tbuckley/cabot-search huggingface dataset:
Is targeting circulating T blood cells a therapeutic option for vitiligo?
Authors: T.R. Matos
Journal: British Journal of Dermatology (2020)

Linked Article: Martins et al. Br J Dermatol 2020; 183:899–908. Vitiligo is an autoimmune depigmenting skin disorder that results from the loss of melanocytes due to an altered proportion and/or function of effector and regulatory T cells.1, 2 More specifically, the T-helper/cytotoxic T-cell (Th)1/(Tc)1 immune response is affected by an increased production of interferon (IFN)-γ and tumour necrosis factor (TNF)-α. In this issue of the BJD, Martins et al. reaffirm the role of Th1 and Tc1 cell subsets in vitiligo disease and its production of both IFN-γ and TNF-α.3 Furthermore, their results show that the frequency of CD4+ and CD8+ circulating Th17/Tc17, Th1/Th17 and Tc1/Tc17 effector memory T-cell subsets is significantly lower in patients with vitiligo (both with stable and active disease) and psoriasis, in comparison with healthy donors. These findings suggest a possible migration of distinct T-cell subsets from the blood into the skin. The same authors have previously shown that vitiligo perilesional skin is imprinted with pathogenic CD8+ resident memory T cells (TRM).4 Future studies should investigate which blood memory T-cell subsets ultimately differentiate into vitiligo-pathogenic TRM cells. Many studies on patients with vitiligo focus exclusively on patients with active disease. However, Martins et al.3 show that the same immune response is found in the blood of patients with active and stable disease. Previous studies have shown the presence of TRM cells in vitiligo skin,4-6 which are likely involved during flares, as previously shown in psoriasis.7 The precise role of circulatory Th1/Th17, Tc1/Tc17 and Th17 cells and the production of interleukin (IL)-17 in patients with vitiligo remains unclear. Studies have shown increased IL-17 expression both in blood and perilesional skin of patients with vitiligo,8 and serum level of IL-17 correlated with disease activity,9 while other studies have observed a similar frequency of IL-17-producing CD4 and CD8 T cells in vitiligo skin and skin from unaffected individuals.4 A single-arm pilot study using secukinumab showed that directly targeting the IL-17 pathway is not a reliable strategy in vitiligo.10 The work of Martins et al.3 raises important questions, such as whether pathogenic IFN-γ-producing cells also secrete IL-17 in patients with vitiligo or whether the IL-17 production is a consequence of the activation of Th1/Th17 or Tc1/Tc17 cells. Together, these findings indicate that targeting blood-specific T-cell subsets that migrate into the skin of patients with vitiligo could prevent the flare of the disease. Nevertheless, further studies will have to elucidate which circulating skin-homing T-cell subsets truly cause the cutaneous changes seen in patients with vitiligo.
Cancer patients’ perceptions of physicians who use an integrated electronic health record (EHR) approach during clinic visits: A double-blinded randomized clinical trial (RCT).
Authors: Ali Haider, Ahsan Azhar, Kimberson Cochien Tanco, Syed Mussadiq Ali Akbar Naqvi, Margeaux Epner, Akhila Sunkepally Reddy, Janet L. Williams, Jimin Wu, Eduardo Bruera
Journal: Journal of Clinical Oncology (2020)

