tbuckley/cabot-search huggingface dataset:
Change of diaphragm electromyograms in patients with obstructive sleep apnea-hypoventilation syndrome and its significance
Authors: Yu-hong Hou
Journal: BMJ (2009)

Objective To explore change of diaphragm electromyograms in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS) before and after nocturnal sleep, as well as effective nasal continuous positive airway pressure (n-CPAP) ventilation treatment for more than two months. Methods Diaphragm electromyogram was recorded with chest surface electrodes in 22 patients with moderate and severe OSAHS and 24 normal people, and phrenic nerve conduction time (PNCT) and diaphragm compound muscle action potential (CMAP) provoked by unilateral magnetic stimulation (UMS) were measured for them before and after sleep. Measurements were repeated for five patients with severe OSAHS after effective OSAHS patients before and after nocturnal sleep than that in normal people bilaterally, (8.4±0. 6)ms and (8.4±0. 9)ms vs (7. 3±0. 8)ms and (7. 3±0. 8) ms for the left side; and (8.4±1.3) ms and (8. 9 ± 0. 8) ms vs (7.2 ± 0. 8) ms and (7.2 ± 0. 8 ) ms for the right side ( P < 0. 01 ), respectively ; and amplitude of CMAP was significantly lower in OSAHS patients, (0. 60±0. 20)mV and (0. 64±0. 29)mV vs (0. 98 ± 0. 28)mV and (0. 97±0. 27)mV for the left side; and (0. 53±0. 23)mV and (0. 56±0. 26)mV vs (0. 93 ±0. 29) mV and ( 0. 94 ± 0. 29 ) mV for the right side, respectively ( P < 0. 01 ) ; but no significant significantly shortened bilaterally in five patients with severe OSAHS after effective n-CPAP ventilation treatment for more than two months, (8.6±0. 7)ms vs (7.4±0. 5)ms for the lfet side and (7. 8±0. 6)ms vs (6.4 ± 0. 6) ms for the fight side ( P < 0. 05 ), respectively. Conclusions Both phrenic nerve conduction and diaphragm muscle function are weakened in patients with OSAHA, which may be related to hypoxia and/ or disturbance of sleep structure at night.

Key words: 
Sleep apnea, obstructive;  Phrenic nerve;  Diaphragm electromyogram
心电图平板运动试验致ST段抬高三例
Authors: 万进, 李七一, 史海波, 刘春玲
Journal: BMJ (2011)

报告我院3例无陈旧心肌梗死者平板运动试验后ST段抬高的病例,分析其运动心电图变化特点,探讨可能机制.例1 患者男,66岁,诉间歇性胸闷伴劳累后胸痛3个月,加重数天.胸痛有时向左肩放散,服速效救心丸可缓解,无心肌梗死史.体检:身高180 cm,体重90kg,血压130/80 mm Hg(1 mm Hg=0.133 kPa),心率65次/min。
Response to checkpoint inhibitors (CPI) in sarcomatoid renal cell carcinoma (sRCC).
Authors: Iris Yeong- Fung Sheng, Wei Wei, Kunal Desai, Kimberly D. Allman, Allison Martin, Laura S. Wood, Sarah Nehez, Susan Taylor, Shilpa Gupta, Timothy D. Gilligan, Moshe Chaim Ornstein
Journal: Journal of Clinical Oncology (2020)

