tbuckley/cabot-search huggingface dataset:
Application of TeamSTEPPS in training of community osteoporosis management team
Authors: Xiuying Mao, Shanzhu Zhu, Hua Yang, Zhijie Yu, Yuezhong Tang, Huajiang Zhu, Donghao Xu, Jiang Yue
Journal: BMJ (2018)

Objective
To evaluate the application of TeamSTEPPS in training of community osteoporosis management team.


Methods
The TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017. The identified patients with osteopenia and osteoporosis were intervened for one year. Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention. The bone density was examined at baseline and 6 months, 12 months after intervention. The effect of intervention was evaluated.


Results
A total of 467 patients (30.87%) with osteopenia and 476 patients (31.46%) with osteoporosis were detected. The cognitive levels of osteoporosis risk factors, including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention (χ2=62.909, 78.742, 59.974, 50.478, 29.512, 34.699, 6.500, 15.779, 6.089, all P< 0.05). The awareness rates of symptoms, including lower back pain or body bone pain, shorter height and hunchback, low energy or nonviolent fracture, were also increased (χ2=59.942, 76.220, 16.856, all P< 0.01). After intervention, the bone mineral density levels were increased compared to those before intervention (F=530.28, P<0.01 for osteopenia group; F=339.51, P<0.01 for osteoporosis group); meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention, between 12 months and 6 months after intervention (t=-0.452, -0.968, -0.516, all P<0.01 for osteopenia group; t=-0.530, -1.045, -0.518, all P<0.01 for osteoporosis group).


Conclusion
The community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.


Key words: 
Osteoporosis; Bone density; Risk factors; Effect evaluation
Spontaneous bladder rupture in the elderly (A report of 28 cases)
Authors: 李泽良, 宫大鑫, 孔垂泽, 温强, 王毅, 毕建斌, 罗祖, 于勇, 丁兆军
Journal: BMJ (2004)

目的 总结老年人自发性膀胱破裂的临床特征、诊断和治疗方法.方法对28例老年人自发性膀胱破裂患者的临床资料进行回顾性分析.结果行膀胱修补术者23例,其中腹膜内型膀胱破裂者19例,腹膜外型膀胱破裂者4例.未手术者5例,其中3例保守治疗痊愈.死亡4例,死亡率为15%.引起自发性膀胱破裂的病因以下尿路梗阻和肿瘤居多.尿液性腹水和氮质血症是腹膜内型自发性膀胱破裂的特征性表现.结论 B超为首选的检查手段;膀胱造影是最敏感的检查手段,对腹膜内型膀胱破裂的诊断意义较大;增强CT对腹膜外型膀胱破裂的诊断有价值.早期诊断、及时治疗是治愈的关键。
肾上腺素诱发无症状甲状腺功能亢进症患者室性纤维颤动一例
Authors: 尹芳, 王焱林, 宋学敏
Journal: BMJ (2012)

报道1例术中应用肾上腺素诱发无症状甲状腺功能亢进症患者室性纤维颤动的处理.术中急行气管插管、电除颤等处理后,患者恢复良好,甲状腺功能检查异常.需重视术前访视和术中监测,熟练掌握突发室颤的紧急处理。
An investigation on staff's opinions on community health services in Ganzhou City
Authors: 袁兆康, 周小军, 万红, 肖云昌, 操秋阳, 蔡燕玲, 邓大安, 洪定香
Journal: BMJ (2006)

