tbuckley/cabot-search huggingface dataset:
Tunnel fistulectomy with multiseton drainage in treatment of complicated anal fistula
Authors: Xionghua Xiang, Tong Li, Haibo Jin, Lili Liu, Weiming Wu, Zhangyu Cai
Journal: BMJ (2018)

Seventy seven patients with complicated anal fistula were randomly assigned to receive tunnel fistulectomy with multiseton drainage (group A, n=38) or traditional fistulectomy (group B, n=39) for treatment.The clinical data and the treatment outcomes of two groups were compared.There was no significant difference in operation time between two groups (P>0.05). However, group A was significantly superior to group B in postoperative pain Numerical Pain Rating Scak (NPRS) score [(2.2±0.84) vs. (4.2±1.3), P<0.05)], wound surface area [(3.7±0.84) cm2vs. (7.28±1.83) cm2,P<0.05], wound healing time [(23.4±2.41) d vs. (38.8±3.49) d, P<0.05 ], cure rate(97.4% vs. 79.5%, P<0.05) and recurrent rate 1 year after surgery(5.3% vs. 25.6%, P<0.05). The postoperative anorectal dynamic parameters of group A were also better than those of group B (P<0.05). Compared to traditional fistulectomy, the tunnel fistulectomy with multiseton drainage has advantages of less pain, faster recovery, less disturbance in anal function and better long-term clinical effect in treatment of complicated anal fistula.


Key words: 
Rectal fistula; Surgical procedures, minor; Drainage; Thread-ligating therapy
Analysis of the fatigue benefit, functionality, and body composition of a program of therapeutic exercise and healthy lifestyle habits in patients breast cancer operated.
Authors: Sofía Ruíz, Bella Pajares, Marcos Iglesias Campos, Cristina Roldán Jiménez, Antonio Cuesta Vargas, Emilio Alba Conejo
Journal: Journal of Clinical Oncology (2020)

e12533 Background: Numerous studies support the benefit of physical exercise in breast cancer, with a lower rate of fatigue, lower risk of recurrence and greater survival. In addition, it prevents cardiovascular diseases, diabetes and obesity. The objective of this work is to analyze the effect of a program of physical exercise and habits of healthy life on fatigue, functionality and body composition in breast cancer patients of the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Methods: Prospective study on 97 patients with breast cancer after completing locoregional treatment and systemic chemotherapy. Treatment with hormone therapy and trastuzumab was allowed. All patients were without disease, without cardiovascular history that contraindicated the program and have signed the relevant informed consent. The duration of the program was 3 months and the parameter measurement was performed before and after. The main objective was analyze cancer-related fatigue and secondary functional parameters, anthropometric and adherence to Mediterranean diet. Fatigue, parameters functional and adherence to Mediterranean diet were evaluated by tests specific and anthropometric by different measurements including use of Tanita TBF-300A. Results: 97 patients were recruited, with a median age of 52 years (32 and 69), 60% had received neo/adjuvant chemotherapy, 84% hormonal therapy and 12% trastuzumab. Most patients underwent conservative surgery. (76%). After 3 months of intervention, women improved significantly cancer-related fatigue (p = 0.000), levels of diet adherence Mediterranean (p = 0.000), as well as functional parameters. One was observed statistically significant improvement in limb functionality/mobility upper, lower limb and general functionality (p = 0.005, p = 0.013 and 0.000, respectively). No differences were observed in terms of mass index body, fat mass or lean mass. Conclusions: This study shows the benefit in functionality and fatigue of an exercise program therapeutic and healthy lifestyle habits in breast cancer operated patients. Despite a significant increase in adherence to the Mediterranean diet, it is not they observed differences in anthropometric parameters.
新余市城市儿童虐待现状及影响因素分析
Authors: 李彪
Journal: BMJ (2005)

儿童虐待是指在相关责任、义务和能力的条件下,各种形式的躯体和(或)精神折磨、性虐待、漠视、放任、商业或其他的剥削,并导致儿童的健康、生存、发展以及尊严受到实际或潜在的伤害[1].为了解城市儿童家庭心理/精神和躯体虐待发生情况,我们于2004年9月抽取新余市5所小学3～5年级学生共1 683名进行调查,现报告如下。
Does chemotherapy affect survival of breast cancer (BC) patients with recurrence score 26-30?
Authors: Sowmya Goranta, Eduard Drizik, UyoyoTonte Omaduvie, Tarek Haykal, Areeg Bala, Swathi Gorle, Shima Sidahmed, Trailokya Nath Pandit, Ashok Kumar Kanugula, Ghassan Bachuwa, Khalil Katato
Journal: Journal of Clinical Oncology (2020)