e17095 Background: sRCC have a generally poor prognosis though recent clinical trial data suggest improved outcomes with CPI. We present a real-world experience of metastatic sRCC patients (pts) treated with a variety of CPI. Methods: Pts with sRCC treated with CPI Cleveland Clinic from 1/1/2015 to 12/31/2019 were identified. Overall survival (OS) was estimated using Kaplan-Meier and compared by log rank test. Results: Of 28 eligible pts identified with sRCC, median age 58, 82% Caucasian, all KPS score &gt; 80%, 86% had IMDC intermediate/poor risk disease, 75% were clear cell, and 71% had prior nephrectomy. 46.4% had prior non-CPI systemic therapy. CPI therapy in this cohort included: 46% nivolumab monotherapy, 18% axitinib/pembrolizumab, 21% ipilimumab/nivolumab, 4% atezolizumab/bevacizumab, 7% atezolizumab, 4% carboplatin/pemetrexed/pembrolizumab. At a median follow up of 13.6 months (range 6.5-31.4), ORR was 36% (4% CR, 32% PR) and median OS was 13.8 months (95% CI: 9.23-NA). Median time to response was 3.2 months (range 2.4-13.1) and median duration of response was 8.1 months (range 0-25.5). Ten of the 13 patients started subsequent therapy due to progression. At the time of analysis, 39% were still alive and 25% of patients were still on initial I/O therapy (7+ -30+ months). There were no clear correlations between specific disease-related factors (including IMDC risk, time-to treatment of &gt; or &lt; 1 year, or prior systemic therapy) and response (all were p &gt; 0.05). Conclusions: ORR and CR rates were lower in this real-world population of metastatic sRCC pts compared to clinical trial data, which should be a result of various CPI treatments and lines of treatment. However, these data highlight the heterogeneity of sRCC in general and need for additional investigations into impact of percentage of sarcomatoid features, genomic analyses, line of therapy, and CPI choice to optimize outcomes in sRCC pts.
Effects of individualized management on indicators of patients with type 2 diabetes mellitus
Authors: Yan Wang, Yonghua Wu, Jingyi Jiang, Qinfang Shi
Journal: BMJ (2018)

Thirty eight patients with type 2 diabetes mellitus (T2DM) signed with the Lingering Garden Subdistrict Community Health Service Center of Suzhou Gusu District from October to December 2015 were enrolled in the study. The patients were classified as low risk group (n=3), moderate risk group (n=11), high risk group (n=21) and extremely high risk group (n=3) according to risk stratification of the JADE program based on estimated glomerular filtration rate (eGFR) and risk factors [obesity, dyslipidemia, hypertension, diabetic retinopathy, urinary protein creatinine ratio, foot disease, glycosylated hemoglobin A1c(HbA1c), fasting plasma glucose(FPG) or non fasting plasma glucose]. The patients were managed by a team consisting of general practitioners, general nurses and specialists; the individualized management was implemented with reduction of controllable risk factors and complications as the goal. After one year of management (March 2016 to February 2017) the indicators of T2DM were evaluated. The results showed that the TC, LDL-C, FPG and HbA1c levels were significantly improved in both moderate and high risk groups (P<0.05); the TC, LDL-C and FPG levels in the extremely high risk group were also significantly improved (P<0.05).


Key words: 
Case management; Risk stratification; General practitioner; General nurses
Harnessing tumor immunity with chemotherapy: Mathematical modeling for decision-making in combinatorial regimen with immune-oncology drugs.
Authors: Vesna Cuplov, Guillaume Sicard, Dominique Barbolosi, Joseph Ciccolini, Fabrice Barlesi
Journal: Journal of Clinical Oncology (2020)

e14095 Background: Combining chemotherapy and immune checkpoint inhibitors (ICI) is challenging due to the near-infinite choice of dosing, scheduling and sequencing between drugs. The aim of this work is to develop a phenomenological model that describes the synergistic effect between cytotoxics and immune check point inhibitors in patients with cancer. Methods: Inspired from literature, we have developed an integrative mathematical model that includes tumor cells, cytotoxic T cells (CTLs) and regulatory T cells (TREGs) plus pharmacokinetics (PK) inputs. Loss in tumor mass is due to combined effect of direct chemotherapy-induced cytotoxicity and CTLs immune response, which is in turn inhibited by the tumor and mitigated by TREGs in the tumor micro-environment. The model describes as well the impact of chemotherapy-induced lymphodepletion on immune tolerance, whereas ICIs protect CTLs against tumor inhibition. Identification of model’s parameters and simulations of various scheduling were performed using Mlxplore software and a Python standalone code. In vitro and in vivo experiments using lung cancer models generate experimental data to adjust model parameters. Results: Complex interplays between cytotoxics and immune cells were best described by a 10-parameters model so as to ensure better identifiability. PK/PD relationships were integrated using compartmental modeling. In silico simulations show how changes in dosing and scheduling impact efficacy endpoints, an observation in line with data from the literature. Ongoing in vitro and in vivo experiments with pemetrexed-cisplatin doublet and anti-PD1 pembrolizumab help optimizing the model’s parameters in a self-learning loop. Conclusions: This work is at the frontier between mathematical modeling and experimental therapeutics with ICIs. In silico modeling and simulations could help narrow down the treatment choices and define optimal combinations prior to running clinical trials. Such model will help identify optimal dosing and scheduling, so as to achieve better synergism and efficacy.
Application of Patient Enablement Instrument (PEI)
Authors: Meng Chen
Journal: BMJ (2020)