e24201 Background: Our previous RCT found that cancer patients prefer and positively perceive physicians who communicate face-to-face as compared to using the EHR. However, the use of EHR in the examination room remains a practical necessity. Based on the existing literature, our team developed a simple and very short intervention to integrate the EHR into the encounter, which includes optimal positioning of the computer, a proper introduction to the computer, effective time management for data-entry while maintaining patient-physician interaction and use of the EHR as a tool to enhance patient education. Methods: In this double-blind, crossover RCT, 120 patients with advanced cancer were enrolled between April 1, 2019, and September 15, 2019. Our objectives were to compare patients’ perceptions of physicians’ compassion, communication skills, professionalism, and patients’ overall physician preference after watching 2 standardized scripted-video vignettes of physicians: one portraying the use of a standard EHR approach and the other portraying use of an integrated EHR approach. Both actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. After viewing each video, patients completed validated questionnaires rating their perception of the physician’s compassion (0 = best, 50 = worst), communication skills (0 = poor, 70 = excellent) and professionalism (0 = poor, 20 = very good). Patients were also asked to rate their overall physician preference. Results: After watching the first video, the integrated EHR, compared to the standard EHR, resulted in better scores for physician compassion (median [interquartile range], (5[0-10] vs 12[4-25]; P = .0009), communication skills (69[63-70] vs 61[50-69]; P = .0026) and professionalism (20[18-20] vs 18[14-20]; P = .0058). The majority of cancer patients preferred an integrated EHR physician as their provider (70[58%] vs 21[18%], P &lt; 0.0001). Patients with college or an advanced degree had a 5 times higher chance of preferring an integrated EHR physician ( P &lt; 0.0171). Conclusions: Cancer patients perceived physicians who used an integrated EHR approach as more compassionate, professional, and with better communication skills. Moreover, they preferred an integrated EHR physician to be their provider. Integrated EHR has the potential to improve communication in oncological settings. Clinical trial information: NCT03856060 .
The impact of high intensity interval training on functional performance, body composition and quality of life in a diverse group of cancer survivors.
Authors: Jennifer Lynn Beebe-Dimmer, David Finlay, Julie J. Ruterbusch, Tara Baird, Michael S. Simon, Judith Abrams, Felicity W. K. Harper
Journal: Journal of Clinical Oncology (2020)

12057 Background: Given the well-documented benefits of regular exercise to cancer survivors, in 2012, an expert panel assembled by the American Cancer Society recommended that patients engage in at least 150 minutes per week of moderate-to-vigorous physical activity. However, few patients meet this goal. We have also observed racial differences in reported participation in regular exercise among cancer survivors living in Metropolitan Detroit, Michigan. Methods: The CAPABLE study is a 12- week pilot exercise intervention that introduces cancer survivors to the sport of CrossFit. We evaluated the impact of this unique, high-intensity interval training method on functional performance, cardiovascular endurance, body composition and health-related quality of life (HRQOL) as measured by the Functional Assessment of Cancer Therapy (FACT) instrument. All measures were summarized at baseline and program exit. Paired signed rank tests were used to assess change in each of these measures over time. Results: Of the 48 participants enrolled in the pilot, 37 (77%) were considered adherent to the program (attending at least 75% of sessions over the 12-week period). The mean age of participants was 58.5 years, 73% identified as African American and the majority of participants were breast cancer survivors (N = 20). The mean body mass index (BMI) at baseline was 32.8 kg/m 2 decreasing to a mean of 31.7 kg/m 2 at exit (BMI change -1.1, p &lt; 0.001). Similar changes were observed in % body fat measured by bioelectrical impedance. There were significant improvements in all measures of functional performance over 12-weeks (all p &lt; 0.001). We observed significant and meaningful improvements in reported HRQOL measured by the FACT survey, overall (FACTG total change +9.5 (p &lt; 0.001)) and in each one of the individual domains (physical, social, emotional, and functional well-being). Conclusions: We observed significant improvements in performance, body composition and quality of life among cancer survivors introduced to a high-intensity interval training program. Understanding and eliminating barriers to programs like these are critical to improving outcomes and reducing cancer health disparities. Clinical trial information: NCT03750981 .
Bosutinib (BOS) for chronic phase (CP) chronic myeloid leukemia (CML) after imatinib (IMA) failure: ≥8-y update of a phase I/II study.
Authors: Tim H. Brümmendorf, Jorge E. Cortes, Yeow Tee Goh, Musa Yilmaz, Rebecca B. Klisovic, Simon Purcell, Andrea Viqueira, Eric Leip, Carlo Gambacorti-Passerini
Journal: Journal of Clinical Oncology (2020)

