tbuckley/cabot-search huggingface dataset:
The Quebec Cannabis Registry: a pharmacovigilance and effectiveness study on the use of medical cannabis in cancer patients.
Authors: Antonio Vigano, Michelle Canac-Marquis, Rihab Gamaoun, Pierre Beaulieu, Andrée Neron, Yola Moride, Marc O Martell, Julie Desroches, Jordi Perez
Journal: Journal of Clinical Oncology (2020)

12109 Background: The Quebec Cannabis Registry (QCR) was launched in 2015 to allow physicians to prescribe medical cannabis (MC) in the province of Quebec, Canada. This study aimed to investigate the safety and effectiveness of MC in cancer patients using pharmacovigilance data prospectively collected for up to 24 months. Methods: Patients were enrolled in the QCR between May 2015 and October 2018 and followed every 3 months. Study outcomes included adverse events (AE), pain severity and interference (Brief-Pain Inventory), wellbeing (Revised-Edmonton Symptom Assessment Scale) and overall health scale (EQ5D5L) at baseline and at each follow-up (F-UP). Significance of changes over time were assessed using repeated-measures ANOVA. Results: Out of the 2991 patients enrolled in the QCR, 358 (12.8%) were cancer patients (mean age 57.7 (± 14.6); 171 (47.8%) males). The main cancer types were breast (16.2%), lung (11.7%), leukemia (11.5%) and colorectal (11.2%). MC was prescribed primarily for pain (72.1%), anxiety (4.7%), nausea (4.5%), anorexia (3.9%), and insomnia (3.1%). A total of 13 patients (3.6%) reported AE with only three being serious (one unrelated to MC: stroke; and two possibly related: diarrhea, from CBD oil overdose and pneumonia from smoking MC). Mean scores significantly (p &lt; 0.05) improved between baseline and 3 months F-UP for pain severity (4.8 ± 1.5 vs 4.1 ± 1.8), pain interference (4.6 ± 1.8 vs 3.8 ± 1.7), and the overall health scale (60 ± 21 vs 71 ± 18). Well-being scores also significantly improved between baseline and 6 months F-UP (4.4 ± 2.1 vs 3.5 ± 2.8). Conclusions: Population-based data shows that cancer patients can benefit safely and effectively from MC as a complementary treatment, when prescribed and monitored under medical-nursing supervision.
Diagnosis and treatment of penetrating injury in distal segment of common bile duct during biliary tract exploration
Authors: Li-xue Du, Yu Zhang, Wu-jun Wu, Xi-lin Geng, Hui Li
Journal: BMJ (2009)

Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications.

Key words: 
Common bile duct diseases;  Biliary tract surgical procedures
A systematic review of evidence for cannabis and cannabinoids as adjuvant therapy in palliative and supportive oncology care.
Authors: Sebastian Jugl, Shailina Keshwani, Lauren Adkins, Coy D. Heldermon, Almut Winterstein, Amie Goodin
Journal: Journal of Clinical Oncology (2020)

