tbuckley/cabot-search huggingface dataset:
A randomized clinical trial of intrauterine device MYCu
Authors: 李淑芝, 左文莉, 武淑英, 王玉, 张淑兰, 赵艳晖, 崔满华, 李楷滨, 胡建强
Journal: BMJ (2010)

Objective To observe safety and efficacy of intrauterine device MYCu IUD that releases indomethacin. Methods In total, 2000 women requiring IUD for contraception were chosen from domestic multiple clinical centers according to an unified standard. MYCu IUD and TCu380A IUD were randomly inserted for 1000 women each, respectively. All women were regularly followed-up one, three, six and 12 months after insertion. Results All the women were followed-up for 11 985.9 and 11 753.6 person-months in MYCu IUD and TCu380A IUD groups, respectively, with cumulative IUD application rates of 97. 80% and 94. 70%, and cumulative pregnancy rates with IUD of 0. 10% and 0. 31%, respectively. Cumulative expulsion (or partial expulsion) rate in MYCu IUD group was 0. 10%, significantly lower than that in TCu380A IUD one (1.73%), P ＜0. 01, and cumulative removal rate due to medical reasons (bleeding or pain) was 1.51 % and 2. 94%, respectively, P ＜ 0. 05. Rate of IUD-associated termination and overall rate of termination differed significantly between the two groups, P ＜0. 01. Adverse reactions one, three, six and twelve months after IUD insertion included irregular bleeding, prolonged menstruation, increased menstrual blood volume and pain, less in indomethacin-containing MYCu IUD group than those in TCu380A IUD without containing it, P ＜ 0. 01. Conclusions MYCu IUD is a comparatively ideal IUD that should be promoted for extensive use, with extremely low expulsion rate, good contraceptive effect, convenience and safety in insertion and removal, and less adverse effects.

Key words: 
Intrauterine devices,medicated ;  Intrauterines device,copper ;  Contrast clinical trial ;
Multi-institutional comparative effectiveness of advanced cancer longitudinal imaging response evaluation methods: Current practice versus artificial intelligence-assisted.
Authors: Andrew Dennis Smith, Brian C. Allen, Asser Abou Elkassem, Rafah Mresh, Seth T. Lirette, Yujan Shrestha, J. David Giese, Reece Stevens, Dillon Williams, Ahmed Farag, Ahmed Khalaf
Journal: Journal of Clinical Oncology (2020)

2010 Background: Current-practice methods to evaluate advanced cancer longitudinal tumor response include manual measurements on digital medical images and dictation of text-based reports that are prone to errors, inefficient, and associated with low inter-observer agreement. The purpose of this study is to compare the effectiveness of advanced cancer longitudinal imaging response evaluation using current practice versus artificial intelligence (AI)-assisted methods. Methods: For this multi-institutional longitudinal retrospective study, body CT images from 120 consecutive patients with multiple serial imaging exams and advanced cancer treated with systemic therapy were independently evaluated by 24 radiologists using current-practice versus AI-assisted methods. For the current practice method, radiologists dictated text-based reports and separately categorized response (CR, PR, SD, and PD). For the AI-assisted method, custom software included AI algorithms for tumor measurement, target and non-target location labelling, and tumor localization at follow up. The AI-assisted software automatically categorized tumor response per RECIST 1.1 calculations and displayed longitudinal data in the form of a graph, table, and key images. All studies were read independently in triplicate for assessment of inter-observer agreement. Comparative effectiveness metrics included: major errors, time of image interpretation, and inter-observer agreement for final response category. Results: Major errors were found in 27.5% (99/360) for current-practice versus 0.3% (1/360) for AI-assisted methods (p &lt; 0.001), corresponding to a 99% reduction in major errors. Average time of interpretation by radiologists was 18.7 min for current-practice versus 9.8 min for AI-assisted method (p &lt; 0.001), with the AI-assisted method being nearly twice as fast. Total inter-observer agreement on final response categorization for radiologists was 52% (62/120) for current-practice versus 75% (90/120) for AI-assisted method (p &lt; 0.001), corresponding to a 45% increase in total inter-observer agreement. Conclusion: In a large multi-institutional study, AI-assisted advanced cancer longitudinal imaging response evaluation significantly reduced major errors, was nearly twice as fast, and increased inter-observer agreement relative to the current-practice method, thereby establishing a new and improved standard of care.
糖尿病肾病的诊断
Authors: 赖凌云, 林善锬
Journal: BMJ (2004)

