tbuckley/cabot-search huggingface dataset:
Bedside noninvasive scoring system in diagnosis of coronary heart disease
Authors: 张灿秀, 肖喜刚, 王岚峰, 潘薇, 刘洪仁, 黄永麟
Journal: BMJ (2012)

Objectives To evaluate the effectiveness of bedside noninvasive scoring system in diagnosis of coronary heart disease (CAD).Methods Six hundred and twelve patients with suspected CAD in our hospital were enrolled (343 males and 269 females) from September 2008 to October 2010,with an average age of 55 ± 7 y.The detailed history was taken; physical examination,resting electrocardiogram,blood biochemistry,treadmill exercise test and/or 12 lead Holter monitoring,64 or 256 rows CT coronary artery imaging and coronary artery angiography were performed in all patients.The risk factors for CAD were screened by multiple questionnaire surveys with Delphi method.The risk factors were stratified according to the results of expert survey: heavy smoking,diabetes mellitus,typical angina,positive treadmill exercise test and positive Holter monitoring electrocardiogram were included in the highest risk factors with an integrated scores of 8 ; dyslipidemia of 3 items,hypertension complicated with left ventricular hypertrophy were high risk factors with an integrated scores of 6; males≥40 y,medium smoking,dyslipidemia of 2 items,pathoglycemia,heavy drinking,positive ECG and post-menopause females were moderate risk factors with integrated scores of 4; Low risk factors contain moderate drinking and dyslipidemia of item,were classified as low risk factors with an integrated scores of 2. The bedside noninvasive scoring system was evaluated in all patients and the results were compared with those from multi-slice spiral CT or coronary angiography.Results When integrated score ≥ 24 was set as the cut-off level for diagnosis of CAD,thesensitivity,specificity,positive predictive value and accuracy were 89.95％,85.63％,94.03％ and 88.73％ respectively.When integrated score≤ 14 was set as the exclusion criteria of CAD,the sensitivity,specificity,positive predictive value and accuracy were of 93.10％,82.86％,98.09％ and 84.80％ respectively.The accuracy was lower than that of multi-slice spiral CT or coronary angiography( P ＜0.05 ).Conclusions The bedside noninvasive scoring system is effective for preliminary diagnose of CAD,but need to be further improved.

Key words: 
Coronary disease; Diagnostic techniques, cardiovascular; Research design
Influence of Eastern Cooperative Oncology Group performance status (ECOG PS), tumor size and age on patient outcomes after anlotinib treatment: A subgroup analysis based on ALTER01031 trial for medullary thyroid carcinoma (MTC).
Authors: Ming Gao, Yihebali Chi, Xiangqian Zheng, Dapeng Li, Pingzhang Tang, Zhengang Xu, Xiaohong Chen, Minghua Ge, Yuan Zhang, Zhuming Guo, Jun Wang, Jie Chen, Jiewu Zhang, Ying Cheng, Zhendong Li, Hui Liu, Jianwu Qin, Jingqiang Zhu, Ruochuan Cheng
Journal: Journal of Clinical Oncology (2020)

