tbuckley/cabot-search huggingface dataset:
Clinical utility of germline genetic testing after tumor genomic testing in colorectal cancer patients.
Authors: Nhu Ngo, Stephen E Lincoln, Kingshuk Das, Daniel Esteban Pineda Alvarez, Shan Yang, Scott T. Michalski, Sarah M. Nielsen, Edward D. Esplin, Robert Luke Nussbaum
Journal: Journal of Clinical Oncology (2020)

e16089 Background: Practice guidelines support genomic and biomarker testing of colorectal cancer (CRC) to inform treatment options in advanced disease and to screen for MMR deficiency/MSI/Lynch syndrome. As yet, guidelines for follow-up germline testing are not well established. In 2019 ESMO recommended reflex germline testing when pathogenic variants (PV) were found in any of 27 cancer susceptibility genes (CSG) in tumor samples (PMID 31050713). The CSGs were chosen because PV in these genes were clinically actionable and had “germline conversion rates” (GCR) of &gt; 10% (proportion of tumor-detected PV that were germline). We examined the utility of germline testing in a cohort of CRC patients who had prior tumor sequencing. Methods: We reviewed somatic &amp; germline PV in an unselected consecutive series of CRC patients who were referred for germline testing and had prior tumor testing. We determined the GCR for genes with pathogenic germline variants (PGV) and compared our results to ESMO data. Results: 66 of 238 (27%) patients harbored PGV. 15% of PGV were not reported in the tumor assay. High GCR for BRCA1/2 (30%), MMR genes (40%), PALB2 (57%), and BRIP1 (67%) were in keeping with ESMO. Low GCR for APC (1.4%) and TP53 (3%) were similar to ESMO, and reflective of high somatic mutation rates in these genes. We noted high GCR for CHEK2 (75%) and ATM (24%), two genes not included in ESMO guidelines due to their intermediate penetrance. Conclusions: ESMO guidelines provide a key starting point for when reflex germline testing should be pursued after tumor testing. In our study 27% (65/238) of patients had PGV that conferred potential eligibility for targeted therapy or clinical trials. For CRC, finding PV in MMR genes, BRCA1/2, and other relevant CSGs should prompt follow-up germline testing. In cases with APC PV in tumor, ESMO recommended reflex germline testing only in patients &lt; 30 yo, where the GCR was &gt; 10%. Our study suggests that reflex germline testing after tumor sequencing yields clinically actionable results. [Table: see text]
Material, psychological, and behavioral financial hardship and prostate cancer treatment type.
Authors: Reginald Tucker-Seeley, Weizhou Tang, Colony Brown, Jamie Bearse
Journal: Journal of Clinical Oncology (2020)

e19013 Background: A prostate cancer diagnosis can have a significant financial impact on the family; and, the various treatment options present a variety of economic consequences. Treatments can present short- and long-term sequelae leading to additional therapies, and the costs for the household can vary depending on the type of treatment received. Cancer survivorship research has shown that many survivors experience financial hardship following diagnosis. Financial hardship has recently been conceptualized in cancer survivorship research across three domains: material, psychological, and behavioral. The material domain refers to the lack of financial resources (e.g. material hardship), the psychological domain refers to how one feels about the lack of financial resources (e.g. financial worry), and the behavioral domain captures the financial adjustments made in response to a lack of financial resources. The purpose of this study was to investigate the association between the material, psychological, and behavioral domains of financial hardship and the type of prostate cancer treatment received. Methods: The prostate cancer non-profit organization, ZERO - The End of Prostate Cancer, conducted an online “Prostate Cancer Education Survey” to determine information needs among individuals diagnosed with prostate cancer (N = 1,000). We used bivariate tests and simple and adjusted multivariable logistic regression models to test the association between financial hardship and the type of treatment received. Results: The results revealed no statistically significant differences across the treatment types for material hardship. Patients who received chemotherapy and primary hormone therapy had higher odds (OR = 1.84; CI: 1.01-3.33) of reporting psychological hardship compared to those reporting active surveillance/watchful waiting; and those reporting active surveillance/watchful waiting had higher odds (OR = 1.50; CI: 1.07-2.11) of reporting psychological hardship compared to those reporting surgery. Patients who received chemotherapy also had higher odds (OR = 2.52; CI: 1.30-4.88) of reporting behavioral hardship compared to those reporting active surveillance/watchful waiting treatment. Conclusions: Explicating the material, psychological, and behavioral correlates of prostate cancer treatment types provides greater specificity for potential intervention targets where programs can be designed for reducing specific types of financial hardship following prostate cancer diagnosis and during survivorship.
General practioners are "the first-line guardsmen" in prevention and treatment of chronic kidney disease
Authors: 郑法雷, 章友康
Journal: BMJ (2007)

