tbuckley/cabot-search huggingface dataset:
Redefining mental healthcare: going multidisciplinary to manage multimorbidity
Authors: Simon Rosenbaum, Grace McKeon, Brendon Stubbs, Megan Teychenne, Alexandra Parker, Robert Stanton, Felipe Schuch, Amit Mistry, Zachary Steel, Joseph Firth
Journal: British Journal of Sports Medicine (2020)

People with mental illness are twice as likely to develop cardiovascular, respiratory, infectious and metabolic diseases compared with the general population.1This disparity in health occurs from the earliest presentation of mental ill health and affects people across the life span,1 reducing life expectancy by 15–30 years compared with the general population.2 This poor physical health, as well as the associated widening mortality gap,3 has been described as a ‘human rights scandal’.2 This problem led to a Lancet Psychiatry Commission1 on protecting the physical health of people living with mental illness, with a focus on prevention and early intervention across all levels of treatment. The Lancet Psychiatry Commission outlines advances in our understanding of the link between physical and mental health, summarising findings from over 100 systematic reviews and meta-analyses, providing a practical blueprint towards protecting the physical health of this vulnerable population.1 Importantly, the blueprint recommends that all people living with mental illness have access to exercise and dietary interventions as part of routine mental healthcare.

For people living with mental illness, higher rates of smoking, sleep disturbance, physical inactivity and …
Genomic testing among patients (pts) with newly diagnosed advanced non-small cell lung cancer (aNSCLC) in the United States: A contemporary clinical practice patterns study.
Authors: Adam Gondos, Luis G. Paz-Ares, Diego Saldana, Marlene Thomas, Céline Mascaux, Lukas Bubendorf, Fabrice Barlesi
Journal: Journal of Clinical Oncology (2020)

9592 Background: We describe contemporary clinical patterns of guideline-mandated genomic testing in newly diagnosed US pts with aNSCLC. Methods: From the Flatiron Health electronic health record-derived de-identified database, we included pts with newly diagnosed advanced non-squamous cell carcinoma of the lung between 1.1.2018–6.30.2019 who had received first-line (1L) therapy. We defined inadequate testing as no successful test for at least one of four examined genes: ALK, BRAF, EGFR, and ROS1. We grouped pts according to testing received into users of next-generation sequencing (NGS) testing, including a subgroup using comprehensive genomic profiling (CGP, exemplified by Foundation Medicine, Inc.), users of non-NGS testing, and no testing. We describe the following aspects of genomic testing before the start of 1L therapy: occurrence of testing, patterns of use of testing technologies, occurrence of inadequate testing, test failures, percentage of pts with potentially missed targeted therapy with US Food and Drug Administration approval (no positive test and &lt;4 successful tests), and recent trends in genomic testing. Results: Among 2971 included pts, 690 (23.2%) had no genomic testing before 1L treatment. Among pts who had a test (n=2281), 59.4% (n=1355) received NGS (CGP: 18.8%, n=429), while 40.6% (n=926) received non-NGS tests only. In the CGP user group, 79.7% of pts received no other type of test, compared with 29.8% of pts in the other NGS group. Inadequate testing was recorded in 13.4% of NGS-tested pts (CGP: 4.9%), compared with 52.5% of pts tested by non-NGS only. Test failures contributed to unsuccessful testing in 4.2% of pts tested by NGS (CGP: 1.2%) and in 6.8% of pts who received non-NGS tests. In the NGS group, 10.1% (CGP: 3.0%) of patients potentially missed a targeted therapy option, compared with 40.3% in the non-NGS group. EGFR and ALK testing were performed in ≥95% of pts, regardless of the testing group; however, only 83.6% and 55.7% of pts received tests for ROS1 and BRAF, respectively, in the non-NGS group. In the latter group, for the first 6 months of 2019, 88.4% and 58.2% of pts were tested for ROS1 and BRAF mutations, respectively. Conclusions: Not performing any, or performing only inadequate genomic testing in pts with newly diagnosed aNSCLC remains a concern in clinical practice. The use of NGS, particularly CGP, may help to avoid suboptimal testing, minimize test failures, and improve uptake of testing for newly introduced biomarkers, enabling individualized, targeted therapy.
Application of multiple methods in puncture fluid examination for diagnosis of axillary cystic/solid mass
Authors: Wenzhi Zhang, Gaoyi Yang, Yu Pei, Jianping Xu
Journal: BMJ (2016)

