tbuckley/cabot-search huggingface dataset:
Adherence to extended adjuvant endocrine therapy following Breast Cancer Index (BCI) testing in women with early-stage hormone receptor (HR)-positive breast cancers.
Authors: Julia Foldi, Catherine A. Schnabel, Max Salganik, Lajos Pusztai, Tara B. Sanft
Journal: Journal of Clinical Oncology (2020)

527 Background: Evidence suggests continuing endocrine therapy (ET) beyond 5 years (yr) may reduce breast cancer recurrence in early stage HR+ breast cancers. Given the modest benefit and potentially serious adverse effects of extended ET (EET), improved approaches to identify patients who are at increased risk of late distant recurrence and who derive benefit from EET are critical. Guidelines recommend shared decision-making between oncologists and patients. The adherence rate to EET by 5 yr is only 50-60%. BCI is a gene-expression assay used to predict late distant recurrence and is predictive of benefit from EET. We assessed adherence to EET in women who had BCI testing. Methods: Women with stage I-III HR+ breast cancer s/p 3.5 yr of adjuvant ET and had BCI testing at our institution (8/2013-7/2015) were included. Pts who had &lt; 4 yr of follow-up since BCI testing were excluded. Information including demographics, tumor characteristics, treatment history, number DXA scans, history of osteopenia/osteoporosis were collected. Data on medication adherence was based on prescriptions in the electronic health record. Results: 102 pts were included in our analysis. The median age was 61yr (46-89 yr). The majority of pts had stage I (63%), N0 (77%) and HER2- (90%) disease. 50 pts (46%) received chemotherapy. 44 (43%) received tamoxifen and 79 (77%) had an aromatase inhibitor. BCI categorized 61 (60%) pts as low risk, 26 (25%) as intermediate, and 15 (15%) as high risk for late distant recurrence. 61 (60%) and 41 (40%) pts were predicted to have low and high likelihood of benefit from EET, respectively. All 15 (100%) pts categorized as high risk for late recurrence were predicted to have a high likelihood to benefit from EET; all were recommended to continue EET by their oncologist and all 15 elected EET. 11 (73%) completed 10 yr or were on EET at last follow-up. Of the 4 (27%) pts who stopped before 10 yr, 1 pt had metastatic recurrence and 3 had intolerable side effects. Pts on EET underwent an avg of 1.91 DXA scans, compared with 1.23 for those who stopped ET at 5 yr (p = 0.003). At a median follow-up of 10 yr from diagnosis, there were 2 metastatic (1/15 in the high risk and 1/26 in the intermediate risk group) and 1 local recurrence (1/61 in the low risk group). Conclusions: In pts who continued ET beyond 5 years based on BCI testing and discussion with their oncologist, the rates of adherence and persistence to EET were higher than those previously published. EET may increase the number of DXA scans performed.
Oncology fellows’ survivorship clinic: An opportunity for education and multidisciplinary care delivery.
Authors: Hira Latif, Kristi D Graves, Asma Ali Dilawari
Journal: Journal of Clinical Oncology (2020)

