tbuckley/cabot-search huggingface dataset:
Circulating stromal cells as a potential blood-based biomarker for screening invasive solid tumors.
Authors: Daniel Adams, Steven H. Lin, Harvey I. Pass, Saranya Chumsri, Rena G. Lapidus, Martin Edelman, Raymond C. Bergan, Susan Tsai, Rebecca Aft, Sreeraj Pillai, Mark Watson, Amy K. Kim, Kazuaki Chikamatsu, Masanori Hayashi, David M Loeb, Navin R. Pinto, R. Katherine Alpaugh, Cha-Mei Tang, Thai Huu Ho, Jeffrey R Marks
Journal: Journal of Clinical Oncology (2020)

3535 Background: Peripheral blood allows for a simple non-invasive method for isolating various cancer associated circulating stromal cells (CStCs) which may predict for cancer presence. Cancer Associated Macrophage-Like cells (CAMLs), a specific CStC, are phagocytic myeloid cells that derive from an immunological response to cancer and emanate from primary tumors. Using a filtration platform we screened the peripheral blood of untreated newly diagnosed cancer patients (n = 308) for CAMLs. In parallel, we screened patients with newly diagnosed non-malignant diseases, i.e. lupus, benign cysts, etc. (n = 39), and healthy control samples (n = 76). We found that CAMLs are highly prevalent (87%) in the blood of cancer patients, but uncommon in non-malignant conditions (20%) &amp; absent in healthy individuals (0%). Methods: Anonymized peripheral blood were taken from 308 cancer patients after confirmation of invasive malignancy [stage I (n = 76), stage II (n = 73), stage III (n = 72), stage IV (n = 65) and unstaged non-metastatic (n = 22)] with pathologically confirmed lung (n = 65), pancreas (n = 53), breast (n = 52), prostate (n = 40), esophageal (n = 30), renal cell (n = 18), hepatocellular (n = 15), neuroblastoma (n = 10), melanoma (n = 8), and other (n = 17). Further, anonymized blood was taken from patients with untreated non-malignant conditions including benign breast masses (n = 19), lupus (n = 11), liver cirrhosis (n = 5), benign prostatic hyperplasia (BPH) (n = 3), and viral infection (n = 1); or from healthy control volunteers (n = 76). CAMLs were isolated from whole peripheral blood by the CellSieve™ microfiltration technique and defined as enlarged, multinuclear cells with cytokeratin and/or CD45/CD14 positive. Results: CAMLs were found in 87% of all cancer patients regardless of stage, ~5.4 CAMLs/7.5mL blood. Specifically, CAMLs were found in 80% of Stage I, 90% Stage II, 89% Stage III, and 97% Stage IV patients. No CAMLs were found in any healthy controls, but were found in 26% of benign breast masses, 18% of lupus, 0% of BPH and 0% of cirrhosis. In total, CAML sensitivity in cancer vs healthy was 87% (CI95% 82-90%), specificity = 100% (CI95% 95-100%), PPV = 100% (CI95% 100%), NPV = 67% (CI95% 58-71%). CAML sensitivity in cancer vs benign was 87% (CI95% 82-90%), specificity = 80% (CI95% 64-91%), PPV = 97% (CI95% 95-98%), NPV = 43% (CI95% 35-51%). Conclusions: CAMLs, a Circulating Stromal Cell subtype, is a sensitive blood based biomarker found in all stages of cancer that is rare in non-malignant conditions and absent in healthy individuals.
Continuous renal replacement therapy in cytokine release syndrome following immunotherapy or cellular therapies?
Authors: Catalin Constantinescu, Sergiu Pasca, Tiberiu Tat, Patric Teodorescu, Catalin Vlad, Sabina Iluta, Delia Dima, Dana Tomescu, Ecaterina Scarlatescu, Alina Tanase, Olafur Eysteinn Sigurjonsson, Anca Colita, Hermann Einsele, Ciprian Tomuleasa
Journal: Journal for ImmunoTherapy of Cancer (2020)