目的 了解社区卫生服务机构职工对社区卫生服务的认识和看法.方法 选择赣州市章贡区的赣江、解放、南外3个社区卫生服务中心,用偶遇法从10个方面调查社区卫生服务机构职工的看法,用百分数法及评分法评价调查结果,用logistic回归分析探索影响总评分的因素.结果 职工对社区卫生服务的评价普遍较高,其中同事合作、进修态度、服务能力3项满意率分别为95.96%、90.91%、88.88%,而个人收入和职工收入2项满意率较低,分别为24.24%和43.43%.后勤人员对个人收入满意度差;后勤人员和高年龄组人员对培训进修积极性最低.结论 社区卫生服务机构职工对社区卫生服务的满意度较高.应引进各种激励机制、优化管理体制以提高职工的收入,以利于社区卫生服务可持续发展。
Colina 111 PET results in a nonmetastatic castration-resistant cancer (nmCRPC) in population that is negative by conventional imaging: True incidence from real-world evidence data.
Authors: Martin Pitzzu, Luciana Gennari, Norberto Olguin, Gustavo Jankilevich
Journal: Journal of Clinical Oncology (2020)

e17522 Background: Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC) is characterized by a rising prostate-specifing antigen (PSA) level, castrate testosterone levels,and no evidence of distant metastases by conventional bone scan and croos-sectional image of the chest,abdomen and pelvis. SPARTAN and PROSPER trials recently demonstrated metastasis free survival in patients with nmCPRC treated with apalutamide with androgen blockade therapy and enzalutamide respectively, Real incidence of nmCPRC in latinoamerican population is unknown. Therefore, patients with negative conventional imaging could be metastatic with PET use, fall the percentage of non metastatic setting PET Colina demonstrated improved sensitivity and specificity used for biochemically recurrent hormone – sensitive patients and staging advanced disease. Colina – PET performance in nmCPRC remain largely unknown and requires evaluation. In this study we examined the incidence of nmCPRC in an Argentinian population by conventional imaging studies and the impact of use of Colina Pet. Methods: Overall 300 patients from public and private insitutions were assessed. Real World Evidence Prostate cancer database were retrospectively screened for records of patients with nmCPRC. Results: Three hundred medical records of consecutive patients with prostate cancer were assessed. All patients were evaluated by multidisciplinary team Localized disease 214 patients and metastatic Prostate Cancer Castration Sensitive 86 patients. With a median a six years of median follow up, 43 patients developed Prostate Cancer Castration Resistant. Six patients showed nmCPRC criteria, in all of them Colina Pet was indicated. After PET colina 5 cases were positives and only one patient were negative. Conclusions: The incidence or nmCPRC is 0,02% in argentine cohort and drop out to 0,003% with PET use. Colina-PET detected loco-regional of M1 disease in nearly all patients with CPRC and no detectable metastasis by conventional imaging. Further epidemiologic with real world evidence data studies with cost-efective evaluations should be launched to put in context the rol of PET in this setting.
Phase Ib/II trial of tisotumab vedotin (TV) ± bevacizumab (BEV), pembrolizumab (PEM), or carboplatin (CBP) in recurrent or metastatic cervical cancer (innovaTV 205/ENGOT-cx8/GOG-3024).
Authors: Ignace Vergote, Nicole Concin, Mansoor Raza Mirza, Camilla Mondrup Andreassen, Domenica Lorusso, Christine N. Gennigens, Susana N. Banerjee, Roisin Eilish O'Cearbhaill, Susana Campos, Leonardo Viana Nicacio, Lamar Eaton, David M. O'Malley, Ibrahima Soumaoro, Bradley J. Monk
Journal: Journal of Clinical Oncology (2020)