7549 Background: BOS is approved for newly diagnosed CP CML and CML resistant/intolerant to prior therapy. In a phase I/II study, BOS showed durable efficacy and manageable toxicity in patients (pts) with CP CML after IMA failure. We report an ≥8-y update of this phase I/II and ongoing extension study. Methods: Pts with CP CML resistant/intolerant to IMA (CP2L) or IMA + dasatinib and/or nilotinib (CP3L) or with accelerated/blast phase (AP/BP) CML or Philadelphia chromosome+ acute lymphoblastic leukemia with prior tyrosine kinase inhibitor (TKI) therapy (ADV) received BOS starting at 500 mg/d. Results: 54/284 (19%) CP2L pts were still on BOS after ≥9 y and 8/119 (7%) CP3L and 5/167 (3%) ADV pts after ≥8 y; 61 CP2L pts discontinued BOS since y 5 and 21 CP3L and 12 ADV pts since y 4. Overall, the most common reason for discontinuation was disease progression/lack of efficacy in CP2L (27%), CP3L (42%) and ADV (50%) pts; last dose before discontinuation was ≥500 mg/d in 59 (21%), 28 (24%) and 46 (28%) pts, respectively. In CP2L pts, median (range) of follow-up was 54 (1–155) mo, treatment duration 26 (&lt;1–155) mo and dose intensity 438 (87–599) mg/d; responses were durable (Table) and overall survival (OS) at 9 y was 74% vs 84% at 5 y. OS at 8 y was 69% in CP3L, 54% in AP CML and 23% in BP CML pts vs 78%, 59% and 23% at 4 y. 55 CP2L, 29 CP3L and 98 ADV pts died on study (10, 3 and 2 since the 4/5-y reports); 15, 5 and 3 had on-treatment transformations to AP/BP. Most common new treatment-emergent adverse events since y 5 in CP2L pts were pleural effusion (n=13), arthralgia (n=12) and increased blood creatinine (n=11). Conclusions: After ≥8 y, BOS continued to show durable efficacy and no new safety signals in pts with CP CML on long-term treatment, providing further support for BOS use after prior TKIs. Clinical trial information: NCT00261846 and NCT01903733 . [Table: see text]
Identifying burnout in young oncologists: The sooner the better.
Authors: Elena Elez, Annabel Cebria, Joaquim Bosch-Barrera, Cotes Almudena, Fernando Gálvez Montosa, David Paez, Maria Teresa Quintanar Verduguez, Avinash Ramchandani Vaswani, Jacobo Rogado Revuelta, Manuel Sánchez Cánovas, Enrique Sanz-Garcia, Josep M Miquel, Encarnación González Flores, Álvaro Rodríguez-Lescure, Ruth Vera
Journal: Journal of Clinical Oncology (2020)

11010 Background: Professional burnout is an important issue for the healthcare systems with potentially relevant consequences in the quality of patient care. Young oncologists are a special risk population, due to high workload, academic pressure and other specific factors related to cancer care. Work life and lifestyle factors are related with burnout levels and may define specific interventions to reduce and prevent burnout. Methods: A survey based on the validated Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS MP) was conducted. Additional questions to explore work life and lifestyle factors were included. We studied potential burnout amongst young Spanish oncologists (residents and oncologist in the first 5 years of professional performance). Statistical analyses, including linear regression, were carried out to test the relations between overall burnout score and work and lifestyle factors. Results: We obtained 243 responses to the survey. The sample was representative in terms of age, sex, geographic region, professional profile (residents and young oncologists) and a homogeneous distribution per year of residence (final participation rate was of 26.6%). Regarding 5 Burnout profiles, 32.1% of the participants were classified as Ineffective, 25.1% as Burnout, 21% as Engaged, 17.3% as Overextended and 4.5% as Disengaged. Percentage of Burnout profile is higher in medical oncology residents (28.24%) than in young oncologists (19.79%). The highest percentage of burnout profile was observed in the second-year residents (35,71%) and gradually decreases, in parallel to an increase in the engaged profile. The multivariable linear regression analysis showed a significant correlation between not having a good work life balance and adequate vacation time and the burnout score. Conclusions: Burnout affects a significant number of young oncologists with significantly different profiles and differences across regions. Adapted interventions to the most frequent profiles and at different stages of the training and professional career may be necessary particularly at the early beginning. Actions towards achieving a better work and personal life balance and stress management could be effective. These results are the basis for the prospective part of our study that aims to design an intervention and to assess its efficacy in this population.
中心静脉导管行心包穿刺引流10例分析
Authors: 陈康, 郑新玲
Journal: BMJ (2005)