11023 Background: Cancer survivors in the U.S. are expected to exceed 20 million by 2026. Most fellows do not receive formal training in survivorship during oncology fellowship despite cancer survivorship comprising 2% of the American Board of Internal Medicine's Oncology examination and the recent accreditation standards related to survivorship care from the Commission on Cancer. Methods: We developed a survivorship curriculum and a multidisciplinary survivorship clinic staffed by a medical oncologist and physiatrist in September 2018. Oncology fellows rotated during their ambulatory block and completed surveys assessing skills and perceptions of competence at the beginning and end of the academic year. Results: 8 fellows completed the pre-survey and 6 of them completed the post-survey. While only a quarter had delivered a survivorship care plan/treatment summary prior to starting clinic, all fellows had delivered these (median=2, range=2-8) at the end of the year. Most fellows had seen survivors of breast, colorectal and hematologic malignancies prior to starting clinic; few had seen survivors with lung (12.5%), GU (0%) or head and neck (25%) cancer. These numbers increased, particularly with fellows’ seeing survivors of GU (50%) and head and neck cancers (100%) at the end of the year. Prior to the rotation less than half the fellows had assisted with managing cancer survivors’ treatment consequences or provided continuity of care through a multidisciplinary team. Similarly, only 25% had counseled cancer survivors with psychosocial concerns. On the post-survey, 100% of fellows reported practicing and feeling experienced in these domains. Post- survey showed improvement in self-reported competence levels in caring for cancer survivors (see Table). Conclusions: Participating in a survivorship clinic has a positive impact on oncology fellows’ experience and competence in caring for cancer survivors. Future directions are geared toward expansion of fellows’ skills to include areas related to cardiovascular and physical medicine. [Table: see text]
Abstract 16279: Serine Protease Inhibitor (serpin) Reactive Site Loop Peptides Prevent Transplant Vasculopathy and Inflammatory Vasculitis
Authors: Sufi R Morshed, Sriram Ambadapadi, Ganesh Munaswamy-Ramanujam, Hao Chen, Donghang Zheng, Emily Feldman, Scott Tibbetts, Alexandra Lucas
Journal: Circulation (2015)

Aim: Ser ine p rotease in hibitors ( Serpins ) regulate key clotting and inflammatory pathways. Two anti-inflammatory Serpins , neuroserpin (NSP) and Serp-1 markedly reduce arterial inflammation and plaque growth in a rodent aortic transplant vasculitis model after single dose infusion. NSP is a mammalian serpin that inhibits thrombolytic proteases and Serp-1 is a virus-derived serpin that inhibits both thrombotic and thrombolytic proteases. We postulated that proteolytic cleavage of the reactive site loop (RSL) produces active peptide derivatives with expanded functions. 8 peptide sequences encompassing predicted cleavage sites for Serp-1 and NSP were synthesized and tested in mouse aortic allograft transplant and herpesvirus (MHV68) vasculitis models. The main aim was to assess therapeutic potential for RSL peptides derived from NSP and Serp-1 in vascular inflammation. Methods: We assessed the capacity of 8 predicted serpin RSL peptides, 4 from Serp-1 and 4 from NSP to reduce vascular inflammation. 40 C57BL/6 mice had aortic allograft transplant with a single IV injection of each single peptide. 29 IFN-γR KO mice had MHV-68 infection and were treated for 10 days with S-2 (ISRMAV), S-7 (GTTASSDTAITLIPR), Inverse S-7 (RPILTIATDSSATTG), S-8 (MAVLYPQVIVDHPFFFLIRNR) peptides, or Saline control. Results: RSL peptides with R or RN sequences, but not RM, and with 0-+1 charge significantly reduced vascular inflammatory cell invasion and plaque growth after aortic transplant from C57Bl/6 donor to BALB/c recipient transplant mice (5-6 transplants/peptide) (P &lt; 0.01). S-1, S-3, S-7 &amp; S-8 peptides reduced inflammation and plaque in aortic transplant. Hydrophobicity and negative charge in S-6 peptide increased thrombosis. S-7 peptide also significantly improved survival in a lethal MHV68 infection vasculitic model (150 days survival; P &lt; 0.043), while inactive S-2 peptide, Inverse S-7 and S-8 had no effect (P = NS; 40 days) (P&lt; 0.043). Conclusions: In conclusion, a series of serpin RSL peptides were synthesized based upon natural protease cleavage sites. RSL peptides have demonstrated significant efficacy in reducing inflammatory vasculitis after transplant or after lethal mouse herpesviral (MHV) infections, extending serpin regulatory activity.
Implementing a genomic oncology program in an integrated health care network with large scale genomic Next Generation Sequencing (NGS) testing of advanced cancers in a community setting.
Authors: Jennifer Marie Suga, Sachdev P. Thomas, Thach-Giao Truong, Tilak Kumar Sundaresan, Minggui Pan, Won Kim, Elizabeth Hoodfar, Lirong Cheng, Elaine Chung, Pamela Tse, Ninah Achacoso, Chen Jiang, Desiree Goldstein, Laurel A. Habel
Journal: Journal of Clinical Oncology (2020)