TPS6095 Background: Patients (pts) with recurrent/metastatic cervical cancer (r/mCC) receive paclitaxel/platinum or paclitaxel/topotecan ± BEV as first-line standard-of-care therapy. Tissue factor (TF) expression has been associated with poor prognosis in solid tumors, and TF is highly expressed in r/mCC. TV is an investigational antibody-drug conjugate composed of a fully human, TF-directed monoclonal antibody covalently attached to the microtubule-disrupting agent monomethyl auristatin E (MMAE) via a protease-cleavable linker. Upon internalization, MMAE is released resulting in cell cycle arrest and apoptotic cell death. In pts with previously treated r/mCC, TV monotherapy (IV 2.0 mg/kg Q3W) demonstrated a manageable safety profile and encouraging antitumor activity (investigator-assessed confirmed ORR, 24%; median DOR, 4.2 mo) [Hong DS et al. Clin Cancer Res. 2019. doi: 10.1158/1078-0432.CCR-19-2962]. The preliminary safety and efficacy data for TV monotherapy suggest a positive benefit/risk profile and warrant further investigation of TV in combination with therapies commonly administered to pts with r/mCC. The global, open-label, phase Ib/II trial innovaTV 205/ENGOT-cx8/GOG-3024 (NCT03786081) evaluates the safety and antitumor activity of TV monotherapy and TV in combination with BEV, PEM, or CBP in pts with untreated or previously treated r/mCC. This abstract presents the new TV monotherapy weekly dosing schedule. Results from this study will inform the further clinical development of TV in the treatment of r/mCC. Methods: Approximately 170 adult pts with recurrent or stage IVB squamous, adenosquamous, or adenocarcinoma of the cervix; measurable disease; and ECOG PS 0-1 will be enrolled. The phase I part of the study will consist of 3 dose-escalation arms for identification of the recommended phase II dose (RP2D) of TV administered Q3W with BEV, PEM, or CBP. In this part, previously treated pts will receive escalating doses of TV (IV Q3W) in combination with escalating doses of BEV (IV Q3W), a fixed dose of PEM (IV Q3W), or a fixed dose of CBP (IV Q3W). The phase II part will include 4 expansion arms. In this phase, pts who have not received prior systemic therapy for r/mCC will receive 1) TV RP2D + PEM or 2) TV RP2D + CBP; pts who received 1-2 prior treatments for r/mCC will receive 3) TV RP2D + PEM or 4) TV monotherapy with weekly dosing (IV 3Q4W). The primary endpoint of phase II is ORR by RECIST v1.1. Secondary endpoints include DOR, time to response, PFS, OS, and safety. Clinical trial information: NCT03786081.
Initial correlative studies from a trial of cetuximab and pembrolizumab in metastatic colorectal cancer (mCRC).
Authors: Patrick M Boland, Jason Muhitch, Scott I Abrams, Orla Maguire, Hans Minderman, David Lawrence Bajor, Joel N. Saltzman, Katy Wang, Alan Hutson, Sarbajit Mukherjee, Renuka V. Iyer, Pawel Kalinski, Christos Fountzilas
Journal: Journal of Clinical Oncology (2020)

4062 Background: Cetuximab is an EGFR-targeting IgG1 mAb. Pre-clinical data suggests cetuximab induces CD8 + cytotoxic T-cell (CTL) infiltration of tumors. We hypothesized that augmentation of CTLs in the tumor microenvironment (TME) may provide the proper milieu for effective PD-1 inhibition in metastatic colorectal cancer (mCRC). We conducted a phase Ib/II study of cetuximab with the PD-1 antibody, pembrolizumab, in mCRC. Correlative blood and tissue samples were collected to assess the impact of this treatment on CTLs, as well as potential compensatory alterations in regulatory T-cells (Tregs) and suppressive MDSCs (NCT02713373). Methods: 3 week treatment cycles included pembrolizumab at 200 mg on day 1 and cetuximab 250 mg/m2 following the 400 mg/m2 loading dose. Tumor biopsies were obtained at baseline and at c4d1 (Day 64). Peripheral blood (PB) was drawn at baseline, c2d1 (day 22) and c4d1 (Day 64). Flow cytometry was performed within 24 hours with additional samples stored for future analysis. In the present analysis, we assessed changes in levels of the cellular populations of interest between cycle 4 and cycle 1. Results: Forty-two RAS-wt patients were enrolled through October 2019. Paired tumor tissues were successfully analyzed for 16 patients and PB for 38. Intratumoral CTLs (CD3 + CD8 + ) increased significantly (+47%, p &lt; .05). In PB, there was a slight overall decrease in PB CTLs (-5%, p = NS) and a significant decrease in CD8 + CD45RO + PD1 + cells (-42%, p &lt; .05). We saw simultaneous decreases in PD-1 + CTLs in the tumor and PB. There was a trend for increase in Tregs (CD4+ Cd25+ FoxP3+) in PB (+11%, p = NS), but an overall increase in the Teff:Treg ratio (+30%, p = NS). CD4 + CTLA4 + cells significantly increased (+37%, p &lt; .05). Granulocytic MDSCs (CD11b + CD14 − CD33 + HLADR − ) in PB decreased significantly on-treatment (-30%, p &lt; 0.5). The sample size and tissue limitations prohibited meaningful evaluation of tissue Tregs and MDSCs via the present methods. Conclusions: Cetuximab and pembrolizumab induced dynamic changes in the TME and PB. The treatment associated increase in intratumoral CTLs was particularly pronounced, consistent with their local expansion and/or influx. This was accompanied by a decrease in PB CTLs. Decreases in multiple PD-1 + lymphoid populations were observed in both tumor and PB, notably PD-1 + CTLs. Of note, we saw a synchronous increase in immunosuppressive CD4 + CTLA4 + T-cells in PB. Patient outcomes are pending maturation. Further analyses are planned, coupled with integration of clinical data. Clinical trial information: NCT02713373 .
Social Isolation and Loneliness in Older Adults—A Mental Health/Public Health Challenge
Authors: Dan Blazer
Journal: JAMA Psychiatry (2020)