Patient enablement is a consultation outcome measure that reflects the extent of patients understanding their health problems and the ability to dealing with. It not only reflects patient′s feeling after the consultation, but also the doctor′s ability of diagnosis and treatment. The Patient Enablement Instrument (PEI) has been developed and used to assess the enablement of patients after consultation. The PEI has the characteristics of brevity and conciseness, and its reliability and validity are widely accepted. This article reviews the current status of the application of PEI and related factors to provide a reference for the its further use in China.


Key words: 
Scale; Patient Enablement Instrument; Validity; Reliability; Associated factors
Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study
Authors: Eloi Marijon, Nicole Karam, Daniel Jost, David Perrot, Benoit Frattini, Clément Derkenne, Ardalan Sharifzadehgan, Victor Waldmann, Frankie Beganton, Kumar Narayanan, Antoine Lafont, Wulfran Bougouin, Xavier Jouven
Journal: The Lancet Public Health (2020)

SummaryBackgroundAlthough mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods.MethodsWe did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area.FindingsComparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12–17, 2012–19), the maximum weekly OHCA incidence increased from 13·42 (95% CI 12·77–14·07) to 26·64 (25·72–27·53) per million inhabitants (p<0·0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69·7 years [SD 17] vs 68·5 [18], 334 males [64·4%] vs 1826 [59·9%]), there was a higher rate of OHCA at home (460 [90·2%] vs 2336 [76·8%]; p<0·0001), less bystander cardiopulmonary resuscitation (239 [47·8%] vs 1165 [63·9%]; p<0·0001) and shockable rhythm (46 [9·2%] vs 472 [19·1%]; p<0·0001), and longer delays to intervention (median 10·4 min [IQR 8·4–13·8] vs 9·4 min [7·9–12·6]; p<0·0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22·8% to 12·8% (p<0·0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0·36, 95% CI 0·24–0·52; p<0·0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic.InterpretationA transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies.FundingThe French National Institute of Health and Medical Research (INSERM)
老年糖尿病合并缺血性肠病一例
Authors: 曹晓红, 陈树, 王丹, 张敏, 张新星, 金静, 刘晓姝, 卢青
Journal: BMJ (2006)

患者女性,79岁.因右下腹疼痛反复发作3年,于2005年3月入院.患者2 型糖尿病史7年,既往血糖控制未达标.近3年出现右下腹痛,呈持续性隐痛,阵发性加重,不伴有腹泻、便血,无黏液、脓血便,无畏寒、发热,多次在我院行外周血常规、大小便常规、腹部B超、妇科检查及纤维结肠镜检查,均未见异常,曾就诊于普外科诊断为慢性阑尾炎,经保守治疗无好转后建议行手术治疗.入院后右下腹痛持续存在,查体右下腹无确切压痛,外周血常规、肠镜检查未见异常,血管彩色超声检查示肠系膜上动脉起始部狭窄,内径为0.61 cm,诊断为2型糖尿病合并缺血性肠病,给予丹参、灯盏细辛、前列地尔、西洛他唑等扩张血管药物,严格控制血糖、血压、血脂水平在正常范围,治疗1周后患者症状好转,1个月后症状消失出院.出院后继维持治疗。
Change in body mass index in breast cancer patients in the first two years from diagnosis.
Authors: Maysa M. Abu-Khalaf, Ayako Shimada, Nikita Nikita, Ida Micaily, Hannah Hackbart, Grace L. Lu-Yao, Meaghan Butryn
Journal: Journal of Clinical Oncology (2020)