e19185 Background: The importance of NGS testing to help guide oncologic therapy decisions has grown over time, presenting a unique challenge for community oncologists to properly translate the NGS test results to treatment (Tx) recommendations for patients. Kaiser Permanente Northern California (KPNC) is a large, integrated health care system providing comprehensive primary and specialty care to 4.4 million members, with over 4000 patients (pts) diagnosed with advanced cancer each year. NGS testing at KPNC is performed in a collaboration with Strata Oncology, that provides systematized comprehensive NGS testing (StrataNGS) paired with a portfolio of genomically guided clinical trials. Methods: KPNC has established workflows for upfront empiric review of all NGS results by our KPNC Genomic Oncology Committee (GOC), that includes representatives from medical oncology subspecialists, genetics, pathology, and clinical trials. KPNC GOC reviews all StrataNGS test results in our KPNC network to identify patients that might benefit from either a clinical trial, appropriate on or off-label drug options and/or genetic counseling. In addition, GOC conducts an in-depth case review per request of the treating oncologist. A study nurse pre-screens all pts whose results match to a trial for eligibility. Results: The numbers of pts tested with StrataNGS has increased over time with around 300 pts tested monthly and 4,977 NGS tests performed since Nov 2017. Median age was 65.2 (Range 18.5-96.0). About 42.4% of Pts were non-white. Approximately, 39% of Pts had an actionable mutation including 21.7% eligible for a promising in or out of network trial. 1.6% and 10.9% pts were potentially eligible for off- or on-label approved drugs, respectively. 4.9% were recommended to receive genetic counseling. The 3 most frequently sequenced cancers were: lung, colon and breast. Conclusions: KPNC is providing systematic subspecialty review and management of NGS results for pts in a community setting. Our approach has allowed for greater adoption of routine NGS testing, especially for rare cancer types with less effective standard Tx options available. This model also helps accrual to genomic-based drug trials that have been a challenge for the field. Workflows to streamline automated centralized acquisition of prior Tx history and analysis of response to therapy are in development.
关于高校全科医学教育师资队伍建设的思考和建议
Authors: 杨巧媛, 王家骥
Journal: BMJ (2005)

全科医学教育是适应当今卫生事业发展需要的新医学教育体系,培养全科医师是未来几十年内我国医学教育改革的重要方向.当前我国全科医学教育的重点放在以技能培训为主的岗位培训上,但从学科建设的长远角度出发,全科医师的培养必须以毕业后教育为主培养高层次全科人才[1],医学院校将成为我国培养全科医师的主渠道[2].培养和建设一支素质过硬、结构合理的全科医学师资队伍,是培养高素质、高质量全科医学专门人才的重要前提和基础,对推动全科医学向深层次发展具有决定性作用[3]。
Association of chronotype and pain at baseline in ovarian cancer survivors participating in a lifestyle intervention (NRG/GOG 0225).
Authors: Tracy E Crane, Austin Miller, Meghan B Skiba, Sidney Donzella, Cynthia A. Thomson
Journal: Journal of Clinical Oncology (2020)

