tbuckley/cabot-search huggingface dataset:
神经内镜辅助治疗老年人慢性硬膜下血肿18例
Authors: 于军, 李旭琴, 熊文德, 石军伟
Journal: BMJ (2006)

老年人慢性硬膜下血肿是临床常见病,以往多采用硬膜下血肿钻孔引流术,由于手术不能在直视下进行,因此,术中可损伤脑组织引起颅内血肿、感染等并发症;同时由于不能将血肿腔内的纤维蛋白降解产物完全清除,从而术后复发率较高.利用神经内镜辅助下钻孔引流慢性硬膜下血肿,可以彻底清除血肿,减少术后并发症,疗效较好,现报告如下。
Feedback survey on application of magnetically guided capsule endoscopy in diagnosis of upper gastrointestinal diseases
Authors: Yi Fang, Lu Chen, Qian Liu, Jiachuan Wu, Bin Xu, Ye Chu, Jie Zhong, Biao Gong, Lu Xia
Journal: BMJ (2016)

Objective
To evaluate the feasibility and acceptability of magnetically guided capsule endoscopy (MCE) as a screening or diagnostic means for upper gastrointestinal diseases.


Methods
One hundred and forty six patients underwent MCE during October 2013 to September 2014. All patients and endoscopists received a feedback survey with a self-administrated questionnaire; the items included the satisfaction of patients and endoscopists, the endoscopic image score, examination results, the endoscopy completion and operation time.


Results
Among 146 patients, 145 completed MCE examination with a completion rate of 99.3% (145/146). The operation time of MCE was(15.20±4.85)min. The score of patient and endoscopist satisfaction was both 4, and patient tolerance score was 0. The divergence rate score was 3; the cleaness score of stomach was 3; and the vision relative definition was 79.31±14.16. The most common examination result was chronic superficial gastritis (67/145, 46.2%), followed by bile reflex gastritis (48/145, 33.1%), normal stomach (39/145, 26.9%), gastric polyps (20/145, 13.8%), chronic atrophic gastritis (18/145, 12.4%), bleeding from erosive gastritis (14/145, 9.7%), reflux esophagitis (6/145, 4.1%), 2.7%(4/145), gastrointestinal ulcer, (3/145, 2.1%), upper gastrointestinal cancer (2/145), duodenal bulb inflammation (2/145), yellow melanoma (1/145), esophageal cyst (1/145) and esophageal varices (1/145). All patients expressed their willingness to receive the same type of upper GI endoscopy if necessary. No capsule retention, perforation or bleeding occurred.


Conclusions
MCE avoids the discomfort of conventional gastroscopy and can improve the compliance and acceptability of patients with excellent safety, maneuverability and feasibility.


Key words: 
Capsule endoscopy; Gastrointestinal diseases; Diagnosis; Questionnaires
Combination therapy with lenvatinib and anti-PD-1 antibodies for unresectable or advanced hepatocellular carcinoma: A real-world study.
Authors: Hui-Chuan Sun, Xiao-Dong Zhu, Cheng Huang, Ying-Hao Shen, Ning-Ling Ge, Yi Chen, Chang-Jun Tan, Jian Zhou, Jia Fan
Journal: Journal of Clinical Oncology (2020)

e16610 Background: Combination therapy of anti-angiogenic therapy and anti-PD-1 antibody had shown promising anti-tumor effects for advanced hepatocellular carcinoma (HCC) in clinical trials. Here we report the effectiveness and safety of the combination therapy of lenvatinib and anti-PD-1 antibodies in a cohort of unresectable or advanced HCC pts. Methods: From Sep 2018 to Jan 2020, 77 consecutive pts received a combination treatment of lenvatinib and an anti-PD-1 antibody. Lenvatinib was given 8 mg/d regardless of patient body weight and anti-PD-1 antibody was used either q2wk (nivolumab or camrelizumab) or q3wk (pembrolizumab, sintilimab or toripalimab). pts who completed at least one efficacy and safety assessment were eligible for this study. Tumor response were evaluated with abdominal contrast-enhanced MRI/CT and/or chest CT every 2 mo (± 1 wk). Laboratory tests were monitored every 2-3 wk. Results: 59 pts were eligible for this study. Of them, 1 (1.7%) were BCLC stage A, 10 (16.9%) were BCLC stage B, 48 (81.4%) were BCLC stage C (including 20 pts in China Liver Cancer [CNLC] stage IIIa and 28 in CNLC stage IIIb). 43 (72.9%) pts were treated as first-line therapy. The table below shows efficacy results. R0 resection was performed in 6 (10.2%) pts due to tumor regression. By the data cut-off date, 13 pts died, and mOS was not mature. Overall, the combination treatment was well tolerated. 28 (47.5%) pts had at least one ≥ grade 3 treatment-emergent adverse event. 3 (5.1%) pts died from immune-related adverse events, 2 of them died from immune-related adverse events after hepatectomy. Conclusions: The combination of lenvatinib + anti-PD-1 antibody is effective and well-tolerated in pts with HCC as first-line or second-line treatment. It is also noted that initially unresectable HCC may be converted to resectable HCC following this combination treatment. [Table: see text]
Application of laparoscopic ultrasonography in laparoscopic partial nephrectomy
Authors: Jin-ming Wang, Lang Feng, Ye Tian, Wen-cheng Lü
Journal: BMJ (2013)

