tbuckley/cabot-search huggingface dataset:
Feasibility study on nursing standards of nursing home for the elders
Authors: Zhao-hui Du, Yun Fan, Yan Ding, Xia Le, Yi Zhang
Journal: BMJ (2012)

We investigated health condition and evaluate the viability of Barthel's measuring scale for 1297 elder patients at 17 nursing homes.We nursed all patients by standards and performed a comparison study.The nursing percentages of highest and lowest levels were higher than the previous ones ( P ＜ 0.01 ),while the nursing percentage of normal level was lower than the previous one ( P ＜ 0.01 ).The cooperation between doctors and nurses became optimized through progressive patient care.Ideal nursing standard should be based upon the doctors' judgment and nurses' evaluation.The new standard will be more suitable for patients and easier to control for nurses.

Key words: 
Geriatric nursing;  Progressive patient care
脑面血管瘤病一例
Authors: 宋彩宏
Journal: BMJ (2008)

患者女,17岁,因反复发作抽搐14年,加重伴意识不清2 h,于2007年10月入院.患者于14年前出现四肢抽搐,3～5 min自然缓解,当时神志不清,有小便失禁.每年均发作5～7次,经多家医院确诊为脑面血管瘤病.2 h前四肢频繁抽搐伴神志不清而来院.出生时右侧额面部有红色斑痣,自幼智力差.家族中无此类疾病者。
DNA damage response and repair (DDR) mutations predict the efficacy of platinum-based chemotherapy for advanced non-small cell lung cancer: A retrospective cohort study.
Authors: Zhiwei Xiao, Lingling Sun, Yating Zheng, Hanrui Chen, Xinting Zheng, Jiamin Luo, Chuying Gu, Wenzhuan Xie, Mengli Huang, Lizhu Lin
Journal: Journal of Clinical Oncology (2020)

e21635 Background: DNA damage response and repair (DDR) pathway alteration is known as a predictive biomarker of platinum-based chemotherapy sensitivity in urothelial carcinoma, breast cancer, ovarian cancer, and prostate cancer. However, the predictive value of DDR in patients with non-small cell lung cancer (NSCLC) is still uncertain. This study investigated the DDR mutations (MUT) of NSCLC to identify potential predictive biomarker. Methods: A retrospective analysis of patients with NSCLC was performed. Targeted exon sequencing with the Next Generation Sequencing (NGS) were performed for 298 patients, and they were divided into two groups based on the presence or absence of mutations in 36 DDR genes. Results: 50 patients treated with platinum-based chemotherapy were identified, of which 17 harbored alterations in DDR genes. The median age was 60.5 years (range, 43 to 79 years). A total of 50 patients were evaluated, the objective response rate (ORR) of patients with DDR MUT was 17.6%, ORR 0% for DDR wild-type (WT), and the disease control rate (DCR) was 76.4% for DDR MUT, 48.5% for DDR WT. In terms of survival analysis, patients with DDR MUT had significantly improved median progression-free survival (mPFS) of 9.2 months compared with 4.8 months for DDR WT (Hazard Ratio (HR) = 0.4134, log-rank P = 0.0117). When EGFR and ALK mutations were excluded, there was no significant difference in mPFS between DDR MUT and WT, but DDR MUT has a tendency to be higher than WT (mPFS: 8.0 vs. 4.7 months, HR = 0.5060, log-rank P = 0.1022). Nevertheless, there was no significant difference in the median overall survival (mOS) between two groups (DDR MUT vs. DDR WT: 21.7 vs. 29.4 months, HR = 1.537, log-rank P = 0.3756), even after EGFR and ALK mutations were excluded, no significant difference can also be gained (HR = 1.818, log-rank P = 0.3972). Conclusions: DDR mutations may be a positive predictive biomarker for response to platinum-based chemotherapy in patients with NSCLC.
Using an ePRO tool to help meet quality metric reporting standards: Screening for tobacco usage and falls risk.
Authors: Joanne S. Buzaglo, Edward Stepanski, Mary Joiner, Deb Taylor, Alexander Musallam, Sylvia S. Richey, Lee S. Schwartzberg, Ari M. Vanderwalde, Veronica B. Decker
Journal: Journal of Clinical Oncology (2020)