12091 Background: Medical cannabis use is increasing significantly in the United States as states reduce restrictions. However, ambiguity concerning the evidence for medical cannabis efficacy and safety, especially in the field of oncology, is persistent. Clinicians therefore face challenges in examining benefits and risks of medical cannabis as adjuvant treatment for cancer patients. This study identifies and evaluates the most recent available evidence for the efficacy of cannabis and cannabinoids as adjuvant in supportive and/or palliative use in patients with cancer. Methods: Electronic databases searched included PubMed, Embase, Web of Science, and Cochrane Library to identify studies published following the latest available systematic review, between July 2016 through October 2019. Studies conducted outside the United States, studies not evaluating cannabis or cannabinoids in Oncology care, and preclinical studies were excluded. Findings were organized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework. Lastly, qualitative synthesis was used to generate summary statements about the role of cannabis and cannabinoids as adjuvant in supportive and/or palliative cancer care. Results: We screened 2,267 articles and included 96 studies in our qualitative synthesis. Among those were 2 RCT’s (1 completed), 6 Systematic reviews with Meta-analysis, 4 Systematic reviews without Meta-analysis, 71 other types of reviews and 13 observational studies. The most frequently reported outcomes assessed were efficacy of cannabis and cannabinoids for: pain (40 of 96; 17 indicating improvement), nausea and vomiting (26 of 96; 20 indicating improvement), cachexia (22 of 96; 2 indicating improvement), and utilization patterns of cannabis and/or cannabinoids among cancer patients (8 of 96). Conclusions: Latest available prevalence estimates indicate that a significant proportion of patients in the United States with cancer use cannabis and/or cannabinoids (18.3-40.0%). There is substantial evidence for the effectiveness of cannabis and cannabinoids in treating cancer-related pain; specifically, oromucosal THC/CBD spray. There is conclusive evidence for the effectiveness of cannabis and cannabinoids in relieving chemotherapy-induced nausea and vomiting; specifically, oral THC. There is inconclusive evidence regarding the effectiveness of cannabis and cannabinoids in treating cancer-related cachexia.
Postoperative radiation therapy (PORT) impact on clinical outcomes of resected atypical meningioma: A meta-analysis.
Authors: Kevin M. Gallagher, furqan akhtar, Philip A. Haddad
Journal: Journal of Clinical Oncology (2020)

2570 Background: Although meningiomas are among the most prevalent types of brain tumors, atypical meningiomas (AM) account for around 4% of all meningiomas. AMs tend to be more aggressive with relatively higher rates of recurrence and mortality. Gross total resection (GTR) has been the standard of care when possible. However, GTR itself is not always enough to prevent recurrence of AMs. The role of PORT remains controversial in AM as the comparative studies to support its use have provided conflicting results. The purpose of this meta-analysis is to evaluate the impact of PORT on clinical outcomes in resected AMs. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) AM diagnosis, (ii) English language, (iii) Simpson graded resections, and (iv) comparative studies reporting recurrence rates (RcR), Progression Free Survival (PFS), and Overall Survival (OS) with hazard ratios (HR) or Kaplan-Meier curves. A meta-analysis was conducted using an inverse variance method with random-effects model. Results: Twenty-two comparative studies with a total of 5,129 patients were included and analyzed. When GTR was attained, PORT was associated with improved RcR (HR = 0.72, 95%CI:0.59-0.86) and PFS (HR = 0.77, 95%CI:0.65-0.90), but not OS (HR = 0.93, 95%CI:0.83-1.04). When subtotal resection (STR) was attained, PORT was associated with improved PFS (HR = 0.35, 95%CI:0.26-0.48) as well as OS (HR = 0.70, 95%CI:0.54-0.89). Conclusions: This is the first meta-analysis to show that PORT is associated with PFS benefit in AMs with GTR and STR. Moreover, PORT significantly improved OS of AMs that underwent STR but had no impact on OS when GTR was achieved. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of PORT in this patient population.
With a little help from my friends: A multi-disciplinary approach to cancer survivorship.
Authors: Scott Capozza, Maura Harrigan, Javin Brita, Angela Khairallah, Tara B. Sanft
Journal: Journal of Clinical Oncology (2020)

