tbuckley/cabot-search huggingface dataset:
Sorafenib as second-line treatment in metastatic renal cell carcinoma: A prospective cohort.
Authors: Ana Elena Martin Aguilar, Haidé Nayeli Núñez-López, Juan C. Carlos Ramirez-Sandoval
Journal: Journal of Clinical Oncology (2020)

e17077 Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with advanced or metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a 2nd-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI). Methods: Prospective observational cohort in Mexico City (July 2012 to July 2019). We included 148 subjects with metastatic RCC, treated by nephrectomy and who had RCC progression despite treatment with sunitinib (n = 144) or pazopanib (n = 4). All patients received sorafenib 400 mg orally twice a day on a continuous dosing schedule until disease progression or intolerable toxicity. The primary endpoint was time to progression evaluated every 12-16 weeks. Risk factors were classified according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC-RF) prognostic model. Results: Mean age of cohort was 58±10 years, 104 (70%) were male, 51 (35%) had none of IMDC-risk factors, and the most common sites of metastasis before sorafenib treatment were lung (n = 79, 53%) and bone (n = 30, 20%). The median progression-free survival and survival after the introduction of sorafenib treatment was 8.5 months (95% IC 6.8-10.2) and 40.1 months (95% IC 35.2-45.0) respectively. Median overall survival from RCC diagnosis to death was 71 months (95% CI 63.9-79.4). Median progression-free survival was longer in advanced RCC with none IMDC-RF compared with subjects with ≥2 IMDC-RF (10.3 [95%CI 6.1-14.6] vs 7.9 [95%CI 5.8-9.9] mo. respectively, p = 0.035). Age &gt; 65 decreased risk of progression after sorafenib therapy (OR 0.33, 95% CI 0.14-0.77, p = 0.010). Median progression-free survival in subjects &gt; 65 yrs old was longer (14 months, 95% CI 9.2-17.9) compared to subjects ≤65 yrs (7.2 months, 95% CI 5.5-8.9, p = 0.018). Adverse events associated to sorafenib occurred in 118 (80%) subjects: hand-foot syndrome (n = 118, 80%), diarrhea (n = 113, 76%), hypothyroidism (41, 28%), and mucositis (84, 57%). Any adverse events corresponding to a grade &gt; 2 occurred in 48 (32%) patients. Conclusions: Sequential inhibition of VEGF with sorafenib as a 2nd-line treatment may benefit patients with metastatic RCC, especially in subjects &gt; 65 yrs old. Further clinical trials are needed.
Management of glioblastoma: State of the art and future directions
Authors: Aaron C. Tan, David M. Ashley, Giselle Y. López, Michael Malinzak, Henry S. Friedman, Mustafa Khasraw
Journal: CA A Cancer Journal for Clinicians (2020)

Abstract Glioblastoma is the most common malignant primary brain tumor. Overall, the prognosis for patients with this disease is poor, with a median survival of &lt;2 years. There is a slight predominance in males, and incidence increases with age. The standard approach to therapy in the newly diagnosed setting includes surgery followed by concurrent radiotherapy with temozolomide and further adjuvant temozolomide. Tumor‐treating fields, delivering low‐intensity alternating electric fields, can also be given concurrently with adjuvant temozolomide. At recurrence, there is no standard of care; however, surgery, radiotherapy, and systemic therapy with chemotherapy or bevacizumab are all potential options, depending on the patient's circumstances. Supportive and palliative care remain important considerations throughout the disease course in the multimodality approach to management. The recently revised classification of glioblastoma based on molecular profiling, notably isocitrate dehydrogenase ( IDH ) mutation status, is a result of enhanced understanding of the underlying pathogenesis of disease. There is a clear need for better therapeutic options, and there have been substantial efforts exploring immunotherapy and precision oncology approaches. In contrast to other solid tumors, however, biological factors, such as the blood‐brain barrier and the unique tumor and immune microenvironment, represent significant challenges in the development of novel therapies. Innovative clinical trial designs with biomarker‐enrichment strategies are needed to ultimately improve the outcome of patients with glioblastoma.
Clinical analysis of 25 cases of Behçet′s disease complicated with pulmonary hypertension
Authors: Hua Zhong, Wenjie Zheng, Ligang Fang, Hong Jiang, Lidan Zhao, Li Wang, Xiaomei Leng, Yong Hou, Xiaofeng Zeng
Journal: BMJ (2016)

Objective
To understand the clinical features of Behcet′s Disease(BD) with pulmonary hypertension(PH).


