tbuckley/cabot-search huggingface dataset:
Teaching in outpatient clinic for general practice residency standardized training
Authors: Yue Sha
Journal: BMJ (2019)

Supervised Teaching Clinic of the General Internal Medicine Department, Peking Union Medical College Hospital, is introduced from three respects including it′s organization form, teaching contents, and feedback given by the supervisor. Through the actual cases in these clinics, it is illustrated how to implement the value of general practice during the interviews and how to deliver it to the residents in standardized training program.


Key words: 
General practice doctor; Teaching; Outpatient clinic
RELAY study of erlotinib (ERL) + ramucirumab (RAM) or placebo (PL) in <i>EGFR</i>-mutated metastatic non-small cell lung cancer (NSCLC): Biomarker analysis using circulating tumor DNA (ctDNA) in Japanese patients (pts).
Authors: Kazuto Nishio, Kazuko Sakai, Takashi Seto, Makoto Nishio, Edward B. Garon, Martin Reck, Koichi Goto, Terufumi Kato, Yoichi Nakanishi, Toshiaki Takahashi, Nobuyuki Yamamoto, Katsuyuki Kiura, Yuichiro Ohe, Tomohide Tamura, Carla M Visseren-Grul, Rebecca R. Hozak, Sameera R. Wijayawardana, Sotaro Enatsu, Kazuhiko Nakagawa
Journal: Journal of Clinical Oncology (2020)

9527 Background: The phase III RELAY study (NCT02411448) showed significantly improved progression-free survival (PFS) for RAM+ERL vs PL+ERL in 449 pts with previously untreated EGFR mutation-positive metastatic NSCLC (median PFS 19.4 vs 12.4 mo, HR 0.591 [95% CI 0.461–0.760], p&lt;.0001). To understand baseline genetic mutations and treatment-emergent (TE) resistance mechanisms, this exploratory liquid biopsy substudy examined biomarkers in ctDNA from participating Japanese pts by next-generation sequencing (NGS) and droplet digital PCR (ddPCR). Methods: Plasma samples were collected at baseline, during treatment (Cycle 4, 13, and every 6 cycles to Cycle 53) and post-study treatment discontinuation (30-day follow-up [30d FU]). Mutations were assessed at baseline and 30d FU by NGS (Ion AmpliSeq Colon and Lung Cancer panel). EGFR mutations and MET and ERBB2 copy number (CN) were assessed at all time points by ddPCR. Baseline markers were analyzed in pts with any detectable baseline mutation (to confirm ctDNA presence; NGS N=84, ddPCR N=74). TE mutations were analyzed in pts with any detectable mutation at baseline and 30d FU (NGS N=26, ddPCR N=28). Among these pts, 81% and 57% for NGS and ddPCR, respectively, had progressed by 30d FU. Results: By plasma NGS, baseline EGFR activating mutations (exon 19 deletion or exon 21 [L858R] mutation) were detected in 83.3% of pts. Common co-occurring baseline mutations were TP53 (42.9%), PTEN (7.1%) and KRAS (6.0%). Baseline TP53 mutation rate was higher in men vs women (p=.02). No difference in PFS was detected by baseline TP53 status (interaction predictive p=.45, prognostic p=.33). TE mutations were detected in EGFR (including T790M), FGFR3, KRAS and TP53. Slightly higher rates of TE KRAS (p=.03) and TP53 (p=.07) mutations were detected in RAM+ERL than in PL+ERL. TE total EGFR mutations (p=.65) or TE T790M (p=.69) did not differ by arm. By ddPCR, baseline EGFR activating mutations were detected in all pts. T790M was detected at baseline in 2/37 pts/arm (5.4%) and was TE in 6/11 (55%) RAM+ERL pts and 7/17 (41%) PL+ERL pts. There was a trend (p=.054) for greater ERBB2 CN in RAM+ERL vs PL+ERL at Cycle 4. MET CN decreased slightly at Cycle 4 in both arms (significant in PL+ERL, p=.003). Biomarker levels by ddPCR across all time points will be presented. Conclusions: Though limited by sample size and likely inconsistent tumor shedding, this exploratory study identified potential differences in TP53, KRAS, ERBB2 and MET by demographics, treatment and/or time. Clinical trial information: NCT02411448 .
他到底有几种病
Authors: 曾昭耆
Journal: BMJ (2005)

