tbuckley/cabot-search huggingface dataset:
Clinicopathologic profile of extramedullary plasmacytoma in Central Valley.
Authors: Salimah Valliani, Mohamad Barakat, Harinder Gill, Jerome Okudo, Haifaa Abdulhaq, Mohammed SANI Bukari
Journal: Journal of Clinical Oncology (2020)

e20551 Background: Extramedullary Plasmacytoma (EMP) occurs when neoplastic plasma cells cross the bone cortex to the surrounding soft tissue or spread hematogenously to other organs. The incidence rate of isolated plasmacytoma is reported to be 2-5% of plasma cell neoplasm. The skeletal system, head and neck are common organs involved. Our study evaluates the clinicopathologic characteristics of patients with EMP, with or without multiple myeloma (MM) in Central Valley, California. Methods: This is a retrospective review of 354 patients diagnosed with plasma cell dyscrasias, from January 2000 to January 2018. 33 patients had pathologically confirmed EMP and were evaluated for clinicopathologic data. Results: The incidence rate of EMP during the study period was 9%. Of the 33 patients diagnosed with EMP, 26 (78%) were associated with MM. The mean age at diagnosis was 62.6 years with no significant difference in mean age at diagnosis between patients with isolated EMP and EMP with MM (p = 0.23). Of the 33 patients, 11 (36.7%) were Hispanic, 11 (36.7%) were Caucasian whilst the rest constitute other minorities. This mirrored the 2010 population profile of the county. There are no statistically significant ethnic differences in the incidence of EMP with OR of 1.96 (p = 0.84). Compared to isolated EMP where aerodigestive system is most common site, bone with soft tissue (21%) is the most frequent site of involvement in EMP with MM [Table]. 9 (37%) patients were found to have IgG kappa as most common serum immunofixation finding in EMP with MM. FISH displayed high risk cytogenetics in 11 (45%) patients in the group. 91% of patients with EMP and MM were treated with chemotherapy alone or in combination with surgery or radiation. The median overall survival of patients with isolated EMP and EMP with MM was 46 months [95% CI: 11.2-80.9] and 55 months [95% CI: 16.3-93.7] respectively. Conclusions: The number of patients with isolated EMP is small for comparison with patients with EMP and MM. EMP occurs frequently with MM either at diagnosis or with disease progression. It tends to have high risk cytogenetics and may signify more aggressive disease. [Table: see text]
Improvement of workflow in home-based rehabilitation for patients with stroke
Authors: Xiaoqing Li, Lei Cheng, Yunqing Zhou, Yu Xu, Jie Zhang, Jianping Wu
Journal: BMJ (2017)

The current workflow in home-based rehabilitation for stroke patients were modified through focus group discussion, brainstorming and literature review. The mapping of three-tier rehabilitation network, the defined function of home-based rehabilitation and its integration with other rehabilitation services were made by literature review. The improved version of home-based rehabilitation flow chart specified the contents in the guideline Three-tier rehabilitation network of stroke rehabilitation in China . The chart provides a reference for the implementation of home-based rehabilitation in community health service centers with the family doctor system.


Key words: 
Stroke; Rehabilitation; Community health service
冰毒引起的复杂情况
Authors: 曾昭耆
Journal: BMJ (2009)

男性,25岁,平日身体健康.2008年7月2日偶然服用了一次冰毒,导致心跳增快,全身抽搐,并有窒息感、频死感.到某医院急诊,心电监护示心率260次/min,呼吸急促,无其他异常.给予普萘洛尔(心得安)5 mg后,心率150次/min,症状渐减轻,离院。
身材矮小儿童的诊治
Authors: 石凤英, 张美和
Journal: BMJ (2008)

专家:儿科临床上因生长障碍就诊的患儿较为多见.生长发育障碍病因复杂,全身性疾病、内分泌疾病、骨骼畸形、脑肿瘤等均是常见病因.最为常见的是内分泌系统疾病,现主要以下丘脑-垂体-生长素轴功能障碍引发的身材矮小进行讨论。
Attention to easily overlooked complications of diabetes mellitus
Authors: Mingxia Yuan
Journal: BMJ (2018)