Methods
The etiology, clinical features, treatment and prognosis of 25 patients with Bahcet′s disease (BD) complicated with pulmonary hypertension (PH) admitted in Peking Union Medical College Hospital from January 2000 to August 2015 were retrospectively reviewed.


Results
Total 912 BD patients were hospitalized during the same period, among whom 25 cases were complicated with PH accounting for 3%. There were 15 males (60%) and 10 females (40%), with the mean age of (33±12) years (range 19 to 66 years). The median interval from the diagnosis of BD to the onset of PH was 1 year (range 0 to 40 years). The most common cause of PH was heart valve disease (n=10, 40%), followed by pulmonary arterial stenosis or occlusion (n=6, 24%), pulmonary arterial aneurysm with thrombus (n=1, 4%), pulmonary thrombosis (n=1, 4%), cardiomyopathy (n=1, 4%); there were no causes identified in 6 cases (24%). Pulmonary arterial pressures estimated by echocardiography were 40 to 117 mmHg(1 mmHg=0.133 kPa) with a mean pressure of (60±22) mmHg. When the PH developed, elevated erythrocyte sedimentation rate (ESR) and increased hypersensitive C-reactive protein (hs-CRP) were founded in 48% (11/23) and 82% (14/17) of patients, respectively. After treated with glucocorticoid(96%, 24/25), immunosuppressive agents(92%, 23/25), anticoagulation or thrombolysis(36%, 9/25)and specific targeted vasodilator(32%, 8/25), the levels of ESR and hs-CRP declined in 91% (10/11) and 71% (10/14) of patients, respectively; and pulmonary arterial systolic pressure declined in 50% of cases (8/16). Among 9 patients followed for 2 to 96 months, 4 died, 1 aggravated, 2 kept stable and 1 improved.


Conclusion
PH is an uncommon complication in disease.Heart valve disease, pulmonary artery involvement are the major causes of PH. The therapeutic effect and prognosis are poor.


Key words: 
Behcet′s disease; Pulmonary hypertension
第十四届全国暨第九届全球华人泌尿外科学术会议纪要
Authors: 刘贤奎, 孔垂泽
Journal: BMJ (2008)

2007年11月16至18日,第十四届全国暨第九届全球华人泌尿外科学术会议在厦门国际会议展览中心胜利召开.本次大会共收到来自国内外的论文5000余篇,大会、分会场交流论文共433篇,参会者3000余人。
The impact of age on early breast cancer after breast conserving therapy: Results of a subanalysis from the accelerated partial breast irradiation IMRT Florence trial.
Authors: Icro Meattini, Calogero Saieva, Isacco Desideri, Livia Marrazzo, Gabriele Simontacchi, Pierluigi Bonomo, Stefania Pallotta, Lorenzo Livi
Journal: Journal of Clinical Oncology (2020)