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Practice-changing use of 21-gene oncotype DX breast recurrence score assay in a public hospital in Brazil: Results of 155 cases.
Authors: Andre Mattar, Guilherme Ribeiro Fonseca, Murilo Barato Agudo Romão, Jorge Yoshinori Shida, Monica Maria Agata Stiepcich, Debbie M Jakubowski, Calvin Y. Chao, Sergio C Oliveira, Luiz Henrique Gebrim
Journal: Journal of Clinical Oncology (2020)

e12518 Background: The 21-gene assay estimates risk of recurrence expressed as a Recurrence Score result between 0 and 100. The assay is clinically validated to predict chemotherapy (CT) benefit in node-negative (N0) and node-positive (up to three axillary nodes, N1) hormone receptor-positive (HR+) early-stage breast cancer (ESBC). The TAILORx study, which randomized 6711 women with N0 ESBC and Recurrence Score result 11-25 to hormonal therapy (HT) ± CT, demonstrated that patients older than 50 years derived no benefit from CT+HT, although younger patients with Recurrence Score result 16-25 may derive some benefit. The 21-gene assay has been incorporated in practice guidelines worldwide, based on evidence of clinical utility in N0 and N1 ESBC. We evaluated the impact of the 21-gene test on treatment decisions for patients with N0 and N1 ESBC at Sistema Único de Saúde in Brazil. Methods: Eligible patients were post-surgery with T1/T2 tumors, had HR+, HER2−, N0 or N1 ESBC, and were candidates for adjuvant systemic therapy. Treatment recommendations, CT+HT or HT alone, were captured before and after 21-gene test results. All patients were seen at Pérola Byington Hospital, a public hospital in São Paulo, Brazil. TAILORx results were used to guide decisions for or against CT for each patient. Results: From 08/2018 to 04/2019, 155 women were enrolled. Patient mean age was 57.6 years (29-78), 116 (75%) were postmenopausal, and 53 (34%) had N1 breast cancer. Based on clinical data alone, 151 patients had pre-assay recommendations of CT. Post-assay, 106 of 151 patients (70%) had changes in CT recommendation: 104 (69%) initially recommended CT received HT alone, and 2 (1%) initially recommended HT alone received CT+HT (Table). Using the modified Adjuvant!Online criteria for clinical risk classification, 109 of 155 patients (70%) had high risk, 48 (44%) of whom received CT. Of 46 patients with low clinical risk, 10 (22%) received CT. CT use trended with histologic grade: 11% with grade 1, 69% with grade 2, and 61% with grade 3. Most of our patients had tumor bigger than 2 cm (61%) with 8% bigger than 4 cm. Conclusions: The change in clinical practice at this public hospital was greater than expected: 69% of initial treatment recommendations were changed with the Recurrence Score result to omit CT. Clinicopathologic criteria did not correlate well with Recurrence Score results and did not identify those most likely to benefit from CT. A cost-effectiveness study is underway at our institution. [Table: see text]
成人社区获得性肺炎的致病菌及抗菌药物治疗
Authors: 赵鸣武
Journal: BMJ (2006)