e19191 Background: ASCO has implemented the Quality Oncology Practice Initiative (QOPI), a certification program established to evaluate oncology practice performance. Also, a growing number of accreditation (JCAHO) and merit-based organizations (MIPS) maintain falls risk assessment standards. Practices often lack the necessary resources to comply with required metric reporting standards. The study purpose was to document the effectiveness of using an electronic Patient Reported Outcome (ePRO) system to facilitate compliance with a core QOPI standard, documentation of smoking status by second office visit, and with JCAHO and MIPS falls risk assessment. Methods: This study used a retrospective, observational design with ePRO collected via the Patient Care Monitor (PCM), a web-based ePRO system linked to electronic medical record data. All study data were collected as part of routine clinical care at a community oncology practice during an 11-month interval (1/2019–11/2019). Patients at an initial clinic visit completed a tobacco usage survey and a brief falls risk survey on the PCM platform via a handheld e-tablet. Results: Overall, 6,613 unique patients completed the PCM survey (mean age 59; 33% male/67% female; 55.4% White, 38% Black). Cancer type was known for a subset of patients (22% breast, 9% hematologic, 4% lung, 5% colorectal, 3% prostate, 11% other types). Across the collected PRO measures, there was an over 98% completion rate with only 1-2% missing data. A relatively significant proportion (51%) indicated they had never used tobacco products and 15% indicated that they were current users. Among patients who ever used tobacco products, 34% indicated they smoked cigarettes, 4% smoked cigars, and 3% used electronic cigarettes. Over a fifth of patients (22%) indicated they had at least one fall over six months; 10% indicated having experienced one fall; 6% indicated two falls; 6% indicated 3 falls or more. 17% indicated they use an ambulatory aid and 12% reported a recent fall within the past 3 months. Conclusions: This study demonstrates that using an ePRO system is an effective way to screen for tobacco usage and falls risk and can be used to: 1) monitor health-related behaviors to enhance physician-patient communication; 2) provide an audit trail for QOPI, JCAHO, MIPS and other quality metric reporting. Automated collection of PRO data allows the healthcare team to focus their clinical time on patients showing increased risk. Overall, an ePRO system contributes to creating a culture of excellence at community oncology practices.
Long-term survival of combined ablation therapy and tremelimumab with or without durvalumab in advanced hepatocellular carcinoma.
Authors: M. Cecilia Monge B., Changqing Xie, John McVey, Donna Mabry-Hrones, Austin Duffy, Bradford J. Wood, Tim F. Greten
Journal: Journal of Clinical Oncology (2020)

e16689 Background: Immune checkpoint inhibitor therapy has recently been approved for the treatment of patients with Hepatocellular Cancer (HCC). Data on long-term survival is lacking and the predictors of good outcomes are unknown. The combination of locoregional therapies (transarterial chemoembolization or radiofrequency ablation) plus tremelimumab (trem) with or without durvalumab (durva) was studied in patients with advanced HCC. We report the long-term survival and analyze predictors of good response in two trials of immune checkpoint and ablation treatment in advanced HCC. Methods: Adult patients (pts) with pathologically confirmed HCC with advanced or sorafenib refractory disease who satisfied the eligibility criteria were enrolled in the studies (NCT02821754, NCT01853618). They received treatment with trem, 10 mg per kilogram every 4 weeks for six doses followed by 3 monthly infusions (23 pts) or trem 75 mg flat dose every 28 days for four doses and then durva 1500 mg flat dose every 28 days (35 pts). Subtotal radiofrequency or chemoablation was done on day 36. Results: The average overall survival in the 58 pts was 10.1 months (range 0.9 to 74.2 months); 41.6% were alive at 12 months and 5.5 % were alive at 61 months. A select group of patients had exceptional overall survivals up to 67 months. Predictors of improved overall survival included the presence of higher grade immune related (irAEs) (OR 0.235, p = 0.075) and a partial or stable disease response per RECIST. No new late toxic effects were noted during this long term follow up. Conclusions: Impressive overall survival times of up to 68.8 months were observed with ICI and subtotal ablation in patients with advanced HCC; the presence of irAEs and the tumor response per RECIST may be predictive of better overall survivals. To our knowledge this has not been previously reported in the literature. Clinical trial information: NCT02821754,NCT01853618 .
Mini-blasting lithotrite for treating incarcerated stone in distal common bile duct under choledochoscope
Authors: Pei-tu Ren, Bao-chun Lu, Huan-jian Xu, Xing-liang Fang, Hong Fu
Journal: BMJ (2011)