糖尿病慢性并发症累及全身多个系统。相对于众所周知的糖尿病慢性并发症(心脑血管病变、周围神经病变、肾病和视网膜病变)，还有很多累及其他系统的并发症也并不少见，但因为涉及不同学科专业，往往被忽视，易导致漏诊、误诊。本文针对这些易忽视的糖尿病并发症进行概述，旨在引起全科医师和相关交叉学科医护人员的共同关注，加强对相关疾病的认识，全面防治糖尿病及其慢性并发症。
Proposal for mental health service capacity building in primary care
Authors: Yanling He
Journal: BMJ (2019)

精神卫生服务融入全科医疗服务中是世界趋势，也是我国的趋势。全科心理健康服务能力不足使全科医生在日常医疗活动中提供心理健康服务的意识不强，缺乏信心、知识和技能。文章介绍了上海市公共卫生体系建设项目全科心理健康服务能力建设专项，在搜集整理国内外全科心理健康服务培训要求、问卷调查、实地调研、专家咨询和培训实践基础上，制定了全科心理健康服务能力培训大纲、配套课件和考核方案，进行了有益的尝试，供同道借鉴。
Screening for abnormal angle of trunk rotation among adolescents in Yichang city
Authors: Chunxia Wei, Zuneng Lu, Xiaoqun Huang, Liangwen Sun, Xinglan Long, Yun Zeng
Journal: BMJ (2018)

Total 3 483 students in 4 to 9 grade from primary and middle school in Xiling District of Yichang city were selected by stratified cluster random sampling method between September and October 2016 to participate in screening for abnormal angle of trunk rotation (ATR), including 1 797 boys and 1 686 girls aged 9-15 years. The ATR was measured with Scoliometer and the ATR >5° was defined as abnormal. The overall abnormal ATR rate was 7.60%(265/3 483), that in boys was 4.73%(85/1797) and in girls was 10.68%(180/1 686) (χ2=43.75, P<0.05). The abnormal ATR rate in age group 13-15 was higher than that in age group 9-12 [10.62%(159/1 496) vs. 5.33%(106/1 987), χ2=36.92, P<0.01]. Students with low BMI had higher abnormal ATR rate than that with normal or higher BMI(χ2=30.00, P<0.01); and students with left handedness had lower abnormal ATR rate than that with right handedness or double handedness(χ2=6.59, P=0.04). The abnormal ATR rate was not associated with dietary habits or sports in the daily life of students.The results show that gender, age, BMI and handedness affect abnormal rate of ATR.


Key words: 
Adolescent; Scoliosis; Cross-sectional studies
Analysis of Overall Survival Benefit of Abemaciclib Plus Fulvestrant in Hormone Receptor–Positive, ERBB2-Negative Breast Cancer
Authors: Manuel David Gil-Sierra, María del Pilar Briceño-Casado, Silvia Fénix-Caballero
Journal: JAMA Oncology (2020)

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 Oncology HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Oncology journal
Antiemetic prophylaxis with NEPA: Final results of the German AKYPRO study.
Authors: Joerg Peter Schilling, Steffi Busch, Carsten Hielscher, Martin Holländer, Julia Klenske, Mark-Oliver Zahn, Meinolf Karthaus
Journal: Journal of Clinical Oncology (2020)

