tbuckley/cabot-search huggingface dataset:
Frequency and prediction of non-medical opioid use behaviors (NMOU) among advanced cancer patients referred to a supportive care center (SCC).
Authors: Sriram Yennu, Joseph Anthony Arthur, Suresh Reddy, Tonya Edwards, Zhanni Lu, Aline Rozman de moraes, Susamma M Wilson, Elif Erdogan, Manju P Joy, Shirley Darlene Ethridge, Leela Kuriakose, Jimi S. Malik, John M Najera, Saima Rashid, Yu Qian, Michal J Kubiak, Kristy Nguyen, Jimin Wu, David Hui, Eduardo Bruera
Journal: Journal of Clinical Oncology (2020)

12086 Background: One of the methodological barriers to conducting research on interventions for NOMU (Aberrant Opioid Use Behaviors) among cancer patients is the lack of data on the frequency of this problem. Although the frequency of risk factors has been established by our group and others, not all the patients with risk factors will be diagnosed with having NMOU behaviors, and some patients with no previous risk factors will engage in NMOU. AIM: To characterize the overall frequency of NMOU for a duration of 3 months, as well independent predictors for NMOU. Methods: In this retrospective study, 1558 consecutive patients referred to supportive care clinic (SCC) from 3/18/2016 to 6/6/2018 were reviewed for development of NMOU using established diagnostic criteria. Patients were eligible if they were ≥18 years, had a diagnosis of cancer, and were on opioids for pain for at least a week. All patients were assessed with the Edmonton Symptom Assessment Scale (ESAS), SOAPP-14, and CAGE-AID. Descriptive statistics, spearman correlation coefficient, multivariate analysis were performed. Results: 299 patients (19%) had ≥1 NMOU behavior. The median (IQR) NMOU behavior was 1 (1-2); range 1-10. Most NMOU occurred at 1 st and 2 nd follow up visits. The most frequent NMOU behavior was unscheduled clinic visit for inappropriate refills. 29/299 (10%) NMOU patients received specialized care for high-risk for aberrant opioid misuse by interdisciplinary team. Results of multivariate logistic regression model showed Marital status (Divorced vs. Married, OR=1.47, 95% CI: 0.98, 2.22, p=0.654 (marginally significant); Single vs. Married, OR=1.68, 95% CI: 1.15, 2.46, p=0.0079), SOAPP (Positive vs. Negative, OR=1.42, 95% CI: 1.05, 1.93, p=0.0238), morphine equivalent daily dose (MEDD) (OR=1.004, 95% CI: (1.003, 1.006), p&lt;0.0001) and ESAS pain (OR=1.11, 95% CI: 1.06, 1.17, p&lt;0.0001) were independently associated with the presence of NMOU during follow-up visits. Conclusions: 19% cancer patients followed at SCC had detectable NMOU behaviors. Being single, SOAPP+, pain severity and high MEDD were independent predictors for NMOU. This information will assist clinicians and investigators designing clinical and research programs in this important field.
Diagnostic Value of 123-I-MIBG Cardiac Scintigraphy for the Prediction of Conversion from Idiopathic REM Sleep Behavior Disorder to Dementia with Lewy Bodies, and the Differential Diagnosis of Neurodegenerative Diseases
Authors: Seto Makiko, Nakata Ruka, Yuasa Takayuki, Nakao Yoko, Ichinose Katsuhiro, Tomita Itsuro, Satoh Hideyo, Satoh Akira, Ochi Makoto, Kondo Hideaki, Tsujihata Mitsuhiro
Journal: Alzheimers Disease & Dementia (2017)