The clinical data of 91 patients with axillary cystic/solid mass receiving ultrasound-guided mass puncture in Hangzhou Red Cross Hospital and Hangzhou Third Hospital from March 2010 to October 2015 were retrospectively analyzed. The biopsy cytology examination and routain bacteria culture of puncture fluid were applied in 44 cases (control group); while X-pert examination of puncture fluid was performed in addition to biopsy cytology examination and routain bacteria culture in 47 cases (study group). The histopathological examination of surgical specimens were used as gold standard. The overall diagnostic accuracy rates of study and control groups were 93.6% (44/47) and 68.2% (30/44), respectively(P=0.002). The diagnostic accuracy rates for tuberculous abscess in study and control groups were 100.0%(28/28)and 57.7%(15/26), respectively (P=0.000). However, there were no significant differences in diagnosis of other diseases, including metastatic carcinoma, abscess other than tuberculous and lymphatic hygroma between two groups. The study shows that diagnostic accuracy of multiple examination methods of puncture fluid for axillary cystic/solid mass is high and has clinical application value.


Key words: 
Biopsy, needle; X-pert exam; Cystic and solid mass
Expercise tress test in management of chronic obstructive pulmonary disease
Authors: 苑晓春, 张劭夫
Journal: BMJ (2008)

仅以第一秒用力呼气容积(FEV1)的变化对慢性阻塞性肺疾病(COPD)的病情分级,不能够全面评价患者病情和判断预后.近年来,随着BODE指数[(B)体重指数,(O)气流受阻指数,(D)呼吸困难,(E)运动能力]的提出[1],越来越多的研究倾向于应用运动试验客观评价患者的活动能力,1981年美国胸科学会曾推荐把运动试验作为估价COPE)患者身体状态和工作能力的检查项目.我国COPD诊疗指南亦推荐将6 min行走试验(6MwT)作为运动耐力的指标[2]。
[OPTIMAL 3] A phase III trial to evaluate the efficacy and safety of DHP107 (Liporaxel, oral paclitaxel) compared to Taxol (IV paclitaxel) as first line therapy in patients with recurrent or metastatic HER2 negative breast cancer (BC) (NCT03315364).
Authors: Sung-Bae Kim, Qingyuan Zhang, Tao Sun, Jae Hong Seo, Keun Seok Lee, Tae-Yong Kim, Zhongsheng Tong, Kyong Hwa Park, Yong Wha Moon, Shusen Wang, Wei Li, Yaewon Yang, Jingfen Wang, Xian Wang, Jonggwon Choi, Ji Eun Lee, Koung Eun Yoon, Seongwuen Chung, Binghe Xu, Joohyuk Sohn
Journal: Journal of Clinical Oncology (2020)