国际肾脏病学会和国际肾脏基金联合会2006年联合提出倡议,将每年3月份的第2个星期四定为世界肾脏日[1],是要在全世界敲起警钟,以唤起人们对慢性肾脏病(chronic kidney disease,CKD)的关注[1-2]。
Impact of US population demographic changes on projected incident cancer cases from 2019 to 2045 in three major cancer types.
Authors: Jimmy Nguyen, Pavel Napalkov, Nicole Richie, Stella Arndorfer, Marko Zivkovic, Andy Surinach
Journal: Journal of Clinical Oncology (2020)

e19044 Background: The United States (US) Census Bureau has forecasted an unprecedented shift in the US demographics by 2045, in which there will be no single majority race/ethnicity. Due to well-characterized health disparities among different races/ethnicities in oncology and projected demographic changes, it is of interest to assess changes in the burden of three most frequent cancers: breast cancer (BC) for women, prostate cancer (PC) for men, and colorectal cancer (CRC) for both genders between 2019 and 2045. Methods: Historical age-adjusted rates (AARs) for BC in women, PC in men, and CRC in patients of all ages and stratified by race/ethnicity were collected from the SEER 18 database for 2000-15 period. AARs for cancers of interest were analyzed in Joinpoint Regression Program to obtain an average annual percent change (AAPC) for 2000-15. AARs were then projected to 2045 by assuming the rate behavior is equal to the AAPC. Projected absolute cases per 100,000 were generated by multiplying projected AARs with the associated projected population, retrieved from the US Census Bureau 2017 National Population Projects, and dividing by 100,000. The absolute change in projected patient numbers of cancer cases by race/ethnicity were assessed between 2019 and 2045. Results: From 2019 to 2045, a decrease of 4% is expected in the White Non-Hispanic (WNH) population while the Black (B), Hispanic (H), and Asian/Pacific Islander (API) populations are projected to increase 24%, 54%, and 57%, respectively. In the same time period, the projected number of BC incident cases for women of all ages decreased by 1% in WNH while the B, WH, and API populations were projected to increase 72%, 98%, and 120%, respectively. In both genders of all ages, a 39% and 17% reduction in the number of CRC incident cases in the WNH and B is expected compared to a 61% and 11% increase in the WH and API populations, respectively. Given observed reduction in PC incidence, especially in men 65+, the number of incident PC cases is projected to decrease by 2045 for all included races/ethnicities. Conclusions: Among racial and ethnic minorities, an increase in the number of BC and CRC cases is expected between 2019 and 2045. Projected decrease in PC cases is likely a result of decrease in incidence rates between 2010 and 2015 and should be assessed as new data become available. Currently, racial and ethnic minorities comprise &lt; 20% of patients enrolled in clinical trials, demonstrating the need to understand biologic and social underpinnings of disparities in clinical outcomes in underrepresented groups.
MGMT methylation as a prognostic factor in IDH wild type anaplastic gliomas.
Authors: Enrico Franceschi, Alicia Tosoni, Vincenzo Di Nunno, Antonella Mura, Sofia Asioli, Annalisa Pession, Raffaele Agati, Alexandro Paccapelo, Stefania Bartolini, Alba Ariela Brandes
Journal: Journal of Clinical Oncology (2020)