在医院外罹患的感染性肺实质炎症为社区获得性肺炎(CAP).具有咳嗽、咳痰、发热,肺实变体征等临床表现和白细胞增高,胸部X线片有片状或斑片状阴影,并除外其他有关疾病者即可做出诊断,其中,胸部X线表现是确诊必须的条件。
Application of nerve stimulator for obturator nerve block in transurethral resection of bladder tumor
Authors: Shuaibin Wang, Tengfei Gu, Yunfan Bao
Journal: BMJ (2016)

Clinical data of 120 patients undergoing transurethral resection of the bladder sidewall tumors (TURBt) were retrospectively analyzed. Before TURBt the obturator nerve was blocked under the guide of the nerve stimulator in 46 cases (block group)and not blocked in 74 cases (unblock group). The incidence of obturator nerve reflex and bladder perforation in block group was significantly lower than that in unblock group(7% vs. 35%, P=0.000 and 0 vs. 19%, P=0.002, respectively). The operation time and the duration of bladder continuous saline irrigation after operation in block group were shorter than those in unblocked group [(32.2±12.5) vs. (43.2±24.5) min, P=0.001 and (8.9±6.4) vs. (13.3±10.8) h, P=0.013, respectively]. The efficiency value of TURBt in block group was better than that in unblock group [(5.8 ±3.9) vs. (9.3 ± 7.0) min/cm2,P=0.001]. The obturator nerve block guided by the nerve stimulator can improve the safety and the efficiency of TURBt.


Key words: 
Urinary bladder neoplasms; Obturator nerve
Prognostic markers for overall survival and outcome to LuPSMA radionuclide treatment in patients with metastatic castration-resistant prostate cancer.
Authors: Andrei Gafita, Jeremie Calais, Hui Wang, Manuel Weber, Hendrik Rathke, Clemens Kratochwil, Rouzbeh Esfandiari, Wesley R Armstrong, Shahneen Kaur Sandhu, Robert Tauber, Ebrahim Delpassand, Uwe Haberkorn, Wolfgang A Weber, Ken Herrmann, Johannes Czernin, Michael S Hofman, Wolfgang Peter Fendler, Matthias Eiber
Journal: Journal of Clinical Oncology (2020)