TPS1106 Background: Paclitaxel is a microtubule-stabilizing drug used for various cancers including breast cancer (BC) and gastric cancer (GC). DHP107 is an oral paclitaxel solution formulated with non-toxic excipients using DH-LASED technology, which doesn’t require pre-treatment. DHP107 demonstrated comparable efficacy and safety to IV paclitaxel for patients with advanced GC (Ann Oncol 2018), and was market approved as the first oral paclitaxel in 2016 for GC in Korea. In previous OPTIMAL phase II study, the primary endpoint objective response rate (ORR) was 54.5% in HER2 negative metastatic BC (MBC) patients and 44.4% in triple negative BC (TNBC) patients. Disease control rate (DCR) was 90.9% by the investigators’ assessment. Toxicity was manageable (2019 ESMO). OPTIMAL phase III is being conducted in Korea, China and Eastern Europe based on this result and another phase II study (OPERA) is being performed in USA. Methods: OPTIMAL 3 study is a multinational, multi-center, randomized and open-label trial enrolling HER2 negative (HR+/HER2- or TNBC) recurrent or metastatic BC patients. Patients are randomized to either study (DHP107) or control group (IV paclitaxel) in a 1:1 ratio and stratified by disease free interval (DFI≤48 weeks vs &gt;48 weeks), visceral metastasis status (visceral vs non-visceral) and country. Patients are administrated with DHP107 (200mg/m 2 p.o. bid) or IV paclitaxel (80mg/m 2 infused) on D1, 8, 15, q4wks. Tumor assessments are performed on every 8 weeks (±7 days) from C1D1 until disease progression (RECIST V1.1). Key inclusion &amp; exclusion criteria are hormone receptor (ER/PR) positive or negative, HER2 negative, ECOG performance status ≤1 and no prior chemotherapy in recurrent or metastatic disease. The primary endpoint is progression free survival (PFS). Secondary endpoints include ORR, overall survival (OS), time to treatment failure (TTF), DCR, quality of life (QoL) and safety. Total target number of patients is 476 with an estimated 10% drop-out rate. The test is based on non-inferiority hypothesis (HR=1.33) with 80% power. The primary endpoint will be analyzed using a one-sided test at a 2.5% significance level, and other endpoints will be analyzed using a two-sided test at a 5% significance level, with 95% confidence interval. The first subject was enrolled in Jan 2019 and recruitment is ongoing and is expected to be completed in Dec 2020. Final results of this study will be announced by the end of 2022. Clinical trial information: NCT03315364 .
Improving care for patients with stage III/IV NSCLC: Learnings for multidisciplinary teams from the ACCC National Quality Survey.
Authors: Ravi Salgia, Leigh Boehmer, Catherine Celestin, Judy Yu, David R. Spigel
Journal: Journal of Clinical Oncology (2020)

228 Background: Refinement of the multidisciplinary team (MDT) approach continues to offer significant potential for improving the quality of non-small cell lung cancer (NSCLC) care and adherence to guideline-recommended protocols. This opportunity arises, in part, from insufficient characterization of MDT practice patterns and barriers to optimal care provision within U.S. cancer programs. The Association of Community Cancer Centers (ACCC), therefore, conducted a national survey to improve understanding on how patients with stage III/IV NSCLC were diagnosed and managed across different practice settings, with the aim of informing the design and execution of process-improvement plans to address identified barriers. Methods: ACCC convened an expert steering committee of multidisciplinary specialists, including oncologists, thoracic surgeons, pathologists, pulmonologists, and representation from patient advocacy, for a comprehensive, double-blind, web-based survey (January–April 2019) to obtain insights on cancer care delivery for patients with NSCLC in a diverse set of U.S. community cancer programs. Results: Of 1211 questionnaires, 639 responses affiliated to 160 unique cancer programs across 44 U.S. states were suitable for analysis. In total, 41% (n = 261) of respondents indicated that their cancer program did not have a thoracic multidisciplinary clinic. Nurse navigators (P = 0.03) and radiation oncologists (P = 0.04) were significantly more likely to engage in shared decision-making practices than other disciplines. The average time to first therapeutic intervention in newly diagnosed patients was 4 weeks (range = 1–10 weeks; n = 298). A significant negative correlation between frequency of tumor board meetings and time to complete disease staging (P = 0.03) was observed. The most challenging barriers to delivering high-quality NSCLC care are listed (Table). Conclusions: Multiple opportunities exist to improve the delivery and quality of care for patients with stage III/IV NSCLC, including reducing barriers to effective care coordination and patient education, screening, diagnosis and biomarker testing, and adherence to evolving standards of care. [Table: see text]
The value of lymph node ultrasound and whole body PET/CT in stage IIB/C patients prior to SLNB.
Authors: Emma H.A. Stahlie, Bernies Van Der Hiel, Annemarie Bruining, Michel W.J.M. Wouters, Yvonne Schrage, Winan J. van Houdt, Alexander Christopher Jonathan Van Akkooi
Journal: Journal of Clinical Oncology (2020)