糖尿病肾病是糖尿病微血管病变最危险的并发症之一.1型糖尿病肾病的发病率为20%～40%,2型糖尿病的发病率为10%～20%,糖尿病患者死于肾功能衰竭的就有5%～10%.因此能够早期诊断、早期治疗以延缓糖尿病肾病的进展,是目前本病预防和治疗的重点。
慢性充血性心力衰竭
Authors: 吴东, 刘永太, 陈嘉林
Journal: BMJ (2011)

一、左心室射血分数(LVEF)正常并不能排除心力衰竭 LVEF是反映心脏收缩功能最常用的指标,是心脏超声检查的重要项目.其计算方法是每搏输出量(SV)除以左心室舒张未容积(LVEDV).多数慢性心力衰竭(心衰)患者都有不同程度的LVEF下降(＜50%)。
谈谈感冒的治疗和预防
Authors: 李静, 张晋, 邵隽一
Journal: BMJ (2009)

李静:人们常说的感冒一般指的是普通感冒,和急性鼻炎、急性咽炎等一起构成上呼吸道感染的大概念.普通感冒是最常见的疾病之一,据美国国家卫生统计中心数据,在美国全科医生的门诊病人中,有16.4%是因上呼吸道症状就诊,在门诊量为20～25个病人的工作日中,一个全科医生要接待3～4位上呼吸道感染的病人.现在先来说说感冒的治疗。
The current situation in assessment and therapy for elderly insomnia
Authors: 寿涓, 祝墡珠
Journal: BMJ (2010)

失眠是睡眠数量或质量达不到正常需求的一种主观体验~([1]).研究表明,10%～15%的成年人存在持续的失眠,这个比例在妇女和老年人中更高~([2]).长期失眠会削弱机体的免疫力,加重原有的躯体和精神疾患,影响工作和学习效率,进而影响生存质量,增加意外事故的发生。
A prospective observational study of combinatorial abiraterone (AA) and radical radiotherapy (RT) in node-positive (N+) prostate cancer (PCa).
Authors: Mark Ting Le Tan, Wai Yee Woo, Adelene Sim Yen Ling, Jeffrey Tuan, Terence Wee Kiat Tan, Youquan Li, Li Yan Khor, Joe Poh Sheng Yeong, Chien sheng Tan, Kae-Jack Tay, Lui Shiong Lee, Ravindran Kanesvaran, Melvin Lee Kiang Chua
Journal: Journal of Clinical Oncology (2020)

