tbuckley/cabot-search huggingface dataset:
泪小管炎三例误诊分析
Authors: 杨文慧, 颜华, 韩琪
Journal: BMJ (2010)

例1 患者女,62岁,因左眼流泪、流脓1年于外院诊为慢性泪囊炎,多次行泪道冲洗无效,于2009年1月来本院门诊检查,左眼上泪小点呈鱼嘴样噘起,生理盐水冲洗上泪小点,反流伴脓液,下泪小点冲洗通畅.挤压上泪小管可见豆渣样脓性分泌物溢出,伴异味,细菌培养阴性,诊断左眼慢性上泪小管炎.无菌条件下行上泪小点和泪小管切开,术中发现上泪小管膨大,内有大量灰白色豆渣样物质,用刮勺清除脓性物质后,以庆大霉素稀释液2 mg/ml冲洗,术后局部滴用左氧氟沙星滴眼液.术后第1天,于切开的上泪小管用庆大霉素稀释液冲洗,有少量豆渣样物冲出.术后第3天、第5天冲洗,均无脓性物质反流,上泪小管呈劈裂样,冲洗不通畅.随访10个月,无复发。
Efficacy and tolerability of elotuzumab-based three-drug regimens for high-risk multiple myeloma: A meta-analysis.
Authors: Arafat Ali Farooqui, Shaha Nabeel, Muhammad Tariq, Aqsa Ashraf, Zahoor Ahmed, Muhammad Salman Faisal, Mohammad Ammad Ud Din, Zartashia Shahab, Alireza Setarehaseman, Faiz Anwer
Journal: Journal of Clinical Oncology (2020)

e20550 Background: Efficacy of elotuzumab (E) based regimens in high risk multiple myeloma (MM) (i.e, ISS stage II/III and t(4;14) or (del17p) has not been thoroughly investigated. The aim of this study was to assess the efficacy of E based 3-drug regimens compared to non-E based regimens in high risk MM. Methods: A systematic review of literature was done to identify randomized controlled trials (RCTs) which reported overall response rates (ORR), progression free survival (PFS) and overall survival (OS) of MM patients (pts) with E based 3-drug regimens. Odds ratios (OR) of ORR were computed and hazard ratios (HR) of PFS and OS (along with 95% confidence intervals; CI) were extracted to compute a pooled HR using RevMan v.5.3 to report the efficacy of E based 3-drug regimens. A random effects model was employed only when there was significant heterogeneity among studies ( &gt; 40%, as assessed by I-squared). Results: After screening 604 studies, 04 RCTs were included (n = 986 patients). E was evaluated with lenalidomide (L), pomalidomide (P), bortezomib (B) and dexamethasone (d). ELd regimen was studied in 359, EPd in 60 and EBd in 77 pts. Total 496 pts were evaluated with E. Pooled analysis of E based 3-drug regimens showed improved PFS (HR 0.69, 95% CI 0.59-0.81; p &lt; 0.00001, I 2 = 0%) and ORR (OR 1.92, 95% CI 1.33-2.78; p = 0.0005; I 2 = 25%) as compared to non-E 2-drug regimens. Relapsed/refractory MM pts (n = 456) also showed improved ORR in E vs non-E groups (OR 1.88, 95% CI 1.19-2.97; p = 0.007; I 2 = 47%). Sub-group analysis showed 30% reduction in progression in high risk MM pts (HR 0.70, 95% CI 0.53-0.94; p = 0.02; I 2 = 0%) and 31% in standard risk pts (HR 0.69, 95% CI 0.53-0.88; p = 0.003, I 2 = 0%). OS showed 25% reduction in risk of death with E based regimens (HR 0.75, 95% CI 0.62-0.91; p = 0.004, I 2 = 0%). E proved to be clinically safe across all patients (OR 1.10, 95% CI 0.78-1.57; p = 0.58; I 2 = 71%). Conclusions: Elotuzumab based 3-drug regimens appear to abrogate high risk features in MM compared to 2 drug regimens.
卡泊芬净治疗血液病合并肝功能损害三例
Authors: 张艳, 仇红霞, 张苏江, 许戟, 张丽娟, 王菱菱, 胡昳歆, 李建勇
Journal: BMJ (2011)