6018 Background: Chronotype is defined as an individual’s propensity to sleep at a specific time in a 24-hour cycle with late chronotype associated with poorer health outcomes including cancer. Chronotype remains relatively undefined in ovarian cancer. The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) study is testing whether 1205 women randomized to a diet and physical activity intervention for 24-months will have longer progression-free survival versus an attention control. Here we determine the association of late and early vs mid chronotypes and patient reported outcomes (PROs), lifestyle behaviors and biomarkers of metabolic health and inflammation in ovarian cancer survivors post-treatment (≤ 6.5 months). Methods: Chronotype was determined using self-reported time to bed (early &lt; 9 pm; mid ≥ 9 pm - ≤12 am; late &gt; 12 am) captured through the Pittsburg Sleep Quality Index and PROs were measured using subscales of the Rand-36 questionnaire. Validated questionnaires for diet and physical activity were used and biomarkers were collected at routine clinic visits. A total subsample of 438 ovarian cancer survivors enrolled in NRG/GOG 0225- LIVES study with all available baseline measures were included in analyses. Descriptive statistics, general linear mixed models, and Pearson correlations were performed. Results: Reported pain was significantly higher in late chronotypes (P &lt; 0.05) when compared to early and mid-chronotypes. Total sleep duration was significant between the 3 chronotypes (P &lt; 0.05) with late chronotype experiencing less sleep (6.77 ± 1.67 hrs) than mid chronotype (7.04 ± 1.31 hrs) and early chronotype (7.56 ± 1.33 hrs). Higher reported pain was significantly correlated to poorer CRP levels (r = -0.198, P &lt; 0.001) suggesting higher systemic inflammation and poorer blood insulin levels (r = -0.116, P &lt; 0.05) independent of chronotype classification. All other subscales of the RAND 36 and physical activity were not associated with chronotype. Diet quality trended towards significance with a positive association observed in early and an inverse association in late chronotypes (P = 0.06). Conclusions: Late chronotypes reported higher levels of pain which was associated with poorer sleep and diet quality and higher levels of inflammation and insulin. More robust data, including actigraphy, are being analyzed and will provide additional insight of the role of circadian rhythm and phenotype on pain and key biomarkers in ovarian cancer survivors. Clinical trial information: NCT00719303.
Open-label, phase I study evaluating feasibility and safety of subcutaneous IMP321 (LAG-3Ig fusion protein, eftilagimod alpha) combined with avelumab in advanced stage solid tumor entities: Results from stratum D of the INSIGHT platform trial.
Authors: Thorsten Oliver Goetze, Daniel Wilhelm Mueller, Mohammad-Reza Rafiyan, Dragan Kiselicki, Regina Eickhoff, Elke Jaeger, Salah-Eddin Al-Batran
Journal: Journal of Clinical Oncology (2020)

3099 Background: Stratum D of the INSIGHT study investigates the feasibility and safety of s.c. application of IMP321 (eftilagimod alpha) combined with the PD-L1 inhibitor avelumab in advanced stage solid tumors. The MHC class II agonist IMP321 activates antigen-presenting cells followed by CD8 T-cell activation. The addition of avelumab aims at enhancing activity by combining IMP321’s activating effects on immune cells with the release of immune inhibitory effects caused by interruption of the PD-1/PD-L1 axis. Methods: This investigator-initiated phase I trial consists of four strata: intratumoral (A) or intraperitoneal IMP321 (B); s.c. IMP321 with SOC (C) or with PD-L1 inhibition (D). This abstract focuses on Stratum D. Patients (pts) receive 800mg avelumab i.v. q2w along with s.c. IMP321 injections (6mg IMP321 in cohort 1 and 30mg IMP321 in cohort 2). 12 pts are planned in stratum D : 6 pts in cohort 1 and 6 pts in cohort 2. Primary endpoint is safety. Results: So far, 8 pts have been enrolled (6 in cohort 1 and 2 in cohort 2). In 6 pts (cohort 1) treated for different tumor indications (gastric, gallbladder, colon cancer, pleural mesothelioma), no dose limiting toxicities occurred. 3 serious adverse events (SAEs) (1 acute kidney injury grade 5 in 1 pt, 2 preileus grade 3 in 1 pt) were reported, none of them was related to any of the study drugs. In total, 34 adverse events (AEs; grade 1-2, 21; grade 3, 12; no grade 4; grade 5, 1) have been documented in 5 pts. Most common grade 1-2 AEs were pain, nausea, and injection site reaction in 50%, 33%, and 17% of the pts. Most common grade 3 AEs were nausea/vomiting, preileus/ileus, and ascites in 33%, 33%, and 17% of the pts. One AE grade 5 (acute kidney injury) was reported. 4 AEs grade 1-2 were possibly or definitely related to IMP321 (injection site reaction 2x; fever; lipohypertrophy), 6 AEs grade 1-2 were possibly or definitely related to avelumab (nausea 2x; chills; fever; dyspnea; lipohypertrophy). All AEs grade 3-5 were unrelated to any of the study drugs. Of the 8 pts enrolled so far, 4 had disease progression (acc. to RECIST 1.1), 1 partial response, 1 stable disease with some extent of tumor shrinkage, and 2 have not had tumor assessment yet. Conclusions: Combination treatment with avelumab 800mg and IMP321 6mg is safe and well tolerated. Cohort 2 will be presented at the meeting. Clinical trial information: NCT03252938 .
Combined detection of immunobiological markers in pleural or peritoneal exudates of patients with tuberculosis and malignant tumors
Authors: Bao-xin Su, Jin-ling Wang, Shu-cui Li
Journal: BMJ (2011)