Recently, an increasing number of novel drugs were approved in oncology and hematology. Nevertheless, pharmacology progress comes with a variety of side effects, of which cytokine release syndrome (CRS) is a potential complication of some immunotherapies that can lead to multiorgan failure if not diagnosed and treated accordingly. CRS generally occurs with therapies that lead to highly activated T cells, like chimeric antigen receptor T cells or in the case of bispecific T-cell engaging antibodies. This, in turn, leads to a proinflammatory state with subsequent organ damage. To better manage CRS there is a need for specific therapies or to repurpose strategies that are already known to be useful in similar situations. Current management strategies for CRS are represented by anticytokine directed therapies and corticosteroids. Based on its pathophysiology and the resemblance of CRS to sepsis and septic shock, as well as based on the principles of initiation of continuous renal replacement therapy (CRRT) in sepsis, we propose the rationale of using CRRT therapy as an adjunct treatment in CRS where all the other approaches have failed in controlling the clinically significant manifestations.
Impact of delays in initiation of adjuvant endocrine therapy and survival among patients with breast cancer.
Authors: Kimberley Lee, Lisa K. Jacobs, Jodi Segal
Journal: Journal of Clinical Oncology (2020)

537 Background: Time to adjuvant endocrine therapy concerns patients and clinicians, but its impact on overall survival is not clear. There are no population level studies that address this question. Our primary objective is to describe the relationship between time from diagnosis of breast cancer to start of adjuvant endocrine therapy and overall survival. Methods: This is a population-based cohort study using prospectively collected population level data from the National Cancer Database (NCDB). The NCDB prospectively collects data on incident cancer cases from over 1500 Commission on Cancer-accredited facilities nationally. NCDB captures approximately 70% of incident cases of cancer in the United States. The participants are women with Stage II and III estrogen or progesterone receptor positive, human epidermal receptor 2 negative, invasive breast cancer who underwent definitive surgical treatment. Results: Of the 391,594 women in this study, 12,162 (3.1%) began treatment with adjuvant endocrine therapy more than 12 months after initial diagnosis of hormone receptor positive, invasive breast cancer. Mean age at diagnosis was 59.7 years (SD 13.4). Predictors of delayed initiation of adjuvant endocrine therapy include Black race or Hispanic ethnicity (adjusted odds ratio [aOR] of Black vs White, 1.57; 95% CI, 1.48-1.66; P &lt; .001, Hispanic vs White, aOR 1.22, 95% CI 1.13-1.32; P &lt; .001), Insurance other than private insurance (Medicare vs Private, aOR 1.09, 95% CI 1.01-1.17; P = .007, Medicaid vs Private, aOR 1.36, 95% CI 1.28-1.45; P &lt; .001), higher stage of disease at diagnosis (Stage III vs II, aOR 1.24, 95% CI 1.19-1.30; P &lt; .001), and delayed surgery or chemotherapy (Delayed surgery vs On-time lumpectomy, aOR 2.76, 95% CI 2.60-2.93; P &lt; .001 and Delayed chemotherapy vs no chemotherapy, aOR 11.5, 95%CI 10.6-12.5). With median follow-up of 63.2 months, 67,335 (17.2%) patients died by the end of follow-up. Delayed initiation of AET resulted in no change in the hazard of death (HR, 1.00; 95% CI, 0.95-1.05; P = .97) compared to initiation within 12 months of diagnosis after adjusting for age, race and ethnicity, insurance type, urban vs rural residence, neighborhood income and education, comorbidity, cancer grade, stage, and receipt of timely or delayed surgery, chemotherapy, and/or radiation therapy. Conclusions: These results suggest that there may be no detriment to survival if initiation of adjuvant endocrine therapy occurs 12 to 24 months after initial diagnosis compared to within 12 months of diagnosis, as currently recommended.
Clinical characteristics of 277 pregnant women with blood glucose screening
Authors: Yue Teng, Xiao-ming Lin
Journal: BMJ (2009)