523 Background: The Oncotype-DX recurrence score (RS) allows providers to identify hormone receptor positive and HER2-negative breast cancer (BC) patients that may benefit from adjuvant chemotherapy (AC). The TAILORx Trial showed no benefit of AC among patients with RS of 11-25, except for patients younger than 50 years. There are, however, limited studies examining any benefit of AC among those with RS of 26-30. We sought to examine the effect of AC on BC-specific survival among these patients utilizing a national database. Methods: We queried the Surveillance, Epidemiology, and End Results database for newly diagnosed female BC patients between 2010-2015. We included patients with T1-T3, hormone receptor positive, HER2-negative, and lymph node-negative BC with RS of 26-30. Patients with tumors 5 mm or less and with incomplete records were excluded. Cox Proportional-Hazards Model was done to examine the effect of AC on BC-specific survival. A sub-group analysis was performed for patients younger than 50 years to examine the effect of AC on BC-specific survival. Results: We included 2,982 patients, of whom 1,686 (56.5%) received AC. Administration of AC was associated with lower age (56.5 [9.2] vs 61.8 [9.7], p &lt; 0.001), Grade III&amp;IV (39.7% vs 30.2%, p &lt; 0.001), married or patients with partners (66.5% vs 61.5%, p &lt; 0.001), and T stage &gt; 1 (31.3% vs 26.8%, p = 0.03). AC was not associated with insurance status, race, and histology. Overall 5-year BC-specific survival was 97.3% (96.2-98.3%). After adjustment through cox regression, AC was found to not have an effect on survival (HR: 0.54 [0.27-1.10], p = 0.09). There were 579 (19.4%) patients that were younger than 50 years, and AC did not have an effect on survival among these patients (HR: 0.44 [0.08-2.44], p = 0.35). Similarly, among the 2,403 (80.6%) patients aged 50 or older, AC did not have an effect on survival (HR: 0.49 [0.22-1.11], p = 0.09). Conclusions: In this retrospective analysis, administration of AC was associated with lower age, higher grade, marital status, and T stage. AC did not affect BC-specific survival among patients with a RS of 26-30. Subgroup analysis did not show any benefit of AC among patients younger than 50 years or among those 50 or older. Further prospective randomized trials are warranted to identify sub-groups that may potentially benefit from AC.
Delayed PET/CT scanning in locally advanced squamous cell carcinoma of the head and neck (SCCHN) receiving definitive chemoradiation: Outcomes and management of “incidental” findings.
Authors: Sunitha Alluri, Michael J Yunes, Lucinda J Cassells, Seth Kaufman, Thomas Napier, Wilson C. Mertens
Journal: Journal of Clinical Oncology (2020)

e18558 Background: Comparative PET/CT scanning 3-4 months after chemoradiation is often used to determine the need for salvage therapy, but approaches to managing incidental findings prior to, and incomplete response after, therapy vary. Methods: PET/CT scans before and 3-4 months after completion of definitive combined modality therapy for locally-advanced head and neck cancer (AJCC7 stage III-IVB) from 2008-14 were evaluated for FDG-avid masses and abnormal metabolic activity outside of the expected area of involvement, response to treatment and subsequent management. Results: Of 78 eligible patients, 72 had follow-up scans. Scans prior to therapy demonstrated abnormal FDG uptake in non-enlarged cervical lymph nodes in 17 (22%) and were upstaged. Pre-treatment scans revealed FDG-avid uptake outside of expected involvement in 23 patients (9 lung [ &lt; 1.5 cm or ground glass], 4 GI, 3 bone [without CT correlate], 3 lymph nodes, 1 prostate, 1 thyroid, 3 other; 3 had multiple sites). Lung (2), bone (1) and thyroid (1) lesions were biopsied prior to therapy; on post treatment scans 20/23 demonstrated resolution while 2 had lung resections for new primaries (1 died). After therapy, 43/72 (60%) patients had a complete response (CR) without other abnormal uptake; 10/72 (14%) obtained a CR in treated areas, but developed metastases; 19/72 (26%) had persistent uptake, of whom 10 (14%) were shown to have persistent disease; 11 biopsies, 7 further PET/CT, 18 other imaging, 3 LN dissections (1 malignant) and two other salvage surgeries were performed. CR patients had a 3-year overall survival (OS) of 94%; OS was similar regardless of pre-treatment uptake. Conclusions: Minor FDG uptake outside of the head and neck on initial scanning is frequent and most of these will resolve. Persistent uptake is common 3-4 months after therapy but only half of these are persistent cancer. Patients with a normal PET/CT scan after therapy have excellent survival.
Analysis for results of cervical cancer screening among 4006 women at Qiaozi Town, Huairou District, Beijing
Authors: Chun-ling Hou, Jing-jing Chen
Journal: BMJ (2010)