e19020 Background: The rate of obesity in adults is 34% in the city of Philadelphia, with rates being highest among non-Hispanic blacks and Hispanics. We sought to evaluate how BMI varies by age and race/ethnicity at time of initial encounter for a breast cancer (BC) diagnosis (dx), and investigate factors predictive of BMI change in the first 2 years of dx. Methods: We identified 1,833 patients (pts) in our electronic medical record, (1/2015-present), who had a BC dx at their first hospital or ambulatory encounter using ICD-10 code C50.X, and had BMI recorded at baseline (BL) (6 mo pre-and up to 3 mo post), at 1 yr +/- 3 mo and 2 yr +/- 6 mo. We summarized demographic data (age, gender, marital status, race/ethnicity) with mean and standard deviation for continuous variables and with count and percentage for categorical variables. Descriptive statistics were summarized by 3-level BMI categories: underweight/normal (≤ 24.9), overweight (25 to 29.9), and obese (&gt;30) and compared with ANOVA test, Chi-square-test or Fisher’s exact test as appropriate. Mixed effect regression analysis was conducted to adjust for the effects of time (i.e., BL, 1 yr, 2 yr), gender, race/ethnicity and the interaction of time and race and ethnicity in estimating mean BMI. We calculated the mean change of BMI between the BL and later time points by race/ethnicity. The significance level of all tests was set a priori to the 0.05 level. Results: 99.4% of pts were female; mean age was 63 yrs; White (60 %), Black/AA (27 %). By BMI category, we did not observe a substantial difference in the mean age of dx and gender (p = 0.18 for age and p = 0.55 for gender). We observed a substantial difference in race/ethnicity among BMI categories (p &lt; .0001); the highest percentage of obese pts were Black/AA. In the mixed effect model, the reference level was set as a white female with an average (avg) systolic blood pressure of 137.8. The estimated avg BL BMI of this reference group was 28.8. We observed that among Asian/Pacific Islander (API) pts the avg BL BMI is lower by 3.5 ( p &lt; .0001) and among female Black/AA pts the avg BL BMI is higher by 2.6 ( p &lt; .0001) compared to reference group. No significant change was noted in mean BMI between BL and 1 yr for any race and ethnicity group, and only the Hispanic/Latino group had a declining trend for change in BMI between BL and 2 yr (estimate: -1.9; 95% CI: -5.9, 2.1). Conclusions: In our cohort, Black/AA pts likely have higher BL BMI and API pts likely have lower BL BMI compared to White pts. We found no significant difference in change of BMI by race and ethnicity group during the first 2 years from an initial encounter for a BC dx.
Comprehensive genomic profile by Foundation Medicine test in guiding routine decisions for second-line treatment in advanced non-small cell breast cancer (NSCLC): Preliminary results of lung-ONE study.
Authors: Federico Rojo, Enriqueta Felip, Oscar Juan-Vidal, Rosario Garcia Campelo, David Aguiar Bujanda, Josefa Terrasa, Rafael Lopez Castro, Antonio Calles, Alfredo Paredes, Reyes Bernabe Caro, Isidoro C. Barneto - Aranda, Juana Campillo, Luis Garcia Palacios, Javier De Castro
Journal: Journal of Clinical Oncology (2020)

e21555 Background: Lung-ONE study aims to determine the clinical utility in making decisions on planned 2 nd line therapy in advanced NSCLC based on a comprehensive genomic profile (CGP) test as FoundationOne CDx or FoundationOne Liquid and describe alterations found on these patients. Methods: Lung-ONE included advanced/metastatic NSCLC patients being treated on first-line, with molecular diagnostic wild-type (or unknown) for at least ALK, EGFR, and ROS-1 genes. Patients treated with targeted therapies or immunotherapy were excluded. This interim analysis describes the findings of CGP from patients of Lung-ONE with driver genomic alterations (GAs) and the investigators decision to change the planned second line treatment or not. Patients continue being followed-up for up to 2 years. Results: As of November 15 2019, 152 patients were included. At the time of sampling, 90.7% had received ≥2 different chemotherapy regimens and other therapies. Main testing for ALK and ROS-1 was IHC in 91.4% and 73.8%, respectively; and for EGFR, it was qPCR in 99.3%. Planned 2nd-line based on routine molecular profile was chemotherapy and, mainly checkpoint inhibitors (61.7%). CGP was assayed on 102 (67.1%) tissue specimens and 50 (32.9%) blood samples. Of the 1,581 GAs identified in 141 patients, 541(34.2%) were potential drivers in 131. The most frequently mutated genes were TP53 in 72(55%) patients and KRAS in 52(40%). TMB and MSI signatures were calculated on 82 patients. 21% had &lt; = 16 mut/Mb. Other GAs of interest are presented in table. Therapeutic orientations were recommended for 116/152(76.8%) patients. In 39/151(25.8%) patients the GAs had approved drugs in NSCLC or other tumor types. CGP outcomes, would be used by 27% of oncologists to guide targeted 2nd-line. Conclusions: CGP detected mutations that are informative for choosing personalized treatment in 25%. CGP demonstrates the ability of detect druggable genomic alterations missed at diagnosis opening new treatment options. [Table: see text]
The hospital of the future: Is bigger better? Concentration in the provision of secondary care
Authors: John Posnett
Journal: BMJ (1999)