6527 Background: Anlotinib is a newly developed TKI achieved a nearly 2-fold PFS prolongation in a randomized, placebo-controlled phase 2b trial (NCT02586350) for MTC, the results of which were firstly published in 2019 ASCO annual meeting. This subanalysis examined the influence of baseline demographic (ECOG PS score, age) and tumor size on efficacy in this study. Methods: Kaplan-Meier method was applied to estimate the median PFS (mPFS) for subgroups of patients (pts) received anlotinib or placebo based on ECOG PS score (0 vs. 1), median tumor lesion diameter ( &lt; 67 vs. ≥67mm) and age ( &lt; 55 vs. ≥55 years old). Results: 91 eligible pts were randomly assigned in a 2:1 ratio to receive anlotinib or placebo. The numbers of pts in each subgroup were summarized in the table below. In placebo arm, mPFS did not differ significantly between pts with ECOG PS 0 and 1 (11.3 vs. 11.1months; HR = 0.895 [95% CI 0.347, 2.312], P = 0.821) or between pts with tumor lesion diameter &lt; 67mm and ≥ 67mm (7.0 vs. 11.1 months; HR = 1.168 [95% CI 0.463, 2.945], P = 0.737). Conversely, pts in anlotinib arm with ECOG PS 0 obtained more PFS benefits (34.6 vs. 14.0 months; HR = 0.331 [95% CI 0.163, 0.671], P = 0.002). Similarly, anlotinib treated pts with tumor lesion diameters &lt; 67mm achieved a longer mPFS (Not reached vs. 14.0 months, HR = 0.567 [95% CI 0.280, 1.147], P = 0.111). Consistent with that has been verified in differentiated thyroid cancer, high age predicted poor prognosis as mPFS were 14.3 months and 6.8 months in pts &lt; 55 and ≥ 55 years old respectively in placebo arm (HR = 0.322 [95% CI 0.116, 0.893], P = 0.007).). Anlotinib treatment exhibited PFS improvement to pts in both age groups but higher PFS prolongation was observed in pts &lt; 55 years old (22.4 vs. 14.0 months; HR = 0.720 [95% CI 0.321, 1.614], P = 0.381). Conclusions: This analysis showed that for pts in placebo arm, PFS was similar regardless of functional status (ECOG PS) or tumor size while older pts had higher progression risk. Treatment with anlotinib exhibited greater PFS benefits for pts with better functional status (ECOG PS = 0), younger age or lower tumor burden. These results indicated that it is reasonable to start anlotinib treatment at a relative earlier disease stage before the worsen of ECOG PS, increase of tumor size or ageing. Clinical trial information: NCT02586350 . [Table: see text]
Special nursing and intermittent pneumatic pressure pump in prevention of deep venous thrombosis after cesarean section in women with prethrombosis state
Authors: Xiwei Zhang, Liyan Geng, Jie Gao, Huan Xiao, Wei Ma, Dan Tian, Rui Li, Yanrong Jin
Journal: BMJ (2016)

One hundred and three pregnant women undergoing cesarean section were divided into study group (n=60) and control group (n=43). Both groups received routine nursing and used anti-embolism stockings to prevent deep venous thrombosis of lower limbs; patients in study group received additional intermittent pneumatic pressure pump treatment and special health education. The incidence of postoperative lower limb swelling, pain, skin color changes and deep venous thrombosis in the two groups were compared. Results showed that the incidence rate of postoperative lower limb deep venous thrombosis in study group was 0.8%, which was significantly lower than that in control group(5.8%, P<0.05). There were significant differences in incidence of lower limb swelling, lower limb pain and abnormal skin color between two groups(P<0.05). The study indicates that intermittent pneumatic compression and special health education can effectively reduce the incidence of deep venous thrombosis of lower limb after cesarean section in pregnant women with prethrombosis state.


Key words: 
Thrombophilia; Lower extremity deep vein thrombosis; Cesarean section
Risk of venous thromboembolism in patients receiving neoadjuvant chemotherapy for ovarian cancer.
Authors: Derman Basaran, Jessa Suhner, Dib Sassine, Thomas Boerner, Ying L Liu, Rachel N. Grisham, William P. Tew, Ginger J. Gardner, Oliver Zivanovic, Yukio Sonoda, Kara C. Long-Roche, Dennis Chi, Gerald A. Soff, Elizabeth Lin Jewell
Journal: Journal of Clinical Oncology (2020)