566 Background: The impact of age on local recurrence rate of patients affected by early breast cancer is still unclear. The standard of care for older adult largely varies depending on patient- and tumor-related features, but also on national guidelines. We recently presented the 10 years median follow update of the APBI-IMRT Florence phase III trial. The primary aim of the present analysis is to identify the potential relationship between age and ipsilateral breast tumor recurrence (IBTR) in this setting of patients. Methods: This retrospective analysis was performed on the whole series of 520 patients who were enrolled in the trial after breast conserving surgery and randomized to receive APBI or whole breast irradiation. We analyzed patients stratified by age (70+ vs 40-69 years). Results: At a median follow up time of 10.7 years, we recorded 15 IBTR events. Four hundred and three patients (77.5%) were aged less than 70 years old (11 IBTR) and 117 patients (22.5%) were aged 70 years or older (4 IBTR). At the univariate analysis the age (70+ vs 40-69 years) was not significantly correlated with IBTR occurrence (HR 1.33, 95% CI 0.42-4.17; p=0.63). The only significant prognostic factor was adjuvant endocrine therapy, also at the multivariable analysis (HR 0.26, 95% CI 0.07-0.94; p=0.041). Main results are summarized in the table. Within the luminal-like patients (n=437; 12 IBTR events), the age did not impact on the IBTR rate (HR 0.91, 95% CI 0.19-4.31; p=0.91) and adjuvant endocrine therapy lost its significance (HR 0.32, 95% CI 0.09-1.11; p=0.072). Conclusions: Our trial subanalysis did not demonstrate a significant effect of age on IBTR rate for early breast cancer patients receiving a breast conserving therapy. Due to the low number of events, the benefit of adjuvant endocrine therapy is unclear and calls for further investigations. Clinical trial information: NCT02104895 . [Table: see text]
Duration of FOLFOX adjuvant chemotherapy in high-risk stage II and stage III colon cancer with deficient DNA mismatch repair.
Authors: Zehua Wu, Huabin Hu, Chao Wang, Yan Huang, Yanhong Deng
Journal: Journal of Clinical Oncology (2020)

4075 Background: In the IDEA collaboration, noninferiority was not confirmed for 3 months versus 6 months of FOLFOX adjuvant chemotherapy among patients with high-risk stage II and stage III colon cancer (CC). Patients with deficient DNA mismatch repair (dMMR) have a good prognosis, but for whom, whether limiting the duration of adjuvant therapy will compromise oncologic outcomes remains undefined. We evaluated the impact of 3 months of FOLFOX adjuvant chemotherapy or surgery alone in comparison with 6 months of FOLFOX on disease-free survival (DFS) in dMMR CC patients. Methods: This retrospective study included all consecutive patients who underwent curative surgical resection for high-risk stage II or III dMMR CC between May, 2011 and July, 2019. Prognostic factors were analyzed using Cox models, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results: A total of 242 dMMR CC patients were included (43.4% high-risk stage II, 56.6% stage III). The patients received 6 months of FOLFOX adjuvant chemotherapy (n = 66; median cycles [rang] = 12 [10-12]), 3 months of FOLFOX (n = 87; median cycles [rang] = 6 [4-8]), or surgery alone (n = 89). Three groups were generally well balanced, although more patients with stage III were in the 6-month therapy group (74.2%), compared with the 3-month therapy group (57.5%) and the surgery alone group (42.7%). As compared with 6 months of FOLFOX adjuvant chemotherapy in the overall population, 3 months therapy reduced DFS in multivariable analysis (HR, 2.78; 95CI, 1.18 to 6.47; P = 0.02), similar to surgery alone (HR, 2.30; 95CI, 0.99 to 5.38; P = 0.05). In the subgroup analysis, a therapy duration of 6 months was statistically superior to a duration of 3 months only in the patients with stage III, with a 3-year rate of DFS of 86.2% versus 70.8% (HR, 3.06; 95% CI, 1.14 to 8.19; P = 0.026). Conclusions: This study supports the 6-month duration of FOLFOX adjuvant chemotherapy in stage III dMMR CC.
Differential genetic variations and prognostic predicting factors in colorectal cancer patients with or without liver metastasis.
Authors: Honghua Peng, Guifeng Liu, Lele Song, Ying Bao, Xi Zhang, Lehong Zhou, Sudan Cao, Shiying Dang, Shifu Chen, Mingyan Xu, Peiguo Cao
Journal: Journal of Clinical Oncology (2020)