Twenty five patients with incarcerated stone in distal common bile duct were treated with mini-blasting lithotrite under choledochoscope from June 2008 to September 2010.The clinical data of patients were retrospectively analyzed.The successful rate of surgery was 100％.The clearance rate of first procedure was 92％ (23/25),2 cases underwent second procedure and all were successful.There were no severe operative complications including bile duct injury,perforation,hemorrhage or bile leakage.Miniblasting lithotrite is a safe and effective method for treating incarcerated stone in distal common bile duct.

Key words: 
Cholangiopancreatography,endoscopic retrograde;  Choledocholithiasis
急性肺栓塞的临床诊断要点
Authors: 刘锦铭
Journal: BMJ (2006)

引起肺栓塞(PE)的血栓主要来源于深静脉血栓(DVT).DVT与PE为同一疾病过程在不同部位、不同阶段的两种表现形式,二者共属于静脉血栓栓塞症(VTE)[1].国外发现其先天性易患因素主要包括遗传性抗凝血酶-Ⅲ(AT-Ⅲ)缺乏症、遗传性蛋白C缺乏症、遗传性蛋白S缺乏症以及活化的蛋白C抵抗、凝血酶原基因G20210A变异、先天性纤溶异常等.国人VTE先天性易患因素方面的研究尚少,不十分清楚.获得性易患因素有高龄、血栓性静脉炎、静脉曲张、外科手术、骨折和创伤、心肺脑血管疾病、恶性肿瘤、制动、妊娠和服用避孕药、结缔组织病、肥胖、吸烟、肾病综合征、糖尿病、长途旅行、植入人工假肢等[2].然而临床上相当多PE患者不易找到易患因素,因此值得注意。
Johnson and Johnson pays hundreds of women in Scotland harmed by mesh implants
Authors: Clare Dyer
Journal: BMJ (2020)

The pharmaceutical giant Johnson and Johnson has agreed to pay an undisclosed sum to settle a legal action by hundreds of Scottish women who claimed they suffered serious injuries from the company’s pelvic mesh implants.

The settlement came as four lead cases brought by women who suffered pain and other serious side effects from the implants, made by Johnson and Johnson subsidiary Ethicon, were about to reach court in Edinburgh.

Johnson and Johnson confirmed that the settlement covered the majority of actions against it in Scotland but took issue with a …
Inefficacy of chromogranin a assays as neuroendocrine tumor diagnostic tools compared to the NETest.
Authors: Anna Malczewska, Mark S. Kidd, Alexandra Kitz, Beata Kos-Kudla, Irvin Mark Modlin
Journal: Journal of Clinical Oncology (2020)

