tbuckley/cabot-search huggingface dataset:
Study of efficacy and tolerability of paclitaxel and carboplatin as a concurrent chemotherapeutic radiation sensitizer regimen in patients of esophageal cancer: Prospective observational study from tertiary center in northern India.
Authors: Pankaj. Goyal, Krushna A. Chaudhari, Ullas Batra, Parveen Jain, Chaturbhuj Agrawal, Vineet Talwar, Sumit Goyal, Sneha Bothra, Kshitij Domadia, Venkata Pradeep Babu, Dinesh Chandra Doval
Journal: Journal of Clinical Oncology (2020)

e16526 Background: Neo-adjuvant chemotherapy followed by surgery is the standard of care in non metastatic oesophageal cancers. After the overall survival benefit observed in Cross trial, Paclitaxel and Carboplatin based neo-adjuvant chemoradiation has become the preferred treatment modality. There is paucity of data of its efficacy and tolerability in Indian patients. So this prospective study was done to assess the same. Methods: We enrolled 64 patients aged 18-75 years with histologically confirmed, potentially resectable squamous-cell carcinoma of the esophagus or esophagogastric junction from Aug 2017 to Jan 2019. On days 1, 8, 15, 22, and 29, carboplatin AUC 2 and paclitaxel 50 mg/m 2 intravenously and a total radiation dose of 41.4 Gy was given in 23 fractions of 1.8 Gy each by external-beam radiation. Pathological complete response rate, Clinical response based on PET-CT scan and tolerability of paclitaxel and carboplatin as a concurrent chemotherapeutic radiation sensitizer regimen was studied. Results: 23 out 64 patients underwent surgery while others were either lost to follow up or they refused for surgery. Of these 23, 87.5% could complete all 5 planned cycles of chemotherapy. Complete pathological response was found in 73.9% patients. Statistically significant correlation was found between pathological and PET-CT based response (p-0.044). 4 patients showed distant progression on PET-CT based evaluation after neoadjuvant chemo radiotherapy before surgery. The most common major hematologic toxic effects were leukopenia (14%) and neutropenia (12.5%). Febrile neutropenia and grade 3 anemia was observed 2 and 4 patients respectively. The most common major non-hematologic toxic effects were vomiting (4.6%), nausea (3.1%), bronchoesophageal fistula(3.1%). Post operative mortality was seen in 1(4.3%) patient. Grade 3 pulmonary complications, atrial fibrillation and anastomotic leak was observed in 1 patient each. Conclusions: Concurrent chemoradiotherpy with weekly paclitaxel and caboplatin is well tolerated in Indian patients. High complete resection rate and PCR rate can be achieved with this regime with manageable adverse effect profile. Response evaluation with PET-CT after completion of preoperative therapy has correlation with pathological complete response.
医院获得性肺炎的发病机制及防治
Authors: 何礼贤
Journal: BMJ (2006)

医院获得性肺炎(hospital-acquired pneumonia,HAP)或称院内肺炎(nosocomial pneumonia,NP)是指患者入院时不存在,也不处于感染潜伏期,而于入院≥48 h发生的肺炎,包括在医院内感染而于出院48 h内发生的肺炎.HAP是我国第1位的院内感染,占各部位院内感染构成比的30%左右,发病率为2.33%.据上海市18家综合性医院横断面调查,HAP导致平均住院日延长31 d,每例增加直接医疗费用1.8万元以上….HAP病死率为20%～50%,重症HAP病死率高达70%[2].因此积极有效地防治HAP是合理使用与节约医疗卫生资源以及改善患者预后的重要环节,也是医疗安全的基本内容。
The regulation of RNA Polymerase II mediated transcription by Caspase-8 in ovarian cancer.
Authors: Sven Becker, Ranadip Mandal, Monika Raab, Mourad Sanhaji, Klaus Strebhardt
Journal: Journal of Clinical Oncology (2020)