e24082 Background: Long term cancer survivorship care is an integral part of the overall arc of oncology care. There is currently no standard of care for survivorship care beyond dissemination of a Survivorship Care Plan and data evaluating current models is limited. Furthermore, the most current Commission on Cancer recommendations suggest that a multi-disciplinary approach to cancer survivorship will best address the late and long-term side effects that survivors experience 1 . Methods: A multi-disciplinary adult cancer survivorship clinic at Yale Cancer Center and Yale New Haven Hospital was established in October 2006. This clinic is overseen by a medical oncologist and features the medical expertise of four distinct providers: an advance practice practitioner (such as an APRN or PA), a licensed clinical social worker, an oncology board-certified registered dietitian and an oncology board-certified physical therapist. Survivors meet with each provider for 30 minutes. A follow-up visit is scheduled 2-3 months later to assess the interventions discussed at the first visit and make modifications as necessary. This comprehensive approach allows the providers to address a wide array of late and long-term side effects from cancer treatment, including fear of recurrence, cancer related fatigue and weight management. Beginning with evidence-based research in their respective fields, each provider can create an individualized plan to address these concerns. Results: The National Comprehensive Cancer Network's Distress Thermometer demonstrated an almost 75% decrease in distress in cancer survivors pre- to post initial visit (n = 1,116 patients). Additionally, cancer-related fatigue, as measured by the MD Anderson Brief Fatigue Inventory, decreased by almost 50% from first to second visit (n = 313 patients). Conclusions: This poster is the first to demonstrate the feasibility of implementing a multi-disciplinary cancer survivorship clinic to address the late and long-term side effects of cancer survivors. Further research evaluating the correlation between improved access to long term survivorship care, as well as the health care providers required to provide optimal care in this setting, is needed. 1. American College of Surgeons Comminssion on Cancer, https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx . Accessed February 10th, 2020.
Final analysis of KEYNOTE-189: Pemetrexed-platinum chemotherapy (chemo) with or without pembrolizumab (pembro) in patients (pts) with previously untreated metastatic nonsquamous non-small cell lung cancer (NSCLC).
Authors: Delvys Rodriguez-Abreu, Steven Francis Powell, Maximilian Hochmair, Shirish M. Gadgeel, Emilio Esteban, Enriqueta Felip, Giovanna Speranza, Manuel Dómine Gomez, Susanna Y. Cheng, Helge Bischoff, Nir Peled, Martin Reck, Rina Hui, Edward B. Garon, Michael J. Boyer, Takayasu Kurata, Jing Yang, Tuba Bas, Fabricio G. Souza, Marina Chiara Garassino
Journal: Journal of Clinical Oncology (2020)

9582 Background: The phase III KEYNOTE-189 study (NCT02578680), showed significant improvements in OS and PFS with pembro + chemo vs placebo + chemo in pts with previously untreated metastatic nonsquamous NSCLC without sensitizing EGFR/ALK mutations. We report the protocol-specified final analysis of KEYNOTE-189. Methods: Pts were randomized 2:1 to receive 35 cycles of pembro 200 mg Q3W (n = 410) or placebo Q3W (n = 206) plus 4 cycles of pemetrexed (pem) and carboplatin/cisplatin followed by maintenance pem. Pts in the placebo + chemo arm could crossover to pembro upon PD. PFS and OS were primary endpoints; ORR was a secondary endpoint. PFS2 (time from randomization to objective tumor progression on next-line treatment/death), was an exploratory endpoint. Results: At data cutoff (May 20, 2019), median (range) time from randomization to data cutoff was 31.0 (26.5–38.8) mo. 17 pts in the pembro + chemo arm and 1 pt in the placebo + chemo arm were receiving initially assigned treatment; 84 pts crossed over to pembro. Median (95% CI) OS (22.0 [19.5–24.5] vs 10.6 [8.7–13.6] mo; HR 0.56 [95% CI, 0.46–0.69]) and PFS (9.0 [8.1–10.4] vs 4.9 [4.7–5.5] mo; HR 0.49 [95% CI, 0.41–0.59]) were longer with pembro + chemo vs placebo + chemo (Table). The 2-y OS rate was 45.7% vs 27.3% and the 2-y PFS rate was 22.0% vs 3.4%. ORR was 48.3% with pembro + chemo vs 19.9% with placebo + chemo. 56 pts in the pembro + chemo arm completed 35 cycles of pembro among whom ORR was 85.7% (4 CR, 44 PR, 8 SD) and median OS was not reached. 292 (72.1%) pts in the pembro + chemo arm and 135 (66.8%) pts in the placebo + chemo arm had grade 3–5 AEs. Conclusions: Pembro + chemo continued to show improved outcomes in OS, PFS, ORR and PFS2 compared with placebo + chemo, with manageable toxicity. These findings support first-line pembro + chemo in pts with previously untreated metastatic nonsquamous NSCLC. Clinical trial information: NCT02578680 . [Table: see text]
Macrocytosis as a predictor of response to capecitabine in solid cancers: A meta-analysis.
Authors: Fahad Almugbel, Laith Al-Showbaki, Michelle Nadler, Alexandra Desnoyers, Ramy Saleh, Eitan Amir
Journal: Journal of Clinical Oncology (2020)