e17555 Background: The conventional treatment backbone of N+ PCa has been hormonal therapy (HT) alone. Nonetheless, evidence from the STAMPEDE trial suggests that there could be survival benefit with the addition of local RT or AA, and there may be synergy between RT and AA in these advanced patients. We therefore conducted a prospective observational study to evaluate the efficacy of combination AA+HT+RT in patients with N+ PCa. Here, we report the preliminary biochemical response and toxicity data. Methods: Patients with N+M0/N+M1a, biopsy-proven adenocarcinoma of the prostate were enrolled. Patients were staged by 68 Ga-PSMA-PET or whole body MRI. Exclusion criteria were i) ECOG ≥2; ii) cardiac event of &lt; 6 mo interval; iii) bone and visceral metastasis. Treatment protocol entailed 18 mo of combination AA (1000 mg plus 5 mg prednisolone once daily) and HT (LHRH agonist/antagonist); RT was delivered to the prostate (78 Gy) +/- pelvis (54 Gy with simultaneous boost of 60-66 Gy to grossly involved lymph nodes in M0 patients). This was matched against a control group that received long-term HT +/- RT (N = 38). Primary endpoint of this analysis was PSA ≤0.1 ng/ml at 6 mo; secondary endpoints were PSA ≤0.1 ng/ml, testosterone ≤0.7 nmol/l at 12 mo, and toxicity outcomes. Germline genetic profiling was performed in all patients. Results: From Feb 2017 to Aug 2019, 18 men were recruited to this study, with a median fu of 15 mo (range 6.0-35.0 mo). Median age was 66.0 y (IQR 62.0-71.0y); median baseline PSA was 18.2 ng/ml (range 3.0-272); 66.7% had GS 8-10 disease; and 22.2% had M1a disease. Combination AA+HT+RT achieved PSA of ≤0.1 ng/ml in 80.0% (N = 12) and 93.3% (N = 14) of patients at 6 mo and 12 mo, respectively, in contrast to 29.4% and 25.0% of patients who were treated with HT+RT and HT alone, respectively. We observed profound castration of 87.5% (N = 14) at 6 mo, and 91.7% (N = 11) at 12 mo. Four and 6 patients experienced acute G2 genitourinary and gastrointestinal toxicities during RT, respectively; 2 patients reported late G2 GU. One patient experienced G2 fatigue and G1 liver enzyme dysfunction, resulting in dose reduction of AA. Genetic testing revealed a patient with BRCA2 frameshift mutation; interestingly, this patient failed to achieve a PSA of ≤0.1 ng/ml at 12 mo. Conclusions: We demonstrate that combinatorial AA+HT and definitive RT is well tolerated, and yield a pronounced early PSA response in N+ PCa. Long-term data will inform if this early efficacy signal leads to improved survival in these patients.
Genomic profiling identified novel prognostic biomarker in Chinsese glioma patients.
Authors: Hainan Li, Changguo Shan, Chongzhu Fan, Shengnan Wu, Mingyao Lai, Linbo Cai, Dan Zhu, Fufeng Wang, Yedan Chen, Yuqian Shi, Kaihua Liu, Xian Zhang, Hua Bao, Xue Wu, Xiaonan Wang, Yang Shao, Zhi Li
Journal: Journal of Clinical Oncology (2020)

e14538 Background: Molecular charactersitcs are essential for the classification and grading of gliomas. However, majority of current understanding is based on public databases that might not accurately reflect the Asian population. Here, we studied the mutation landscape of Chinese glioma patients in hope to provide new insights for glioma prognosis and treatment. Methods: Tissue samples from 112 glioma patients underwent next-generation sequencing targeting 425 cancer-relevant genes. Gene mutations and copy number variations were investigated for their prognostic effect using overall survival data. Pathway-based survival analysis was peformed using top ten predefined oncogenic pathways. Results: We identified similar prevalence of currently established molecular diagnostic markers of glioma, including TP53 (33%), EGFR(26%), TERT (24%), PTEN (21%), ATRX (14%), BRAF (13%) and IDH1/2 (6%). Among all genetic abberations with more than 5% occurrence rate, four mutations and four copy number gains were significantly associated with poor overall survival (univariate, P &lt; 0.05). Of these, TERT mutations (hazard ratio [HR], 3.14; 95% confidence interval [CI], 1.31 to 7.49; P = 0.01) and EGFR amplification (HR, 2.67; 95% CI, 1.20 to 5.95; P = 0.02) remained significant after adjusting for clinical parameters. Similarly, PIK3CA mutations, which was also frequently mutated in glioma but not used for clinical classification, were found to correlate with poor prognosis (HR, 2.61; 95% CI, 1.19 to 5.74; P = 0.02). Additionally, we have also identified MCL1 amplification as a potential novel biomarker for glioma (HR, 2.73; 95% CI, 1.47 to 5.07; P &lt; 0.001), which was seldom reported in the TCGA database and might possibly be ancestral specific giving its high prevelance in our cohort (found in 32% patients). Pathway analyses revealed significantly worse prognosis with abnormal PI3K (HR, 1.81; 95% CI, 1.12 to 2.95; P = 0.02) and cell cycle pathways (HR, 2.04; 95% CI, 1.2 to 3.47; P &lt; 0.001), both of which stayed meaningful after adjusting for clinical factors. Conclusions: In this study, we discovered PIK3CA mutations and MCL1 amplification as novel prognostic markers of glioma. We also demonstrated shorter survival with abnormal PI3K and cell cycle pathways that provided an intergrative understanding of glioma.
血清可溶性E-选择素在支气管哮喘患儿的检测价值
Authors: 杨文东, 马庆海
Journal: BMJ (2005)