12095 Background: NEPA is a fixed combination antiemetic of the NK 1 -receptor-antagonist (RA) netupitant and the 5-HT 3 -RA palonosetron. Primary objective of this prospective non-interventional study in Germany was to assess quality of life of cancer patients (pts) undergoing moderately (MEC) or highly (HEC) emetogenic chemotherapy (CT) who received NEPA for prophylaxis of nausea and vomiting (CINV). Secondary objectives were patient reported outcomes as well as effectiveness and safety of NEPA. Here we report final data of the quality of life analysis. Methods: The study included 2.405 pts in 162 centers receiving 3 consecutive cycles of CT as one or two day MEC or HEC. Primary endpoint was impact of quality of life (QoL) due to vomiting or nausea, documented by Functional Living Index–Emesis (FLIE) questionnaires. Effectiveness was reported in patient diaries. Complete response (CR) was defined as no emesis and no rescue medication (RM). Non-significant nausea (NSN) was no or mild nausea. Adverse events (AEs) were reported on d1–21 of each cycle. Results: 2.173 patients were included in the final analysis (full analysis set; FAS). The majority of patients (n = 1976; 91%) received 1-day chemotherapy, 64% HEC, 36% MEC. Median age was 58 years and the majority (85%) was female. Cancer diagnoses: breast 66%, gastrointestinal 10%, ovarian 7% or lung 5%, other 12%. Chemotherapy: AC 57%, carboplatin 19%, cisplatin 8%, oxaliplatin 8% and other 8%. 84% of pts with HEC and 82% with MEC felt no impact on daily life due to vomiting in cycle 1 remaining constant in C2 and C3. 54% HEC patients and 59% MEC patients reported no impact on daily life due to nausea in cycle 1. CR rates ranged between 81-84% and were comparable between different HEC or MEC. NSN rates in MEC ranged from 75% (MEC) to 62% (HEC). Drug-related AEs were rare with constipation, fatigue, insomnia, and nausea as the most common (in &gt; 1% pts). Conclusions: NEPA was highly effective in the prevention of CINV and maintenance of QoL in this real world study. Over 80% of pts reported that their daily live was not influenced by emesis while nausea was more difficult to control. Effectiveness was high and patients and physicians estimate was comparable.
Adding precision to 2018 ASCO/CAP HER2 testing guidelines in breast cancer with genomic profiling.
Authors: Adam Brufsky, Jennifer A. Crozier, Paul J. Chuba, Sung Ho Lee, Andrea Menicucci, Heather M. Kling, Erin Yoder, William Audeh
Journal: Journal of Clinical Oncology (2020)

3570 Background: Biological heterogeneity of HER2 positive breast cancers has been suggested by a modest benefit of HER2-targeted therapies reported in the APHINITY and ExteNET trials. This highlights the need for improved biomarkers that more precisely identify patients who benefit from HER2-directed agents. The 80-gene molecular subtyping signature (80GS) classifies breast tumors into Luminal, HER2 or Basal type based on the gene expression of downstream signaling pathways. Previous work showed a substantial proportion of tumors identified as HER2 equivocal or HER2 positive by 2013 ASCO/CAP guidelines may be reclassified as non-HER2 type by 80GS. In 2018, ASCO/CAP HER2 IHC/ISH classification guidelines were revised to reduce the frequency of HER2 equivocal cases, for which treatment recommendations have been ambiguous. Here we evaluated concordance between HER2 status by 2018 ASCO/CAP guideline classification and 80GS molecular subtyping. Methods: Pathology reports are provided by physicians for samples that are tested with the 70-gene risk of distant recurrence signature (70GS) and 80GS as part of routine diagnostic care. This analysis includes data sent to Agendia (Irvine, CA) from January 2019 to January 2020. HER2 IHC/ISH results based on ASCO/CAP 2018 guidelines were available for 1453 samples. Results: Of 1453 samples, 1336 (92%) were HER2 negative, 99 (7%) were HER2 positive, and 18 (1.2%) were HER2 equivocal under 2018 guidelines. 80GS reclassified 57 of 99 (58%) HER2 positive tumors as Luminal and 11 of 99 (11%) as Basal; the remaining 31% were confirmed HER2. Furthermore, 55 of 99 (55%) HER2 positive tumors were also ER and PR positive by IHC, with 48 (87%) of these reclassified as Luminal type. Of HER2 negative tumors, 80GS classified 94 of 1336 (7%) as Basal and 2 of 1336 (0.15%) as HER2. Of HER2 equivocal tumors, 16 of 18 (89%) reclassified as Luminal and 2 of 18 (11%) as Basal. Conclusions: In this real-world diagnostic dataset, 2018 ASCO/CAP guidelines resulted in few HER2 equivocal tumors overall, confirming the positive impact of the revised guidelines. However, 80GS reclassified 69% of HER2 positive tumors to non-HER2 molecular subtypes, suggesting these tumors may have suboptimal responses to HER2-directed therapy compared to HER2 enriched. All HER2 equivocal tumors reclassified to non-HER2 subtypes. Molecular classification by 80GS adds further precision in classifying HER2 positive patients and potential to predict responsiveness to HER2-targeted therapies. Further studies are warranted to validate the utility of HER2 status based on 80GS.
Advance in diagnosis and treatment of adult-onset Still's disease
Authors: 赵丽丹, 张烜, 唐福林
Journal: BMJ (2008)