卡泊芬净是一种棘白菌素类抗真菌药,具有广谱抗真菌活性且毒性低,与其他抗真菌药物无交叉耐药,因具有良好的安全性,肝功能不全患者亦可使用.2009年1月至6月,对3例肝功能损害的血液病患者使用了卡泊芬净治疗,现报道如下。
Survival among breast cancer patients with a history of previous cancer.
Authors: Sandi Pruitt, Hong Zhu, David E. Gerber, Daniel Heitjan, Bhumika Maddineni, Danyi Xiong, Ethan Halm, Caitlin C. Murphy
Journal: Journal of Clinical Oncology (2020)

e14080 Background: A growing number of women newly diagnosed with breast cancer have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. Among women diagnosed with incident breast cancer, we examined the impact of previous cancer on overall and cancer-specific survival. Methods: This population-based cohort study included patients age ≥66 years and diagnosed with breast cancer between 2005-2015 in linked SEER-Medicare data. Separately by breast cancer stage, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression for women with and without previous cancer, adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident breast cancer. Results: Of 138,576 women diagnosed with incident breast cancer, 10,822 (7.8%) had a previous cancer of another organ site and many of these (n = 5,014, 46.3%) were diagnosed ≤5 years of breast cancer. For all breast cancer stages except IV in which there was no significant survival difference, women with vs. without previous cancer had worse overall survival (see Table). This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, while women with previous cancer generally had favorable breast-cancer specific survival, the impact of previous cancer on this outcome varied over time. Conclusions: Many women newly diagnosed with breast cancer are already cancer survivors. These women have generally worse overall survival, worse survival from other causes, but their disease-specific survival varies depending on their breast cancer stage and over time. Future analyses will explore time-varying effect of previous cancer on breast cancer survival. [Table: see text]
Should You Recommend Inhaled Corticosteroids for This Patient With Chronic Obstructive Pulmonary Disease?
Authors: Risa B. Burns, Asha Anandaiah, Mary B. Rice, Gerald W. Smetana
Journal: Annals of Internal Medicine (2020)

Approximately 12 million adults in the United States receive a diagnosis of chronic obstructive pulmonary disease (COPD) each year, and it is the fourth leading cause of death. Chronic obstructive pulmonary disease refers to a group of diseases that cause airflow obstruction and a constellation of symptoms, including cough, sputum production, and shortness of breath. The main risk factor for COPD is tobacco smoke, but other environmental exposures also may contribute. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2020 Report aims to provide a nonbiased review of the current evidence for the assessment, diagnosis, and treatment of patients with COPD. To date, no conclusive evidence exists that any existing medications for COPD modify mortality. The mainstay of treatment for COPD is inhaled bronchodilators, whereas the role of inhaled corticosteroids is less clear. Inhaled corticosteroids have substantial risks, including an increased risk for pneumonia. Here, 2 experts, both pulmonologists, reflect on the care of a woman with severe COPD, a 50–pack-year smoking history, frequent COPD exacerbations, and recurrent pneumonia. They consider the indications for inhaled corticosteroids in COPD, when inhaled corticosteroids should be withdrawn, and what other treatments are available.
Exploring the clinical efficacy of the total body skin exam.
Authors: Tanner Harding, Jennifer Seyffert, Brittany Maner, Anuj Kunadia, Shawn Camner, Martin Yungmann, Murray Cotter, James A. Solomon
Journal: Journal of Clinical Oncology (2020)