4612 Background: Chromogranin A (CgA) remains a commonly used diagnostic and monitoring tool for neuroendocrine tumor disease despite NCCN guidelines identifying it as a category 3 (major concerns about utility) biomarker. Several commercial assays have been developed to measure this protein (or its fragments) and are available both at CLIA-certified laboratories (USA) as well as in NET Centres of Excellence (CoEs - Europe). CgA is typically reimbursed by insurance companies and appears in several guidelines (e.g., ENETS). We sought to directly evaluate the accuracy of detecting NET disease using two different CgA assays, one in the USA (NEOLISA, EuroDiagnostica, IBL-America, CLIA-certified laboratory) and one in an ENETS CoE (CgA ELISA, Demeditec Diagnostics, Germany). We compared the results to the NETest, a circulating mRNA assay, recently validated as an IVD for NETs. Methods: Patients: NETs ( n=258) including lung: n=43; duodenum n=9; gastric: n=44; pancreas: n=67; small bowel: n=40; appendix: n=10; rectum: n=45. No image-evidence of disease ( n=122) (IND) and image-positive disease (IPD) ( n=136). CgA assays (plasma): NEOLISA, ULN &gt;108ng/ml, DD: ULN&gt;99ng/ml. Data mean±SEM. NETest (whole blood): qRT-PCR - multianalyte algorithmic analyses, CLIA-laboratory. All samples de-identified and assessed blinded. Statistics: Mann-Whitney U-test, Pearson correlation &amp; McNemar-test. Results: In the entire group ( n=258), NEOLISA assay CgA levels were significantly ( p&lt;0.0001) higher (216±91ng/ml) vs. the DD-assay (76±8ng/ml). The assays exhibited a high concordance in output (Pearson r=0.81, p&lt;0.0001), but there were 10.9% ( n=31) discordant results. This reflected the NEOLISA assay detecting more CgA-positive samples. IPD group: CgA-positives were detected in 48/136 (35%, NEOLISA) vs. 28 (21%, DD-assay). McNemar’s Chi 2 =15.04, p&lt;0.001 OR: 11.0, indicating the NEOLISA was significantly better than the DD-assay. The NETest, in contrast, was positive in 135/136 (99%; OR: 87-106, p&lt;0.0001). IND group: CgA-positives were detected in 12/122 (10%, NEOLISA) vs. 9 (7%, DD-assay; p=NS). The majority (75%) of positives were associated with gastric NETs. The NETest was positive in 7 (6%); 4 were gastric NETs and 3 exhibited elevated CgA. Conclusions: Two standard CgA assays used for NET management (one accepted by Medicare in the USA, the second used at a CoE in Europe) only detect NET disease in 21-35% of cases. In contrast, a circulating mRNA fingerprint, the NETest, is ~99% accurate for detecting NET disease.
Dissecting the immune infiltrate induced by ADT and PD-1 blockade in men with metastatic hormone-sensitive prostate cancer using single-cell RNA-sequencing.
Authors: Jessica Hawley, Aleksandar Obradovic, Xinzheng Victor Guo, Matthew Chaimowitz, Clara A Easterlin, Matthew Dallos, Emerson A. Lim, Charles G. Drake, Mark N. Stein
Journal: Journal of Clinical Oncology (2020)

e17548 Background: Overall survival of men with de novo metastatic, hormone-sensitive prostate cancer (mHSPC) is improved by treatment intensification with docetaxel and hormone therapy compared to androgen deprivation therapy (ADT) alone. However, castration-resistant prostate cancer (CRPC) invariably develops. We and others have shown that ADT induces a robust and complex immune infiltrate in localized prostate cancer, in both animal models and humans. We are conducting a clinical trial (NCT03951831) to test the hypothesis that the ADT-induced immune infiltrate can be further augmented with chemotherapy and an anti-PD-1 inhibitor in men with mHSPC. Here, we present single-cell RNA-sequencing analysis of paired metastatic tumor biopsies at baseline and on-treatment. Methods: In our phase 2, open-label, single-center trial, eligible patients with mHSPC are treated with phased administration of ADT, cemiplimab (anti-PD-1 inhibitor), and docetaxel. All patients undergo baseline metastatic tumor biopsies as well as on-treatment biopsies after either ADT alone or ADT in combination with cemiplimab. Biopsies are dissociated by gentleMACS protocol, and single cells are sequenced using the 10X Chromium platform. Cells are Quality-control filtered to those with over 1000 Unique Molecular Identifiers and less than 25% mitochondrial RNA, then clustered on global gene expression and on inferred protein activity by unsupervised Louvain algorithm with silhouette score selection of optimal clustering resolution. Cell types are assigned by the singleR algorithm and tumor cell identity is verified by inference of Copy Number Variations (InferCNV). Differential gene expression across sub-clusters is performed, and baselines will be compared to their paired on-treatment sample (N = 3). Results: Preliminary results showed a significant increase in the normalized fold-change of CD8+ T cells in on-treatment samples relative to baseline samples (P &lt; 0.001). There was also a dramatic increase in other immune cell subtypes with treatment. In addition, we found a shift in transcriptional state of tumor cells and that tumor cells expressing KLK2/KLK3 significantly dissipate with treatment (normalized fold-change 0.56, P &lt; 0.001). Conclusions: Taken together these show the feasibility of SS-RNA-seq on PC metastatic lesions and provide initial support for the hypothesis that ADT induces complex immunological changes in the tumor microenvironment (TME) in metastatic prostate tumors.
Correlation between ultrasound parameters and hormone level in patients with polycystic ovary and polycystic ovary syndrome
Authors: Qinghong Zhao, Hua Shi, Jing Yang, Jiaqi Hu, Yuguo Zhang, Qian Chen
Journal: BMJ (2014)