关于常规心包穿刺术操作的风险一直有争议,其严重并发症发生率高达11.4 %～20.0 %[1].我们于2003年1月至11月对10例心包积液的住院患者采用中心静脉留置管行心包穿刺置管引流,效果较好。
Health-related quality of life (HRQOL) burden in patients with relapsed/refractory diffuse large B-cell lymphoma (RR-DLBCL) and non-Hodgkin’s lymphoma (RR-NHL).
Authors: Vincent Lin, Bhagyashree Oak, Julia Snider, Josh Epstein
Journal: Journal of Clinical Oncology (2020)

e20070 Background: CAR T therapy is being investigated as 2 nd line therapy in RR-DLBCL. To evaluate its impact on patients’ HRQOL, it is essential to understand the HRQOL of patients receiving current standard of care (SOC) therapy for DLBCL and NHL patients. Methods: A systematic literature review (SLR) of studies reporting HRQOL in RR-DLBCL patients was conducted in March 2019 (updated to include RR-NHL in May 2019) using EMBASE, MEDLINE, Cochrane (all from 2007), Northern Light and International Society for Quality of Life Research abstracts (both from 2017). A targeted literature review (TLR) for untreated or 1 st line patients was conducted in July 2019 using PubMed. Search terms included diseases, lines of therapy and patient-reported outcome (PRO) measures. Abstracts and publications were screened for eligibility and data were extracted. Results: Of the 977 publications screened for the SLR, 26 met the inclusion criteria. Another 18 studies were included from the TLR. The most commonly used PRO measures were the SF-36 (10 studies), EORTC QLQ-C30 and FACT-Lym (8 studies each). The EORTC QLQ-C30 showed statistically significant or clinically meaningful changes in a greater number of domains (86%) than the FACT-Lym (75%) and SF-36 (62%). Additional results in table. Conclusions: While research is limited, RR-DLBCL patients receiving current SOC therapy report decreases in HRQOL and health utility. Further research is needed on how existing and future therapies may affect HRQOL among RR-DLBCL patients. [Table: see text]
シェーグレン症候群,気管支拡張症に合併したAustrian Syndromeの1例 | 文献情報 | J-GLOBAL 科学技術総合リンクセンター
Authors: 本田健, 平野能文, 公受伸之, 石橋豊, 徳丸睦, 小谷暢啓, 菅森峰, 國澤良嗣, 高橋伸幸, 坂根健志, 佐藤秀俊, 吉冨裕之, 若林景子, 安達和子, 島田俊夫
Journal: Circulation (2007)
老年人的视力减退
Authors: 杨晓慧
Journal: BMJ (2012)