对34例发作期和28例缓解期支气管哮喘患儿定量检测血清可溶性E-选择素(sE-SLT).发作期、缓解期血清sE-SLT水平分别为(23±7)μg/L和(17±5)μg/L,均显著高于对照组(P<0.01),发作期血清sE-SLT异常率也显著高于缓解期.提示血清sE-SLT可用于判定支气管哮喘患儿病情和观察疗效。
SWOT analysis on participation of community nurses in chronic disease management under tiered referral system
Authors: Li Wang, Lijie Chang, Hao Wu, Lihua Liu, Chunyan Zhang, Weiming He
Journal: BMJ (2016)

阐述社区护士在分级诊疗中参与慢性非传染性疾病(慢性病)管理的优势和劣势以及机遇和挑战，并运用SWOT[strength(优势)、weakness(劣势)、opportunity(机遇)和threat(挑战)]分析法提出了SO战略组合、ST战略组合、WO战略组合、WT战略组合等对策，为社区护士在分级诊疗中有效参与慢性病管理工作提供参考。
Optimization of colorectal cancer screening in a community of Shanghai
Authors: Jing Zhou, Huichao Wu, Zhiyong Li, Bin Chen
Journal: BMJ (2018)

The colorectal cancer screening program was implemented in Pujiang community health service center of Minhang District of Shanghai in 2015 (before optimization)and 2016(after optimization). The screening results were compared between 2015 and 2016. In 2015 the positive rate of FOBT was 20%(4 564/22 819), and 707 subjects received further screening colonoscopy with a compliance rate of 15.49%(707/4 564). Colonoscopy detected 4 cases of colorectal cancer, 30 cases of intraepithelial neoplasia, 240 cases of colorectal polyps (including 167 cases of colorectal adenoma) and 6 cases of colorectal inflammatory lesions. In 2016 the positive rate of FOBT was 12.58%(2 947/23 424), 817 subjects received screening colonoscopy with a compliance rate of 27.72%(817/2 947). Colonoscopy detected 5 cases of colorectal cancer, 101 cases of intraepithelial neoplasia, 430 cases of polyps (including 330 cases of colorectal adenoma) and 9 cases of inflammation lesions. There were no significant differences in the detection rates of colorectal cancer, inflammatory and other lesions between 2015 and 2016(P>0.05), the colonoscopy compliance, detection rate of intraepithelial neoplasia and polyps in 2016 were significantly higher than those in 2015(P<0.05). The results suggest that through various measures to optimize the implementation of the colorectal cancer screening, community health service center can improve the colonoscopy compliance in FOBT-positive subjects, the early detection rate of precancerous lesions and polyps in the community.


Key words: 
Colorectal neoplasms; Colonoscopy; Community health centers
Comparative efficacy, safety, and tolerability of immune checkpoint inhibitors (ICIs) in cancer.
Authors: Laith Al-Showbaki, Michelle Nadler, Alexandra Desnoyers, Fahad Almugbel, David W. Cescon, Eitan Amir
Journal: Journal of Clinical Oncology (2020)