In total, 4006 women aged 25 -65 years at Qiaozi Town, Huairou District, Beijing were screened for cervical cancer during April to June, 2009. Results showed that 54. 52% of the women screened suffered from varied gynecological illness, highest in those aged 30 - 34 years ( 80. 90% ) and lowest in those aged 50 -54 years. The top three gynecological morbidity among them were cervicitis (34. 77% ), virginities ( 12. 88% ) and uterine leiomyoma (8. 34% ). Precancerous lesions in 12 women,endometrial cancer in one woman and cervical cancer in one woman were detected by cervical cytological examinations.

Key words: 
Uterine cervical neoplasm;  Mass screening
Overall survival (OS) and long-term disease-free survival (DFS) of three versus six months of adjuvant (adj) oxaliplatin and fluoropyrimidine-based therapy for patients (pts) with stage III colon cancer (CC): Final results from the IDEA (International Duration Evaluation of Adj chemotherapy) collaboration.
Authors: Alberto F. Sobrero, Thierry Andre, Jeffrey A Meyerhardt, Axel Grothey, Timothy Iveson, Takayuki Yoshino, Ioannis Sougklakos, Jeffrey P. Meyers, Roberto Labianca, Mark P. Saunders, Dewi Vernerey, Takeharu Yamanaka, Ioannis Boukovinas, Eiji Oki, Vassilis Georgoulias, Valter Torri, Andrea Harkin, Julien Taieb, Anthony Frank Shields, Qian Shi
Journal: Journal of Clinical Oncology (2020)