e22079 Background: Stage IIB/IIC (pT3b-T4N0) patients are known to have high-risk primary tumors, even higher risk than some stage IIIA/B melanomas (AJCC Staging System 8 th edition), however they follow the same routine to sentinel lymph node biopsy (SLNB) as more low-risk tumors. A priori the risk of finding SLNB or other metastases is much higher for these thick and/or ulcerated primary melanomas compared to the thinner ones. Guidelines are not conclusive regarding the use of preoperative imaging in these cases. Recently, a trend to more frequently use cross-sectional imaging has been noticed. However, others have previously shown that preoperative ultrasound was the most sensitive. The aim of this pilot study was to assess the value of ultrasound (US) and Positron Emission Tomography/Computerized Tomography (PET/CT) prior to SLNB for stage IIB/C (pT3b-T4N0) melanoma patients. Methods: Starting 2019-04, all patients with a pT3b melanoma or higher (8 th AJCC) were included. All patients underwent US and PET/CT before their planned lymphoscintigraphy and routine SLNB. Suspected metastases were confirmed with cytologic puncture. Results: A total of 20 patients were screened. Seven patients (35%) had metastases detected by imaging: one by PET/CT, three by US and three by both imaging modalities. Three of these metastases were detected by US as well as PET/CT. All metastases were nodal. For all seven patients treatment was altered to lymph node dissection with adjuvant therapy. Of the 13 patients in whom no metastases were identified by imaging, six (46%) still had a positive sentinel node (SN). Conclusions: This study showed that this select group of patients had a high risk of metastases prior to SLNB and that all recurrences except one, were detected by ultrasound. This suggests that nodal staging with US is sufficient and can replace the need for SLNB when metastases is proven with cytology. Despite negative imaging, SLNB cannot be foregone for pT3b-pT4N0 melanoma patients, as many still have an involved SN. Cross-sectional imaging can be reserved for patients after positive cytology or SN to confirm the absence of distant visceral metastases.
Safety of double and a half-layered esophagojejunal anastomosis in total gastrectomy with gastric cancer.
Authors: Pengfei Ma, Yuzhou Zhao, Xijie Zhang
Journal: Journal of Clinical Oncology (2020)

e16563 Background: Esophageal jejunal anastomotic fistula is still one of the serious postoperative complications of gastric cancer, the incidence was 1% ~ 16.5%. The aim of this study was to evaluate the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy. Methods: The new method was called double and a half layered esophagojejunal anastomosis: esophagojejunal anastomosis was performed with a tubular stapler, then the anastomosis was reinforced by absorbable suture (Full-layer continuous suture, slurry muscularis embedding). The new method was used in observation group (n = 295). In the control group(n = 469),the esophagojejunal anastomosis was performed with a tubular stapler, then reinforced by intermittent suture with absorbable sutures. Data analysis including operating time, blood loss, anastomosis time, types and cases of postoperative complications, and postoperative hospitalization time. Results: The data of 764 patients who performed radical gastrectomy between May 2015 and May 2019 were analyzed retrospectively. 1.Surgery situations: The operating time (140.66±26.96 min vs 139.61±22.75min, t= 0.581, P&gt; 0.05) blood loss (200.61±111.03ml vs214.45±114.09ml, t= -1.481, P&gt; 0.05), anastomosis time (20.44±4.31min vs19.92±4.58min, t= 1.573, P&gt; 0.05), postoperative hospitalization time (15.35±6.46 d vs15.89±5.58d, t= -1.229, P&gt; 0.05) .2. Postoperative situations: the rates of anastomotic complications in observation group was 1.69% (5/295) and 4.69% (22/469) in control group, with a statistically significant difference between two groups( χ2 = 4.768, P&lt; 0.05). The rates of anastomotic leakage in observation group was lower than that in the control group 1.02% (3/295) vs 3.41% (16/469) ( χ2 = 4.282, P&lt; 0.05) . The severity of anastomotic leakage, anastomotic stenosis, anastomotic bleeding were no statistically significant differences between two groups( χ 2 = 2.030,1.261,0.075, P&gt; 0.05). Total postoperative complications: 101 cases (34.24%) in the observation group, 14 cases (4.75%) with severe complications, and 1 case death. 151 cases (32.2%) in the control group, 34 cases (7.25%) with serious complications, and 2 cases death ( χ2 = 0.838, Z = -1.465, P &gt; 0.05). Conclusions: Double and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy, which can reduce the incidence of anastomosis complications.
又一个肌酸激酶增高的患者
Authors: 曾昭耆
Journal: BMJ (2006)