成人Still病(adult-onset Still's disease,AOSD)是一种病因不清、以发热、一过性红色皮疹、关节炎和多脏器受累为特征的自身免疫性疾病.这些症状与系统型起病的幼年特发性关节炎(systemic-onset juvenile idiopathic arthritis,SoJIA)类似,而后者又被称作幼年Still病.这一疾病在文献中曾被称作变应性亚败血症(subsepsis allergica)、Wissler's综合征、Wissler-Fanconi综合征等.AOSD世界各地均有散发病例,女性发病稍高于男性,3/4的患者起病年龄在16～35岁之间[1]。
Advancing precision medicine in clinical oncology: Whole exome paired tumor-normal DNA and RNA sequencing at a single-institution cancer center.
Authors: Kevin McDonnell, Amit Kulkarni, Melissa Woodhouse, Sidney A Smith, Christine Hong, Marilena Melas, Kathleen Heller, Charalampos Lazaris, Duveen Sturgeon, Charité Ricker, Ilana Solomon, Julie Culver, Katrina Lowstuter, Jennifer Morales Pichardo, Veronica Jones, Gregory Idos, Joseph D Bonner, Stephen B. Gruber
Journal: Journal of Clinical Oncology (2020)

e14006 Background: Next generation sequencing (NGS) allows for reliable, comprehensive and cost-effective identification of clinically actionable genetic and genomic alterations. The increasing adoption of NGS in clinical oncology has increased our ability to identify germline alterations predisposing to cancer development as well as somatic changes enabling prescription of individualized cancer treatment and enhanced clinical trial participation. Here we summarize implementation of an NGS-based precision medicine initiative involving oncology patients from a single institution cancer center. Methods: IRB-approved NGS matched whole exome (WES) germline and solid tumor somatic tumor sequencing together with somatic tumor RNA sequencing (RNA-seq) were performed using germline DNA extracted from peripheral blood lymphocytes and nucleic acids for tumor DNA and RNA sequencing obtained from formalin-fixed, paraffin-embedded tumor specimens. Results of sequencing and analyses were presented to a multi-disciplinary tumor board to establish recommendations for management of germline pathogenic variation, therapeutic drug matching, clinical trials eligibility and molecularly informed patient prognosis. Results: A total of 1,005 patients completed sequencing. Germline and somatic WES exceeded 100X and 250X mean target coverage, respectively; somatic RNA-seq exceeded 200 million mean reads. Patients ranged in age from 17 to 90 years. The study cohort comprised comparable numbers of female (51%) and male (49%) patients. Ethnicities and races were broadly represented with 22% of participants identifying as Hispanic, 14% as Asian, 4% as Black, 55% as Non-Hispanic White and 5% as other. The most common solid tumor histological classification was colorectal (18%), followed by breast (16%), prostate (7%), head and neck (7%), sarcoma (7%), ovarian (5%), melanoma (4%) and lung (3%). Bioinformatic analyses and precision medicine tumor board review established that 12% of patients harbored a germline pathogenic variant and 43% carried clinically actionable genetic/genomic alterations; a majority of patients met molecular requirements for participation in a clinical trial. Conclusions: This study confirms the feasibility and utility of clinical NGS and precision medicine tumor board review in clinical oncology to identify germline genetic pathology, deliver personalized cancer therapeutics, increase clinical trial enrollment and clarify diagnosis and prognosis.
Evaluation of the early prediction score system for multiple organ dysfunction syndrome in the elderly
Authors: Qing-wu Tan, Qing-hua Li
Journal: BMJ (2011)