A total of 104 patients with polycystic ovarian changes on ultrasound were divided into polycystic ovary syndrome (PCOS) and polycystic ovaries (PCO) groups according to their clinical symptoms and endocrine examinations. And 40 women with normal ovulation served as the controls. Ovarian volume (OV), ovarian stroma area (SA), ovarian total area (TA) and SA/TA ratio were measured by transvaginal ultrasonography. Their endocrine hormone levels were determined. Patients with PCOS showed significantly higher OV, SA, TA and SA/TA than those of PCO and control groups. SA/TA was positively correlated with testosterone. The median serum levels of anti-Mullerian hormone (AMH) and inhibit B in the PCO group were intermediate between those in control and PCOS groups. AMH and inhibin B of PCOS were higher than the PCO and control groups. It indicated that the levels of AMH and inhibit B were associated with the degree of polycystic ovaries and they could be used to differentiate PCOS and PCO. SA/TA is associated with the elevated serum testosterone of PCO. And SA/TA is an important ultrasonic parameter for diagnosing PCOS.


Key words: 
Polycystic ovary syndrome; Ultrasonograph, Doppler, color
Bendamustine-bortezomib-dexamethasone (BVD) in heavily pretreated multiple myeloma: Old/new in novel agents' era.
Authors: Claudio Cerchione, Lucio Catalano, Davide Nappi, Anna Emanuele Pareto, Fabrizio Pane, Giovanni Martinelli
Journal: Journal of Clinical Oncology (2020)

e20517 Background: Bendamustine is a bifunctional alkylating agent, with low toxicity, proved to be effective in relapsed, refractory and in new diagnosed Multiple Myeloma (MM). In this retrospective study, It has been evaluated efficacy and tolerance of Bendamustine, in combination with bortezomib-dexamethasone (BVD) in patients with relapsed and refractory MM (rrMM), whose prognosis is particularly severe. A retrospective real-life analysis of patients with rrMM who had been treated with BVD as salvage therapy has been performed. Methods: 56 patients (31 M/25 F), with rrMM, median age at diagnosis 57.3 years (r. 36-82), median age at start of treatment 61.8 years (r.37-83) treated with several lines of treatments (median 6, r. 2-11), every refractory to all the drugs previously received (also Bortezomib), received BVD (B 90 mg/sqm days 1,2; V 1.3 mg/sqm days 1,4,8,11, D 20 mg days 1,2,4,5,8,9,11,12, Pegfilgrastim day +4) every 28 days, until progression. All patients had previously been treated with schedule containing bortezomib and IMIDs, and 30% had also received radiotherapy. 67%of them had undergone at least to a single auSCT. All patients were relapsed and refractory to last therapies received before BVD. Results: Bendamustine was well tolerated, with grade 3 transfusion-dependent anemia in 41% of patients, and 37% grade 3 neutropenia (no ospedalization was required, no septic shocks were observed). No severe extrahematologic toxicity was observed, only grade 1 gastrointestinal side effect (nausea), treated by common antiemetic drugs. According to IMWG, after a median follow-up of 14 months (r.2-36), ORR was 64% (36/56: 4 CR, 7 VGPR, 16 PR, 9 MR) with 8 PD and 12 patients in SD, which can be considered as an impressive result in this subset of rrMM patients. In particular, for 11 patients, BVD was, after having achieved at least a PR, a bridge to second auSCT, and for two patients a bridge to alloSCT. Three patients have shown a notable PR after failure of novel agents (i.e. Carfilzomib and Pomalidomide). Median time to response was 1.2 months (r.1-3), median OS from diagnosis was 62.7 months (r.6-151), median OS from start of Bendamustine was 9.8 months (r.2-36). Conclusions: The triplet Bendamustine-Bortezomib-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, and, in particular cases, it could be considered as a bridge to a second autologous or allogenic SCT.
A phase Ib/II study of olutasidenib in patients with relapsed/refractory IDH1 mutant gliomas: Safety and efficacy as single agent and in combination with azacitidine.
Authors: Macarena Ines De La Fuente, Howard Colman, Mark Rosenthal, Brian Andrew Van Tine, Danijela Levaci, Tobias Walbert, Hui Kong Gan, Maria Vieito, Mohammed M. Milhem, Kate Lipford, Sanjeev Forsyth, Sylvie Mireille Guichard, Yelena Mikhailov, Alexander Sedkov, Blythe Thomson, Patrick Francis Kelly, Varun Monga
Journal: Journal of Clinical Oncology (2020)