6073 Background: To identify the incidence of newly occurring venous thromboembolism (VTE) in patients with ovarian cancer receiving neoadjuvant chemotherapy (NACT). Methods: Using our prospectively maintained ovarian cancer database, we identified all ovarian cancer patients who received NACT at our institution from 4/15-9/18. VTE events included clinically diagnosed deep venous thrombosis (DVT) or pulmonary embolism (PE). Patients who presented with VTE prior to induction of NACT or patients on anticoagulation therapy prior to diagnosis were excluded. The incidence of newly occurring thrombotic events were categorized according to treatment phases, defined as 1) NACT prior to interval debulking surgery (IDS); 2) intraoperative and 30-day post-IDS; and 3) adjuvant chemotherapy. Results: 290 patients underwent NACT during the study period. Thirty-eight patients (13%) who presented with VTE, 12 (4%) on anticoagulation at presentation, and 4 (1.4%) seeking only a second opinion were excluded from analysis. Of the 236 evaluable patients, the overall rate of VTE during all treatment phases was 15% (35/236). In treatment phase I, 11% (27/236) of patients experienced VTE during NACT. In phase II, an additional 2.5% (6/236) developed VTE in the intraoperative and 30-day postoperative period. In phase III, an additional 0.8% (2/236) experienced a thrombotic event &gt;30 days postoperatively. Sevety-seven percent (27/35) of VTE events occured during phase I. Conclusions: Patients receiving NACT for advanced ovarian cancer are at high risk for the development of clinically detectable thromboembolic events. The highest rate of new VTE events was seen during induction of NACT, a phase of treatment traditionally without any prophylactic anticoagulation. Further research regarding the timing of thromboprophylaxis for this patient population is warranted. [Table: see text]
Handgun Ownership and Suicide in California
Authors: David M. Studdert, Yifan Zhang, Sonja A. Swanson, Lea Prince, Jonathan A. Rodden, Erin E. Holsinger, Matthew J. Spittal, Garen J. Wintemute, Matthew Miller
Journal: New England Journal of Medicine (2020)

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.).
Impact of concurrent angiotensin inhibitors on outcomes with PD1/L1 inhibitors for patients (pts) with metastatic urothelial carcinoma (mUC).
Authors: Catherine Curran, Gregory Russell Pond, Pier Vitale Nuzzo, Sarah Abou Alaiwi, Amin Nassar, Xiao X. Wei, Kerry L. Kilbridge, Bradley Alexander McGregor, Praful Ravi, Arvind Ravi, Guru Sonpavde
Journal: Journal of Clinical Oncology (2020)

e17044 Background: Preclinical data indicate that angiotensin inhibition may improve drug delivery by enhancing tumor perfusion partly by downregulating transforming growth factor (TGF)-β. Since (TGF)-β appears to be associated with resistance in patients with mUC receiving PD1/L1 inhibitors, we investigated whether angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) may enhance the outcomes of mUC pts receiving PD1/L1 inhibitors. Methods: Data from mUC pts who received PD1/L1 inhibitors at the Dana-Farber Cancer Institute (DFCI) was obtained. Data for ACEI and ARB administration was collected with concurrent administration defined as ongoing therapy from the time of starting PD1/L1 inhibitor treatment. A Cox logistic regression was used to investigate the impact of concurrent ACEI/ARB on any regression of tumor (ART, any decrease in size of tumor on scan) defined as any tumor regression after controlling for known prognostic factors (performance status, sites of metastasis, neutrophil/lymphocyte ratio, platelet count, hemoglobin). Results: Data was available for 178 pts with mUC who received pembrolizumab (79), atezolizumab (83), nivolumab (15), and durvalumab (1). Prior platinum chemotherapy was administered in 153 pts (86%). 33 pts (18.5%) received AECI/ARBs: 24 pts (13.5%) received ACEI and 9 pts (5.1%) received ARBs. Of 145 patients who did not receive an ACE-inhibitor nor an ARB, 49 (33.8%) patients experienced ART and their median overall survival (OS) was 9.1 months. Among/33 patients who did receive an ACEI or an ARB, 17 (51.5%) exhibited ARTand their median OS was 17.0 months. Multivariable analysis controlling for known prognostic factors revealed that patients who received ACE inhibitors or ARBs had greater ART (HR 3.0 [95% CI 1.25-7.17], p = 0.014) and improved OS, (HR 0.49 [95% CI 0.28-0.88] p = 0.016). Conclusions: In this hypothesis-generating study, concurrent angiotensin inhibitors including ACEI or ARBs were associated with significantly better outcomes in mUC pts receiving PD-1/L1 inhibitors. These results require validation in a larger mUC dataset in conjunction with probing the effect in other malignancies.
A case of suspected lupus nephritis with negative serum anti-nuclear antibody and positive serum anti-Sm antibody
Authors: Wenbin Wen, Yanmei Ma, Wei Zhang, Shuaishuai Shi, Yin'e Zhao, Yu Wang
Journal: BMJ (2017)