Seven cases of renal tumor treated at our hospital from May 2009 to November 2011 were assigned to undergo laparoscopic ultrasonography assisted laparoscopic partial nephrectomy. The mean operative duration was 109 minutes (range:102-121). And the mean volume of blood loss was 82 ml (range:60-120). All patients had confirmed negative margins. Renal clear cell carcinoma was definitely diagnosed in all cases. Laparoscopic ultrasonography could provide more precise information of renal tumor within renal capsule. Thus it may be used to guide the operation so that tumors are excised more completely, residual tumor tissues avoided and normal renal tissues protected.


Key words: 
Laparoscopic ultrasonography; Laparoscopes
Socioeconomic disparities in <i>MGMT</i> promoter methylation testing for glioblastoma patients.
Authors: Bryan Iorgulescu, Nayan Lamba, Timothy R. Smith, David A. Reardon
Journal: Journal of Clinical Oncology (2020)

7029 Background: MGMT promoter methylation holds important prognostic and predictive implications for glioblastoma (GBM) patients. Herein we evaluate whether any barriers faced MGMT testing. Methods: Adults with newly-diagnosed GBMs were identified from the U.S. National Cancer Database (2010-2016). Patient socioeconomic, tumor, and cancer program features were evaluated for association with MGMT testing by multivariable logistic regression. Results: Of 12,380 GBM patients, only 57% had MGMT testing–a rate that increased to 74% by 2016. Testing was independent of patients' sex or race/ethnicity (all p &gt; 0.05); and was largely independent of GBM histology, size, and location. Older patients were less likely to receive testing (54% of ≥70-years-olds vs 62% of those in their 40s, p = 0.01). Insurance status was an independent predictor of testing: only 43% of uninsured patients had testing, vs 61% of privately-insured or 55% of Medicare patients (p≤0.01). The uninsured rate dropped from 3.6% in 2010 to 2.5% in 2016 and was associated with Medicaid expansion under the Affordable Care Act. Patients from non-expansion states had the lowest rates of testing (55%), vs patients from expansion states (58%, p &lt; 0.001). Additionally, household incomes were independently associated with testing: only 50% of patients living in the poorest quartile of households had testing vs 61% in the richest quartile (p = 0.001). Diagnosing hospital type was also an independent predictor of testing: patients diagnosed at academic/NCI-designated cancer programs were most likely to have testing (65%), vs only 45% of community and 44% of comprehensive community cancer program patients were provided testing (all p &lt; 0.001). By 2016, testing rates had improved in all program types–particularly at comprehensive community (67%) and academic (80%) programs, but lagged at community programs (56%, p &lt; 0.001). Patients without MGMT testing received less chemotherapy (mOR = 0.66, p &lt; 0.001) and were associated with worse overall survival (mHR = 1.08, p = 0.002). Conclusions: Newly-diagnosed GBM patients in the U.S. who were uninsured, from the poorest quartile of households, or diagnosed at community cancer programs faced significant barriers to receiving MGMT testing. Medicaid expansion under the ACA was associated with reduced uninsurance, increased Medicaid insurance, and improved rates of testing. Reduced testing rates were associated with less chemotherapy and worse OS. Together our results indicate that substantial socioeconomic and care setting disparities exist in MGMT testing for GBM patients.
Cemiplimab as first intervention for patients with locally advanced cutaneous squamous cell carcinoma.
Authors: Jennifer Lynn Atlas, Marina Kanos, James Thomas Symanowski, Daniel Brickman, Meghan Forster, Catherine Frenkel, Zvonimir Milas, Terry Sarantou, Richard L. White, Asim Amin
Journal: Journal of Clinical Oncology (2020)