e18082 Background: According to the WHO, in 2018, the number of new cases and mortality worldwide due to ovarian cancer, were 295,414 and 184,799, respectively, making it one of the most lethal gynaecological cancers in the world. The standard therapy of ovarian cancers is still comprehensive cytoreductive surgery followed by a combination of platinum-taxane based primary chemotherapy. Second line therapies include Carboplatin or Cisplatin in combination with Paclitaxel, PLD or Gemcitabine, with or without Bevacizumab. Unfortunately, late stage ovarian cancer cases are still incurable, however, several new drugs are under development or are undergoing clinical trials. At present, these new approaches can only stabilize the disease or delay its recurrence. Caspase-8, the predominant initiator of the extrinsic apoptotic pathway, also plays critical roles in a number of other non-apoptotic functions. It is also frequently down-regulated in ovarian cancer and we wanted to understand how this down-regulation could support the development of ovarian cancer. Methods: The analysis of the association between CASP8 expression and patient prognosis in ovarian cancer patients found that low CASP8 expression was significantly correlated with poor OS, with a median OS of 37.43 (low expression) and 49.97 (high expression) months, and higher clinical stages. CRISPR/Cas9 mediated CASP8 KO in multiple high- and low-grade ovarian cancer cell lines resulted in significant increases in their invasiveness. Results: Caspase-8 interactome analysis revealed that it can regulate the RNA Pol II mediated transcription, which was corroborated through multiple in vitro and ex vivo experiments. Global Transcriptomics and Proteomics analysis of the KO cells revealed significant upregulation of genes involved in metastasis, which was again verified in in vitro and ex vivo experiments. Additionally, the KO cells were significantly resistant towards standard chemotherapeutics like Carboplatin, a transcription inhibitor, either alone or in combination with Paclitaxel. Conclusions: Presently, we are working on orthotopic ovarian cancer mouse models to validate - the potential of Caspase-8 to regulate metastasis; and the targeting of RNA Pol II to sensitize them to standard chemotherapeutics. We are also developing organoid banks from patient derived ovarian cancer tissues, with low Caspase-8 expression, to validate the upregulation of genes identified in our ‘omics’ data and the potential of targeting them, along with RNA Pol II, to sensitize them to standard chemotherapeutics.
Duty to treat: where do the limits lie?
Authors: Julian Sheather, John Chisholm
Journal: BMJ (2020)

Doctors are dying. The combination of a novel virus, no existing treatment, and inadequate supplies of personal protective equipment (PPE) is putting frontline health workers at risk of serious harm. The question arises: when does work based risk become unacceptable? Does a point come when health professionals have the right not to treat seriously ill patients if their PPE is inadequate?

Doctors’ primary duty—to quote the General Medical Council—is to make the care of patients their first concern. This is a paradigm example of what moral philosophers call a “special” positive duty. It can be helpful to compare them to general positive duties. It is widely accepted that we are all under general positive duties—positive in the sense that they require some action from us. If I see a toddler struggling in a garden pool, and I can rescue her without excessive risk, then I am under a duty to do so. It would also be reasonable to criticise me for refusing. These duties are general as they presuppose no special relationship between rescuer and rescued. General duties are not onerous. If I cannot swim and see a child struggling in a torrent, it …
First-line biological agents plus chemotherapy in elderly patients with metastatic colorectal cancer: A retrospective pooled analysis.
Authors: Pilar Garcia-Alfonso, Eduardo Diaz-Rubio, Albert Abad, Alfredo Carrato, Bartomeu Massuti, Rosa Rodríguez Alonso, Jose Luis Manzano, Andres J. Muñoz Martín, Gema Durán, Beatriz García de Paredes, Maria Jose Safont Aguilera, Reyes Ferreiro Monteagudo, Eva Martinez de Castro, Encarnación González Flores, Manuel Valladares-Ayerbes, Cristina Gravalos Castro, Vicente Alonso Orduña, Jose María Vieitez, Pilar Escudero, Enrique Aranda
Journal: Journal of Clinical Oncology (2020)