64岁男性,30多年来因多次体检发现肝功能不正常,被消化科诊断为慢性肝炎、肝硬化,经多种保肝治疗无效.其后发现空腹及餐后血糖高,内分泌科诊断为2型糖尿病,给予口服降糖药,疗效也不理想.不久又因心电图出现完全性右束支传导阻滞,被心内科诊断为冠心病.1996年,在一次常规体检腹部B超检查时,发现肝内鸭蛋大占位性病变,肿瘤科诊断为肝癌。
Safety profile of ripretinib, including impact of alopecia, and Palmar-Plantar Erythrodysesthesia Syndrome (PPES) on patient-reported outcomes (PROs), in ≥ fourth-line advanced gastrointestinal stromal tumors (GIST): Analyses from INVICTUS.
Authors: Suzanne George, Michael C. Heinrich, John Raymond Zalcberg, Sebastian Bauer, Hans Gelderblom, Patrick Schoffski, Cesar Serrano, Robin L. Jones, Steven Attia, Gina Z. D'Amato, Ping Chi, Peter Reichardt, Mario E. Lacouture, Elva Cha, Julie Nicole Meade, Rodrigo Ruiz-Soto, Jean-Yves Blay, Margaret von Mehren
Journal: Journal of Clinical Oncology (2020)

11539 Background: Ripretinib is a novel switch-control TKI that broadly inhibits KIT and PDGFRA kinase signaling. In INVICTUS (NCT03353753), a randomized, double-blind, placebo (PBO)-controlled trial of ripretinib in ≥4 th -line advanced GIST, ripretinib reduced the risk of disease progression or death by 85% vs PBO with a favorable overall safety profile. Common ( &gt; 20%) adverse events (AEs) included, but were not limited to, alopecia and PPES. Exploratory analyses evaluated the impact of alopecia and PPES on quality of life (QoL). Methods: Patients (pts) with advanced GIST previously treated with at least imatinib, sunitinib, and regorafenib were randomized (2:1) to ripretinib 150 mg QD or PBO. AEs were graded using CTCAE v4 and PROs collected using EQ-5D-5L (EQ5D) and EORTC QLQ-C30 (C30). Repeated measures (RM) models assessed the impact of alopecia and PPES on 5 PROs (EQ5D visual analogue scale; and C30 physical functioning, role functioning, and the overall health and overall QoL questions) within the ripretinib arm. Fixed effects were sex, alopecia/PPES, and ECOG scores at baseline. Results: 128/129 randomized pts received treatment (85 ripretinib 150 mg QD; 43 PBO). Alopecia, regardless of causality, occurred in 44 (51.8%) on ripretinib (34 [40.0%] grade 1; 10 [11.8%] grade 2) and 2 (4.7%) on PBO (both grade 1). PPES occurred in 18 (21.2%) on ripretinib (11 [12.9%] grade 1; 7 [8.2%] grade 2); none on PBO. The median times in days to first occurrence and worst severity grade with ripretinib were 57.0 and 62.5 for alopecia; 56.5 and 57.0 for PPES. The RM models showed a slight trend towards improvement in PRO score over time for pts with alopecia; the only association reaching a P-value of &lt; 0.05 was between alopecia and increased overall QoL. None of the associations between PPES and PRO scores reach P &lt; 0.05. All PRO p-values are nominal, and no statistical significance is being claimed. Conclusions: Ripretinib had a favorable overall safety and tolerability profile. When stratified by alopecia and PPES, patient-reported assessments of function, overall health, and overall QoL were maintained over time. For both alopecia and PPES, onset and maximum severity occurred almost simultaneously, indicating that these events generally did not progressively worsen. These results suggest that alopecia and PPES are manageable and do not have a negative effect on function, overall health, and QoL. Clinical trial information: NCT03353753 .
A community oncology palliative care program: Pain-related inpatient utilization in oncology care model (OCM) patients.
Authors: Adil Jamal Akhtar, Jeffrey H. Margolis, Karna Sheth, Andrew A. Muskovitz, Karma Maxwell, Richard Philip Zekman, George Howard, Yusuf Qamruzzaman, Savitha Balaraman, Samer Ballouz, Mohammed Ibrahim, Mitchell Folbe, Mohammed S. Ogaily, Lexi Stortz, Maria Fabbiano, Shehnaz Pancholi, Anoosha Maria Tauquir
Journal: Journal of Clinical Oncology (2020)