我国老年人口规模庞大,老龄化速度快,随着年龄的增加,视力残疾的患病率逐渐增加,花费在治疗及康复方面的费用明显增加.因此,通过对老年人视力残疾的病因、老年人常见眼病的筛查、治疗以及预防的掌握,对老年人常见眼病做出正确判断,并通过早期发现、转诊治疗、健康教育等方法才能更好地维护老年人的视力。
A randomized controlled trial of video-education or in-person genetic counseling for men with prostate cancer (ProGen).
Authors: Huma Q. Rana, Jill E. Stopfer, Nancie Petrucelli, Diane R. Koeller, Sara Pirzadeh-Miller, Brian Reys, Lindsay Kipnis, Samantha Culver, Donna Rachel Vatnick, Rebecca Silver, Joanna Mercado, Rebecca Sue Gelman, Michelle Weitz, Virginia Speare, Jill S. Dolinsky, Elisabeth I. Heath, Theodora Suzanne Ross, Kevin Dale Courtney, Judy Ellen Garber, Mary-Ellen Taplin
Journal: Journal of Clinical Oncology (2020)

1507 Background: Approximately 10% of men with advanced prostate cancer (PC) have pathogenic/likely pathogenic variants (PV) in cancer susceptibility genes and their identification may lead to targeted therapy. Genetic testing (GT) can also guide cancer surveillance and prevention for family members. While GT is recommended for men with potentially lethal PC, traditional testing models are strained, and access limited. The ProGen study examined a novel pretest model aimed at providing access to GT while promoting informed consent. Methods: Inclusion criteria were: potentially lethal PC (metastatic, localized with Gleason score ≥8, rising/persistent PSA after local therapy), diagnosis age ≤ 55 years, prior malignancy, family history suggestive of a PV and/or at oncologist’s discretion. Consented subjects from 3 sites were randomized 3:1 to video education (VE) or in-person genetic counseling (GC). Subjects who consented to GT had 67 genes analyzed (Ambry, USA) with results disclosed by telephone by a genetic counselor. Outcomes included GT uptake, PV prevalence, and survey measures of satisfaction, distress, genetics knowledge, family communication, and impact on cancer care (obtained at the time of intervention, and at 1, 4, and 12 months after result disclosure). Two-sided Fischer exact tests were used for between-arm comparisons. Results: Over a 2-year period: 662 subjects were randomized, VE or GC were completed by 604 subjects (VE: 93.1%, GC: 88.8%) of whom 596 subjects (VE:98.9%, GC:97.9%) consented to GT. To date, 591 subjects have completed GT (VE: 99.3%, GC: 98.6%). At the time of intervention, most subjects agreed or strongly agreed that their assigned arm was useful (VE: 95%, GC: 88%). Differences were not statistically significant. Notably, 84 PV were identified in 78 subjects (13.2%), with BRCA1/2 PV accounting for 32% of subjects with a positive result ( BRCA2:21, BRCA1:4). Conclusions: In this randomized trial, both novel VE and traditional GC yielded high GT uptake without significant differences in outcome measures of acceptability and satisfaction. VE enabled access to critical GT results while maintaining the core tenants of informed consent. PV were found in 13.2% of subjects, 32% of whom had BRCA1/2 PV. Analysis of collected survey data to inform strengths and limitations of VE as compared with pretest GC will be presented. Clinical trial information: NCT03328091.
Patient-reported and clinician-rated performance status and general health among women with gynecologic cancers on palliative chemotherapy.
Authors: Hanneke Poort, Embree Thompson, Gang Lu, Nancy Lynn Keating, Ursula A. Matulonis, Susana M. Campos, Neil S. Horowitz, Margaret Dinardo, Kenzie Carlson, Jukka-Pekka Onnela, Alexi A. Wright
Journal: Journal of Clinical Oncology (2020)