Clinical data of 277 pregnant women attended to nutrition clinic at Haidian District Maternity and Children's Hospital,Beijing were analyzed retrospectively,including 64 cases of gestational diabetes mellitus(GDM),85 cases of gestational impaired glucose tolerance(GIGT)and 128 normal women(84 normal fasting blood glucose and 44 abnormal fasting blood glucose but normal glucose challenge test,GCT).There was a higher proportion of pregnant women with family history of diabetes among those with abnormal GCT.as compared to those with normal GCT(P＜0.05).Mean age was significantly higher in women with GDM than that in normal ones(P＜0.05),but no statistically significant difference in it was found between women with GIGT and normal GCT(P＞0.05).Body weight in women with GIGT was higher both before pregnancy and at GCT than that in normal ones(P＜0.05).Serum levels of total cholesterol and triglyceride presented an increasing trend in pregnant women of varied groups since their first prenatal care visits(P＜0.05),higher in those with GDM and/or GIGT than those in normal ones(P＜0.01).

Key words: 
Diabetes,gestational;  Glucose intolerance test
Umbilical cord blood stem cell transplantation via hepatic artery in treatment of liver cirrhosis
Authors: 胡小宣, 陈海鸥, 钱林, 刘莉, 陈峰, 张征, 刘洪娟
Journal: BMJ (2011)

Thirty four patients with decompensated cirrhosis received umbilical blood stem cell transplantation via hepatic artery from December 2008 to August 2009. The symptoms and biochemical testing results were observed before and after stem cell transplantation. One month after the transplantation,appetite was improved in 32 patients ( 94% ), physical capacity improved in 29 patients ( 85% ) and the abdominal distention relieved in 28 patients (82%). Abdominal B-ultrasonography showed that ascites decreased in 15 cases(60% ), and disappeared in 9 cases(36% ). Six month later the mean serum albumin levels were increased from ( 30. 9 ± 0. 6) g/L to ( 35.5 ± 2. 5 ) g/L( P ＞ 0. 05 );alanine aminotransferase levels decreased from (57 ±7) U/L to (46 ± 10) U/L(P ＞0. 05);total bilirubin decreased from (47 ±5 )μmol/L to (25 ±4) μmol/L(P =0. 017);prothrombin time decreased from ( 17.9 ±0. 7) s to ( 16. 4 ±1.3) s (P ＞ 0. 05 ). Hemophagocytic syndrome developed in one case but no severe adverse reactions occurred. The results indicate that umbilical blood stem cell transplantation may improve liver function in various degrees with safety for patients with liver cirrhosis.

Key words: 
stem cell transplantation ;  cirrhosis ;
Survival analysis between narrower surgical margins and guideline-recommended margins for excision of cutaneous squamous cell carcinoma: A multicenter, retrospective study of 1,204 Japanese cases.
Authors: Natsuki Baba, Yasuhiro Nakamura, Hiroshi Kato, Shigeto Matsushita, Noriki Fujimoto, Shiro Iino, Shintaro Saito, Jun Asai, Masashi Ishikawa, Hiroshi Yatsushiro, Yu Kawahara, Taisuke Matsuya, Ryuichiro Araki, Yukiko Teramoto, Katsuhito Sasaki, Yuri Asami, Minoru Hasegawa, Akifumi Yamamoto
Journal: Journal of Clinical Oncology (2020)