一位男性患者,59岁,某国营大公司老总,工作劳累、紧张,脾气急,5年前于某心脏病专科医院已诊断为冠心病.因连续3年健康检查均发现肌酸激酶增高(300U/L左右),此次单位查体发现肌酸激酶仍高,体检医生怀疑其患心肌梗死,瞩立即到心内科检查.患者因此有些紧张,第2天就来门诊找我,要求住院诊治。
A pilot study of nintedanib in molecularly selected patients with advanced non-small cell lung cancer (NSCLC) (NCT02299141).
Authors: Saiama Naheed Waqar, Usha Rawat, Daniel Morgensztern, Sanjana Shah, Jeffrey P. Ward, Siddhartha Hk Devarakonda, Timothy Patrick Rearden, Feng Gao, Ramaswamy Govindan
Journal: Journal of Clinical Oncology (2020)

e21694 Background: Nintedanib is a small molecule tyrosine kinase inhibitor targeting VEGFR1-3, PDGFR and FGFR. The purpose of the study was to evaluate the response rate for patients with advanced non-small cell lung cancer (NSCLC) with mutations in TP53, VEGFR1-3, PDGFR-A, PDGFR-B, and FGFR1-3 treated with nintedanib as part of an open label, single arm pilot study. Methods: Patients with advanced NSCLC previously treated with platinum-doublet chemotherapy with ECOG PS≤1 and adequate organ function were enrolled. Exclusion criteria included cavitary or necrotic tumors with invasion of major blood vessels, history of recent thromboembolic events, predisposition to bleeding or thrombosis, myocardial infarction and weight loss &gt; 10% within past 6 months. Nintedanib was administered at a dose of 200 mg orally twice daily during each 28-day cycle until disease progression or unacceptable toxicity. Response assessments were performed every 8 weeks. The primary endpoint was overall response (ORR) by RECIST 1.1. Secondary endpoints included progression-free survival (PFS) and correlating outcomes with specific mutations. Results: Between 5/7/2015 and 11/15/2019, 20 patients were enrolled to study. The median age was 66 years, 15/20 (75% were females), 17/20 (85%) had received prior immunotherapy and 11/20 (55%) had received at least three prior lines of systemic therapy. The ORR was 15% with 3/20 partial responses (PR), while 12 patients had stable disease (SD), with disease control (PR+SD≥16 weeks) rate of 60% (12/20). The median progression-free survival and median overall survival were 18 weeks (95% CI: 8-31) and 48 weeks (95% CI:15-56) respectively. All three responders had a TP53 mutation and had received prior immunotherapy. There were nine grade 3 events including transaminitis in 20%, while one patient each (5%) experienced hyperbilirubinemia, anorexia, fatigue, hypertension, and nausea. Grade 4 events included transaminitis (10%) and cerebral edema (5%). There was one grade 5 cardiac event, which was unrelated to nintedanib. Conclusions: In this pilot study in heavily pretreated and molecularly selected patients with metastatic NSCLC, nintedanib showed modest activity. Clinical trial information: NCT02299141.
Covid-19 and refugees, asylum seekers, and migrants in Greece
Authors: Elias Kondilis, Karl Puchner, Apostolos Veizis, Christos Papatheodorou, Alexis Benos
Journal: BMJ (2020)