10065 Cemiplimab as First Intervention for Patients with Locally Advanced Cutaneous Squamous Cell Carcinoma (cSCC) Background: Cutaneous squamous cell carcinoma is the second most common non-melanoma skin cancer. Early stage disease is managed with local intervention in the form of surgery or radiation and translates into cure for greater than 95% of the patients. Patients with high risk disease who have large primary lesions, neural, or nodal involvement are usually not amenable to cure with local intervention and may experience significant morbidity, disfigurement, or functional deficits. These patients had no effective systemic treatment options until recent approval of cemiplimab. We report the outcomes for upfront treatment with cemiplimab in locally advanced cSCC. Methods: This is a single institution retrospective study of patients with locally advanced cSCC defined as those requiring more than simple excision and/or complex repair or regional disease with nodal involvement who received at least two doses of cemiplimab between January 1, 2018 through January 17, 2020. Patients with radiologically measurable disease had response evaluated per RECIST criteria. Patients who had no measurable disease had their clinical response (complete resolution or healing of primary lesion) assessed per treating physician and need or lack of local intervention documented. Adverse events were assessed and graded per CTCAE criteria. The primary end point was to ascertain the need for local intervention. Results: Thirty six patients were eligible. Twenty-two (61%) patients treated with upfront cemiplimab were able to avoid local intervention with surgery and/or radiation; four patients progressed or died on treatment. Three (8%) patients received local intervention. Eleven (31%) patients are still receiving cemiplimab and local intervention decision is pending. The overall response rate was 69% and the clinical benefit rate was 92%. The median treatment duration was six months and the median number of doses received was six. Adverse events occurred in 31% of patients; the most common adverse event was dermatitis. Conclusions: Upfront treatment with cemiplimab in patients with locally advanced cSCC obviated need for disfiguring/complex surgery or radiation in majority of patients. Cemiplimab was tolerated well; no new safety signals were observed. Neo-adjuvant phase II study is in development.
Requirement of objective structured teaching evaluation (OSTE) use for general practice trainers and station design
Authors: Jie Gu, Tianhao Wang, Limin Ren, Zhigang Pan
Journal: BMJ (2019)

Objective
To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.


Methods
A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016. The survey included basic information, OSTE use requirements, frequency of  teaching scenarios, and frequency of teaching methods.


Results
The survey showed that 86.3% (234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3% (250/271) for training teaching competence. The proportion of having been observed and being given feedback from superior trainers for teaching process was higher in hospital trainers than that in community trainers [68.3% (110/161) vs. 40.9% (45/110) , χ2=20.060, P 0.01). In the part of frequency of teaching methods, the proportion of often plus always was higher in clinical supervisor′s report [60.9%(165/271)], applied knowledge test [52.4%(142/271)] and problem-based learning [38.0%(103/271)]; there were no significant differences in above questions between the two types of trainers (all P>0.01).


Conclusion
The requirements of assessment and training by using OSTE are strong in GP trainers. The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.


Key words: 
General practice trainer; OSTE; Needs analysis
Growth factor and its role in the treatment of patients with soft tissue extremity sarcoma receiving chemotherapy managed at an academic center: A retrospective study.
Authors: Neha Pancholy, Vonn Walter, Joseph J. Drabick, Edward J Fox, Nicholas George Zaorsky, Monali K. Vasekar
Journal: Journal of Clinical Oncology (2020)

e23573 Background: Surgery still remains the mainstay of treatment with curative intent for high grade extremity soft tissue non rhabdomyosarcoma sarcomas (HG ESTS). Adjuvant/neoadjuvant Chemotherapy (CT) is still debatable, but most experts agree about its role in HG-ESTS in combination with radiation (R). Interdigitated CT+R is an attractive method of delivering these modalities of treatment in short time prior to surgery, however safety of using growth factor (GF) while administering CT+R in HG ESTS is largely unknown. We conducted a retrospective study of the toxicities associated with GF administration in this setting at a single institution. Methods: Electronic medical records at one institution were reviewed to identify patients having a diagnosis of extremity STS between October 2017- January 2020. Demographics, details of tumor characteristics, and treatment details were noted. Details of Interdigitated (ID)CRT were noted; the intended CT regimen was doxorubicin/ifosphamide/mesna (MAI) at 100% of the intended dosing. Data regarding the toxicities associated with GF administration were also evaluated in these patients; specifically, the development of febrile neutropenia, thrombocytopenia and pulmonary toxicity were evaluated. Patients who presented with metastatic disease were excluded from this analysis. Results: 22 patients were identified. Median age was 63 years. Of these, 9 patients (40%) were smokers. At diagnosis, 6 patients (27%) had metastatic disease. The most common site of primary disease was the thigh (50%). The most common histology was undifferentiated pleomorphic sarcoma (59%). CT monotherapy was administered in 3 patients. RT was administered in 14 patients, out of whom interdigitated CRT was administered in 10 patients. 60% of patients who initiated were able to receive 3 cycles of ID-CRT prior to Surgery. GF was administered in 14 patients who received regimens including CT. Of patients receiving ID-CRT who received GF, 60% completed ID-CRT without delays. No delays occurred due to thrombocytopenia. Febrile neutropenia occured in 22% of patients who received GF. Only 1 patient who received GF suffered prolonged thrombocytopenia. No patients who received GF were noted to have pulmonary toxicity. Conclusions: For adults with HG ESTS, GF administration with ID-CRT does not appear to cause any additional delay in treatment due to prolonged thrombocytopenia or lung toxicity. Inclusion of GF administration in further prospective trials of ID-CRT appears feasible.
AST-to-APOA ratio to predict overall survival in hepatocellular carcinoma receiving TACE.
Authors: Yongjian Chen, Xing Li, Jie Chen, Gang Qin, Yidan Qiao, Shaozhuo Huang
Journal: Journal of Clinical Oncology (2020)