10063 Background: Controversy exists regarding the optimal surgical margin for cutaneous squamous cell carcinoma (cSCC). Current NCCN Guidelines recommend excision with a 4–6-mm clinical margin for low-risk cSCC and wider ( &gt; 6-mm) clinical margin for high-risk cSCC tumors. However, adherence to this guideline is often difficult, as high-risk cSCCs frequently occur on the faces of elderly patients. Thus, we aim to investigate the correlation between different surgical margins and prognosis in patients with cSCC. Methods: Patients with cSCC who had undergone surgical excision of the primary site between 2011 and 2019 at 11 Japanese institutions were included in this study. Patients were divided into two groups: the standard margin group (SMG) with excisions adhering to the guideline-recommended margins, and narrower margin group (NMG) with excisions with narrower margins than are guideline-recommended. Local recurrence-free survival (LRFS), relapse-free survival (RFS), and overall survival (OS) were estimated using Kaplan–Meier analysis and compared between the two groups. Results: A total of 1204 patients with cSCC (SMG, 637; NMG, 567) were included in this study. RFS was significantly lower in SMG than in NMG (5-year RFS 72% vs 79%; P = 0.03); however, no statistically significant differences were observed between the two groups in LRFS (5-year LRFS 80% vs 82%; P = 0.41) or OS (5-year OS 84% vs 83%; P = 0.90). Due to striking statistical significance in several characteristics of patients between the two groups, subgroup analyses, focusing on the cohort of head and neck cSCCs, were also performed. The patient characteristics were similar between SMG and NMG in both the T1-sized tumor ( &lt; 2 cm, SMG, 182; NMG, 250) and T2-sized tumor (2 cm ≤ tumor &lt; 4 cm, SMG, 130; NMG, 136) cohorts, based on AJCC-TNM staging (8th edition). There were also no significant differences between the SMG and NMG in LRFS (5-year LRFS, T1: 80% vs 86%; P = 0.59; T2: 85% vs 84%; P = 0.84), RFS (5-year RFS, T1: 80% vs 81%; P = 0.84; T2: 77% vs 76%; P = 0.99), or OS (5-year OS, T1: 82% vs 87%; P = 0.42; T2: 88% vs 85%; P = 0.68). Furthermore, when the NMG was divided into the two margin groups (margins reduced by &lt; 3 mm or ≥3 mm from the standard margin), no significant difference was observed in LRFS, RFS, and OS. Conclusions: This study did not reveal a significant impact of the size of clinical excision margins on survival in patients with cSCCs. Strikingly, the narrower margins may be more appropriate for &lt; 4 cm-sized head and neck cSCCs.
Recent progress of glucagon-like peptide-1 analogue and the treatment of diabetes
Authors: 王战建, 刘珊, 苏杰英
Journal: BMJ (2008)

胰高血糖素样肽-1(glucagons-like peptide-1,GLP-1)是一种典型的脑-肠轴激素,在中枢由孤束核、背侧及腹侧髓质、嗅球的神经元核周体产生;在外周由分布于空肠、回肠和盲肠的神经内分泌L-细胞分泌,在体内以多种形式存在.人体进餐或口服葡萄糖后,L-细胞被激活,导致GLP-1被迅速释放入血液中,加强胰岛素的合成与分泌.由于GLP-1对调节餐后葡萄糖水平起重要作用,人们对其在治疗糖尿病中的作用进行了广泛研究,使得GLP-1由一个生理性肠降血糖素成员迅速地转变为一种具有潜力的治疗糖尿病的药物。
Searching for the “exit ramp”: Bereaved caregivers (BCGs) describe discontinuation of transfusions at the end of life (EOL) for loved-ones (LOs) dying from acute myeloid leukemia (AML).
Authors: Larry Dean Cripe, Caroline Martin, Katie Sargent, Layla Baker, Ann H. Cottingham
Journal: Journal of Clinical Oncology (2020)