The levels of C-reactive protein(CRP),adenosine deaminase(ADA),total cholesterol (TC),lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),ferritin(Fer),β2-microglobulin (β2-MG),alpha-fetoprotdn(AFP),carbohydrate anfigen12-5(CA125),carbohydrate antigen19-9(CAl99),carbohydrate antigen15-3(CA153),eyfra211(CY211)and neuron specific enolase(NSE)were detected by automatic chemistry analyzer or electrogenerated chemiluminescence analyzer in pleural and peritoneal exudates from 48 cases oftuberculosis and 82 cases of malignant tumors.The levels of CRP,ADA and β2-MG in tuberculotic exudates were higher than those in malignant exudates(P<0.01).However,the levels of TC,LDH,CEA,Fer,CA153,CY211,NSE,AFP,CA125 and CA199 in malignant exudates were higher than those in tuberculotic exudates(P<0.01).Combined determination of CRP,ADA,TC,LDH,CEA,Fer,and β2-MG in pleural and peritoneal exudates are of value in differentiation of tuberculosis from malignant exudates.Combined determination of CA153.CY211 and NSE in pleural effusions and AFP,CA125 and CA199 in peritoneal effusions can improve the semitivity and specificity of diagnosis for malignant exudates.

Key words: 
Hydrothorax; Nature
并发下肢静脉血栓和肺栓塞的甲状腺功能亢进症一例
Authors: 王宗方, 曹蘅
Journal: BMJ (2006)

患者女,48岁,因左下肢疼痛5 d,右侧胸痛1 d入院.患者5 d前无明显诱因出现左下肢疼痛、肿胀,逐渐加重.曾在当地医院治疗,症状未缓解.1 d前自觉右侧胸痛,少咳,无痰,无咯血。
Model to predict brain metastasis (BM) in patients with metastatic germ-cell tumors (mGCT).
Authors: Ryan Ashkar, Sandra K. Althouse, Clint Cary, Timothy A. Masterson, Richard Foster, Nasser H. Hanna, Lawrence H. Einhorn, Nabil Adra
Journal: Journal of Clinical Oncology (2020)

5057 Background: BM is an independent adverse prognostic factor that can lead to treatment complications and failure in pts with mGCT. We aimed to establish an effective and practical model for prediction of BM in mGCT. Methods: 2,256 consecutive pts with mGCT treated at Indiana University between January 1990 and September 2017 were identified. Pts were divided into 2 categories: BM present (N = 144) and BM absent (N = 2112). Kaplan-Meier methods were used to analyze progression free survival (PFS) and overall survival (OS). Logistic regression was used to determine a predictive model for whether BM was present. The data was separated 50/50 into training and validation datasets with equal numbers of events in each. Results: Baseline characteristics for 2 groups are listed in Table. 2-yr PFS and OS for pts with vs without BM: 17% vs 66% (p &lt; 0.001) and 62% vs 91% (p &lt; 0.001) respectively. Among the 144 pts with BM, 64 (44%) had radiation only (whole-brain radiotherapy or gamma knife), 21 (15%) had BM-surgery only, 14 (10%) had both radiation and BM-surgery. 45 pts (31%) did not receive local therapy for BM. A stepwise selection was used to determine the best model with p &lt; 0.15 as the entry and staying criteria. The model with the largest ROC AUC was used moving forward. The model was tested in the validation dataset. A model was generated including age at diagnosis≥40 (1 point), presence of pulmonary metastases (3 points), bone metastasis (1 point), pre-chemotherapy hCG≥5000 (1 point), and choriocarcinoma predominant histology (1 point). Patients with 0 points had a 0.4% probability of BM, 1 point: 1%, 2 points: 2.6%, 3 points: 7%, 4 points: 16%, 5 points: 32%, 6 points: 56%, and 7 points: 77%. Details regarding analysis in training and validation datasets will be presented. Conclusions: The prediction model developed in this study demonstrated discrimination capability of predicting BM occurrence and can be used by clinicians to identify high-risk pts. [Table: see text]
缬沙坦与依拉普利联合治疗2型糖尿病肾小球高滤过的临床观察
Authors: 王雪琴, 郁忠勤, 余鸣, 李海英
Journal: BMJ (2006)

