56 to 0.68 in PD-L1 &gt;1% (p = 0.7). Conclusions: The significant improvement in OS favoring the use of ICIs over SoC does not seem to be confined to patients with PD-L1-overexpressing tumours. The difference in efficacy according to PD-L1 status appears to be, at best, marginal.
Combined vaccination with immunoglobulin in prevention of vertical transmission of HBV from father to baby
Authors: Liang-bin Xia, Lei Jiang, Ai-bin Li, Jing Yang, Wang-ming Xu
Journal: BMJ (2008)

Four hundred and five pregnant women whose husbands had positive HBeAg,HBsAg and anti HBc were recruited in the study.Among them.218 women with positive HBsAb were completely randomized into group A and group B,while 187 cases with negative HBsAb formed group C.Women in group A and group C were injected with hepatitis B immunoglobulin(HBIG)before delivery.All newborn babies in 3 groups received routine HCV vaccination.in addition babies in group A and group C also received HBIG iniection within 24 h after birth.The HBV infeetion rate of newborns was 12.1%in group A,12.8%in group B and 23.0%in group C respectively.

Key words: 
Hepatitis B virus;  Vaccination