e16049 Background: Although liver metastasis is the most common metastasis for colorectal cancer (CRC), the molecular mechanism determining the metastasis has not been clarified. Our study aims to investigate the potential molecular mechanisms of liver metastasis by comparing the genetic variations between patients with or without liver metastasis, and to explore the prognostic factors for the two groups of patients. Methods: 57 stage I-IV CRC patients (49 with stage III/IV) were enrolled. 26 patients had no liver metastasis while 31 patients had liver metastasis when they were recruited. Whole-exome sequencing was performed on the primary cancer tissues of all patients. All patients were followed up for up to 50 months. Results: We found that the tumor mutation burden (TMB) of primary cancer tissue from patients with liver metastasis was significantly higher than those without metastasis (P &lt; 0.05). When the mutation frequency was compared at whole-exome level, the mutation frequency of TCF7L2 and TRIM77 genes of primary cancer tissues was found to be significantly higher in patients with liver metastasis (TCF7L2: 35.48% vs. 3.85% (P = 0.0037) for patients with or without metastasis; TRIM77: 16.13% vs. 0% (P = 0.050) for patients with or without metastasis). Further study revealed that in patients with liver metastasis, patients with TRIM77 mutations showed worse overall survival (OS) than those without TRIM77 mutations (P &lt; 0.0001). Similarly, patients with 7_12p.13.33 amplification, 10_14q32.33 amplification, and 4_10q23.31 deletion showed worse OS than those without the mutations (P &lt; 0.05). In contrast, in patients without liver metastasis, patients with 6_20q13.33 amplification showed worse OS than those without the amplification. Conclusions: The TMB of CRC patients with liver metastasis was significantly higher than those without liver metastasis. TCF7L2 and TRIM77 gene mutations may be predictive for liver metastasis. TRIM77 mutation, 7_12 p.13.33 amplification, 10_14q32.33 amplification, and 4_10q23.31 deletion were related to poor OS in patients with liver metastasis, while 6_20q13.33 amplification was related to poor OS in patients without liver metastasis.
Preclinical efficacy of gemcitabine in MLL-rearranged infant acute lymphoblastic leukemia
Authors: Priscilla Wander, Laurence C. Cheung, Sandra S. Pinhanҫos, Luke Jones, Mark Kerstjens, Susan T.C.J.M. Arentsen-Peters, Sajla Singh, Grace-Alyssa Chua, Patricia Garrido Castro, Pauline Schneider, M. Emmy M. Dolman, Bianca Koopmans, Jan J. Molenaar, Rob Pieters, C. Michel Zwaan, Rishi S. Kotecha, Ronald W. Stam
Journal: Leukemia (2020)
肩胛骨化脓性骨髓炎一例
Authors: 赵宇宙, 张辉, 武长林
Journal: BMJ (2007)

患者男,16岁,主因左肩疼痛、肿胀伴发热半个月于2002年9月2日入院.患者半个月前出现左肩疼痛、肿胀伴发热,无感冒、外伤病史,症状逐渐加重,左肩关节因疼痛活动受限,近半月体温一直在38℃以上,最高达40℃,在家自服退热药(具体不详)体温不降,来我院内科就诊。
Efficacy analysis for Canalith repositioning of benign paroxysmal positional vertigo in elders
Authors: Yongxia Mao
Journal: BMJ (2014)

To explore the characteristics of benign paroxysmal positional vertigo(BPPV)and examine the efficacy of Canalith repositioning in elders. A retrospective study was carried out among 47 BPPV cases at our hospital from January 2011 to June 2012. Posterior semicircular canal received Epley maneuver (n=35) and Lempert rolling for horizontal semicircular canal (n=12). Curative effect was evaluated after 1 week and 3 months. After Canalith repositioning, the initial success rate was 91.5% (43/47) and the effective rate 8.5% (4/47). After 1 week, the success rate was 100%. Nine patients (19.1%) had recurrence in the same canal previously affected, and all improved with a new repositioning maneuver. Canalith repositioning is both safe and effective in the treatment of BPPV.