12094 Background: Oncology Division of Michigan Health Professionals (MHP) participates in OCM. A comprehensive community oncology program for early and timely involvement of palliative care (PC) was launched in September 2017 to help achieve the OCM program goals of high-quality, cost-effective, coordinated care. PC provides a single point of care for all-cause pain management. PC program included pre-program training and continuous education for early and timely involvement of PC. This study aims to assess the educative effect of PC to reduce pain-related inpatient admissions (Pain IP) in all MHP OCM patients, irrespective of PC-referral. Methods: This initiative was led by palliative care physicians and included continuous education and reinforcement of the benefits, every 2-4 weeks, by sharing PC outcomes data with MHP physicians. Physician feedback was part of the program enhancements that were regularly reviewed during monthly MHP physician meetings. Retrospective claims review was performed with OCM episodes from Oct 2016 – Mar 2019. Monthly Pain IP utilization (based on diagnosis code) per 1000 OCM patients (UPK) was analyzed within pre- and post- PC Program start (Sep 2017). Cost per Pain IP included mean of 30-day follow-up skilled nursing facility (SNF) stay and 30-day outpatient facility expenses. Monthly historical Pain IP (pre-PC UPK) was compared to post-PC Pain IP UPK to calculate OCM savings from PC education at MHP. Results: Pain IP peaked at 7.12 UPK in September 2017 when PC program training and education started, then fell as low as 0.87 UPK in January 2019. Unit cost per Pain IP was $12,473. Post-PC (Sep 2017 – Mar 2019), there were 40 fewer Pain IP admissions compared to Pre-PC Pain IP for a total cost savings of $498,920. Conclusions: After PC Program, Pain IP decreased in MHP OCM population (PC-referred and PC not referred). This trend suggests PC training and continuous education for OCM providers is reducing IP utilization. This also translated to a significant cost saving for OCM/Medicare of $498,920. Study was limited by OCM claims available as of December 2019. Results may be refreshed as more data becomes available.
Phase II study of durvalumab plus total neoadjuvant therapy (TNT) in locally advanced rectal cancer: The GEMCAD-1703 DUREC trial.
Authors: Jaume Capdevila, Ismael Macias Declara, Maria Carmen Riesco Martinez, Joan Maurel, Jorge Hernando, Vicente Alonso, Begoña Graña Suárez, Javier Gallego Plazas, Ferran Losa, Ruth Vera, Marcos Melian, Begona Navalpotro, Daniel Acosta, Marc Diez, Alejandro Garcia-Alvarez, Xabier Garcia-Albeniz, Carlos Fernandez-Martos
Journal: Journal of Clinical Oncology (2020)