e15151 Background: Multiple ICIs have been approved, and in some diseases there is a choice of more than one ICI. The comparative safety, efficacy, and tolerability are not known. Here we report on a network meta-analysis comparing different ICIs targeting PD1 or PDL1. Methods: Randomized trials (RCTs) supporting the registration of a single agent anti-PD1 or anti-PDL1 inhibitors between 2015-2019 were identified. We extracted the hazard ratio (HR) for overall survival (OS) and calculated the odds ratio (OR) for commonly reported safety and tolerability outcomes. We then performed a network meta-analysis including only disease sites in which more than one ICI has been approved. Multiple pair-wise comparisons were then performed. When more than 2 comparisons were available for a pair of ICIs these were pooled into a single estimate. Analyses were performed in Microsoft Excel and RevMan 5.3. Results: Of 16 RCTs included, 10 in non-small-cell lung cancer, 2 in melanoma, 2 in head and neck squamous cell carcinoma and 2 in urothelial cancer. There was a total of 10673 patients in the analysis. Compared to pembrolizumab, efficacy was similar for nivolumab (HR 1.06, 95% CI 0.97-1.16) and for atezolizumab (HR 1.05, 95% CI 0.93-1.20). However, avelumab appeared inferior (HR 1.29, 95% CI 1.07-1.57). Pembrolizumab showed similar odds of serious adverse events (SAEs) as nivolumab (OR 1.12, 95% CI 0.56-2.27) and atezolizumab (OR 1.05, 95% CI 0.55-2.04). However, compared to nivolumab, atezolizumab was associated with more SAEs (OR 2.14, 95% CI 1.47-3.12). Avelumab had the lowest odds of grade 3-4 adverse events compared to pembrolizumab (OR 0.42, 95% CI 0.24-0.74), nivolumab (OR 0.38, 95% CI 0.24-0.62) and atezolizumab (OR 0.21, 95% CI 0.14-0.33). Atezolizumab was associated with more grade 3-4 adverse events than nivolumab (OR 1.84, 95% CI 1.37-2.47). The odds of treatment discontinuation without progression were similar between nivolumab and atezolizumab (OR 1.20, 95% CI 0.73-2.00), but higher with pembrolizumab compared to nivolumab (OR 1.35, 95% CI 0.83-2.17) and atezolizumab (OR 2.56, 95% CI 1.29-5.00). Pembrolizumab was associated with higher OR of immune related adverse events (IRAEs) compared to nivolumab (OR 2.12, 95% CI 1.49-3.03) and atezolizumab (OR 1.63, 95% CI 1.09-2.43), while the OR of IRAEs was almost similar between nivolumab and atezolizumab. Conclusions: Pembrolizumab, nivolumab, and atezolizumab have similar efficacy. Avelumab appears efficacious. Safety and tolerability seem better with avelumab, but worse with atezolizumab and pembrolizumab.
Multidisciplinary team management for high grade immune-related adverse events (irAEs): A single center experience.
Authors: PRABHSIMRANJOT SINGH, Osama Abu-Shawer, Amanda Brito, Eric Yenulevich, Shilpa Grover, Raja-Elie E Abdulnour, Nicole R. LeBoeuf, Patrick Alexander Ott, F. Stephen Hodi, Joseph O. Jacobson, Osama E. Rahma
Journal: Journal of Clinical Oncology (2020)

e15076 Background: Immune checkpoint inhibitors (ICIs) are increasingly used in the management of cancer. High grade irAEs are uncommon but can be severe and require hospital admission. There is an urgent need for early identification and triage of patients with irAEs in order to improve their management and outcomes. Methods: We established Immunotherapy toxicity (ITOX) team as the first in nation inpatient service at DFCI and Brigham and Women's Hospital (BWH) along with our partners at Massachusetts General Hospital (MGH) that is specifically devoted to mitigating irAEs. The ITOX service is consistent of 2 PAs and a medical oncology attending with an expertise in immunotherapy. The service utilizes algorithms that are modified from the ASCO and NCCN guidelines by our medical subspecialty experts at BWH. The service uses a multi-disciplinary approach with around the hour consulting service from experts in the field including GI, pulmonary, endocrinology and others. We leveraged EPIC to triage patients who are admitted to BWH and have ever received or currently on immune checkpoint inhibitors (ICIs). The daily list generated by EPIC is then curated manually by a PA to identify patients with potential irAEs. Results: A total of 138 patients with high grade irAEs were admitted to BWH between June 2018 and June 2019. Seventy percent of the 201 irAEs- related admissions were to ITOX service (70% accuracy in triaging). Most common irAEs was colitis (31%), pneumonitis (28%) and hepatitis (13%) which is consistent with the most common reported irAEs due to ICIs. Eighty five percent of the patients had grade 3 irAEs and 15% were admitted with life threatening grade 4 adverse events. About half of the patient had received ICI monotherapy; 33% received combination of ICI and non-ICI (chemotherapy or targeted therapy) and 17% received combination of ICIs. Most patients responded to steroids and only 9% had steroid-refractory irAEs requiring other immunosuppressive agents. The average length of stay for irAEs-related admission was 11 days with readmission rate of 26% within a year. Over 50 patients consented for tissue and blood biospecimen collection at the time of toxicity. Conclusions: We demonstrated the feasibility of empowering EMR to accurately triage patients with suspected irAEs to the ITOX service that is supported by institution developed guidelines and specialists. Our model is adaptable in major academic centers and can have major impact on quality improvement and future research studies that can be conducted in this unique setting.
胎儿保健:人类保健的起点
Authors: 黄醒华, 孔丽君
Journal: BMJ (2007)