10078 Background: The clinical efficacy of the total body skin exam has long been the subject of debate. A 2016 report by the United States Preventative Services Task Force (USPSTF) found the current body of evidence was “insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in [asymptomatic] adults.’’ However, the USPSTF based its recommendations on studies evaluating mainly the ability of primary care physicians to diagnose melanoma through total body skin exams (TBSE). This study seeks to address this insufficiency in the current literature by exploring the clinical efficacy of the dermatology provider performed TBSEs as a screening tool with respect to the detection of malignant melanoma (MM), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC). Methods: A search was performed within the electronic medical record of a large multi-state dermatology group practice for all instances of new and established patient office visits occurring from 1 January 2018 to 31 December 2019. Per practice policy, it is denoted whether each office visit includes a TBSE or partial skin exam (PSE). The number of MM, SCC, and BCC diagnoses made within the context of each class of skin exam was analyzed. Results: Of the 930,706 office visits analyzed, 438,027 TBSEs and 492,679 PSEs were performed. For each of the three types of skin cancer surveyed, the number of cancers diagnosed in the context of a TBSE was significantly greater than the number diagnosed in the context of a PSE. One MM was diagnosed per 161.0 TBSEs and 371.3 PSEs ( Χ 2 ( df = 1, N = 930706) = 662, p &lt; 0.001). One SCC was diagnosed per 56.7 TBSEs and 108.4 PSEs ( Χ 2 ( df = 1, N = 930706) = 1258.5, p &lt; 0.001). One BCC was diagnosed per 10.2 TBSEs and 17.8 PSEs ( Χ 2 ( df = 1, N = 930706) = 5884, p &lt; 0.001). Conclusions: Skin cancer is detected at significantly higher rates in TBSEs than PSEs. The finding that one MM is detected in 161 TBSEs may be compared to one cervical cancer is detected in 3,776 Pap smears. Thus, a TBSE is 23.5 times more likely to identify a MM than a Pap smear is to identify a cervical cancer. This trend holds even when adjusted for prevalence. Further analysis will allow for the comparison of exam types with respect to patient age, staging, lesion size, and Breslow depth at time of cancer diagnosis. This continued analysis will allow for a more detailed risk benefit-analysis and insight into the clinical efficacy of the TBSE.
Maintenance therapy with oral cyclophosphamide plus celecoxib in patients with metastatic Ewing sarcoma: Results of the Italian Sarcoma Group/AIEOP EW-2 study.
Authors: Nadia Puma, Asaftei Dorin Sebastian, Anna Paioli, Gianni Bisogno, Marco Rabusin, Luca Coccoli, Angela Tamburini, Giuseppe Maria Milano, Maurizio Mascarin, Rossella Bertulli, Giovanni Grignani, Carla Manzitti, Francesco De Leonardis, Marta Giorgia Podda, Arcangelo Prete, Piero Picci, Rosamaria Mura, Franca Fagioli, Alessandra Longhi, Roberto Luksch
Journal: Journal of Clinical Oncology (2020)

10517 Background: The prognosis of patients with metastatic Ewing sarcoma remains poor. The primary aim of the ISG/AIEOP EW2 Study (EUDRACT# 2009-011197-15) was to evaluate the feasibility and efficacy of maintenance therapy with oral cyclophosphamide plus celecoxib. Methods: From June 1 st 2009 to Nov 22 nd 2019, 112 patients with metastatic Ewing sarcoma at onset entered the ISG/AIEOP EW2 study, consisting of induction chemotherapy, radiotherapy and/or surgery at the site of the primary tumor, a consolidation phase with high-dose busulphan/melphalan + autologous stem cell rescue, whole-lung irradiation (12-15Gy), and a maintenance phase of 180 days with cyclophosphamide 50 mg daily (35 mg/mq daily if age &lt; 14 years) plus celecoxib 400 mg twice daily (250 mg/mq twice daily if age &lt; 14 years). Exclusion criteria from the maintenance phase were disease progression, cardiac or gastro-intestinal comorbidity. For CTCAE v4.0 grade 3-4 toxicities a temporary interruption was planned. Results: Seventy-one patients were eligible and entered the maintenance phase. Median age was 16 years (range 13-41); sites of metastases were lung or single bone (n = 56) and multicentric metastatic spread (n = 15). Sixty-one patients terminated the maintenance phase, 4 patients are still on treatment, 1 patient interrupted the treatment due to auto-immune thrombocytopenia at 4 months, 5 patients were withdrawn throughout maintenance due to disease progression/relapse. The duration of maintenance therapy was 89% of the scheduled days, with a median suspension length of 12 days (range 1-44 days). Causes of temporary suspension were hematological toxicity (19 episodes), infections (12 episodes), gastrointestinal disorders (9 episodes), fluid retention/distal oedema (3 episodes), renal disorders (3 episodes). Median follow-up was 42 months. The 3-year EFS of patients who entered the maintenance phase was 0.79 ± 0.09 for lung or single bone, and 0.19 ± 0.11 for those with multicentric metastatic spread. Conclusions: This schedule of maintenance phase is feasible, despite previous intensive treatment. A longer follow-up is needed to monitor side effects and to evaluate clinical outcome of patients with lung or single bone metastases, while the outcome remains dismal for multicentric metastatic Ewing sarcoma. Clinical trial information: NCT02727387.
Effect of gonadotropin-releasing hormone analogue on pregnancy outcome of endometriosis infertility patients after laparoscopic surgery
Authors: Hongxia Zhang, Xia Liu, Liping Wang, Weiping Fu, Qin Zhu
Journal: BMJ (2015)

Objective
To investigate the effect of gonadotropin-releasing hormone analogue(GnRH-a)on pregnancy outcome in patients with endometriosis infertility after laparoscopic surgery.