e16637 Background: Current guidelines lack definitive evidences about the predictive capability of clinical parameters for transcatheter arterial chemoembolization (TACE). The aim of this study was to comprehensively investigate the predictive factor among stage I-IV liver hepatocellular carcinoma (LIHC) patients after TACE. Methods: We investigated the clinical features of 211 stage I-IV patients with LIHC in discover group and 341 patients in validation group. Overall survival (OS) was estimated using the Kaplan-Meier method and the log-rank test. Results: Univariate Cox regression revealed that Monocyte count, TNM stage and AST-to-APOA ratio (AAR) were associated with unfavorable OS. AAR was identified as an independent predictor of OS using multivariate analysis. Kaplan-Meier curve demonstrated that patients with AAR &lt; 50 displayed better prognosis. The median follow-up time was 17.1 (95%CI, 14.4 to 19.3) months, 3-year overall survival was 55.9% in the low AAR group versus 28.6% in the high AAR group, and there was significant difference in OS (Hazard ratio [HR] 0.47, 95%CI 0.33 to 0.67, P &lt; 0.001). The AAR showed predictive ability for OS (12-month, AUC = 0.707). These findings were successfully validated in validation group (HR 0.62, 95%CI 0.46 to 0.84, P = 0.002; 12-month AUC = 0.636). Conclusions: AAR was an independent predictor among LIHC patients after TACE. Patients with lower AAR were optimal candidates for TACE.
Structural changes of substantia nigra in patients with unilateral Parkinson′s disease
Authors: Xinxin Ma, Wen Su, Shuhua Li, Haibo Chen, Shuai Peng, Chunmei Li, Rui Wang, Min Chen
Journal: BMJ (2016)

Magnetic resonance imaging (MRI) findings were studied in 19 patients with non-dementia Parkinson′s disease (PD) Hoehn-Yahr Stage 1 and 1.5 and 38 healthy subjects. The width and area of pars compacta of substantia nigra (SNc), substantia nigra (SN) and midbrain were measured. The width and area ratios of SNc to SN were calculated. Compared with controls, the widths of right SNc was narrower, bilateral ratios of SNc to SN width were decreased in PD group. As to the area of substantia nigra, there was no significant difference between PD and controls. The width of left SN and the ratio of right SNc to SN width was negatively correlation with age of patients. The ratio of left SNc to SN width, the area of bilateral SNc and left SN, as well as the ratio of right SNc to SN area had negative correlation with the disease duration; however, there was no correlation with gender, Hoehn-Yahr Stage, the Unified Parkinson disease rating scale score, mini mental state scale, education years, levodopa equivalent daily dose, Hamilton Depression Scale or Hamilton Anxiety Scale in PD group. The results indicate that there are bilateral structural changes of SN in unilateral PD patients, which may be more significant with increasing disease duration. The measurement of SNc width and SN area can be used as an objective indicator for diagnosis and disease progression monitoring of PD.


Key words: 
Parkinson disease; Magnetic resonance imaging; Pars compacta of substantia nigra
Vertigo and dizziness in children: a clinical analysis of 82 cases
Authors: Xiangli Zeng, Jintian Cen, Yinfei Liang, Shuqi Zhang, Zhicheng Li, Gendi Yin, Tao Yuan
Journal: BMJ (2018)

Objective
To analyze etiology, clinical manifestation and diagnosis process of vertigo and  in children.