A close observer of the NHS over the past 10 years might be forgiven for thinking that the debate about the concentration of acute hospital services has been driven more by the needs of NHS managers and the medical professions than by the needs of the local populations that they are supposed to serve. Managers have faced pressures to reduce unit costs and, in particular, the “wasteful” costs of management itself. The medical professions, through their respective royal colleges, have encouraged the closure or rationalisation of smaller units through pressures for greater subspecialisation.
不同肺组织活检术在肺部块影诊断中的价值比较
Authors: 韦杰, 黄梅, 李少明, 陈斌, 万仁平
Journal: BMJ (2006)

对肺部X线片或CT检查显示为肺部块影的680例门诊和住院患者采取4种途径取肺活检组织,486例经纤维支气管镜肺活检,58例X线引导下肺活检,116例CT引导下肺活检,20例开胸肺活检.对4种途径的阳性率进行对比分析,提示对中央型肺部块影,宜将经纤维支气管镜肺活检作为首选方法;对周围型肺部块影以CT引导下穿刺肺活检作为首选方法。
Provider preferences for attributes of artificial intelligence in breast cancer screening: A discrete choice experiment.
Authors: Nathaniel Hendrix, A. Brett Hauber, Christoph I. Lee, Aasthaa Bansal, David Leroy Veenstra
Journal: Journal of Clinical Oncology (2020)

e14118 Background: One of the emerging medical applications of artificial intelligence (AI) is the interpretation of mammograms for breast cancer screening. It is uncertain what attributes would result in acceptance of AI for breast cancer screening (AI BCS) among ordering clinicians. Methods: We performed qualitative interviews to identify the most important attributes of AI BCS for ordering clinicians. We then invited US-based primary care providers (PCPs) to participate in a discrete choice experiment (DCE). The experiment featured 15 choices between radiologist alone and two AI BCS alternatives where respondents traded better metrics on some attributes for worse metrics on others. Responses were analyzed using a mixed logit model adjusting for preference heterogeneity to determine the probability of recommending AI BCS. Results: In qualitative interviews, the six most important attributes to PCPs were AI sensitivity, specificity, radiologist involvement, understandability of AI decision-making, supporting evidence, and diversity of training data. Forty PCPs completed the DCE. Sensitivity was the most important attribute: a 4 percentage point improvement in sensitivity over the average radiologist increased the probability of recommending AI by 0.41 (95% confidence interval (CI), 0.38-0.42). Specificity was approximately half as important. Respondents were indifferent to whether radiologists confirmed all or only screens likely to be abnormal. However, no radiologist involvement reduced the probability of recommendation by 0.31 (95% CI, 0.29-0.31). An AI developed using data from diverse populations increased the probability of recommendation by 0.38 (95% CI, 0.36-0.39). Lastly, an AI that is transparent in the rationale for its decisions increased the probability of recommendation by 0.41 (95% CI, 0.39-0.41). Conclusions: PCPs prefer AI BCS that improves sensitivity versus specificity, and involves radiologists in the confirmation of abnormal screens. Improving sensitivity alone, however, will likely not be sufficient to support widespread PCP acceptance – algorithms will need to be developed with diverse data and more transparent explanations of their decisions.
Clinical analysis of 35 cases with perloperafive pulmonary embolism
Authors: Zhi-hai Gao, Xiao-mei Zhang
Journal: BMJ (2008)

Thirty-five patients with perioperative pulmonary embolism during January 2000 and October 2006 were analyzed retrospectively.Disease diagnosis and treatment outcomes were assessed.Of the 35 patients,2 died without any management,and 33 received conventional anti-coagulation and thrombolysis.including 3 percutaneous catheterization.Disease improvement Was seen in 29.Four deaths occurred after no response to the treatment.Thus,early diagnosis and treatment,which miight depend on further understanding of pulmonary embolism,could play an important role in reduced adverse events.Prevention is crucial to avoid perioperative occurrence of pulmonary embolism.

Key words: 
Pulmonary embolism;  Intraoperative period