The purpose of this study was to investigate the diagnostic availability of cMIBG in differentiating Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB) from related Neurodegenerative Diseases (NDDs) and to clarify the utility of cMIBG as a predicative biomarker for the conversion from Idiopathic REM Sleep Abnormal Behavior Disorder (iRBD) to α-synucleinopathies.
Utilizing a novel four-drug regimen to reduce the incidence of infusion-related reactions for first-dose rituximab infusions: An institutional review of rituximab infusion-related reactions in lymphoma patients.
Authors: Trace Bartels, Logan Moore, Daniel Oscar Persky, Abhijeet Kumar, Ivo Abraham, Ali McBride
Journal: Journal of Clinical Oncology (2020)

e19148 Background: Rituximab is a chimeric monoclonal anti-CD20 antibody utilized in the treatment of several disease states including B-cell non-Hodgkins Lymphoma. Infusion-related reactions (IRR) with rituximab occur with an incidence of up to 77% during the first infusion. The occurrence of an infusion reaction adds to the cost and time of rituximab administrations, especially with prolonged chair time and increased nursing and physician support, and decreased quality of life. The University of Arizona Cancer Center (AZCC) initiated a four-drug premedication regimen consisting of dexamethasone, famotidine, diphenhydramine, and acetaminophen. Our study examined the frequency of first-dose rituximab infusion reactions with our premedication regimen as compared to other published regimens. Methods: A retrospective chart review for all first-dose rituximab infusions was conducted for lymphoma patients treated with BR or RCHOP regimens from 11/2013 through 6/2019 at the AZCC. Data points collected included baseline patient demographics as well as rituximab infusion data. Results: In our study, the median age of the patient population was 64 years (range 22-89), 60.5% were males, and the average BSA was 2 m 2 (range 1.39-3.04). The average rituximab dose was 750 mg (range 521-1140) and the average infusion time was 301 minutes (range 197-512). IRR with first time Rituximab was seen in 19 patients out of 81 total patients (23.5%). Of these IRR, 52.6% occurred in BR versus 47.4% in RCHOP. The most frequent IRR symptoms seen included flushing, itching, feeling hot, and tingling. The average infusion time for IRR patients was 334 minutes versus 284 minutes in patients not experiencing IRR. Grade 2 reactions were reported in 14 patients (73.7%) with grade 3 IRR’s reported in 5 patients (26.3%). Onset of IRR occurred on average during the first 61.6 minutes of the start of infusion (range 10-108 minutes). Conclusions: A novel four drug premedication regimen consisting of corticosteroids, antihistamines H2RA antatagonist and analgesic, resulted in a much lower rituximab infusion reaction rate (23.5%) than what has been previously reported in literature using standard premedications ( &gt; 50%). The utilization of this four drug combination therapy provides the means to reduce first dose rituximab IRR in patients while maximizing patient care and increasing the number of patients who were able to receive Rapid Rituximab during their next cycle of chemotherapy.
物理检查在医学教育中的地位
Authors: 陈牧雷, 梁金凤, 王世鑫
Journal: BMJ (2007)

科技发展日新月异,各种临床诊疗新技术不断涌现,传统物理检查手段的重要性不禁受到质疑,年轻医生床旁诊疗的技能水平正在逐步退化.现阶段是否还有必要强调物理检查,要求临床医生精于物理检查呢?
A dedicated lung cancer immunotherapy outpatient clinic: The first experience in China.
Authors: Chongrui Xu, Hai-Yan Tu, Yueli Sun, Yang-Si Li, Bing-Fei Xu, Bin-Chao Wang, Hua-Jun Chen, Zhen Wang, Qing Zhou, Jin-Ji Yang, Chanchan Li, Yi-Long Wu
Journal: Journal of Clinical Oncology (2020)