报道1例临床呈显性蛋白尿，血清抗核糖核蛋白及抗Sm抗体持续阳性表达，而临床无多系统损害表现，血清抗核抗体阴性，肾脏病理呈IgG4亚型表达为主的不典型膜性肾病表现，提示临床虽无多系统损害表现且血清抗核抗体呈阴性表达的蛋白尿患者，不能排除狼疮性肾炎可能；血清抗Sm抗体持续阳性，未必可明确诊断系统性红斑狼疮，建议临床资料与肾脏病理结合，合理诊治。
非酒精中毒性Wernicke脑病五例临床与磁共振成像特征
Authors: 鲁丛霞, 林青, 曲红丽, 李骏, 马琪林
Journal: BMJ (2010)

一、临床资料 例1患者女,18岁,因烧心、反酸1个月,精神行为异常10 d入院.既往无饮酒史,无特殊服药史.1个月前出现烧心、反酸、厌食,在本院经胃镜检查后确诊胆汁反流性胃炎,给予抑酸、保护胃黏膜等对症支持治疗,10 d来渐出现言语混乱,诉能看见鬼怪。
Drivers and barriers to clinical trials (CTs) participation among oncological and non-oncological patients in Poland: A cross sectional survey.
Authors: Artur Kotowski, Dariusz Świetlik, Maja Dominika Kotowska, Michał Wronowski, Andrzej Mariusz Fal
Journal: Journal of Clinical Oncology (2020)

e24191 Background: Understanding patients decision-making process regarding participation in a clinical trial (CT) is crucial for research associates. It enables efficient recruitment and timely completion of a study. The patients perspective is becoming increasingly important worldwide however Polish patients attitudes to CTs have not been studied well enough yet. This study analyses multiple factors influencing oncological (onco) and non-oncological (non-onco) patients decisions to participate in CTs. Methods: Total of 401 hospitalized adults who have never participated in a CT were recruited to take a paper and pencil interview survey. 211 patients (52.6%) were diagnosed or treated for cancer and 190 (47.4%) for non-oncological diseases. The majority of respondents were: (1) women: 256 (63.8%), (2) people with secondary education: 223 (55.6%), (3) at the age of 60-69: 147 (36.7%), (4) living in cities over 100k inhabitants: 179 (44.8%). Results: If proposed, 49.9% of all respondents would agree to be enrolled in a CT (non-onco 52.1% vs onco 47.8%, p = 0.61); 14.9% would refuse (13.3% vs 16.3% respectively) and 35.2% were not certain about the decision (34.6% vs 35.9%). Top two drivers for participation in CTs of non-onco patients were: chance of receiving a new drug (78.6%) and better access to medical care (74.5%), while for oncological respondents: better access to medical care (77.0%) and to additional diagnostic tests (76.0%). Altruism was declared by a total of 54.5% respondents. Main reasons for not participating were: concerns about toxicity – 57.6% (p = 0.14), about lack of efficacy – 44.1% (p = 0.01) and refusal to be a “guinea pig” – 59.3% (p = 0.23). For uncertain respondents, the most convincing factors for enrollment was a terminal phase of the disease: 57.1% in total (onco 69.3% vs non-onco 43.1%, p = 0.01). The results of subanalyses based on demography and type of diagnosis were not of statistical significance. Conclusions: The willingness to participate in CTs is high, which is mainly driven by a chance for a better access to medical care and additional diagnostic tests. Improved access to state-financed care and innovative medicines for chronically ill patients in Poland are needed.
Biomarker lead time for predicting progression in women with ovarian cancer compared to imaging.
Authors: Alexandra Samborski, Alexandra Michelle Blackman, Michael Craig Miller, Elizabeth Eklund, Geralyn Messerlian, Richard G. Moore
Journal: Journal of Clinical Oncology (2020)