Method
The clinical data of 82 children with vertigo and  treated in our hospital from January 2006 to December 2016 were retrospectively analyzed.


Results
There were 46 girls and 36 boys with a female∶male ration of 1.28∶1. The median age of patients was 9.0 years (14 months - 18.0 years) and 21 cases were less than 6 years old. The chief complaints were repeatedly falling, crying, walking unsteadily and scratching the ear for unknown reasons. For children aged >5 years may express  roof or tent rotation ; for those aged >6 - <15 years (n=34), the main complaint was more ambiguous  dizziness ; for those aged ≥ 15 - ≤ 18 years (n=27) with the main complaint of  dizziness may clearly express the  sense of rotation or  the feeling of feeling drowsy, the top-heavy sense,  and the accompanying deafness, earfullness, tinnitus and so on. Among 82 cases, there were 15 cases of benign paroxysmal vertigo (BPV, 18.3%), 12 cases of secretory otitis media (SOM, 14.6%), 11 cases of vestibular migraine (VM, 13.4%), 9 cases of benign paroxysmal positional vertigo (BPPV, 11.0%), 8 cases of inner ear malformation (9.8%), 8 cases of Meniere′s disease (9.8%), 7 cases of vestibular neuritis (8.5%), 6 cases of sudden deafness with vertigo (7.3%), 4 cases of central vertigo (4.9%), 1 case of rare genetic disease (1.2%) and 1 case of vertigo due to mental psychological (1.2%). The incidence of BPV, VM and Meniere′s disease in girls was higher than that in boys. There was a tendency to self heal in BPV with the age increasing, in 15 BPV cases, 8 after 12 years of age, 3 after 14 years old had no vertigo attacks, and 4 cases were still in follow-up. The attack frequency of VM was decreased, and the extent was reduced with the age. Children older than 6 years were able to cooperate to vestibular function tests, and the majority completed the tests.


Conclusion
The analysis shows that the etiology of vertigo and  in children is different from that of adults. Central vertigo and rare genetic disorders with  as the first symptom are of great harmfulness, so intensive observation and multidisciplinary consultations are recommended.


Key words: 
Child; Vertigo; Pathological conditions, signs and symptoms; Diagnosis; Diagnosis, differential
Effects of hyperbaric oxygen therapy on recovery of cognitive function in stroke patients on hemodialysis
Authors: Jing Chang, Xiao-jun Qiu
Journal: BMJ (2012)

To explore the clinical efficacies of hyperbaric oxygen therapy on the recovery of cognitive function in stroke patients on hemodialysis.Forty stroke patients on hemodialysis were assigned randomly into hyperbaric oxygen therapy (HBO) (n =20 ) and routine therapy groups (n =20).Patients of HBO group received both hyperbaric oxygen therapy and routine therapy.Nerves functions and cognitive function were observed before and after therapy to compare the clinical outcomes.Neuropsychological tests,minimental status examination (MMSE) and activities of daily living (ADL) were used for assessing cognitive function.Then the outcomes were compared with those of the control group.Nerves function and cognitive dysfunction of the treatment group had significant improvement (P ＜ 0.01).Hyperbaric oxygen can significantly improve cognitive dysfunction in stroke patients on hemodialysis.

Key words: 
Renal dialysis; Hyperbaric oxygenation
慢性肾脏病
Authors: 吴东, 蔡建芳, 陈嘉林
Journal: BMJ (2012)

一、慢性肾脏病少不少,全看预防好不好按照肾小球滤过率( GFR)的变化,将慢性肾脏病(CKD)分为5期:1期:GFR≥90 ml/min,属正常范围,但患者已有可引起肾损害的基础疾病(例如糖尿病、高血压、高血脂等);此时治疗原则是控制基础疾病,防止CKD进展.该期患者人数众多,能否有效预防CKD的发生和发展,有重要的卫生经济学意义,也是社区医生义不容辞的责任.2期:GFR为60 ～ 89 ml/min,应继续控制危险因素,同时认真评估CKD进展情况.3期:GFR为30 ～ 59 ml/min,此时CKD往往已出现并发症,例如代谢性酸中毒、电解质紊乱、贫血等,应予适当处理.4期:GFR为15 ～ 29 ml/min,此时应开始为肾脏替代治疗(血液透析、肾脏移植)做准备.5期:GFR已降至15 ml/min以下,将不可避免地需要肾脏替代治疗,不仅患者遭受很大痛苦,高昂的医疗费用也将导致严重的公共卫生负担.因此,早发现、早治疗有助于延缓CKD病情进展,减少终末期病例,节约卫生资源。