4017 Background: Biological agents, in combination with chemotherapy, are recommended as first-line treatment of metastatic colorectal cancer (mCRC); however, evidence guiding appropriate management of elderly patients with mCRC is lacking. This study compared the efficacy and safety outcomes in older versus younger patients with mCRC who received first-line biological therapy. Methods: This retrospective analysis used pooled data from five Spanish TTD collaborative group studies of adults with advanced CRC who received first-line treatment with bevacizumab, cetuximab or panitumumab, stratified by age (≥65 vs &lt; 65 years). Endpoints included progression-free survival (PFS), overall survival (OS), overall response rate (ORR) and safety. Results: In total, 999 patients from five studies were included in the analysis; 480 (48%) were aged ≥65 years and 519 (52%) were aged &lt; 65 years; 733 (73.37%) were treated with bevacizumab, 189 (18.92%) received cetuximab and 77 (7.71%) received panitumumab. Median PFS did not significantly differ between patients aged ≥65 versus &lt; 65 years (9.9 vs 9.4 months; hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.88–1.17). Median OS was significantly shorter in older versus younger patients (21.3 vs 25.0 months; HR 1.21; 95% CI 1.04–1.41; P = 0.0132). There was no significant difference between older versus younger patients in ORR (59% vs 62%). Older patients experienced more treatment-related grade ≥3 adverse events. Conclusions: Biological agents are an effective first-line treatment option for elderly patients with mCRC, with comparable efficacy in PFS and ORR to that observed in younger patients and a manageable safety profile.
硝酸银明胶剂治疗烧伤238例
Authors: 周亚鹏
Journal: BMJ (2005)

控制创面感染、促进创面愈合是治疗烧伤的重要环节,理想的创面外用药在预防和控制创面感染时起到关键作用[1].1999年至2004年我们对我院烧伤科238例烧伤患者的366个创面进行硝酸银明胶剂临床用药治疗观察,现报告如下。
Association of dynamic changes of methylated SFRP2 in ctDNA with prognosis in advanced gastric cancer.
Authors: Yan Haijiao, Kele Ge, Wenyu Chen, Xizheng Mao, Xiaodong Li, Mingzhe Xiao, Wensong Liu, Jun Wu
Journal: Journal of Clinical Oncology (2020)

e15051 Background: Secreted frizzled-related protein 2 (SFRP2) is a tumor suppressor gene and its hyper methylation could cause its inactivation and promote cancer development. However, whether methylated SFRP2 (mSFRP2) in ctDNA could serve as prognostic biomarker for patients with gastric cancer has not been thoroughly studied. Methods: Stage III or IV gastric cancer patients treated with systemic chemotherapy in the Third Affiliated Hospital of Soochow University from 2015 to 2017 were included. The mSFRP2 before and during chemotherapy were dynamically detected from ctDNA by digital polymerase chain reaction-based technologies. Results: In total, 121 patients were enrolled, with 63 in stage III and 58 in stage IV. Baseline median mSFRP2 was higher in stage IV than stage III (64 VS 18 copies/ng, P &lt; 0.001). In stage III GC, the top 50% mSFRP2 population had shorter median disease-free survival (DFS, 11.0 months VS NR; HR, 13.05; 95% CI, 3.05-55.95;) and overall survival (OS, 17.0 months VS NR; HR, 7.80; 95% CI, 1.81-33.60). Similar results were observed in stage IV GC that the median progression-free survival (PFS, 4.0 VS 7.0 months; HR, 2.74; 95% CI, 1.58-4.78) and OS (12.0 VS 16.0 months; HR, 3.14; 95% CI, 1.67-5.92) was shorter in patients with top 50% mSFRP2. During the dynamic monitor along treatment, elevated mSFPR2 was associated with worse PFS (5.0 VS 7.0 months; HR, 2.17; 95% CI, 1.25-3.76) and OS (12.0 VS 15.5 months; HR, 3.51; 95% CI, 1.94-6.35) in stage IV patients. Conclusions: Our study shows the association between SFRP2 methylation and its dynamic change and prognosis in patients with gastric cancer. Our results provide a potential biomarker in ctDNA for prognosis and dynamic monitoring in patients with gastric cancer.
Plasma-derived cfDNA to reveal potential biomarkers of response prediction and monitoring in non-small cell lung cancer (NSCLC) patients on immunotherapy.
Authors: Francesco Vallania, Karen Assayag, Peter Ulz, Adam Drake, Hayley Warsinske, John St John, Girish Putcha, Luc Cabel, Sophie Beaucaire-Danel, Nicolas Girard, Francois-Clement Bidard
Journal: Journal of Clinical Oncology (2020)