2523 Background: Anaplastic gliomas are classified according to the presence of IDH-mutation. IDH wild type (IDH wt) is associated with poor prognosis and limited effectiveness of treatments.The aim of this study was to find out if MGMT methylation represents a prognostic factor in this setting. Methods: Anaplastic gliomas are classified according to the presence of IDH-mutation. IDH wild type (IDH wt) is associated with poor prognosis and limited effectiveness of treatments.The aim of this study was to find out if MGMT methylation represents a prognostic factor in this setting. Results: The analysis included 73 pts with grade III, IDH wt (19.3%) gliomas. Median follow-up time was 69.9 months. Median age was 50 (Range: 18-75), M/F ratio was 40(54.8%)/33(45.2%).MGMT promoter was methylated in 34 pts (46.6%) and unmethylated in 39 pts (53.4%). After surgery, 9 pts (12.3%) received RT alone, 57 pts (78.1%) received both RT and CT (sequential, concomitant or both). Median survival was 26.2 months. In multivariate analysis age (HR = 1.064, 95%CI: 1.030-1.099; P &lt; 0.001) and MGMT methylation (HR = 0.422, 95%CI: 0.210-0.848; P = 0.015) were independently associated with risk for death. Conclusions: IDH wild type confers a dismal prognosis in patients with grade III gliomas. MGMT methylation, as was demonstrated in glioblastoma, represents a prognostic factor that correlated with lower risk for death. Further studies will investigate potential correlations with treatments.
食管黏膜管型撕脱症三例诊治分析
Authors: 孙广智
Journal: BMJ (2009)

例1 患者男,32岁.因胸骨后隐痛、烧心、恶心、呕吐2d于1999年5月13日来院就诊.共呕吐2次,第1次为胃内容物,第2次带少量鲜血,量约5 ml,无黑便,末治疗,要求胃镜检查.胃镜见胃窦部为慢性浅表性胃炎,十二指肠球及降部未见异常,贲门以上食管至距离门齿20 cm一段食管表面黏膜缺失,食管肌层暴露,表面粗糙,无光泽,食管腔内光线灰暗,无渗血。
治疗肱骨髁上骨折137例
Authors: 高学峰, 朱付兰
Journal: BMJ (2005)

肱骨髁上骨折是小儿常见骨折之一,占肘部骨折的60%～70%,肘内翻是其常见并发症,其发生率为3.3%～79.2%,平均30%.目前尚无统一的预防方法[1].我院自1997年1月至2003年5月共收治肱骨髁上骨折患者137例,分别采用手法整复、手术、骨牵引及电视X线下闭合穿针治疗,现报告如下。
Glycogen storage disease typeI complicated with hepatocellular carcinoma:a case report and literature review
Authors: Zong-wen Ban, Chong-mei Lu
Journal: BMJ (2009)

Objective To summarize and analyze clinical characteristics of glycogen storage disease (GSD)typeⅠcomplicated with hepatocellular carcinoma to improve clinical recognition to it.Methods First case of GSD type Ia complicated with hepatocellular carcinoma(HCC)in China was reported and another 14 cases with detailed clinical data reported in literatures were reviewed in this paper.Results The case was man at age of 19 with chief complaint of hepatic mass founded casually.For all the 15 cases(other 14 from literature reports),mean age at diagnosis of HCC was 32.3 years and average time interval from diagnosis of GSD to diagnosis of HCC Was 23.1 years,as compared to 23.3 years and 14.6 years,respectively in three cases with both hepatitis B virus(HBV)and hepatitis C virus(HCV)seropositive.Serum level of alpha fetoprotein(AFP)was elevated in six patients.Tumor could be located at all lobes of the liver and mainly in the right lobe(eight of 15 cases),with varied size and solitary or multiple tumor.Conclusions Symptoms in GSD typeⅠcomplicated with HCC Was latent at onset.and AFP measurement was questionable in its diagnosis.It is important that physicians should keep more alert to risk of HCC in patients with GSD for its early diagnosis.