e13080 Background: Capecitabine is an effective oral chemotherapy that is widely used in a number of solid cancers both as monotherapy or in combination with other anti-cancer drugs. It has been suggested that mean corpuscular volume (MCV) is associated with response to capecitabine. Methods: We searched PubMed for studies exploring the association between capecitabine and macrocytosis or MCV. We extracted the hazard ratios (HR) reporting progression-free (PFS) or overall survival (OS) data when comparing macrocytosis to normal/low MCV. If HR were not directly reported, we estimated them from survival plots using the Parmar method. HR were then pooled in a meta-analysis using generic inverse variance and random effects modeling. Results: Among the 13 identified studies, five were eligible for analysis, comprising a total of 446 patients. One study was a randomized trial and four were retrospective cohort studies. Mean patient age was 53 and cancer sites included breast (n = 226; 50%), colon (n = 131; 29 %) and stomach (n = 89; 19%). Capecitabine was used in combination with other drugs in 64% of patients. There was no association between macrocytosis and PFS (HR 0.91, 0.60-1.38, p = 0.65). Among the 3 studies reporting OS data, there was a significant negative association between macrocytosis and worse OS (HR 1.79, 1.38-2.34, p &lt; 0.001). Conclusions: Macrocytosis in patients treated with Capecitabine was found to have no impact on PFS, but was associated with an inferior OS. This finding suggests that macrocytosis is more likely to be a prognostic factor rather than a predictive biomarker of response to capecitabine.
Final analysis of phase I study of ceritinib in pediatric patients with malignancies harboring activated anaplastic lymphoma kinase (ALK).
Authors: Johannes H Schulte, Lucas Moreno, David Simon Ziegler, Lynley V. Marshall, C. Michel Zwaan, Meredith Irwin, Michela Casanova, Constantino Sabado, Beate Wulff, Mario Stegert, Luojun Wang, Felipe K. Hurtado, Fabrice Branle, Matthias Fischer, Birgit Geoerger
Journal: Journal of Clinical Oncology (2020)

10505 Background: Activation of anaplastic lymphoma kinase has been detected in several pediatric malignancies, including anaplastic large-cell lymphoma (ALCL), inflammatory myofibroblastic tumor (IMT), neuroblastoma and others. Preliminary findings from this phase 1, multicenter, dose-escalation study (NCT01742286) indicated a Maximum Tolerated Dose (MTD)/Recommended Dose for Expansion (RDE) of the potent oral ALK inhibitor ceritinib to be 510 mg/m 2 (fasted) and 500 mg/m 2 (fed) in pediatric patients (pts). Here, we report final safety, pharmacokinetics (PK) and efficacy results. Methods: Children aged ≥1 to &lt;18 years with advanced, mostly pretreated, ALK-aberrant malignancies were enrolled in this study. Dose escalation was conducted to determine the MTD/RDE of ceritinib (primary objective), in both fasted and fed states, following which pts entered an expansion phase to evaluate safety, tolerability, and efficacy at the MTD/RDE. Secondary objectives were evaluation of safety, PK, and efficacy (overall response rate [ORR], duration of response [DOR] and progression-free survival [PFS]). Results: A total of 83 pts (median age, 8 years) with ALK-aberrant malignancies were enrolled into dose-escalation (n = 40) and expansion (n = 43) study periods. Of these, 55 pts (neuroblastoma, n = 30; IMT, n = 10; ALCL, n = 8; others, n = 7) were treated with ceritinib at MTD/RDE (510 mg/m 2 [fasted], n = 13; 500 mg/m 2 [fed], n = 42). Systemic exposure of ceritinib between the two doses was comparable, so data were pooled for efficacy assessment. The ORRs (95% CI) were 75% (34.9-96.8) for pts with ALCL, 70% (34.8-93.3) for IMT and 20% (7.7-38.6) for neuroblastoma. The median DOR was 15 months (95% CI: 5.8, 22.2) for the 6/30 pts with neuroblastoma who had confirmed CR or PR treated at fasted/fed MTD/RDE. Median DOR was not reached for those with ALCL and IMT. Most common adverse events (AEs) (N = 83; all-grades, all-causality, ≥50% of pts): vomiting (86.7%), diarrhea (78.3%), increased ALT (65.1%), increased AST (59.0%), nausea (56.6%), and abdominal pain (50.6%). Grade 3/4 AEs were observed in 80.7% of pts (mostly transaminase elevations) and were manageable. Six pts (7.2%) were discontinued from ceritinib due to a grade 3/4 AE (mostly transaminase elevation). Conclusions: Substantial activity was observed with ceritinib at the RDE in pts with IMT, ALCL and heavily pretreated neuroblastoma. The toxicity profile of ceritinib in children was manageable and similar to that previously reported in adults. Clinical trial information: NCT01742286.
DeBakeyIII型主动脉夹层累及左髂动脉一例
Authors: 于东祥, 梁占浩
Journal: BMJ (2005)