e18074 Background: Both CA125 and HE4 are biomarkers used to monitor women diagnosed with epithelial ovarian cancer (EOC). When these biomarkers increase and suggest progression of disease, imaging is frequently obtained for further assessment and confirmation. This study aims to assess how far in advance these biomarkers begin to trend upwards in comparison to the radiographic evidence of disease progression. Methods: This was an IRB approved retrospective trial. Residual longitudinal serum samples drawn for serum CA125 levels during treatment and monitoring from women with EOC were obtained. The samples were drawn every 3-5-weeks for patients on chemotherapy and every 3 months while monitoring. Serum CA125 and HE4 levels in the residual sera were analyzed at each time point. Imaging data was collected for each patient. Patients were included if either HE4 or CA125 was a marker for their disease. For each patient, the date of time point when the biomarker started to trend upward was identified and the date of radiographic evidence of progression was determined. The lead time (in days) for elevation of both CA125 and HE4 prior to evidence of radiographic progression was determined for each patient. Results: A total of 48 patients undergoing 58 treatment and monitoring events were identified. Each had evidence of disease progression by CA125 levels, HE4 levels, and computed tomography (CT). CA125 was the first biomarker to trend upward for 9 events (15.5%), HE4 was the first biomarker for 10 events (17.2%), and both increased simultaneously for 39 events (67.2%). Mean lead time for CA125 elevation prior to progression on imaging was 60 days (95% CI: 43 - 78, median = 44, range = 0 - 386). For HE4, mean lead time was 66 days (95% CI: 48 – 83, median = 46, range = 0 - 386). There was no significant difference in the average lead times between the two biomarkers (p &lt; 0.01). Conclusions: When used for EOC monitoring both CA125 and HE4 have similar average lead times (~2 months) prior to the detection of progressive or recurrent disease by CT imaging.
A phase II randomized study of telaglenastat, a glutaminase (GLS) inhibitor, versus placebo, in combination with pembrolizumab (Pembro) and chemotherapy as first-line treatment for KEAP1/NRF2-mutated non-squamous metastatic non-small cell lung cancer (mNSCLC).
Authors: Ferdinandos Skoulidis, Joel W. Neal, Wallace L. Akerley, Paul K. Paik, Thales Papagiannakopoulos, Karen L. Reckamp, Jonathan W. Riess, Yonchu Jenkins, Sacha Holland, Francesco Parlati, Yijing Shen, Sam H. Whiting, Naiyer A. Rizvi
Journal: Journal of Clinical Oncology (2020)

TPS9627 Background: Mutational activation of the KEAP1/NRF2 pathway occurs in &gt;20% of NSCLC patients (pts). KEAP1/NRF2 activation protects tumor cells from diverse forms of oxidative stress and promotes tumor growth and survival. In pts w/ advanced NSCLC, mutation of the KEAP1/NRF2 pathway is associated w/ dramatically reduced survival and poor outcomes following standard-of-care therapy. These tumors have increased dependence on GLS-mediated conversion of glutamine to glutamate due to upregulation of NRF2 target genes involved in glutamine metabolism. Telaglenastat (CB-839), an investigational, first-in-class, potent, oral GLS inhibitor, has demonstrated preclinical activity in KEAP1/NRF2-mutated NSCLC cell lines and xenograft models. This study will evaluate the safety and efficacy of telaglenastat + standard-of-care pembro and chemotherapy as 1L therapy for KEAP1/NRF2-mutated non-squamous mNSCLC (NCT04265534). Methods: This phase II, randomized, multicenter, double-blind study will enroll ~120 pts with histologically or cytologically documented stage IV non-squamous NSCLC w/ KEAP1 or NRF2 mutation, no prior systemic therapy for mNSCLC, measurable disease (RECIST v1.1), ECOG PS 0-1, and no EGFR, ALK, ROS, or other actionable mutation w/ available approved therapy in 1L setting. KEAP1 or NRF2 mutations will be determined by next generation sequencing (NGS), and study-provided liquid biopsy NGS will be available. Pts will be randomized 1:1 to receive telaglenastat (800 mg BID PO) or placebo, in combination with pembro, carboplatin, and pemetrexed at standard doses on day 1 of each 21-day cycle. Pts will be stratified by STK11/LKB1 mutational status and M stage of cancer (M1a-b vs M1c). The study will include an initial safety run-in period (n=12; 1 cycle). Co-primary endpoints are safety and investigator-assessed progression-free survival (RECIST v1.1). Secondary endpoints include overall response rate, duration of response, overall survival, and efficacy analysis in the subgroup of pts w/ biochemical confirmation of KEAP1/NRF2 pathway activation. Findings of this novel NGS biomarker-selected study will inform the efficacy and safety profile of telaglenastat + standard-of-care chemoimmunotherapy for 1L treatment of KEAP1/NRF2-mutated, non-squamous mNSCLC. Clinical trial information: NCT04265534 .