Key words: 
Glycogen storage disease,type I; Carcinoma,hepatocellular
Three versus six months of adjuvant chemotherapy for colorectal cancer: A multi-country cost-effectiveness and budget impact analysis.
Authors: Catherine Hanna, Jose Antonio Robles-Zurita, Robert J. Jones, Kathleen Boyd
Journal: Journal of Clinical Oncology (2020)

7076 Background: The international Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority and significantly less toxicity of 3 versus 6 months of adjuvant chemotherapy for patients with colorectal cancer (CRC). This study assesses the value of shorter treatment and the economic implications of implementing the findings from the perspective of the countries that participated in the SCOT trial. Methods: Individual patient level data (n=6055) from the SCOT trial was used in a fully-pooled, cost utility analysis for the six participating countries. The incremental net monetary benefit (INMB) per patient was calculated using a willingness to pay threshold of one Gross Domestic Product per capita for each country. Responses to a clinician questionnaire (n=265 across 21 countries collected in April 2019) were used to estimate extent of practice change. The budget impact over 5 years of using shorter treatment was calculated, using 2019 and US dollars (USD) as the base year and currency, respectively. Results: Cost drivers for differences between the SCOT trial arms were reduced chemotherapy costs and fewer hospitalisations in the first treatment year. The INMB per patient of using shorter treatment and subsequent monetary impact on healthcare provider budgets resulting from implementation are shown in Table. This is a cost saving treatment strategy in all countries. The budget impact over 5 years amounts to savings of nearly half a billion USD. Conclusions: The economic burden of CRC treatment globally exceeds $39 billion per annum. Understanding the costs and consequences of widespread clinical practice change is important for optimal budget planning. This study has widened the transferability of results from a phase III cancer trial, showing shorter treatment is cost-effective from a multi-country perspective. The vast savings could provide benefit elsewhere within a limited healthcare budget, and justify the investment in conducting the SCOT trial. [Table: see text]
小儿肺炎或胸膜炎误诊为急性阑尾炎12例
Authors: 张秋现
Journal: BMJ (2004)

1998年1月～2002年12月共误诊小儿肺炎并/或胸膜炎为急性阑尾炎而施行手术12例. 1.临床资料:12例中男性7例,女性5例.年龄2～12岁.其中右下叶肺炎7例,左下叶肺炎1例,右下叶肺炎并发胸膜炎2例,右侧结核性胸膜炎2例(含包裹性积液1例).发病至入院时间12 h～6 d.12例均有右下腹痛、腹肌紧张,麦氏点压痛11例,可疑反跳痛6例,发热9例,咳嗽、咯痰4例,恶心、呕吐3例,胸闷1例.血常规白细胞总数及中性升高者10例.首诊行胸片检查者4例,其中肋膈角浅钝1例,肺纹理粗乱2例,正常1例.住院至确诊3～6 d.12例中9例行单纯非特异性抗感染治疗而愈,1例行非特异性抗感染并抽胸水1次而愈,余2例行抗结核治疗并抽胸水2～4次而愈.住院时间10～30 d。
Abstract 15773: Pulmonary Arterial Compliance Can Differentiate Exercise-Induced Pulmonary Hypertension Due to Pulmonary Vascular Disease versus Left-Heart Disease
Authors: C. Danielle Hopkins, John Wells, Stephen Mathai, Ryan J Tedford, Steven Hsu
Journal: Circulation (2019)

Background: Invasive cardiopulmonary exercise testing (iCPET) can unmask early pulmonary hypertension (PH) not detectable at rest (exercise-induced pulmonary hypertension, or EIPH). However, differ...
Community rehabilitation service based on "integrated general-specialty" model
Authors: Yuan Zhang, Rong Chen, Fuliang Zhang, Shuying Peng, Huixian Zhu
Journal: BMJ (2019)

In order to provide quality rehabilitation care for patients in the hierarchical medical service system, a joint rehabilitation team of general practitioner and specialists from secondary and tertiary hospital was formed in Shanghai Xujiahui Community Health Service Center, and the community rehabilitation has been implemented with integrated general-specialty model. This article introduces the characteristics, structure, service contents and advantages of the integrated general-specialty rehabilitation service mode, also presents suggestions for solving the existing problems of the mode.