患者男,68岁.因突发撕裂样胸痛半小时,于2004年10月17日20:20急诊住院.发病前饮酒50 ml,后突发心前区疼痛,剧烈呈撕裂样,伴大汗及胸闷、憋气,无咯血、喘息、发热及晕厥.予口服及静脉点滴硝酸甘油、肝素等药物治疗无缓解,疼痛进行性加剧.查体:急性痛苦病容,烦躁.血压180/100 mm Hg(24/13 kPa),心音有力,心率66次/min,律齐,未闻及器质性杂音,无心包摩擦音及胸膜摩擦音.双肺呼吸音清晰,呼吸频率20次/min。
哺乳期中央区乳腺炎的临床特点及治疗效果分析
Authors: 高雅军, 马祥君, 何湘萍, 汪洁, 高海凤
Journal: BMJ (2011)

患乳腺炎的部位全部或部分位于乳头乳晕区即可定义为中央区的乳腺炎.因为其特殊的结构,此位置的哺乳期乳腺炎发展迅速,患者回乳率高,长期以来成为治疗上的难点.本研究对2007年2月至2009年3月经治的37例哺乳期中央区乳腺炎患者的临床特点及治疗效果总结分析如下。
Transurethral electric resection plus arterial catheterization chemotherapy for T2a bladder carcinoma
Authors: Feng Li, Jinxian Pu, Zhenxin Wang, Ling Zhou
Journal: BMJ (2016)

Clinical data of 23 patients with T2a bladder cancer admitted from March 2008 to August 2013 were retrospectively analyzed. Among 23 patients, 11 cases were treated with transurethral resection (TURBT) plus arterial catheterization chemotherapy (study group) and 12 cases were treated with radical cystectomy (control group). The overall survival time and recurrence free survival time of two groups were compared. Patients in study group were followed up for 20-68 months, recurrence occurred in 5 cases (5/11), including 4 cases of invasive recurrence; patients in control group were followed up for 2~86 months, 1 case had superficial recurrent and underwent TURBT, 2 cases dead due to bladder tumor. During the course of chemotherapy, the main adverse effects were digestive reaction (7/11), fever (4/11), bone marrow suppression (2/11), symptomatic treatment was given, which was tolerated. There were no significant differences in overall survival time and recurrence free survival time between two groups (P>0.05). The quality of life of study group was better than that of control group (P<0.05). It is suggested that the arterial interventional chemotherapy combined with transurethral resection for T2a stage invasive bladder cancer has a certain curative effect with the advantage of preservation of bladder function and higher quality of life.