保健是预防医学中的主要组成部分,其目标已从仅仅降低疾病发生率提高到延长寿命、提高生命质量的水平.人类保健从何时开始尚有争议,关键是对人的生命从何时算起的看法不同,实质就是如何看待人类的胚胎及胎儿.近年来更多的围产医学家认为胎儿作为人生命的开始,有享受保健的权利。
肺结核的影像表现
Authors: 马大庆
Journal: BMJ (2011)

胸部X线平片和CT是肺结核的主要影像检查方法.X线胸片用于发现病变,做出初步诊断,进行随访以观察治疗效果;CT能够清楚显示病灶形态并用于鉴别诊断[1]. 一、各种类型肺结核的影像表现 (一)原发性肺结核 原发性肺结核是结核菌初次感染引起的肺内病变,包括原发综合征和胸内淋巴结核。
Evaluation of molecular pathogenesis of colon cancer in Kerala using high-throughput expression, signaling pathways, and network analyses.
Authors: Prasanth Ariyannur, Pavithran Keechilat, Roopa Paulose, Damodaran M Vasudevan
Journal: Journal of Clinical Oncology (2020)

e16065 Background: The molecular pathogenesis of colon adenocarcinoma (COAD) is attributed to large molecular changes such as Chromosomal Instability and high somatic copy number variation or defective DNA mismatch repair and consequent microsatellite instability (MSI). The prevalence of this type of cancer is increasing in the state of Kerala, India. A detailed study of the signaling pathways could lead to a better understanding of the central molecular pathological changes and potential biomarkers particular to this population. Methods: High throughput somatic expression analysis using Nanostring PanCancer pathway panel assay was performed. Differentially expressed (DE) genes were selected and KEGG pathway enrichment analysis was performed for assessment of canonical signaling pathways. Expression profiles were compared against the public database, Colon Adenocarcinoma cohort of the Cancer Genome Atlas (TCGA-COAD), using the Genome Expression Profiling Interactive Analysis (GEPIA). Protein-protein interaction network analysis was done using Cytoscape. DE genes were compared against immune cell infiltration in the TCGA-COAD from Tumor Immune Estimation Resource (TIMER) databases. Results: Nanostring assay was performed in 10 Tumor-Normal paired FFPE samples of stage II/III colon adenocarcinoma. Out of &gt; 700 genes, significant difference in expression was found in 83 genes (FDR adjusted p -value &lt; 0.01) with fold-change |fc(log 2 )| of at least one. Fold-change |fc(log 2 )| ≥ 2 was found in 19/83 genes. Network analysis clustered 13 out of 17 upregulated genes. Superimposition of the current data on TCGA study showed that among the three genes, four (MET, MCM2, ETV4 and MMP7), were common. DE Genes which were not significant in TCGA COAD study such as INHBA, COL1A1, COL11A1, COMP, SFRP4, SPP1, IL11, LIF, WT1 and DDIT4, were found to be significant in the current study. A few of the unique genes identified in the current study were found to have significant correlation with antigen presenting cells infiltration in the TCGA-COAD studies. Conclusions: Many DE genes from the study population were found to be different from previous large cohort studies in other population. This may suggest a different pathogenesis of COAD in this population, warranting a detailed study on the pathogenesis.