e14022 Background: Immunotherapy (IO) has become the fourth pillar of clinical cancer care. There is an increasing need to the treatment of more patients for a longer period with acceptable cost and risk. We here described the development and operationalization of the first dedicated lung cancer IO outpatient clinic in China using an iterative process. Methods: The clinic is staffed by one attending physician, one medical oncologist, several nurses, and medical assistants along with a dedicated care coordinator. Patients (pts) were scheduled to visit every Thursday morning for the treatment and then visit every 2-4 weeks as per IO regimen. Written informed consent were obtained after well-informing about the IO and possible side-effects, and administration of self-purchased drugs. The minimum workup including routine general physical examinations or tests along with tests specific for IO, and toxicities was undertaken during the clinic visits. Treatments response, adverse events (AE), quality of life (QOL), and patient reported outcomes were measured/reviewed by the oncologist accordingly (CTCAE 5.0, RECIST 1.1, and iRECIST criteria). Pts can report their symptoms and be noticed/alerted during the clinic visits or between visits via electronic interfaces. All these data were integrated into the EMR database (LinkDoc) and valued as continuous documentation to support clinical decisions making, so as to improve clinical symptom management and overall QOL. Also, the pts were coached about possible symptoms and corresponding self-monitoring and management strategies. A standardized workflow was established, as well as staff education and training programs. Results: During May to December 2019, 99 pts presented at our IO clinic, and 79 received IO therapy (46 pembrolizumab, 32 nivolumab, and 1 camrelizumab). Pts on average received 3 cycles (Total: 280; range 1-11 cycles). AE were noted in 57 (72.2%) pts. All pts were well. Conclusions: This study demonstrates that our dedicated lung cancer IO clinic worked well. Therapeutic alliance of IO clinics has already been established with primarily 15 hospitals participated in. The design process and standardized workflow components will be further expanded to other cancers or conditions.
A case series of central nervous system tuberculoma in patients with systemic lupus erythematosus
Authors: Lin Liu, Min Shen, Qian Wang, Dong Xu, Li-dan Zhao, Jin-mei Su, Jing Li, Xue Lin
Journal: BMJ (2013)

Objective
To review the clinical features of systemic lupus erythematosus (SLE) patients with central nervous system (CNS) tuberculoma.


Methods
The medical records of 8 SLE patients with CNS tuberculoma, who were admitted to Peking Union Medical College Hospital from January 2009 to January 2012, were reviewed in this retrospective study.


Results
CNS tuberculoma occurred averagely 39 months after immunosuppressive therapy with an incidence of 0.45% in SLE patients. These patients had an average SLEDAI score less than 5, and their minimal maintenance dose of prednisone was 15 mg/d. Fever (7/8), headache (5/8), motion and sensory disorder (5/8) were the most common symptoms of CNS tuberculoma in SLE patients, and one patient had temporary seizure with loss of consciousness. Cerebrospinal fluid pressure and protein level of these patients increased significantly, while white blood cells were mostly normal or mildly elevated. Gadolinium-enhanced MRI revealed specific ring-like masses in all cases. Other organs infected with tuberculosis occurred in all of them. They all received anti-tuberculosis drugs and one had additional cerebral operation. Seven patients were followed for (20±9) months and all recovered.


Conclusions
CNS tuberculoma usually occurred in non-active SLE patients receiving long-term immunosuppressive therapy, with atypical clinical manifestations and cerebrospinal fluid changes. Enhanced MRI showed ring-like masses which were specific for diagnosis of CNS tuberculoma. Early diagnosis and effective anti-tuberculosis therapy contributes to a benign prognosis.


Key words: 
Lupus erythematosus, systemic; Central nervous system; Tuberculoma
院内缺血性卒中16例临床分析
Authors: 姜春莉, 沈迎建, 荣维君
Journal: BMJ (2007)

院内卒中是指非卒中原因住院患者在住院期间发生的卒中,以缺血性为主,出血性少见,可分为医源性和院内自然卒中,前者与治疗有关,后者与患者自身疾病及伴发高危因素相关.因卒中发生在住院期间,容易引发医疗纠纷.现将我院近十年来诊治的16例院内缺血性卒中病例的病因、临床特点进行分析,查找不足,以降低医源性卒中的发生。
Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: Final analysis of AGO DESKTOP III/ENGOT-ov20.
Authors: Andreas Du Bois, Jalid Sehouli, Ignace Vergote, Gwenael Ferron, Alexander Reuss, Werner Meier, Stefano Greggi, Pernille Tina Jensen, Frederic Selle, Frederic Guyon, Christophe Pomel, Fabrice Lecuru, Rongyu Zang, Elisabeth Avall-Lundqvist, Jae-Weon Kim, Jordi Ponce, Francesco Raspagliesi, Sadaf Ghaem-Maghami, Alexander Reinthaller, Philipp Harter
Journal: Journal of Clinical Oncology (2020)