TPS4122 Background: In clinical stages II and III (cT3-4 and/or N+), preoperative chemoradiotherapy (CRT) or short-course radiation followed by total mesorectal escision (TME) have been the standard of care for the last 15 years. Induction chemotherapy (CT) before CRT (strategy known as TNT) results in fewer toxic effects and improved compliance. TNT may release tumor-neoantigens with platinum-based induction CT, and radiotherapy has the potential ability to induce an immunogenic cell death and counteract an immune-suppressive tumor microenvironment that provides the rationale for combining with immunotherapies. In addition, the presence of tumor infiltrating lymphocytes has been demonstrated in patients with rectal cancer treated with neoadjuvant CRT, reinforcing the rational for immune check-point inhibitors in this setting. We hypothesize that combining TNT with durvalumab (an optimized monoclonal antibody directed against programmed cell death-1 ligand 1) would improve outcome. Methods: DUREC is a multicenter, single-arm, open-label, phase Ib/II study for patients with magnetic resonance (mr) image middle or distal third, mrT3c-d/T4/N2 rectal adenocarcinoma. Treatment: Patients will receive 6 cycles of modified FOLFOX6 prior to CRT (capecitabine with 50.4 Gy in 28 fractions) and TME, combined with durvalumab 1500 mg every 4 weeks during induction CT, CRT and waiting period until surgery. To assess the tolerability and toxicity profile we plan to perform a run-in treatment phase including the first 6 patients in the study, holding recruitment until all of them will be operated and 30-days post-surgery period completed. If ≤ 2 durvalumab-related dose-limiting toxicities (DLTs) are observed, recruitment will continue. The primary objective is pathological complete response (pCR) rate. Secondary endpoints include toxicity, tumor regression grade, R0 resections, clear circumferential margins, surgical complications, NAR score, disease-free survival and a biomarker program on tumor tissue, blood samples and stool microbiota. Statistical design: 58 evaluable patients (assuming a P0 of 16% and a P1 of 30%, with 0.1 alpha and 0.1 beta); Study started recruitment on December 2019. Clinical trial information: 2018-004835-56 .
Cancer-related fatigue (CRF) in breast cancer survivors after treatment: A focus on physical condition.
Authors: Ana Ruiz-Casado, Constanza Maximiano, Miriam Mendez, Alejandro Alvarez-Bustos, Cristina G De Pedro, Marta Mendez, María Romero-Elias, Hector Cebolla, Javier Ramos, Pablo Osorio, Carmen Fiuza-Luces, Beatriz Nuñez García, Blanca Cantos
Journal: Journal of Clinical Oncology (2020)

e24087 Background: Fatigue is one of the most distressing symptoms among breast cancer survivors (BCS) after finishing their treatment. Besides cancer-related factors, fatigue may be influenced by socio-demographic, physical, medical, psychological and behavioural variables. Exercise is recommended to manage CRF. Methods: PH-UEM02 and PH-UEM06 were prospective observational studies in BCS after finishing their treatments. Fatigue was evaluated through the Perform Questionnaire (12-60, being 60 no fatigue). Anthropometry, physical condition (PC) and physical activity (PA) were objectively evaluated. One-mile walk test (MWT), handgrip and sit to stand were used to assess PC. PA was measured by using accelerometers. Clinical data (treatments) were obtained from the clinical record. Socio-economic, diet (PREDIMED questionnaire) and QoL (EORTC QLQ-C30) were reported by BCS. Results: 201 BCS were recruited (age 51±9, BMI 25.9±4, median time from diagnosis 22 months). 73% had been treated with chemo, 66% anthracyclines, 20% trastuzumab, 66% radiotherapy, 81% hormone (24% aromatase inhibitors). Mean PERFORM score (45.6/60). Adherence to Mediterranean diet (9.1/14). EORTC Global score (68.9/100). No association with age, socio-economic or marital status, previous chemo, anthracyclines or radiotherapy, WPA, estimated VO2max, handgrip, sit to stand or PREDIMED score was found. Weight, trastuzumab and MWT time were positively associated with fatigue (&lt;.05). Time from diagnosis, basal and recovery heart rate, global QOL-EORTC were negatively associated. An interesting negative association with nut intake was found (&lt;.05). 42% had a fatigue score (&lt; 45) associated with QOL scores under the normative values for the Spanish population. Conclusions: 1. Prevalence of significant CRF in mid-term BCS is around 40%. Weight was a positive predictor. CRF diminishes along the time and has a strong impact on QoL. 2. Regarding PC/PA, only the time spent in MWT predicted fatigue. Neither WPA, estimated VO 2MAX or muscular strength were associated with fatigue. 3. Regarding previous treatments, only trastuzumab was associated with CRF. 4. Interestingly heart rate (both basal and recovery) and nut intake were strongly associated with CRF. 5. More research is warranted in heart rate variability and potential related biomarkers. [Table: see text]
右颌面肿胀
Authors: 刘杰, 王焕玲, 王辉, 赵大春, 陈嘉林
Journal: BMJ (2009)