Methods
Two hundred and twenty two patients treated with laparoscopic surgery for endometriosis infertility in Jiaxing Maternal and Child Health Care Hospital between January 2010 and December 2012 were enrolled and 184 patients completed the study. Patients were randomly assigned to two groups: 110 patients in GnRH-a group received long-acting GnRH-a (3.75 mg injection every 28 d for 3 times) before trying to conceive, 74 patients in control group were directly trying to conceive for 1 to 36 months. According to endometriosis fertility index (EFI), patients were further subgrouped: GnRH-a group 1 (EFI scores=6-10, n=83), GnRH-a group 2 (EFI scores=0-5, n=27), control group 1 (EFI scores=6-10, n=55) and control group 2 (EFI scores=0-5, n=19). The cumulative pregnancy rate (CPR)and abortion rate were compared among groups and subgroups.


Results
The patients were followed up for 1 to 36 months after trying to conceive, with a median follow-up time of 14 months. The total CPR was 62% (114/184), the median time for gestation was 11 months. Within the first 6 months after operation, the CPR in GnRH-a group and its subgroups were lower than those in corresponding control groups, with significant difference between GnRH-a group and control group [9%(10/110) vs. 32%(24/74), χ2=16.00, P 0.05]. Kaplan-Meier analysis showed that there were no significant difference in CPR between GnRH-a group and control group, GnRH-a group 1 and control group 1, GnRH-a group 2 and control group 2 (all P>0.05). The median time for gestation in GnRH-a group and its subgroups were shorter than those in corresponding control group. The median time for gestation in GnRH-a group was 10 (95%CI: 8.2-11.8) months and that in control group was 17 (95%CI: 11.8-22.1) months. The abortion rate in GnRH-a group and control group was 11% (7/72) and 26% (11/42), respectively (χ2=4.34, P<0.05).


Conclusion
Administration of GnRH-a for 3 cycles can improve postoperative pregnancy rate within 1 year and reduce the abortion rate for endometriosis infertile patients after laparoscopic surgery especially for these with strong fertility.


Key words: 
Endometriosis; Pregnancy; Gonadotropin-releasing hormone; Treatment outcome
Age, sex, and specific gene mutations affect the effects of immune checkpoint inhibitors in colorectal cancer.
Authors: Anqi Lin, Hongman Zhang, Peng Luo, Jian Zhang
Journal: Journal of Clinical Oncology (2020)

e16103 Background: The effect of age and sex on the prognosis of colorectal cancer (CRC) patients treated with immune checkpoint inhibitors (ICIs) has been controversial, and the effect of specific gene mutations on the prognosis of patients treated with ICIs remains to be explored. Based on detailed clinical and genetic data, this study analyzed the influence of the above factors on the overall survival (OS) of CRC patients after ICI treatment and explored the influencing mechanism of various prognostic factors. Methods: We performed survival prognostic correlation analysis and bioinformatics analysis on the clinical CRC cohort receiving ICIs published by Samstein et al. and the clinical and genetic data from The Cancer Genome Atlas (TCGA)-CRC dataset, including immunogenicity and immunosignature analysis, DNA damage response and repair (DDR) pathway analysis, and gene set enrichment analysis (GSEA). Results: Both clinical characteristics and specific gene mutations may be prognostic factors for ICI treatment in CRC patients. Mutation count &gt; 11 (tumor mutation burden (TMB)-high), age &gt; 65, male, RNF43, CREBBP, NOTCH3, PTCH1, CIC, DNT1, and SPEN mutant (MT) were associated with longer OS, while APC-mMT and TP53-MT were significantly correlated with shorter OS. The reason why protective prognostic markers provide better survival benefits to CRC patients may be related to factors such as higher immunogenicity, highly infiltrated immunoactive cells and active immunoactive pathways. Conclusions: Our study is the first to elucidate comprehensive prognostic factors for the treatment of ICIs in CRC patients, from clinical characteristics such as age and sex to specific gene mutations, providing new ideas for immunotherapy in CRC.
Phlebotomy requirements are lower in polycythemia vera patients with low ferritin stores.
Authors: Lindsay Hammons, Lesley Wu, Douglas Tremblay, Lukas Ronner, Yelena Ginzburg
Journal: Journal of Clinical Oncology (2020)