Objective To evaluate the early prediction score system for multiple organ dysfunction syndrome in the elderly (MODSE) induced by pulmonary infection. Methods A total of 316 patients with pulmonary infection aged over 60 were admitted from 2007 Jun to 2009 Jun. All patients were scored by the early prediction score system for MODSE and then classified as high-risk group and non high-risk group. χ2 test was used to analyze the difference in morbidity of MODSE between high-risk group and non high-risk group. Receiver operating characteristic (ROC) curve was drawn, and the area under the curve, sensitivity and specificity was calculated. Results The morbidity of MODSE in high-risk group was higher than that in non high-risk group(χ2=87.569,P＜0.01).The area under the ROC curve was 0.864(P＜0.01).The sensitivity and specificity of the early prediction score system of MODSE were 84.2% and 72. 1%, respectively. Conclusion The early prediction score system for MODSE can be used to predict MODSE induced by pulmonary infection and to screen for the high risk population.

Key words: 
Forecasting;  Multiple organ failure;  Evaluation studies
Intravesical therapy and risk of cystectomy and bladder cancer death after BCG fails.
Authors: Risa Liang Wong, Sarah K Holt, Amy Guo, John L. Gore
Journal: Journal of Clinical Oncology (2020)

e17026 Background: Management of non-muscle-invasive bladder cancer (NMIBC) when BCG fails engages complex decision-making that incorporates consideration of radical cystectomy (RC) and several intravesical options. We sought to characterize trends in practice variation and health outcomes for patients receiving intravesical therapy and radical cystectomy for presumption of recurrent or progressive high-risk NMIBC that has failed BCG. Methods: We identified patients with high-risk NMIBC from SEER-Medicare diagnosed from 2004-2015 who completed a full dose of BCG treatment. We evaluated receipt of intravesical therapy after BCG fails based on a code for a transurethral resection of bladder tumor (TURBT) within 6 months of BCG treatment followed by a switch to a different intravesical agent, systemic therapy, or radical cystectomy. We constructed risk estimates for disease-specific survival and subsequent need for radical cystectomy and using the Kaplan-Meier method and multivariate Cox proportional-hazards models adjusted for competing risks of death and patient clinical/demographic factors. Results: Among high-risk NMIBC patients who received BCG in their first year of diagnosis (n = 14,369), 9.7% (n = 1,273) went on to receive intravesical therapy, 4.2% (n = 607) proceeded directly to cystectomy, 15.8% (n = 2,272) underwent re-induction with BCG, 7.0% (n = 1,009) initiated systemic chemotherapy and 4.4% died without receiving treatment after BCG. Median follow-up after the post-BCG recurrence was 29 months (IQR 42, 14-56). Those receiving intravesical therapy after BCG fails were older, had more comorbidities, resided in rural areas, and had higher proportion of clinical Ta cancers (p &lt; 0.05 for all) compared with immediate RC patients. Intravesical agents after BCG fails are listed in the Figure. Among those undergoing intravesical therapy, 12.9% (n = 478) eventually underwent RC a median 13 months (IQR 20, 7-27) after treatment post-BCG (2-year cystectomy free survival 89.4% [95% CI 88.3-90.5%]). Actuarial 2-year and 5-year bladder cancer-specific survival was 84.0% (95% CI 82.3-85.7%) and 71.0% (95% CI 68.3-73.7%), respectively, after intravesical treatment post-BCG. Conclusions: The heterogeneity in treatments used for NMIBC that fails BCG indicates potential provider uncertainty in the management of this challenging clinical situation. The paucity of effective bladder-sparing therapies, which is reflected in a high 2-year risk of RC and bladder cancer-specific death, highlights the urgent need for new therapies in this patient population.
Human skin biomarkers and his relation with the response to treatment to tyrosine kinase inhibitors in advanced EGFR mutated lung adenocarcinoma.
Authors: Jeronimo Rafael Rafael Rodriguez Cid, Anahi Castañeda-Zárraga, Rodrigo Rodrigo Flores-Mariñelarena, María Elisa Vega-Memije, Valeria Michelle Fernández Garibay, Héctor Trinidad-Bibiano, José Fabián Martínez-Herrera, Carla Paola Sánchez-Ríos, Jorge Alatorre-Alexander, Luis Manuel Martinez, Patricio Santillan-Doherty
Journal: Journal of Clinical Oncology (2020)