e24000 Background: Transfusions may delay hospice care. This study examined how transfusions and other factors influenced care transitions, including decisions related to hospice care, for patients with AML from diagnosis to death. Methods: Nineteen BCGs participated in semi-structured interviews about their experiences. Interviews were audio recorded, transcribed and qualitatively analyzed. Results: The research team identified three stages in BCG experience: 1. Acceptance and Hope: BCG initial response to an AML diagnosis was acceptance of chemotherapy and transfusions as necessary to extend life and potentially cure the AML. Benefits of treatment were emphasized over potential harms or details. 2. Reading the Signals: BCGs learned to interpret information from a variety of sources to appreciate whether their LO was heading in the right direction or not. The signals included discussions with or decisions of the oncologist, changes or no changes in lab results, changes in the LO’s physical condition, and changes in care location in the hospital (e.g., ward bed to ICU bed). Signals were either cautionary or hard stops. Cautionary were seen as conditional, e.g., if things did not improve then LO may be at EOL. Cautionary signals were described as vague and ambiguous. Hard stops were clearer and were typically a clinician decision or recommendation to discontinue treatment and/or transfusions because there was no longer a possibility of benefit. 3. Searching for the Exit-Ramp: Hard stops precipitated awareness that death was imminent and an often-rushed search for how to care for the LO at the EOL. In retrospect the transition made sense to the BCG but they often felt unprepared at the time of transition. Conclusions: The benefits and burdens of transfusions are important signals to BCG about the EOL. Early cautionary signals and discussion may prepare BCG for transitions. Continuation of transfusions in hospice may eliminate a chance for critical conversations.
Prediction of mental health disorder onset and impact on emergency visits following a cancer diagnosis.
Authors: William Chen, Lauren Boreta, Steve E. Braunstein, Julian C. Hong
Journal: Journal of Clinical Oncology (2020)

2041 Background: Cancer patients are at increased risk of mental and emotional distress. The aim of this study is to investigate risk factors and timing of mental health disorder (MHD) onset following a cancer diagnosis, and evaluate its impact on emergency visits. Methods: All patients with a new onset diagnosis of malignancy ( ICD-10 codes C00-C97, with conversion of ICD-9 codes) were identified from an institutional de-identified electronic health data warehouse. Demographic data, Charlson comorbidity index excluding cancer, mortality, and time to onset of a new MHD diagnosis ( ICD-10 codes F00-F99) and emergency visits were extracted and used to calculate rates and Cox-model hazard ratios. A predictive logistic model of MHD was tested on an internal hold-out sample (25%). Results: A total of 110,306 patients with 338,208 person-years of follow up were identified with a new diagnosis of cancer from February 1980 to July 2019, of which 95,474 (86.5%) had no prior diagnosis of MHD. Actuarial rates of new MHD among previously MHD-free patients were 8.1% at 6 months, and 14.1% and 20.8% at 2 and 5 years. Median time to onset of MHD was fastest among head and neck cancer (57 days, HR 2.32 [2.1-2.6]), urinary organ cancer (94 days, HR 2.21 [2.0-2.4]), and lung and thoracic cancers (99 days, HR 2.47 [2.2-2.7]), compared to skin neoplasms (987 days, HR 1.0). Median time to onset was less than one year for all malignancies except for skin neoplasms and male genital cancers (840 days). Male sex, older age, Charlson score, divorce or legal separation, self-identification of a gender-neutral partner, African American or American Indian race, Hispanic ethnicity, current or former smoking status, and self-identification as Christian were associated with higher risk of MHD onset, while married status and native Hawaiian or Pacific Islander race were protective. A logistic model predicted new MHD with an AUROC of 0.72. Onset of new MHD was associated with greater rates of emergency visit (HR 1.92 [1.8-2.0], adjusted for cancer type and Charlson score), and patients with new MHD who experienced an emergency visit had a mean of 3.75+/-0.03 (SEM) total emergency visits versus 2.65+/-0.02 (p &lt; 0.0001). Finally, onset of new MHD was associated with greater mortality even after adjusting for age, Charlson score and cancer type (HR 1.29, [1.23-1.35]). Conclusions: Onset of new mental health diagnosis after a cancer diagnosis was correlated with greater rates of emergency visits and mortality. Cancer patients with risk factors identified here may benefit from increased social and mental health support.
动态血压监测评价服药时间对福辛普利降压效应的影响
Authors: 陈培莉
Journal: BMJ (2004)