6000 Background: The role of secondary cytoreductive surgery in recurrent ovarian cancer (ROC) has been under debate for decades. A recent trial in unselected patients (pts) failed to show an OS benefit. Methods: Pts with ROC and 1st relapse after 6+ months (mos) platinum-free interval (TFIp) were eligible if they presented with a positive AGO-score (PS ECOG 0, ascites ≤500 ml, and complete resection at initial surgery) and were prospectively randomized to second-line chemotherapy alone vs. cytoreductive surgery followed by the same chemotherapy; platinum combination therapy was recommended. OS was primary endpoint in this superiority trial. Results: 407pts were randomized 2010-2014. The TFIp exceeded 12 mos in 75% of pts. 206 pts were allocated to the surgery arm of whom finally 187 (91%) were operated. A complete resection was achieved in 75%; almost 90% in both arms received a platinum-containing second-line chemo. Primary endpoint analysis showed median OS of 53.7 mos with and 46.2 mos without surgery (HR 0.76, 95%CI 0.59-0.97, p=0.03); median PFS was 18.4 and 14 mos (HR: 0.66, 95%CI 0.54-0.82, p&lt;0.001), median time to start of first subsequent therapy (TFST) was 17.9 vs. 13.7 mos in favor of the surgery arm (HR 0.65, 95%CI 0.52-0.81, p&lt;0.001). An analysis according to treatment showed an OS benefit exceeding 12 mos for pts with complete resection (CR) compared to pts without surgery (median 60.7 vs. 46.2 mos); pts with surgery and incomplete resection even did worse (median 28.8 mos). 60 d mortality rates were 0 and 0.5% in the surgery and no-surgery arm. Re-laparotomies were performed in 3.7% of operated pts. Further grade 3/4 adverse events did not differ significantly between arms. Conclusions: This is the first surgical study demonstrating a meaningful survival benefit in OC: Surgery in pts with first relapse and TFIp of 6+ mos and selected by a positive AGO-Score resulted in a significant increase of OS, PFS and TFST with acceptable morbidity and, therefore, should be offered to suitable pts. The benefit was exclusively seen in pts with CR indicating the importance of both the optimal selection of pts (eg. by AGO score) and of centres with expertise and a high chance of achieving a CR. Clinical trial information: NCT01166737.
Mast cells positive to c-kit receptor and to tryptase in normal to cancer pancreatic tissue and the correlation with angiogenesis.
Authors: Carmelo Laface, Michele Ammendola, Valeria Zuccalà, Francesco Luposella, Nicola Zizzo, Rosa Patruno, Mariangela Porcelli, Cosmo Damiano Gadaleta, Marco Tucci, Girolamo Ranieri
Journal: Journal of Clinical Oncology (2020)