9588 Background: Immune checkpoint inhibitors have shown promising results in many advanced cancers, but the response rate remains low. Various molecular and cellular biomarkers, such as elevated tumor-infiltrating cytotoxic T cells and Natural Killer (NK) cells at baseline, are associated with response. Blood-based biomarkers to predict or monitor response remain challenging to develop. Here we investigate the potential of cell-free DNA (cfDNA) biomarkers to predict response to the PD-1 immune checkpoint inhibitor nivolumab in patients with refractory metastatic non-small cell lung cancer (NSCLC). Methods: Plasma from stage IV NSCLC patients enrolled in ALCINA (NCT02866149) was collected before (baseline, BL, n = 30) and at week 8 (W8, n = 17) of nivolumab therapy. Response was determined using RECIST 1.1 (responders n = 5; non-responders n = 25). Whole-genome sequencing was performed to characterize cfDNA fragments. Tumor fraction (TF) was assessed using ichorCNA. Cellular composition was estimated by deconvolution of cfDNA co-fragmentation patterns, and transcription factor activity was estimated by measuring binding site accessibility across the genome. Results: Although estimated TF at baseline did not predict response to nivolumab, NK cell levels estimated by cell-mixture deconvolution were significantly higher in responders at BL (p &lt; 0.05). Furthermore, estimated monocyte levels at W8 strongly correlated with overall survival (r = 0.75, p &lt; 0.0005, HR = 15.02) and were significantly higher in responders (p &lt; 0.05). By evaluating changes in transcription factor binding activity, we identified factors with greater accessibility in non-responders at baseline (DEAF1, THAP11) and W8 (DUX4, PDX-1). Conclusions: Plasma cfDNA signatures may be useful for response prediction and monitoring in NSCLC patients on immunotherapy. Our results suggest that changes in the immune system, as reflected by cellular composition and transcriptional activity inferred from cfDNA, may provide biological insights beyond TF alone that may benefit biomarker discovery and drug target identification.
Prevalence of anxiety and depression and related factors in elderly patients with metabolic syndrome
Authors: Yayu Tang, Ning Zhang, Jian Jia, Haixia Ding
Journal: BMJ (2017)

Objective
To investigate the prevalence of anxiety and depression in elderly patients with metabolic syndrome (MS) and its related factors.


Methods
A total of 672 subjects aged 60 or over undergoing health check-up in two Nanjing community health service centers from November 2015 to October 2016 were enrolled in the study. The basic information and the history of hyperlipidemia, hypertension and diabetes were collected by questionnaire survey; the results of physical examination and biochemical testing were documented. The prevalence of anxiety and depression were investigated by the Hospital Anxiety and Depression Scale (HADS). According to MS diagnostic criteria, the subjects were divided into MS group (n=181) and non-MS group (n=491). The HADS scores of two groups were compared and the influencing factors related to anxiety and depression were analyzed.


Results
The levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index(BMI), levels of fasting blood glucose (FBG), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) were higher and high density lipoprotein cholesterol (HDL-C) was lower in MS group than those in non-MS group (all P<0.05). The prevalence rates of anxiety and depression in MS group (30.9% and 34.8%) were significantly higher than those in non-MS group (20.2% vs. 25.1%, χ2=8.655, 6.288, P=0.003, 0.012). Multivariate logistic regression analysis showed that obesity (BMI≥28 kg/m2), high FBG (≥7.0 mmol/L), hypertension [blood Pressure≥140/90 mmHg (1 mmHg=0.133 kPa)] were the independent risk factors for anxiety in MS patients (OR=3.987, 2.827, 2.375, respectively, all P<0.05); obesity (BMI≥28 kg/m2), high FBG(≥7.0 mmol/L), smoke, high TC (≥5.2 mmol/L), hypertension (≥140/90 mmHg) were the independent risk factors for depression in MS patients (OR=7.718, 3.233, 2.071, 1.932, 1.910, respectively, all P<0.05).


Conclusion
Elderly patients with metabolic syndrome are prone to anxiety and depression, and obesity, high FBG, hypertension and other factors are the risk factors for anxiety and depression.