5548 Background: The aim of this international multicenter retrospective analysis was to identify prognostic markers for the clinical outcome in late-stage mCRPC patients treated with 177 Lutetium-prostate-specific membrane antigen (LuPSMA) radionuclide treatment. Methods: Patients with progressive mCRPC treated with LuPSMA at six centers in Germany, USA, and Australia were considered for inclusion. Eligible patients had 24 predefined, pretherapeutic covariates (demographics, prior mCRPC treatments, and PSMA PET/CT derived parameters) and survival data available. Endpoints included overall survival (OS) and PSA progression-free survival (PSA-PFS). Covariates were tested using univariate and mulitvariate proportional hazards regression Cox models. Results: 267/414 (64%) patients met inclusion criteria and were analyzed. 113 patients participated in clinical trials (ACTRN12615000912583, NCT03042312), while 154 were enrolled in compassionate-access programs. After a median follow-up of 22.5 months, median OS was 13.0 months (95%CI 11.6-14.4); 83% of the patients died. Median PSA-PFS was 4.0 months (95%CI 3.2-4.7). In the multivariate analysis, factors associated with shorter OS were: shorter time since diagnosis of prostate cancer (HR=2.04; p=0.002), lower number of prior systemic therapies (≤3; HR=1.56; p=0.006), prior exposure to chemotherapy (HR=1.42; p=0.05), lower hemoglobin levels (HR=1.13; p=0.002), higher number of lesions (≥20: HR=1.53; p=0.009), multiple sites of metastases (bone/LN only vs. bone + LN; HR=1.39; p=0.03) and visceral involvement (M1c) (HR=1.45; p=0.01). Factors associated with longer PSA-PFS were: longer time since diagnosis of prostate cancer (HR=0.44; p&lt;0.001), higher hemoglobin levels (HR=0.32; p=0.03), presence of pelvic lymph nodes (LN) metastasis (N1) (HR=0.68; p=0.01), no distant lymph node metastases (M1a) (HR=0.66; p=0.01), no skeleton involvement (HR=0.44; p=0.01), no visceral metastases (M1c) (HR=0.51; p&lt;0.001), higher PSMA-positive tumor volume (HR=0.87; p=0.04), and higher SUVmean (HR=0.94; p=0.002). Conclusions: This retrospective analysis identified prognostic factors for survival and treatment response to LuPSMA. Along with the conventional risk factors in mCRPC, PSMA PET/CT can be a useful tool for stratifying patients and guide patient’s selection for LuPSMA radionuclide treatment.
Tumor subtypes associated with prostate cancer (PCa) both as first and second primary tumors: A registry-based analysis.
Authors: Andrew Wellen, David J. Peace
Journal: Journal of Clinical Oncology (2020)

e17528 Background: First primary tumors (FPT) generally are associated with decreased survival and, thus, reduced risk of second primary tumors (SPT). A greater than expected incidence of SPT may indicate causal factors shared in common with a particular FPT, especially if the converse also is observed, i.e. if incidence is also greater than expected when tumor sequence is reversed. We analyzed the Surveillance, Epidemiology, and End Results (SEER) cancer registry to identify tumors with higher than expected incidence in relation to PCa, both as FPT and SPT. Methods: We searched the SEER18 cancer database covering 18 geographical regions of the U.S. from 2000 to 2016. SEER*Stat software v.8.3.6 was used to calculate standardized incidence ratios (SIR) of various SPT after defined FPT. SIR compare the incidence of a particular cancer within subsets of the registry population as a ratio to the expected incidence from a comparable matched group derived from the general population. 813,712 men with prostatic FPT (1° PCa) were included in the analysis for SIR of any SPT, while 2,554,835 men with any FPT were included in the analysis for SIR of prostatic SPT (2° PCa). Results were stratified by race and latency. Reciprocal SIR (1° PCa; 2° PCa) for values with p &lt; 0.05 are reported. Results: Aggregate analysis of all tumors demonstrated lower than expected SIR for SPT, both for any SPT after 1° PCa and for 2° PCa after any FPT (0.69; 0.53). By contrast, six tumor subtypes – small intestine (1.17; 1.19), melanoma (1.05; 1.23), bladder (1.14; 2.02), kidney (1.22; 1.36), thyroid (1.27; 1.36), and chronic myelogenous leukemia (1.10; 1.15) – had bidirectionally increased secondary SIR in relation to PCa. The reciprocal increases were detected across racial subgroups for bladder, kidney and thyroid cancers. SIR tended to be highest in the early post-FPT period (2-11 mo.) with significant increases for bladder (1.49; 6.75), kidney (2.66; 1.87), and thyroid (1.61; 1.65) cancers. These three tumor types retained bidirectional increases in relation to PCa over intermediate latencies (12-119 mo.), but not beyond 120 mo. Conclusions: Overall, FPT were associated with lower than expected incidence of SPT, most likely as a result of shortened life expectancy. However, several tumors were identified that 1). occurred with higher than expected incidence after 1° PCa and 2). were associated with higher than expected incidence of 2° PCa. Further examination of the relationship of these tumors with PCa may identify mutual intrinsic or extrinsic factors that contribute to tumor development.