e16502 Background: In the last years published studies demonstrated that mast cells (MCs) contain pro-angiogenic factors associated with tumoral angiogenesis. Tryptase is the most abundant and potent pro-angiogenic substance contained in MCs secretory granules and it can be released in tumour microenvironment. Up to now few data have been published on the role of MCs in angiogenesis in both pancreatic ductal adenocarcinoma cancer tissue (PDACT) and adjacent normal tissue (ANT). Methods: In this study MCs density positive to C-Kit receptor (MCDP-C-KitR), MCs density positive to tryptase (MCDPT), MCs area positive to tryptase (MCAPT), angiogenesis in terms of microvascular density (MVD) and endothelial area (EA) were evaluated by immunohistochemistry and image analysis in both PDACT and ANT. All tissue samples were obtained from 45 patients with stage T 2-3 N 0-1 M 0 (by AJCC for Pancreas Cancer Staging 7 th Edition) who had undergone surgery. For each analyzed tissue parameter mean ± standard deviation was evaluated in both PDACT and ANT and differences were evaluated by Student t-test. Each analysed tissue parameter was then correlated each other by Pearson t-test analysis. Results: The mean value ± standard deviation (SD) regarding MCDP-C-KitR, MCDPT, MCAPT, MVD and EA in TT was 14.69±4.57, 13.31± 4,23, 171.41±62,39 µ 2 , 29.11±7.93, 201.82±70.05 µ 2 respectively and the mean value ± SD in ANT was 5.61 ± 2.39, 5.13 ± 2.03, 54.43 ± 16.73 µ 2 , 11.45 ± 4.96, 67.60 ± 21.96 µ 2 , respectively. Differences in terms of mean value ± SD between PDACT and ANT were significant for each analyzed tissue biomarker (p ranged from 0,001 to 0,004 by t-test analysis; Table). Data demonstrated that MCDP-C-KitR MCDPT, MCAPT, MVD and EA significantly increased from ANT to PCT. In PCT it was showed a correlation between MCDP-C-KitR and MCDPT (r = 0.87, p = 0.01), MCDP-C-KitR and MVD (r = 0.74, p = 0.02), MCDP-C-KitR and MCAPT (r = 0.81, p = 0.01), MCDPT and MVD (r = 0.72, p = 0.02), MCD-C-KitR and EA (r = 0.73, p = 0.02), MCDPT and MCAPT (r = 0.85, p = 0.01), MCAPT and MVD (r = 0.76, p = 0.02), MCAPT and EA (r = 0.66, p = 0.03), MCDPT and EA (r = 0.69, p = 0.03), MVD and EA (r = 0.82, p = 0.01). Conclusions: Our data suggest that assessed tissue parameters increased from ANT to PDACT and that MCs are associated with angiogenesis in PDACT. On this basis inhibition of MCs by tyrosine kinase inhibitors such as masitinib or inhibition of tryptase by gabexate mesylate may be a novel antiangiogenetic approach in pancreatic cancer therapy.
Abstract 8: Influence of Receiving Hospital Characteristics on Survival after Cardiac Arrest
Authors: Clifton W Callaway, Rob Schmicker, Mitch Kampmeyer, Judy Powell, Graham Nichol, Thomas D Rea, Mohamud Daya, Tom Aufderheide, Dan Davis, Jon Rittenberger, Ahamed H Idris
Journal: Circulation (2008)

Hospital management of out-of-hospital cardiac arrest (OHCA) patients after return of spontaneous circulation (ROSC) can influence patient survival via interventions such as hypothermia and cardiac catheterization (CATH). This study tested the hypothesis that survival differed between different types of hospitals for subjects with ROSC after OHCA. Methods: Adult (≥ 18 years) subjects with paramedic-documented ROSC or who lived &gt;1 day after OHCA were identified with their receiving hospital in a prospective database from 9 regions in the US and Canada. Hospitals were characterized using the American Hospital Directory or the Guide to Canadian Healthcare Facilities. Hospitals were categorized by bed number (large &gt;400; medium 250 – 400; small &lt;250) and CATH capability. Associations between clinical variables, hospital categories, survival time, and survival to hospital discharge were determined using Cox regression and analysis of variance. Results: Between December 2005 and July 2007, 3644 OHCA subjects were treated in 254 hospitals, with similar numbers in large (1026), medium (1094) and small (1276) hospitals. CATH hospitals treated 2123 (58%) subjects, and patient features (63% male, 42% VF/VT, 67% witnessed collapse, and mean call-arrival interval of 5.7 (SD 2.8) minutes) did not differ between hospital categories. CATH hospitals had higher survival than non-CATH hospitals in large (35.1% vs. 27.7%), medium (34.4% vs. 30.7%) and small (38.6% vs. 26.5%) categories (F=19.55; p&lt;0.001). VF/VT (p &lt; 0.001), age (p &lt; 0.001) and witnessed collapse (p &lt; 0.001) were associated with survival time. When adjusted for initial rhythm, call-arrival interval, witnessed collapse, age, sex, region, teaching institution, and trauma center level, there was no significant effect of CATH. However, the interaction of large hospital and CATH was associated with lower hazard of death (0.71, 95% CI [0.54, 0.93]). Conclusions: Transport to a CATH hospital is associated with increased probability of survival to discharge after OHCA. These data cannot determine whether cardiac catheterization was performed or if CATH hospital is a surrogate for more comprehensive cardiac care. Therefore, further work should examine what aspects of in-hospital care affected outcome.
Short-term training workshop of mini-clinical evaluation exercise for community general practitioner trainers
Authors: Qian Chen, Zhi-gang Pan, Shan-zhu Zhu
Journal: BMJ (2013)