4004 Background: In overall population, IDEA pooled analysis did not demonstrate non-inferiority (NI) regarding 3y DFS in pts with stage III CC receiving 3m vs. 6m of adj FOLFOX/CAPOX. However, in pts treated with CAPOX (especially in low-risk pts), 3m of therapy was as effective as 6m. Results of OS and 5y DFS are reported. Methods: OS was defined as time from enrollment to death due to all causes. OS NI margin was conservatively set to be Hazard Ratio (HR) = 1.11, which is equivalent to: the maximum acceptable loss of OS efficacy, by shortening treatment to 3m, was half of the OS efficacy gained in MOSAIC trial (i.e., 2.26% absolute reduction in 5y OS rate). Pre-planned sub-group analyses included by regimen and risk group for both OS and 5y DFS. NI was to be declared if the one-sided false discovery rate adjusted (FDRa) NI p-value &lt; 0.025. Results: With an overall median survival follow-up of 72 m (range per study, 62 to 84 m), 2584 deaths and 3777 DFS events among 12,835 pts from six trials were observed. Across 6 studies, 39.5% of pts received CAPOX (rate by study, 0% to 75.1%). Overall, the 5y OS rate was 82.4% (3m) and 82.8% (6m), with estimated OS HR of 1.02 (95% confidence interval [CI], 0.95-1.11; FDRa NI p, 0.058) and absolute 5-y OS rate difference of -0.4% (95% CI, -2.1 to 1.3%). Overall, the 5y DFS rate was 69.1% (3m) and 70.8% (6m), with estimated DFS HR of 1.08 (95%CI, 1.01-1.15, FDRa NI p, 0.22). HRs (95% CI) within subgroups see table. Conclusions: 5y OS rate reported in IDEA trials was higher than historical rates, regardless of duration of therapy. While overall survival in IDEA did not meet prior statistical assumptions for NI in overall population, the 0.4% difference in 5y OS should be placed in clinical context. OS and 5y DFS results continue to support the use of 3m adjuvant CAPOX for the vast majority of stage III colon cancer pts. This conclusion is strengthened by the substantial reduction of toxicities, inconveniencies and cost associated with shorter treatment duration. Clinical trial information: NCT01150045; 2009-010384-16; NCT00749450; ISRCTN59757862; 2007-003957-10; UMIN000008543; 2007-000354 . [Table: see text]
Association of Ischemic Stroke, Major Bleeding, and Other Adverse Events With Warfarin Use vs Non–vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation With a History of Intracranial Hemorrhage
Authors: Chuan-Tsai Tsai, Jo-Nan Liao, Chern-En Chiang, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Fa-Po Chung, Tze-Fan Chao, Gregory Y. H. Lip, Shih-Ann Chen
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Current guidelines recommend the use of non–vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). Data regarding warfarin sodium use compared with NOAC use in patients with AF with a history of intracranial hemorrhage (ICH) are limited. <h3>Objective</h3> To compare the clinical outcomes of warfarin use and NOAC use in patients with AF with a history of ICH using a nationwide cohort with AF. <h3>Design, Setting, and Participants</h3> A nationwide cohort study from January 1, 2012, to December 31, 2016, was performed using data from the Taiwan National Health Insurance Research Database. The dates of analysis were July 1 to September 1, 2019. The study population comprised patients with AF with a history of ICH and a CHA<sub>2</sub>DS<sub>2</sub>-VASc score (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, prior stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease], age 65-74 years, sex category [female]) of at least 1 for men or at least 2 for women who had received warfarin or NOACs. The clinical outcomes were examined using Cox proportional hazards regression analyses among the study population before and after propensity score matching. <h3>Exposures</h3> Oral anticoagulation with warfarin or NOACs. <h3>Main Outcomes and Measures</h3> The clinical outcomes measured were all-cause mortality, ischemic stroke, ICH, major bleeding, and adverse events. <h3>Results</h3> The study cohort included 4540 patients (mean [SD] age, 76.0 [10.5] years; 2653 men [58.4%]), with 1047 patients receiving warfarin (mean [SD] age, 75.1 [11.4] years; 571 men [54.5%]) and 3493 patients receiving NOACs (mean [SD] age, 76.3 [10.2] years; 2082 men [59.6%]). Compared with warfarin use, NOAC use was associated with statistically significantly lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.517; 95% CI, 0.457-0.585), ICH (aHR, 0.556; 95% CI, 0.389-0.796), and major bleeding (aHR, 0.645; 95% CI, 0.525-0.793), whereas the rate of ischemic stroke was similar in the 2 groups (aHR, 0.879; 95% CI, 0.678-1.141). These results were generally consistent after propensity score matching among 973 patients in each group. <h3>Conclusions and Relevance</h3> Among patients with AF with prior ICH, NOAC use was associated with lower rates of ICH and major bleeding compared with warfarin use, whereas the rate of ischemic stroke was similar in the 2 groups. Among patients with AF with prior ICH, NOACs could be the preferred choice for stroke prevention.
Updates on safety and efficacy of maintenance therapy after autologous stem cell transplantation in newly diagnosed multiple myeloma: A systematic review.
Authors: Ahsan Wahab, Kamran Mushtaq, Maria Khakwani, Aqsa Khan, Afia Ashraf, Tayyab Rehan, Muhammad Shahzeb Khan Khakwani, Aslam Khan, Zahoor Ahmed, Hani M. Babiker, Faiz Anwer
Journal: Journal of Clinical Oncology (2020)

e20503 Background: Multiple Myeloma (MM) is treatable but an incurable hematological malignancy, requiring additional approaches such as maintenance therapy (MT) after autologous-stem cell transplantation. MT aids to achieve deepened response, sustained response and prolongs progression-free survival (PFS) but has a controversy over its overall survival (OS) benefit. Within the last decade, there have been innovative efforts tested for MT. We designed a systematic review to evaluate the current evidence on this topic. Methods: PubMed and Embase were searched for articles published on MT between 01/2010 and 12/2018 and PRISMA guidelines were used to evaluate 76,588 articles on PubMed and 1516 articles on Embase. Thirty-three articles were included in systematic review. Results: Thirteen articles were available on lenalidomide-MT whereas six articles each on thalidomide and proteasome inhibitors, five articles on combination therapy, two articles on miscellaneous and one article on elotuzumab were available, including trials and observational studies. MT (thalidomide 50 mg, lenalidomide 10 mg) was given for a variable period, commonly used till relapse, progression or unacceptable toxicity. Thalidomide showed consistent PFS-benefit but no OS benefit and had significant neurotoxicity, responsible for discontinuations or dose reductions. Lenalidomide had evidence for both, improved PFS and some evidence for better OS and had hematotoxicity, mainly neutropenia which required dose reductions. Secondary primary malignancies were more frequent with lenalidomide. Longer maintenance of lenalidomide was associated with more toxicity. Thalidomide-bortezomib combination had better PFS than thalidomide alone but no OS benefit. Bortezomib-MT improved OS in high-risk patients and renal failure and had dose-dependent toxicity. Bortezomib-MT after bortezomib-based induction was better than thalidomide-based-MT after cytotoxic induction. MT was associated with the achievement of negative MRD-status. Ixazomib was effective and feasible with improved PFS. Combination of bortezomib-lenalidomide-dexamethasone MT was beneficial in high-risk patients. Conclusions: MT improves PFS with limited evidence toward improved OS. For better outcomes, lenalidomide-based-MT should be given routinely; adjustment of dose might be required due to neutropenia. High-risk patients can get benefit from combination therapy. Role of combination MT needs to be further explored in large prospective studies.
Psychosomatic changes of male climacteric syndrome
Authors: Lijun He, Bing Yang
Journal: BMJ (2017)