Key words: 
Community health services; Rehabilitation; Combination of general practice and specialty
利奈唑胺治疗金黄色葡萄球菌心内膜炎并发脑膜炎和多发脓肿一例
Authors: 张敏, 余宏
Journal: BMJ (2009)

患者男,52岁,农民,因反复发热3周于2007年9月23日入住我院.3周前无明显诱因出现头痛、发热.入院查体:体温39℃,心率130次/min,血压98/60 mm Hg(13.1/8.0 kPa),呼吸21次/min;双下肺闻及少量湿啰音;心界不大,心尖区闻及全收缩期吹风样杂音;除颈抵抗阳性和凯尔尼格征阳性(单纯脑膜刺激征)外,其他神经系统检查均无异常.9月24日血常规结果:白细胞7.6×109/L,分类中性粒细胞0.81,血红蛋白119 g/L.9月25日脑脊液检查结果示:外观清亮无色,压力180 mm H2O(1.76 kPa),白细胞15×106/L,糖5.5 mmol/L,蛋白650 mg/L,氯化物119.3 mmol/L,培养5 d未见细菌生长,考虑与标本留取量较少有关。
须癣毛癣菌所致脓癣八例临床分析
Authors: 李发增, 冉玉平, 代亚玲, 何晓丹, 倪均
Journal: BMJ (2007)

结合8例脓癣患儿的临床表现和致病真菌的形态学鉴定结果进行综合分析.结果 示8例脓癣患儿病发、皮损直接镜检均阳性,经鉴定致病菌为须癣毛癣菌;口服伊曲康唑或特比萘芬,辅以外用药物治疗后临床痊愈.提示确诊须癣毛癣菌引起的脓癣后,应用这些药物能达到治愈,无副作用。
The use of a chatbot based on artificial intelligence to collect patients reported outcomes in oncology practice. A pilot study with real-world data.
Authors: Munir Murad Junior, Arthur Nascimento, Alexandre Fonseca De Castro, Lilian Paiva, Amandio S. Fernandes, Luiz Adelmo Lodi
Journal: Journal of Clinical Oncology (2020)

e19119 Background: There is growing interest in enhancing symptoms monitoring during routine cancer care using patient-reported outcomes (PROs). The quality of evidence that demonstrates clinical benefits of this type of assistance is also increasing. However, the best method for this approach is evolving and there are many barriers to implement these tools in the real world scenario. We aim to describe a pilot study about a chatbot with artificial intelligence developed to collect PROs and to optimize adherence to systemic cancer treatment. Methods: This is a case series that reports the first patients in a private oncology clinic in Belo Horizonte, Southeast Brazil who consecutively underwent regular conversations with a chatbot based on artificial intelligence. Data was collected from February the 23 th to December the 3 rd 2019. The virtual assistant interacted with the patient in four different ways, being the first three of these an active search from the chatbot: a) search for adverse events, b) adherence to oral treatment c) screening for depression d) spontaneous patient demand (not an active search). Results: Interaction with the chatbot was offered to 193 patients. A total of 107 patients were included. Of these 74% were female, 55% older than 60 years and 22% had at least 7 years education.194 protocols of treatment were analysed, 66% of these being chemotherapy regimens and 23% hormone therapy. Oral drugs corresponded to 23% of the protocols. The main adverse events reported were fatigue 20%, nausea 13%, pain 11%, diarrhea 10%, lack of appetite 6%. Adverse effects were classified by patients as grade III or IV approximately 24% of the time. For patient safety the system runs a script twice a day to detect any adverse effect and send it to the service attended. A total of 3883 dialogues were initiated, the majority of which (3772) was carried out by the machine. Only 3% of the dialogues were spontaneously initiated by the patients. Once the conversation started, adherence was considerably satisfactory since engagement was 73% for questions about adherence to oral medications and 76% of people reported at least one adverse event. Conclusions: An initial barrier must be surpassed since the chatbot was offered to 193 patients and 86 (44%) did not register for use. Once the contact started, we understand that the use of AI is promising since the engagement rates were very good. It is important to highlight the potential capacity for early identification of symptoms since most dialogues were initiated by the virtual assistant.
THE PROPOSED AMENDMENT TO THE HARRISON NARCOTIC LAW
Journal: JAMA (1921)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
感染性心内膜炎致混合性卒中一例
Authors: 吉万霞, 信宏, 张琦玮, 朴明淑
Journal: BMJ (2005)