Objective
To assess the effect of short-term training workshop of mini clinical evaluation exercise (mini-CEX) for community general practitioner (GP) trainers.


Methods
Thirty six community GP trainers received half-day training workshop of mini-CEX on September 2012. The GP trainers were interviewed with questionnaire before and after the training program and their video scores were analyzed.


Results
47%(17/36) of GP trainers knew of and briefly understood mini-CEX before the training. 42%(15/36) of them had a rough idea of how to use it but nobody had used it before. All of these trainers hoped to know how to carry out mini-CEX. The vast majority of GP trainers completely or basically understood the standards of evaluation for 7 items of mini-CEX after the training. The accurate rate of 1 item was close to 50% in 9-point scale and 5 items exceeded 50% in 3-rank system. There was significant difference in accurate rates of 4 items between two scoring system (all P<0.01).


Conclusions
Community GP trainers recognize the advantage of mini-CEX and have intention to apply it for evaluation of clinical skills in training. The results of short-term intensive workshop are satisfactory, but more training for rating system and practice are necessary.


Key words: 
General practitioner; Teacher training; Mini clinical evaluation exercise
Quantification of immune cell-mediated destruction of tumor cells <i>in vitro</i> using the RNA disruption assay.
Authors: Isabella Pascheto, Laura B Pritzker, Aseem Kumar, Amadeo Mark Parissenti
Journal: Journal of Clinical Oncology (2020)

e15017 Background: Immune checkpoint inhibitors (ICIs) are increasingly being used in the treatment of human cancers, often in combination with cytotoxic chemotherapy drugs. However, current ICIs are costly and are only effective against a fraction of patient tumours. Thus, a tool that could reliably quantify tumour response to ICIs and predict outcome post-treatment would be highly valuable. Patients with non-responding tumours could be spared the costs and toxic side-effects of the ineffective drugs and moved promptly to alternate treatments. We have observed that a variety of structurally and mechanistically distinct chemotherapy agents induce the degradation of ribosomal RNA (rRNA) into a large number of high molecular weight fragments (between the 28S and 18S rRNAs)---a phenomenon we have termed “RNA disruption”. High tumour RNA disruption during treatment, as quantified using the RNA disruption assay (RDA), has been shown to predict pathologic complete response and improved disease-free survival in breast cancer patients. Methods: To assess whether RDA could be used to monitor immune cell killing of tumour cells, we collected peripheral blood mononuclear cells (PBMCs) from consenting healthy human donors and enriched the cell population for natural killer (NK) cells to 90% using a negative selection approach. The cells, with or without IL-2 pre-treatment, were incubated with K562 cells, after which K562 cell killing was quantified over time using a standard immunocytotoxicity assay and K562 cell RNA disruption was measured using RDA. Results: Freshly isolated human NK cells when incubated with K562 chronic myeloid leukemia cells induced cell destruction and RNA disruption in K562 cells in a dose-dependent manner. Pre-incubation with IL-2 augmented both NK cell-mediated RNA disruption and NK-mediated cytotoxicity in K562 cells. Interestingly, the pattern of K562 RNA disruption fragments generated by NK cells was similar to that generated by chemotherapy drugs. Conclusions: RDA was successfully used to quantify immune cell-mediated destruction of tumour cells, raising the prospect of its possible use to monitor tumour destruction by immune cells in vivo and to predict response to ICIs (alone or in concert with cytotoxic chemotherapy drugs).