Key words: 
Urinary bladder neoplasms; Drug therapy, interventional; Prognosis
以病人为中心的临床思维方式
Authors: 吴春容
Journal: BMJ (2004)

以病人为中心的临床思维方式是与以疾病为中心的临床思维方式相对应的.后者的典型流程是:采用以疾病为中心的问诊方式,如你哪儿不舒服?,希望在最短的时间内迅速抓住一些关键线索,然后以此为中心建立诊断假设,再通过体检、实验室检查、特殊检查、试验性治疗、利用时间进行观察等去寻找各种证据,排除或证实诊断假设;一旦原来的诊断假设被推翻,就再建立一个新的诊断假设,直到病人的疾病被确诊,然后制定相应的治疗方案,治愈疾病或控制症状.这种临床思维方式在以应付急性传染性疾病为主的医学环境中取得了极大的成功,其理论基础是单因单果的疾病因果观、特异性病因学说和特异性治疗学说,即一种疾病总能找到一种特殊的病原或病因,也能找到一种特异性的治疗方法,疾病就是病原体--环境--宿主三方面因素相互作用的结果.它已经根深蒂固地存在于临床医生的头脑中,即使在慢性病盛行的时代,单因单果的疾病因果观、特异性病因学说和特异性治疗学说受到严峻挑战的时候,也未能真正动摇临床医生采用以疾病为中心的临床思维方式的信念。
社区医生首先要教会高血压患者正确测量血压
Authors: 张晓林
Journal: BMJ (2006)

偶尔测一次血压发现血压高,并不能诊断为高血压.确切地说,应当非同日连续3次采用标准水银柱血压计测量血压,当收缩压≥140mm Hg(1 mm Hg=0.133kPa)和(或)舒张压≥90mm Hg时,方可诊断为高血压[1].当患者被诊断为高血压后,社区医生就需要首先教会或指导患者正确测量血压。
Psychosocial outcomes following surgery in women with unilateral, nonhereditary breast cancer.
Authors: David Wai Lim, Helene Retrouvey, Isabel Kerrebijn, Kate Butler, Anne C O'Neill, Tulin Cil, Toni Zhong, Stefan Hofer, David R. McCready, Kelly A. Metcalfe
Journal: Journal of Clinical Oncology (2020)

570 Background: Rates of bilateral mastectomy continue to rise in average-risk women with unilateral breast cancer. We aim to characterize psychosocial predictors of surgical procedure and how psychosocial outcomes change over time after surgery for breast cancer. Methods: A prospective cohort of women with unilateral, nonhereditary breast cancer were recruited at University Health Network in Toronto, Canada between 2014-2017. Women completed validated psychosocial questionnaires (BREAST-Q) pre-operatively, and 6 and 12 months after surgery. Outcomes were assessed between three surgical groups (unilateral lumpectomy, unilateral mastectomy, bilateral mastectomy). Predictors of surgical procedure were identified using a multinomial logistic regression model. Change in psychosocial scores over time according to procedure was assessed using linear mixed models. All models control for age, stage, reconstruction and treatment. P values &lt; .05 were considered statistically significant. Results: 506 women underwent surgery as follows: 216 unilateral lumpectomy (43%), 181 unilateral mastectomy (36%) and 109 bilateral mastectomy (22%). In the multinomial regression model, younger age (p &lt; .01), and lower chest physical (p = .03) and sexual well-being (p = .02) predicted having bilateral mastectomy over unilateral lumpectomy while younger age (p &lt; .01) and lower disease stage (p = .02) predicted bilateral mastectomy over unilateral mastectomy. The mixed model demonstrates that breast satisfaction follows a non-linear pattern of change over time, with 6- but not 12-month scores being significantly different from baseline (p = .015). Procedure predicts baseline satisfaction (p = .016), with bilateral mastectomy having worse satisfaction than unilateral lumpectomy. Procedure also predicts change in satisfaction, with unilateral and bilateral mastectomy having lower scores across time than lumpectomy. While a significant improvement in psychological well-being is detected by 12 months (p = .02), those with unilateral and bilateral mastectomy have worse psychological well-being over time compared to lumpectomy. Women having mastectomy start with worse physical well-being than those in the lumpectomy group, but their physical well-being does not decline as much as the lumpectomy group over time (p &lt; .01). Conclusions: Definitive surgical procedure affects the trajectory of psychosocial functioning over time. This emerging data may be used to further facilitate surgical decision-making in women considering contralateral prophylactic mastectomy.