e21544 Background: A relationship between EGFR signaling pathway expression in skin and the use of targeted cancer therapies has been consistently demonstrated. Nonetheless, consistent evidence to support the use of skin biopsies as a surrogate for therapeutic evaluation. Methods: The present study is a prospective single-blind analysis of skin biopsies of patients with confirmed advanced EGFR mutated lung adenocarcinoma. Immunohistochemistry was performed with EGFR, p27, Ki67, STAT3, and MAPK, as well as an H&amp;E histopathological analysis, looking for their relationship with the response to treatment with tyrosine kinase inhibitors. ROC curve analysis was used to determine the cutoff value for each biomarker selected dichotomizing the response to treatment as mentioned in the tissue samples section (adequate response or no response). Kaplan Meier analysis for progression-free survival was performed. Results: From the 35 biopsies obtained, 21 (60%) of the patients were women and 14 (40%) men; the mean age of participants was 60.6±11.7 years. Twelve patients (34.3%) were at the pre-treatment group, 12 (34.3%) had an adequate response to treatment and 11 (31.4%) were at the no response to treatment group. The median progression-free survival was 9 months. The next biomarkers were significantly related to an adequate response to treatment by using a bivariate correlation test: EGFR (p = 0.025), Ki67 (p = 0.015), STAT3 (p = 0.017), stratum corneum thickness (p = 0.039) and the number of layers of the stratum corneum(p = 0.041). A better median of progression-free survival was obtained on those with a value above of the cutoff preestablished of EGFR (21 months versus 7 months, 95% CI 0-46 versus 4.23-9.77, p = 0.025) and number of layers of the stratum corneum (21 months versus 8 months, 95% CI 0-43.81 versus 6.72-9.28, p = 0.030), however, for p27 a better median of progression-free survival was shown in those with a value below the cutoff before mentioned (21 months versus 8 months, 95% CI 8.17-33.83 versus 6.87-9.13, p = 0.031). Conclusions: We found a relationship between EGFR, Ki67, STAT3, stratum corneum, number of layers of stratum corneum, with the response to treatment, and better progression-free survival for high expression EGFR, number of layers of the stratum corneum and low expression for p27. The present study should incite to perform a further investigation to validate these markers as potential prognostic and predictive factors.
Earlier identification and treament of chronic obstructive pulmonary disease
Authors: 何权瀛
Journal: BMJ (2008)

目前已经认识到慢性阻塞性肺疾病(COPD)的主要病理生理特点是进行性发展的气流受限,而且不能完全可逆.同时COPD可以造成沉重的社会经济负担,成为劳动力丧失和死亡的重要原因,因而近年来国外许多学者提出早期干预COPD,并且提出许多理由和依据,诸如早期干预COPD可以减少症状、减少动态过度充气、改善肺功能、提高生存质量等。