e19537 Background: Polycythemia vera (PV) is a myeloid neoplasm of clonal red cell proliferation. Most PV patients are iron deficient at diagnosis, prior to the onset of therapeutic phlebotomy, the mainstay of treatment. More recent studies have also suggested that aberrant iron homeostasis contributes to persistently elevated hematocrit in iron deficient PV patients. In healthy individuals, iron deficiency leads to anemia such that the co-occurrence of polycythemia and iron deficiency in PV is pathological. The purpose of our study is to investigate whether iron deficiency, as defined by serum ferritin &lt; 15 μg/L, at PV diagnosis can predict phlebotomy requirements in PV patients. Methods: 173 patients were diagnosed with PV between 2010 and 2019 at our institution. We analyze ferritin levels, phlebotomy frequency, and cytoreductive therapy in PV patients. Patients are stratified into a “high ferritin” (serum ferritin &gt; 30 μg/L) or “low ferritin” (serum ferritin &lt; 15 μg/L) groups and analyzed at 0-6 months and 4-6 years after diagnosis. 91% of PV patients were treated with phlebotomy and 70% with cytoreductive therapy. 23 and 13 patients had both a ferritin level and a record of the number of phlebotomies at 0-6 months or 4-6 years after diagnosis, respectively. Results: The average number of phlebotomies at 0-6 months after diagnosis was 3.1±1.7, with no statistically significant difference between the low and high ferritin groups. The average number of phlebotomies at 4-6 years after diagnosis was 2.9±2.5, with no statistically significant difference between the low and high ferritin groups (1.9 vs. 4.6 phlebotomies, respectively; p = 0.136). In patients with low ferritin at diagnosis, phlebotomy requirements decreased at 4-6 years relative to 0-6 months after diagnosis (1.9 vs. 3.1 phlebotomies; p = 0.009) while no difference occurred in the high ferritin group. In all PV patients, average serum ferritin increased with time from diagnosis (R = 0.81) and cannot be explained by cytoreductive therapy as there was no significant effect on average ferritin levels (137 vs. 60 μg/L; p = 0.295) or phlebotomy requirements (3.2 vs. 3.4; p = 0.803) at 4-6 years after PV diagnosis. Conclusions: Low ferritin levels at PV diagnosis decreased phlebotomy frequency at 4-6 years relative to 0-6 months after diagnosis. Additionally, cytoreductive therapy did not significantly affect phlebotomy requirements or ferritin levels at 4-6 years post-PV diagnosis. Further work is needed to assess the molecular pathways involved in iron-deficient erythrocytosis in PV.
ELderly Functional Index (ELFI): Validation of a self-reported measure of functional status in cancer patients.
Authors: Wee-Kheng Soo, Madeleine King, Alun Pope, Christopher B. Steer, Bianca Alix Devitt, Susan Li Ling Chua, Phillip Parente, Ian D. Davis, Peteris Darzins
Journal: Journal of Clinical Oncology (2020)

e19126 Background: Functional assessment of oncology patients can be challenging and is often not performed, or is undertaken by the clinician with minimal direct input from the patient. The ELderly Functional Index (ELFI) is a 12-item composite measure of self-reported functioning in cancer patients. ELFI is derived from four scales from the European Organisation for Research and Treatment of Cancer (EORTC) health-related quality of life (HRQOL) suite: Physical, Role and Social Functioning, and Mobility. This study validated ELFI in patients attending oncology clinics. Methods: For evaluation of validity and internal consistency, 621 cancer patients (31% aged &gt;70 years) fully self-completed the ELFI, cognitive functioning (CF) and emotional functioning (EF) scales of the EORTC QLQ-C30, ECOG-performance status (ECOG-PS), instrumental activities of daily living (IADL) and Clinical Frailty Scale (CFS). For evaluation of test-retest reliability, 278 participants self-completed ELFI, CF, EF, ECOG-PS and Global Rating of Change one week later. Results: ELFI demonstrated excellent internal consistency (Cronbach alpha 0.93, p&lt; 0.001) and test-retest reliability (intraclass correlation coefficient 0.90, p&lt; 0.001). Hypotheses regarding convergent and discriminant validity were confirmed (multitrait-scaling). ELFI was better than its component scales and other function measures at differentiating between participants with different function and frailty scores (known-groups validity, Table). Exploratory factor analysis provided empirical support to the structural validity of ELFI. Strong correlation was observed between ELFI, function and frailty scores. Conclusions: ELFI is a validated patient-reported outcome measure of functional status. ELFI captures broader dimensions of functioning compared to ECOG-PS or IADL. As a composite measure, ELFI has enhanced statistical efficiency, reducing the sample size required to detect a given effect. ELFI could be used as a clinical trial endpoint to assess the functional domains of HRQOL. [Table: see text]