患者女,47岁,因右颌面肿胀10个月余于2008年3月4日入院. 患者于2007年5月无明显诱因出现右颌面部肿痛,局部发红,皮温升高,在外院诊为腮腺炎,给予静脉青霉素治疗7 d无效,2007年8月8日行右腮腺切除术。
Aggregated n-of-1 randomized controlled trial of nebulized fentanyl or nebulized furosemide in palliative care patients with refractory breathlessness.
Authors: Pongput Pimsa, Theerasuk Kawamatawong, Kittiphon Nagviroj, Dittapol Muntham, Jitprapa Konmun, Noppadon Kongsuphon, Ruamporn Laorchan, Yupawadee Koomwong, Phichai Chansriwong
Journal: Journal of Clinical Oncology (2020)

e24138 Background: Advance cancer patients frequently have breathlessness and worsening by refractory to conventional therapies, which need adjunctive therapy. Nebulized Fentanyl and nebulized furosemide have been identified as a novel symptoms approach. Individual patients with the same breathlessness conditions may respond differently to similar treatments, thus no standard adjunctive treatments. N-of -1 study is a within-patient randomized, double-blind, and crossover trials in 1 patient. This study aims to comparing the efficacy in relief breathlessness. Methods: N-of-1 study which enrolled patients at Ramathibodi hospital who have breathlessness with mMRC scored ≥ 3 from 1 st Jan 2019 to 31 st Jan 2020. Study was done as 1 cycle of 3-days of treatment that nebulized fentanyl or furosemide or sterile water (SW). Fentanyl 50 mcg or Furosemide 40 mg or SW that all diluted in SW to be in 6 ml. Jet nebulizer increased delivery of aerosol to lungs that all administered for 4 minutes. Main outcome measured breathlessness intensity Borg scale: 0-10, peripheral capillary O2 saturation, Visual cough score, satisfactions, and adverse events (AEs) that collected at baseline, 15, 30 and 60 minutes post treatment. Type of medication that patients preferred. Results: 19 patients were enrolled; 68.4% were ECOG status 4. All patient previously treated with systemic opioids with dose 29.8±20.9 mg/day. Majority were diagnosed with lung metastatic cancer. Baseline of mean Borg scale were not significant in all groups. All 3 medications significantly reduced Borg scale over time; Fentanyl -2.84 ± 0.17(95% CI -3.19 to -2.49); p = 0.0001, Furosemide -3.05±0.22 (95% CI -3.49 to -2.61); p = 0.0001, and SW -2.52±0.21 (95% CI -2.95 to -2.10); p = 0.0001. No significantly different in reduction of breathlessness, AEs and change in visual cough score in all medications. Most of AEs were mild grade. Majority of patients’ preference was furosemide (42.0%). Conclusions: Adjunctive treatment nebulizer drugs with fentanyl, furosemide and sterile water significantly improve breathlessness symptoms. No significant different in efficacy, adverse events in nebulized fentanyl, furosemide and sterile water. N-of-1 trials may provide a rational and effective method to best choose drugs for individuals with breathlessness.
HIV status and history of prior malignancy in immunotherapy trials.
Authors: John Xie, Leigh Deshotels, Gerard Chaaya, Takefumi Komiya
Journal: Journal of Clinical Oncology (2020)