Key words: 
Metabolic syndrome; Anxiety; Depression
EB病毒相关的传染性单核细胞增多症
Authors: 侍效春, 邓国华
Journal: BMJ (2008)

传染性单核细胞增多症是一种临床综合征,典型特征主要为发热、咽峡炎、淋巴结肿大、疲倦、头痛、外周血异型淋巴细胞增多及出现嗜异性凝集抗体,可合并有肝脾肿大与肝功能异常.EB病毒感染是引发传染性单核细胞增多症的常见病因.EB病毒属于疱疹病毒,γ亚科,为双链DNA病毒。
Case finding and diagnosis for active pulmonary tuberculosis with primary treatment:an analysis of 1000 inpatients
Authors: Wei-wei Gao, Jian-ling Bu, Li Xie, Xi-qin Han, Xue-rui Huang
Journal: BMJ (2008)

Objective To study the modes of case finding and diagnosis for inpatients of active pulmonary tuberculosis with primary treatment.Methods Data of 1000 inpatients with active pulmonary tuberculosis input into a computer were analyzed retrospectively.including clinical symptoms,signs and relevant laboratory examinations.to evaluate their diagnostic value.Results Among 1000 active tuberculosis case8 hospitalized with symptoms and signs,95.9 percent suffered by cough,77.7 percent by expectoration and 50.8 percent (n=508) by fever,and 51.5 percent (n=777) with strong positive purified protein defivative (PPD) skin test,61.5 percent with positive serum anti-tuberculosis antibody,48.8 percent with positive acid-fast staining on sputum smear and 57.9 percent with positive sputum bacteriologle culture.And,49.4 percent of the patients were diagnosed by laboratory positive sputum,and 50.6 percent of those with negative sputum were diagnosed by comprehensively clinical considerations,ineluding 51.6 percent positive PPD skin teat, or positive serum anti-tubereulosis antibody,but 48.4 percent of them were all negative in varied laboratory examinations.Conclusions Hospital visit due to symptom is the main method for tuberculosis finding in our country.All those with Cough for two or more weeks should be screened by routine examinations for excluding tuberculosis.Case finding rate Was low by sputum examinations.so comprehensive diagnosis is still important for those tuberculosis patients with negative sputum.
<i>HSD3B1</i> (1245A&gt;C) polymorphism and clinical outcomes in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate (AA) and enzalutamide (ENZA): Results from two prospective studies.
Authors: Isabel Aragon, Daniel Joseph Khalaf, Rebeca Lozano, Matti Annala, Sinja Taavitsainen, David Lorente, Daygen L. Finch, Nuria Romero-Laorden, Joanna Vergidis, Ylenia Cendon, Conrad D. Oja, Maria I Pacheco, Muhammad Zulfiqar, Martin Gleave, Alexander William Wyatt, David Olmos, Elena Castro, Kim N. Chi
Journal: Journal of Clinical Oncology (2020)

5525 Background: The common HSD3B1 (1245A &gt; C) germline variant is associated with increased de-novo synthesis of androgens and worse outcomes in men treated with androgen-deprivation therapy in metastatic hormone sensitive prostate cancer. The aim of this study is to determine the role of this polymorphism on treatment outcomes for AA and ENZA in patients with mCRPC. Methods: A total of 547 patients treated with AA or ENZA for mCRPC from two prospective cohorts; cohort 1 included 202 from British Columbia (Canada) and cohort 2 enrolled 345 patients from the Spanish study PROREPAIR-B. HSD3B1 genotype was determined by targeted sequencing in cohort 1 and by Taqman SNP genotyping assay in cohort 2. Associations between HSD3B1 genotypes and (TTPP), time to progression (TTP) and overall survival (OS) were evaluated via univariate COX regression. Multivariate analysis was performed to determine the independent association of each covariate. Results: The proportions of patients with a homozygous wild-type HSD3B1 (AA), heterozygous (AC) and homozygous variant (CC) genotype were respectively 45.6%, 39.4% and 15%. As expected, known prognostic factors for mCRPC such as hemoglobin, alkaline phosphatase (ALP), LDH, PSA at baseline as well as site of metastasis were significantly associated with TTPP and TPP. In the combined cohort, HSD3B1 (CC) genotype was associated with worse TTP (HR 1.31, 95%CI 1.02-1.67, p = 0.032) and PSA response rates (48% for CC vs 62% and 65% for AA and AC, respectively (p = 0.019, χ²)). Similar trend was observed for TTPP (HR 1.28, 95%CI 0.99-1.66, p = 0.064). OS was not different among genotypes, but was significantly shorter for patients with CC genotype in cohort 1 (HR 1.97, 95%CI 1.14-3.40, p = 0.016). There was no association between HSD3B1 genotype and time to castration-resistance in either of the two cohorts. Multivariable analysis showed that LDH, ALP, hemoglobin and use of AA or ENZA as first-line therapy for mCRPC were independent prognostic factors for TTP and TTPP; non-significant association was observed for genotype and TTP. Conclusions: HSD3B1 homozygous variant genotype (CC) was associated with shorter TTP and lower PSA response rate in mCRPC patients treated with AA or ENZA. However, the CC genotype did not provide prognostic information beyond that conferred by standard clinical variables, suggesting that it may not be a suitable stand-alone biomarker in mCRPC.
Improving Child Health Care Outcomes Through Social Needs Intervention—A Signal
Authors: Chén C. Kenyon, Katie E. McPeak, Alexander G. Fiks
Journal: JAMA Network Open (2020)