Key words: 
Vertigo; Elders
Real-world analysis of peptide receptor radionuclide therapy (PRRT) in the treatment of neuroendocrine tumors.
Authors: Justin Chau, Nanmeng Yu, Hirva Bakeri, Yusuf Menda, Joseph S. Dillon, Chandrikha Chandrasekharan
Journal: Journal of Clinical Oncology (2020)

e16701 Background: PRRT received FDA approval in 2018 for treatment of somatostatin receptor positive gastroenteropancreatic neuroendocrine tumors (GEPNETs) based on NETTER-1 trial data that included only small bowel grade 1 and 2 neuroendocrine tumors. We present real-world data of PRRT outcomes and implementation from a large tertiary treatment center following approval. Methods: Patients treated with PRRT at University of Iowa between Jan 2018 - July 2019 were included in this retrospective study. Patient and tumor characteristics, cumulative dose and cycles of Lu 177 PRRT administered, treatment course, treatment-related toxicity and responses were reviewed, and 1-year progression-free and overall survival rates were calculated. Results: 67 patients received PRRT, of which 61 completed at least 2 doses. Primary tumor sites included small bowel (64.1%), pancreas (20.3%), and lung (9.4%). 43 (64%) had grade 2 NET; 5 had grade 3 (7.4%). 44 (65.6%) completed 4 cycles of PRRT per FDA approval while 10 received 3 cycles (14.9%). Median duration of follow up was 11.7 months. 53 patients received at least 2 doses and at least one imaging procedure post-PRRT. No complete responses were noted. 9 patients were found to have disease progression at last follow up. 1-year progression-free survival was 78% (95% CI 64-88%). 1-year overall survival was 88% (95% CI 75-94%). Of 23 patients who received fewer than 4 cycles, PRRT was discontinued in 4 (5.9%) due to myelosuppression, specifically thrombocytopenia grade 2 and above. 9 patients discontinued therapy due to change in clinical status or progression per treating physician, 2 experienced carcinoid crisis and 2 had renal function deterioration (preexisting renal disease). 5 patients had previously received PRRT with either Y90 or Lu 177 prior to FDA approval and were retreated in our cohort. 5 patients had preexisting renal disease, including one patient on peritoneal dialysis. Conclusions: We noted a higher rate of treatment discontinuation after 3 cycles, possibly due to heavy pretreatment or treatment of patients with advanced disease, not uncommon after a new therapy is approved and implemented into practice. Discontinuation due to myelosuppression or renal dysfunction was minimal, consistent with NETTER-1 data. Our cohort is unique as it included patients who had received prior PRRT as well as others with preexisting renal dysfunction. Despite this, treatment-related toxicity in our cohort was not significantly higher.
A retrospective three-year analysis using real-world data on uptake of broad-based NextGen sequencing panels in community oncology practices.
Authors: Hinco J. Gierman, Nikhil Pai, Casey Catasus, Alvin Tam, Monica Labrador, Joseph Donaldson, Mallika Singaraju, Nick Singleton, John Verniero, Robert E. Smith, Jeffrey A. Scott
Journal: Journal of Clinical Oncology (2020)

e13668 Background: There are over 100 FDA approved targeted therapies across 15 cancer types, offering improved outcomes over existing therapies. However, many of these require genetic testing, for example, advanced non-small cell lung cancer (aNSCLC) patients have over 15 targeted therapies requiring a DNA-based test. Doing multiple tests can exhaust sample, while increasing cost and turn-around time. NGS panels, often with hundreds of genes, can address some of these issues. Here we asked across aNSCLC patients if the use of NGS panels has increased over the last 3 years in community oncology practices. Methods: The Integra Connect database, which includes electronic medical record (EMR) and claims data on over 1,000,000 US cancer patients, was queried across five community oncology practices to identify aNSCLC patients (stage IIIB or IV) treated between January 2017 and January 2020. Manual chart review abstracted tumor type, stage, treatment, and testing. Patients tested for all 7 NCCN recommended genes (EGFR, ALK, ROS1, BRAF, MET, RET, ERBB2) were grouped as “NGS Panel”, patients with less genes as “Single Gene/Small Panel”, and patients with no evidence of testing as “No Test”. A Chi-Square test was used to compare actionable results between patients with NGS panels versus small panels. Results: 1,007 aNSCLC patients were analyzed and showed a doubling of the use of broad-based NGS testing from 13% in 2017 to 26% in 2019 across over 100 oncologists (table). 23% of patients had actionable results when tested on broad-based panels versus 17% using single gene or small panels (p = .048). Targeted therapies were used in 17% of broad-based tested patients, versus 15% in patients tested for single genes or small panels. Conclusions: We see an uptake of broad-based NGS testing in community oncology, which can lead to more actionable results and better utilization of targeted therapies for those patients. However, this seems to be caused by providers shifting from small panels to large panels, rather than an overall increase in testing, as we do not see the percentage of untested patients decrease. [Table: see text]
Relationship between Helicobacter pylori infection and metabolic diseases
Authors: Ying Zhang
Journal: BMJ (2016)