56例高血压患者经2周安慰剂导入期,随机分为两组,分别于每日7:00和21:00给予福辛普利10～20 mg治疗,在服安慰剂末、给药6周后分别行动态血压监测.结果提示福辛普利日服1次能有效控制24 h血压,21:00服药能更好地恢复杓型节律及控制凌晨血压。
Correlation between serum homocysteine level and left ventricular geometry in essential hypertension
Authors: Liqi Li, Lizhong Zhang, Mei Feng, Aichun Qiao, Ke Ma
Journal: BMJ (2018)

Objective
To investigate the correlation between serum homocysteine (Hcy) level and left ventricular geometric patterns in essential hypertensive patients.


Methods
Three hundred and sixteen patients with essential hypertension attending in Shanxi Dayi Hospital from January 2013 to June 2016 were enrolled in the study. Serum Hcy levels were measured and echocardiography was performed to measure left ventricular mass index (LVMI) and relative wall thickness (RWT). According to Hcy level patients were divided into H type hypertension group (Hcy≥10 μmol/L, group A) and non-H type hypertension group (Hcy<10 μmol/L, group B). The correlation of Hcy level with RWT and LVMI was analyzed.


Results
The percentages of concentric remodeling and concentric hypertrophy in group A were higher than those in group B (30.7% vs. 25.3% and 24.7% vs. 18.7%, χ2=3.342 and 3.894, P=0.033 and 0.025). Hcy level was positively correlated with RWT and LVMI(r=0.819 and 0.725, P=0.005 and 0.008).


Conclusion
Serum Hcy level is associated with left ventricular geometry in patients with essential hypertension.


Key words: 
Homocysteine; Hypertension; Left ventricular geometry
Exploring African American males' attitudes towards genetic testing for prostate cancer risk.
Authors: Amy Leader, Thierry Fortune, Pamela Weddington, Nicole Crumpler, Veda N. Giri
Journal: Journal of Clinical Oncology (2020)

e13552 Background: African American (AA) males have disproportionately high prostate cancer (PCA) incidence and mortality rates compared to men of other races. While genetic testing for PCA is rapidly expanding, AA men represent fewer than 10% of those who undergo genetic counseling and testing. Barriers for AA males may include a lack of awareness or understanding, cultural beliefs, financial and access-to-care limitations, fear of discrimination, and mistrust in the healthcare system. These issues may be exacerbated among low-income, urban AA males. Methods: We conducted two focus groups with AA males who live in a low-resource neighborhood in a major US city to explore their understanding about PCA, challenges in obtaining and discussing family health history, and attitudes towards genetic counseling and testing. Prior to the start of the focus groups, men provided informed consent and completed a brief survey to capture demographic and health history information. Focus groups were moderated by a male member of the community, were audio and video recorded, and transcribed verbatim. Transcripts were analyzed using NVivo 12 to deduce themes within the discussions. Results: Seventeen men participated in one of two focus groups. The mean age was 54 years old (range: 40-66). Only 5 men (30%) were married. Ten men (60%) did not report a family history of PCA, while the remaining 7 reported that their father, grandfather, brother or uncle had PCA. All men had a primary care visit in the past 3 years, but only 13 out of 17 men (76%) reported discussing PCA. Focus group discussions and analyses revealed multiple key themes. Men had limited understanding of the prostate and PCA, with somewhat fatalistic views toward cancer. Family history was recognized as an important risk factor for cancer; talking about family history has become easier and more widely accepted. However, there was mixed reaction to genetic testing: most men were unfamiliar with it but were in favor of learning more, while a few did not see the utility of genetic information. Conclusions: AA men continue to have knowledge deficits about PCA. While there is strong understanding that cancer may be hereditary, there is less awareness about PCA genetic testing. Targeted genetic education and addressing access and cost barriers to genetic testing among AA males is needed to increase uptake of genetic testing and participation in genetic trials.