2505 Background: Isocitrate dehydrogenase 1 mutations (mIDH1) are present in &gt;70% of patients with Grade II/III gliomas resulting in production and accumulation of (R)-2-hydroxyglutarate causing DNA hypermethylation and promoting tumorigenesis. Olutasidenib is an oral, potent, brain penetrant (Kpuu=0.4 in intact rodent), and selective inhibitor of mutated IDH1 protein. Methods: Patients (pts) with relapsed/refractory (R/R) mIDH1 gliomas received olutasidenib 150 mg BID, orally either as single agent (SA) or in combination (CO) with azacitidine in a dose confirmation phase Ib followed by efficacy evaluation phase II study (NCT: 03684811). Results: As of 31-Oct-2019, 29 pts with R/R mIDH1 glioma were treated with olutasidenib as SA (n=24) or CO (n=5). The median age was 45 yrs (range: 23-64) &amp; 62% were male. WHO Glioma Grade (Gr) at study entry was: II (17%), III (52%) &amp; IV (31%). Median number of prior treatments was 2 (1-5); 86% had received prior temozolomide. mIDH1 status was locally determined (IHC, NGS or PCR): R132H (86%), R132L (7%), R132C (3.5%) &amp; unspecified (3.5%). The median duration of olutasidenib treatment for SA &amp; CO was 4.8 (1-11.4) &amp; 1 (0.2-2.3) months, respectively. Fifteen pts discontinued (disease progression [n=12], AE [n=1], withdrew consent [n=1], other [n=1]). For SA, the most common (&gt;25%) TEAEs (all grades, regardless of attribution) were: fatigue (50%), nausea (50%), diarrhea (33%), ALT increase (29%) &amp; headache (29%). For CO, TEAEs that occurred in ≥ 2 pts were: nausea (n=4), fatigue (n=2), neutropenia (n=2), ALT increase (n=2) &amp; AST increase (n=2). There were 2 protocol defined DLTs in the CO cohort, 1 pt with Gr 4 ALT, Gr 3 AST &amp; Gr 3 GGT elevations &amp; 1 pt with Gr 3 ALT elevation. No pts experienced a TEAE of QTcF prolongation. SA best responses are shown in Table; CO pts are too early for response assessment. The median PFS for SA was 8.3 months. Twenty (87%) and 11 (48%) pts were alive and progression-free at 6 &amp; 12 months, respectively. Conclusions: SA olutasidenib at 150 mg BID demonstrates acceptable safety and tolerability with preliminary clinical activity in glioma pts. Evaluation of CO is ongoing. Updated safety and clinical activity, as well as evaluations of serum/CSF PK/PD will be provided. Clinical trial information: NCT03684811 . [Table: see text]