Matthew S. Pantell, MD, MS; Danielle Hessler, PhD; Dayna Long, MD; Maoya Alqassari, BA; Christine Schudel, MSW, MPH; Ellen Laves, MD; Denisse E. Velazquez, BA; Anais Amaya, BA; Patricia Sweeney, BA, RN; Abigail Burns, MD, MSW; Francis L. Harrison, BA; Nancy E. Adler, PhD; Laura M. Gottlieb, MD, MPH
宫外孕失血性休克180例治疗分析
Authors: 张红世
Journal: BMJ (2005)

综合本院近10年间180例均经手术和病理证实为异位妊娠内失血患者的临床资料. 1.临床资料:180例患者,年龄24～42岁.发病时间最短3 h,最长可在24 h以上,以6～24 h居多.术中所见:出血量400～500 ml者共21例,500～1 000 ml者31例, 1 200～2 000 ml者105例,2 000～2 500 ml者23例.妊娠部位:输卵管峡部妊娠23例,壶腹部妊娠105例,伞部流产型44例,卵巢妊娠8例。
冠心病的社区康复指导(二)
Authors: 梁崎, 郭兰
Journal: BMJ (2012)

冠心病患者进行运动训练前应对其在运动中出现心血管事件的危险性进行分层(低度、中度和高度),有助于制定运动处方、决定运动进展的速度和选择运动中医务监督的强度.冠心病社区运动康复包括有氧运动训练和抗阻训练,以中等强度的有氧运动为主,每次运动时间达到40～60 min最佳；抗阻训练为重要的补充.冠心病患者在社区进行运动训练时仍需坚持实施安全策略,确保患者顺利达到控制危险因素、提高体能、增进机体和心理的健康等康复目的。
真性红细胞增多症并发肺栓塞一例
Authors: 尹广利, 刘文玲
Journal: BMJ (2011)

患者男,72岁.因发作性胸闷、气短1个月于2010年6月10日入院.1个月前患者开始反复出现活动后胸闷、气短,无胸痛,偶有干咳,经休息后症状可缓解,并自觉活动耐量逐渐下降,行走5 m即出现呼吸困难.既往有高血压病史40年,脑梗死病史9年,肺结核病史40年。
肺减容术治疗重度肺气肿18例
Authors: 张永恒, 彭惠
Journal: BMJ (2007)

回顾性分析18例行肺减容术患者的临床资料,其中9例行胸腔镜单侧肺减容术,4例同期或分期行胸腔镜双侧肺减容术,2例经左侧开胸在食管下段癌根治术的同时行左侧肺减容术,1例肺癌合并重度肺气肿者应用对侧前胸切口行肺减容术,2例经后外侧切口行单侧肺减容术,手术切除每侧肺容积的20%～30%.结果,2例死于呼吸感染;16例术后持续漏气4～15 d后自愈.术后1年随访15例患者均不吸氧,能做一般家务劳动,另1例失访.提示肺减容术可改善重度肺气肿患者的肺功能,但需要严格筛选手术病例和注重围手术期的处理。