e24128 Background: Oncologists’ perceptions of patients’ performance status (PS) and general health are key determinants of eligibility for chemotherapy and clinical trials. We sought to examine correlations between patient-reported and clinician-rated Eastern Clinical Oncology Group PS (ECOG-PS) and general health status (EQ5D) in women with incurable recurrent gynecologic cancers, as well as step counts from accelerometry as a proxy for objective PS. Methods: We used baseline data from a randomized trial evaluating a mobile health intervention that collects patient-reported outcomes and passive smartphone data and provides tailored symptom management advice. Half of participants also received a wearable accelerometer. We calculated Pearson correlations to determine agreement between ECOG-PS and EQ-5D assessments in patient-clinician dyads. We also calculated the median (IQR) step counts among a subset of women with ≥7 days of ≥8 hours wear time. Results: Data from 78 patient-clinician dyads demonstrated a moderate correlation between patient-reported and clinician-rated ECOG-PS (r = .47; P&lt; .000). Among dyads, 38 (49%) had perfect agreement; 36 (46%) had higher patient-reported ECOG-PS, indicating more patient-reported functional limitations, compared with clinician reports; and 4 (5%) had lower patient-reported ECOG-PS. Comparisons between patient-clinician ratings of EQ-5D subscales indicated moderate agreement for mobility (r = 0.44; P&lt; .001), pain/discomfort (r = 0.45; P&lt; .001), and usual activities (r = 0.36; P= .002); and weak or no agreement for anxiety/depression (r = 0.31; P= .007) and self-care (r = 0.02; P&gt; .05). Participants’ daily step counts varied widely (median = 5,511 steps, IQR = 3,784, range 1,736-13,961) and were not associated with patients’ or clinicians’ ECOG-PS estimates (r = -.12; P= 0.44 and r = -0.03; P= 0.84) or patient-reported mobility (r = -0.10; P =0.51). Conclusions: Among women with incurable gynecologic cancers, patients’ and clinicians’ perceptions of patients’ ECOG-PS were moderately correlated, although 46% of clinician ratings were more optimistic than patients’ ratings. There was also moderate agreement between dyads for mobility and pain/discomfort. Patients’ step counts were not correlated with ECOG-PS or patient-reported mobility. Future studies should examine these measures longitudinally to determine which is the most sensitive predictor of clinical outcomes. Clinical trial information: NCT03022032 .
常见舌疾病
Authors: 刘宏伟
Journal: BMJ (2011)

舌是构成口腔的重要器官之一,也是口腔黏膜最易发生病变的部位,它能十分灵敏地反映机体的很多变化,并有感觉、触觉、温度觉以及特殊的味觉.由于活动性强,舌常常受损伤[1].常见的舌部变化有地图舌、沟纹舌、毛舌、镜面舌、草莓舌和牛肉舌.这六种表现都是舌发生病理改变时的肉眼形象外观,就让我们从它们入手,了解其然。
Abstract 12236: Cardiopulmonary Exercise Testing in Aortic Stenosis Patients Before and After Aortic Valve Replacement
Authors: Carl Bellander, Éva Tamás, Eva Nylander, Kristofer Hedman
Journal: Circulation (2018)

Introduction: Cardiopulmonary exercise testing (CPET) has been shown to be prognostic for several heart diseases including the natural course of aortic stenosis (AS). Due to the gradual progression...
社区耐甲氧西林金黄色葡萄球菌感染并急性粟粒性肺结核一例
Authors: 林存智, 朱新红, 田红, 蒋捍东, 孙勇
Journal: BMJ (2012)

患者女,17岁,于2008年6月8日无明显诱因咳嗽,少量黄痰,发热伴寒战,体温38～ 39℃,无盗汗、咯血.当地卫生院胸部X线平片示双侧下肺絮状、细小的粟粒样病灶,双上肺纹理清晰(图1),初步诊断为社区获得性肺炎,给予阿奇霉素静脉滴注,0.5g/d,治疗7d后,不见好转,于6月14日上午转到青岛市市立医院,急诊胸部X线平片提示双下肺部阴影,隐约可见粟粒样阴影(图2).血气分析:PaO253 mm Hg(1 mm Hg =0.133 kPa),PaCO2 29.9 mm Hg,pH值7.542,血钾2.6 mmol/L.提示呼吸衰竭(Ⅰ型)伴呼吸性碱中毒、低血钾,疑诊为急性粟粒性肺结核并重症肺炎、呼吸衰竭并呼吸性碱中毒. 关键词：社区获得性感染