患者,男,35岁.因发热、咳嗽、头痛、视物障碍1个半月入院.入院前1个半月因着凉后出现发热、咳嗽、咽痛,自服感冒药,病情无好转,体温升至39℃,并出现视物模糊.到当地医院查:双侧扁桃体Ⅱ度肿大,有脓点,左侧视野同向偏盲,心肺无异常,其他神经系统检查正常.头CT检查示右侧枕叶出血,头部MRI检查未见异常;凝血功能检查正常.手术清除血肿,并抗感染、止血、降颅压治疗.但仍发热,颈胸部皮肤出现出血点,体温最高达40℃,血常规白细胞25×109/L.血培养出金黄色葡萄球菌,敏感药为左氧氟沙星、苯唑青霉素、庆大霉素等.诊断为败血症,给予敏感抗生素治疗15 d,体温降至37.5℃左右,白细胞数正常.为进一步治疗来我院.既往健康。
Impact of organ function based standard exclusion criteria in diffuse large b-cell lymphoma (DLBCL) patients: Who gets left behind?
Authors: Arushi Khurana, Raphael Mwangi, Grzegorz S. Nowakowski, Thomas Matthew Habermann, Stephen M. Ansell, Betsy LaPlant, Brian K. Link, James Robert Cerhan, Matthew J. Maurer, Thomas E. Witzig
Journal: Journal of Clinical Oncology (2020)

e14100 Background: Only 3-5% of adult cancer patients in the US enroll in clinical trials. Patients with organ dysfunction are often excluded from clinical trials, regardless of specific drug metabolism or relative function of the organ. The ASCO and the US FDA recommend modernizing criteria related to baseline organ function and comorbidities. In hematological malignancies, often the disease itself is the reason for organ function derangement. In order to better inform clinical trial eligibility and improve participation in the future, we evaluated the impact of baseline organ function on the potential eligibility for clinical trial enrollment for real world patients with newly diagnosed DLBCL. Methods: Consecutive, newly diagnosed lymphoma patients were offered enrollment from 2002-2015 into the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence. This analysis is based on 1270 DLBCL patients receiving immunochemotherapy. Baseline organ function parameters were identified from the exclusion criteria for hemoglobin, absolute neutrophil count (ANC), platelet count, creatinine, and bilirubin reported in recent frontline trials in DLBCL (Table). Abstracted clinical labs from the MER were used to determine the percent of patients that would be excluded based on the criteria. Results: We determined that 11-23% of MER DLBCL patients receiving standard of care frontline therapy would have been excluded in the various trials utilizing baseline organ function alone (Table). Hemoglobin and renal function had the greatest impact on exclusion. Conclusions: Current national and international (phase II and III) trials are excluding up to 23% of patients from clinical trial participation based on organ function alone in DLBCL. These data will be useful in future clinical trial development to meet ASCO recommendations to increase trial accrual, while balancing the drug toxicities and patient safety. An online tool was developed based on these results to aid future trial development. [Table: see text]