Douglas and colleagues correctly say that refugees, asylum seekers, and migrants are vulnerable to epidemics.1 Social distancing in the overcrowded places where they commonly reside is impossible, and early detection of cases is difficult owing to their exclusion from national healthcare plans. Local outbreaks among refugees and migrants are expected in epidemics, outbreaks that might go unchecked or even concealed.2

In the covid-19 pandemic, the World Health Organization, the UN Refugee Agency, and the International Organisation for …
过犹不及
Authors: 曾昭耆
Journal: BMJ (2009)

女性84岁,为糖尿病及陈旧性心肌梗死患者.平日生活自理,能从事简单家务劳动.因右脚轻度感染到医院就诊.体温正常,血白细胞9×10~9/L,分类正常.生化检查除血糖稍高外无异常,血钾4.5 mmol/L.经静脉予抗生素治疗。
Leptomeningeal disease after surgical resection and radiosurgery for brain metastases and neurologic death: A multi-institutional analysis.
Authors: Roshan Sudhir Prabhu, Brandon E Turner, Anthony L Asher, Samuel Marcrom, John B. Fiveash, Paul M Foreman, Robert H. Press, Zachary Buchwald, Walter J Curran, Kirtesh R. Patel, William Breen, Paul D. Brown, Krishan Jethwa, Inga S. Grills, Jessica Arden, Lauren M Foster, Matthew A. Manning, Zachary Vaslow, Stuart Burri, Scott G. Soltys
Journal: Journal of Clinical Oncology (2020)

2524 Background: Postoperative radiosurgery (SRS) has been associated with up to 30% risk of subsequent leptomeningeal disease (LMD). We previously demonstrated that radiographic pattern of LMD (classical “sugarcoating” [cLMD] vs. nodular [nLMD]) in this setting is prognostic. The association between radiographic pattern of LMD, type of salvage treatment (tx), and neurologic death (ND) has not been well described. Methods: The records of patients (pts) with brain metastases (BM), of which 1 was resected and treated with adjunctive SRS, and who subsequently developed LMD were combined from 7 tertiary care centers. Pts with classically radiosensitive tumors or prior or planned whole brain radiotherapy (WBRT) were excluded. ND was defined as symptomatic CNS progression around the time of death without life threatening systemic symptoms or progression. Salvage radiotherapy (RT) for LMD was categorized according to use of WBRT vs. focal cranial RT. Results: The study cohort consisted of 147 pts, of which 125 had died with known cause, 107 also received LMD salvage tx, and 82 also had cranial MRI follow-up. The ND rate in the 125 pts who died with known cause was 79%; the rate in pts who underwent LMD salvage tx (n = 107) was 76%. Univariate logistic regression demonstrated radiographic pattern of LMD (cLMD vs. nLMD, odds ratio [OR] 2.9, p = 0.04) and 2 nd LMD failure after salvage tx (OR 3.9, p = 0.02) as significantly associated with ND. The ND rate was 86% for cLMD vs. 68% for nLMD pattern. WBRT was used in 95% of pts with cLMD vs. 52% of pts with nLMD. In the nLMD cohort (n = 58), there was no difference in ND rate based on type of salvage RT (WBRT: 67% vs. focal cranial RT: 68%, p = 0.92). Second LMD failure (vs. not) was associated with higher ND in the nLMD cohort (77% vs. 52%, p = 0.02). Of the 26 pts with nLMD who experienced 2 nd LMD failure, 7 had classical 2 nd LMD, of which 100% experienced ND, and 19 had nodular 2 nd LMD, of which 68% experienced ND (p = 0.09). Conclusions: LMD after surgery and SRS for brain metastases is a clinically significant event with high rates of neurologic death. Classical LMD pattern (vs. nodular) and 2 nd LMD failure after salvage tx were significantly associated with higher risk of neurologic death. In the nodular LMD cohort, radiographic pattern of 2 nd LMD may be associated with risk of subsequent neurologic death. Pts with nodular LMD treated with salvage focal cranial RT or WBRT had similar risk of neurologic death. Methods to decrease LMD and the subsequent high risk of neurologic death in this setting warrant investigation.