男性更年期是男性由中年步入到老年的过渡时期。在此阶段多数男性没有任何临床症状，但大约40%男性会出现不同程度的性功能减退、心理障碍、潮热、注意力不集中、记忆力减退及情绪不稳定等临床症状和体征，并影响许多器官系统的功能，从而影响生命质量。男性更年期综合征可以通过筛查量表进行诊断性筛查，评估需要治疗的患者。生活方式干预与睾酮补充治疗可以用于改善精神心理状态，减轻和缓解更年期相关的临床症状。
剖宫产术后盆腹腔粘连的观察
Authors: 赖幼琳, 胡莉琴, 欧阳忠
Journal: BMJ (2007)

对1999年1月至2006年1月7年间有本院剖宫产史、再次行剖宫产术的356例孕妇的临床资料进行回顾性分析,其中前次手术为新式剖宫产208例(观察组),下腹正中纵切口腹膜外剖宫产148例(对照组).两组盆腹腔均有不同程度的粘连,观察组和对照组无粘连率分别为28.8%和35.1%(P＜0.05),重度粘连率分别为21.2%和8.1%(P＜0.01);观察组1例再次剖宫产开腹困难,导致膀胱损伤,对照组无脏器损伤.说明新式剖宫产导致的盆腹腔粘连较下腹正中纵切口腹膜外剖宫产严重。
心房颤动的心电图表现与注意事项
Authors: 朱天刚, 金小燕
Journal: BMJ (2009)

心房颤动(房颤)是最常见的快速心律失常之一,可由多种原因引起,房颤大多发生于心脏有器质性病变的人,常见于风湿性心脏病(特别是二尖瓣病变)、冠心病、高血压性心脏病、甲状腺功能亢进性心脏病以及慢性缩窄性心包炎等.有时不恰当地使用某种药物也可引起一过性心房纤颤,有些正常人由于过度疲劳也可出现房颤.据统计资料显示,我国房颤的患病率为0.77%,男性为0.9%,女性为0.7%;大于60岁者为7.5%;瓣膜性为12.9%,非瓣膜性为65.2%,特发性为21.9%。
Pegfilgrastim on-body injector: Post-market performance analysis.
Authors: Lucas Maahs, Amy Tang, Zaid Al Saheli, Brigid Jacob, Rishika Polasani, Clara Hwang
Journal: Journal of Clinical Oncology (2020)

e19226 Background: Granulocyte colony-stimulating factors (G-CSF) are widely used in medical oncology for the prevention of neutropenia and its complications. On-body injectors (OBI) have an advantage over the traditional injection (TI) method of not requiring a second visit to the oncology clinic the day after chemotherapy, but these devices are subject to failure. The objective of this study was to assess the efficacy of OBIs in the real world. Methods: Adult women with breast cancer diagnosed between June 2015 and June 2016 treated with cytotoxic chemotherapy and a G-CSF were retrospectively identified from the medical records of Henry Ford Hospital (Detroit, MI, USA). The primary outcome was the incidence of severe neutropenia (SN), defined as an absolute neutrophil count (ANC) ≤500. Secondary outcomes included incidence of neutropenia (ANC ≤1500), neutropenic fever, and mortality. A secondary analysis of the data was performed to identify predictors of SN. Results: A total of 837 cycles of chemotherapy were analyzed. The OBI was used in 395 cycles and the TI in 442. The OBI group had patients that were older, had higher ANC, were more often black, had worse performance status, and were more often smokers. The incidences of SN, neutropenic fever and neutropenia were not different between groups (Table). Mortality was not different between groups when adjusted for confounding variables (OR 1.8, 95% CI 0.9-3.6, p=0.09). Patients with a lower baseline ANC and white ethnicity were at a higher risk for SN. TAC (docetaxel, doxorubicin and cyclophosphamide combined) carried the highest risk for SN among the chemotherapy regimens used. Conclusions: There was no difference in the efficacy of the OBI and TI methods for preventing SN, neutropenic fever, neutropenia, and death. Independent predictors of SN included the chemotherapy regimen used, baseline ANC and ethnicity. [Table: see text]