选择2型糖尿病早期肾小球高滤过患者60例,以双盲随机方式分为血管紧张素受体Ⅱ拮抗剂(ARB)组(缬沙坦80 mg/d)、血管紧张素转换酶抑制剂(ACEI)组(依拉普利10 mg/d)、联合使用上述两种药物(ACEI+ARB)组和安慰剂组各15例,用药过程中每3个月测定1次血糖、糖化血红蛋白、血压、血清肌酐,每6个月测定1次肾体积、肾小球滤过率、尿微量白蛋白排泄率,共观察12个月.结果显示,各治疗组与安慰组比较血压明显下降(P＜0.01),ACEI+ARB组与ACEI组及ARB组比较血压下降更明显(P＜0.01),ACEI+ARB组治疗前后肾体积、肾小球滤过率、尿微量白蛋白排泄率均出现有统计学意义的下降(P＜0.05).提示ACEI及ARB联合治疗能改善2型糖尿病患者早期肾小球高滤过状态,阻止和延缓糖尿病肾病的发生与发展。
如何做一名合格的首诊医生
Authors: 戴玉华
Journal: BMJ (2007)

首诊医生是指首先为患者诊治的医生.在社区医疗服务制度比较健全的国家,家庭医生或社区医疗机构中的一线医生往往承担着首诊医生的任务.首诊医生要对患者的情况做一番详细而扼要的调查研究,做出初步的诊断,再结合自己当时所处的情况,做出及时的判断。
The prevalence and sociodemographic predictors of mobile health applications ownership among cancer survivors.
Authors: Gideon T Dosunmu, Kobina Kwantsin Hagan, Chike Udoye, Moh'd M. Khushman
Journal: Journal of Clinical Oncology (2020)

e24046 Background: The transition of cancer patients from patients to survivors is challenging. Cancer survivors often experience chronic physical, social and mental health needs which remain largely unmet. Due to the growing population of cancer survivors and limited resources available to address their needs, mobile health applications (apps) have emerged to help cancer patients in assuming their new role as survivors. Here, we explored the prevalence and sociodemographic predictors of mobile health apps ownership among Cancer Survivors in the United States using a nationally representative sample. Methods: Data from cycles 1 (2017) and 2 (2018) of the 5th edition of the Health Information National Trends Survey (HINTS 5) was reviewed. Descriptive statistics was used to evaluate the sociodemographic characteristics and the prevalence of mobile health apps ownership among cancer survivors. Univariate logistic regression models were used to explore the relationship between sociodemographic predictors and mobile health apps ownership. Results: We identified 1,097 (weighted estimate of 44,666,781) individuals who self-reported having been diagnosed with cancer in the . Of these, 57.39% were females, 79% were whites, 47.18% had 2 or more medical comorbidities, 63.7% were unemployed and about 50% were aged 65 or more. Prevalence of mobile health apps ownership was 44.82%. Among all the sociodemographic variables; educational level (p = 0.015), income (p = 0.014) and employment status (p &lt; 0.005) were predictors of mobile health apps ownership among cancer. Conclusions: Cancer survivors are digitally connected and can be approached through mobile health apps. In our study, the prevalence of mobile health apps ownership in cancer survivors was 44.8%. Educational level, income and employment status were identified as predictors of mobile health apps ownership. Due to the growing population of cancer survivors and limited resources available to address their needs, efforts to address barriers of mobile health apps adoption and utilization should be encouraged.