Helicobacter pylori infection is a common gastrointestinal infection, which is a major cause of chronic gastritis, peptic ulcer, stomach cancer and gastric mucosa-associated lymphoid tissue lymphoma and other diseases. In recent years, many studies show that Helicobacter pylori infection is closely related with many diseases, which may cause the retardation of children development and affect blood lipids and glucose metabolism. Helicobacter pylori infection may also lead to chronic inflammatory process, results in a large number of cytokines and play an important role in artery atherosclerosis. This paper reviews on the correlation between Helicobacter pylori infection and metabolic diseases and its mechanism as well.


Key words: 
Helicobacter pylori; Metabolic diseases
自体打压植骨加缝匠肌骨瓣移植治疗中晚期股骨头坏死
Authors: 赵凤朝, 马超, 熊传芝
Journal: BMJ (2007)

股骨头坏死是骨科常见、难治性疾病.由于全髋关节置换治疗股骨头坏死的远期效果较差,保头治疗是目前国内外治疗股骨头坏死的重点[1-4].我院自2001年10月至2005年2月,采用自体打压植骨加缝匠肌骨瓣移植治疗中晚期股骨头坏死11例(13髋),效果良好。
由病例分析看类风湿关节炎的诊断与治疗
Authors: 张奉春
Journal: BMJ (2006)

类风湿关节炎(rheumatoid arthritis, RA)是一种以对称性、多关节炎为主要表现的慢性、全身性自身免疫性疾病.确切病因不明,基本病理改变为滑膜炎.在我国RA的发病率约为0.32%～0.34%,全国约有400万患者.目前国际共识,只有早期诊断、早期规范治疗,才能改善预后,提高患者的生活质量.
Diagnosis and treatment of retrocaval ureter in 6 children
Authors: Qing-wei Zhang, Chao-ran Dong
Journal: BMJ (2008)

Clinical data of 6 children with retrocaval ureter were retrospectively analyzed.Diagnoses were mainly based on ultrasound-guided high-dose venous urography,computed tomography(CT)or renal dynamic imaging(single photon emission computed tomography).Surgical operation was the optimal treatment of choice,resulting in different improvement in hydronephrosis but no anastomotic stenosis.

Key words: 
Ureter; Urogenital abnormalities
Complain and vital sign-based identification and assessment of critically-illed patients call on more attention
Authors: 李春盛
Journal: BMJ (2009)

在临床实践中,从事社区卫生工作的全科医生有别于其他专科的医生.无论在门诊还是病房的专科医师,经过相应专业训练就可以轻易地识别出90%以上属于本专业范围内的危重病,即使不属于本专业的疾病也较容易请到相关的专科医生会诊,帮助解决诊治问题.而全科医生却要面对众多专业所共有的常见病的识别、治疗、保健和预防问题。
The prognostic value of plasma brain natriuretic peptide in patients with acute pulmonary embolism
Authors: Jian-long Miao
Journal: BMJ (2010)

The aim of the study is to investigate the prognostic value of plasma brain natriuretic peptide (BNP) in patients with acute pulmonary embolism. Plasma BNP concentrations were measured in 47 cases with acute pulmonary embolism. Plasma BNP levels in massive or sub-massive pulmonary embolism were higher than those in no-massive pulmonary embolism (P = 0. 001,0. 048) ; BNP levels in survival cases were higher than those in fatal cases ( P = 0. 027 ). The incidence of massive or sub-massive pulmonary embolism in patients with BNP >400 pg/ml was higher than that with BNP≤400 pg/ml ( 100% vs. 75%,P = 0. 023 ). Results indicate that plasma BNP concentration might be associated with risk stratification and prognosis of the disease.

Key words: 
Pulmonary embolism;  Natriuretic peptide; brain