e14096 Background: Patients with human immunodeficiency virus (HIV) and history of prior malignancy have been historically excluded from clinical trials. In late 2017, ASCO and Friends of Cancer Research proposed to include patients with HIV and history of prior malignancy for which treatment has been completed for at least 2 years. We aimed to determine if these recommendations were followed. Methods: Using clinicaltrials.gov, we performed a systematic review of immunotherapy trials involving pembrolizumab, nivolumab, avelumab, atezolizumab, and durvalumab. We included all solid tumor trials in patients aged 18 years and older performed between January 1, 2016 and December 31, 2019. The following data were recorded for each trial: study period (2016-17 vs. 2018-19), drug type (pembrolizumab vs other), inclusion of HIV positive population (yes or no), and inclusion of prior malignancy per guidelines (yes or no). A Chi-square analysis was performed on the two study periods in relation to HIV status and history of prior malignancy. The same analysis was also performed on HIV status/ history of prior malignancy in relation to the drug type. Significance was set at p-value &lt; 0.05. Results: A total of 305 studies reached final analysis, of which 123 involved pembrolizumab. For all drugs combined, there was no significant change in the two study periods in the inclusion of HIV patients (p = 0.48) or history of prior malignancy (p = 0.68). A subanalysis of the pembrolizumab trials showed a statistically significant inclusion of history of prior malignancy compared to other drugs in the entire study period of 2016-2019 (p = 0.03), but this did not hold true for HIV status (p = 0.69). Conclusions: Our study suggests that recent recommendations by ASCO and Friends of Cancer Research regarding HIV status and history of prior malignancy are not being followed. This could be due to limited awareness surrounding the recommendations or continued fears regarding treatment-related adverse events in this subset of patients. [Table: see text]
Identification of 2968 strains of Candida and an epidemic analysis
Authors: Wen-li Feng, Yan-qing Wang, Jing Yang, Zhi-qin Xi, Rong-li Zhang, Xiao-qiang Jia
Journal: BMJ (2009)

All 2968 strains of Candida species from deeply infected specimens were isolated from Jan.2004 to Nov.2007 in the hospital, in which the Candida albicans accounted for 73.35% of the isolates,and the C.glabrata,C, krusei,C, tropicalis,C, portugal and C.parapsilosi accounted for 10.28%, 8.52% ,4.45%, 2.22% and 1.18% respectively.In these 4 years, the distribution of a variety of clinical specimens and composition sections were significantly different (P<0.01).The distribution of Candida species and composition sections were not significantly different between 2005 and 2006, the rest inter-annual comparisons were significantly different (P<0.01).

Key words: 
Fungi;  Candida
液化气、天然气及煤气中毒的诊断与治疗
Authors: 李思惠
Journal: BMJ (2005)

液化气(液化石油气)、天然气和煤气(焦炉煤气)都是当前主要的可燃性气体,3种燃气与燃煤比较,均是干净的能源,在工业生产和人民生活中被广泛应用,尤其是天然气更适合成为城市居民生活的主要能源.3种燃气比较,天然气结构最简单,因其含碳量最低,燃烧时产生的二氧化碳(CO2)、一氧化碳(CO)等废气最少,对大气的影响也最小。
胸腔注入三氧化二砷加活性炭治疗癌性胸水的临床研究
Authors: 隋新华, 周晋, 孟然, 田振华, 杨宝峰
Journal: BMJ (2004)

癌性胸水患者27例,随机分为试验组14例和对照组13例,充分引流胸水后,试验组胸腔内注入三氧化二砷加活性炭,对照组注入阿霉素加活性炭.两组缓解率差异无显著性,试验组发热和胃肠道反应发生率低于对照组(P<0.01)。
Criteria of admission and discharge for stroke patients in home-based rehabilitation
Authors: Yuan Fang, Hong Zhang, Jie Zhang, Yongxiang Zhou, Yu Xu, Jianping Wu
Journal: BMJ (2017)

Sixteen experts were invited and two-round Delphi expert consultation of admission and discharge criteria for stroke patients in home-based rehabilitation were conducted from April to October 2015. Results showed that the enthusiasm and authority degree of experts in two rounds consultation were favorable. The modified admission criteria included 8 inclusive conditions and 6 exclusive conditions. Among 8 inclusive conditions, home-based rehabilitation intervention time and NIHSS score were the necessary conditions for admission, in addition to 6 exclusion conditions. With the necessary conditions, if patients had disturbances of one or more following conditions: motor function, tactile and proprioceptive function, communication function, cognitive function, quality of life and other symptoms, they were eligible to be admitted in home-based rehabilitation in community. The discharged criteria contained two aspects: 1. the conditions in admitted criteria reaching the plateau; 2. the occurrence of unexpected situations, including disease worsening, deep vein thrombosis and stroke recurrence. The admission and discharged criteria developed in this study has high credibility and can be recommended for practical application in other communities in home-based rehabilitation of stroke patients, which also can be used for implementation of level-classified rehabilitation for stroke patients.


Key words: 
Stroke; Rehabilitation; Community health services