tbuckley/cabot-search huggingface dataset:
Treatment of fourth-degree laceration of perineum: an analysis of eight cases
Authors: Li-ying Zou, Yan Ruan, Xin Wang
Journal: BMJ (2011)

The clinical data of 8 patients with the fourth-degree laceration of perineum, who were admitted in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2004 to December 2010, were reviewed retrospectively. The causes and clinical strategies were analyzed. The fourth-degree laceration of perineum was mainly caused by improper skills of midwifery, too faster labor,insufficient estimation of fetal-weight and perineal condition and obstetric forceps in this group of patients.Primary suture was performed and all cases achieved complete healing. The improvement of midwifery skill,carefully monitoring the uterine contraction, accurate evaluation of condition of perineum and the fetal-weight and good communication between patients and midwives are the key points to prevent the fourth-degree laceration of perineum.

Key words: 
Birth injuries;  Perineum
Development and validation of a CT-based radiomic model combined with margin-related radiomic features to distinguish precancerous lesions from early-stage lung adenocarcinoma.
Authors: Luyu Huang, Haiyu Zhou, Herui Yao, Yunfang Yu, Hongyuan Zhu, Shaopeng Zheng, Weihuan Lin, Daipeng Xie, Fanjun Zeng, Guoqing Liao, Zenan Lin, Fasheng Li, Peirong Zhang, Bin Xu, Shaowei Wu, Lintong Yao, Wanshan Li
Journal: Journal of Clinical Oncology (2020)

e21044 Background: The purpose of this study was to investigate whether the combined radiomic model based on tumor-associated and margin-related (5mm) radiomic features can effectively improve prediction performance of distinguishing precancerous lesions from early stage lung adenocarcinoma. Methods: 264 patients underwent preoperative chest CT in Guangdong Provincial People’s hospital from March 1, 2015 to December 31,2019 were sorted by three cohorts. All lesions were pathologically confirmed as precancerous lesions or Stage I lung adenocarcinoma and a total of 861 analyzable radiomic features were extracted from two segmented lesions including pulmonary lesions and margins, using PyRadiomics by two senior radiologists. In training cohort, 145 patients (70%) are selected randomly from the single-nodular patients (N = 207). As for the validation cohorts, the models were validated using the resting 62 patients from single-nodular cohort and multi-nodular cohort (n = 57) respectively. Least Absolute Shrinkage and Selector Operation and Support Vector Machine-Recursive Feature Elimination were used for feature selection. ROC analysis and AUC were used to evaluate the performance of three models which were developed by multiple logistic regression on distinguishing the precancerous lesions from early stage lung adenocarcinoma. Results: Selected features from pulmonary lesions and pericarcinous tissue were developed into two independent radiomic models and a combined model. Margin-related radiomic model performs well in three validation cohorts. The AUC Brock of single-nodular cohort in training cohort was 0.912 (95% CI: 0.876-0.948), while in single-nodular validation cohort was 0.93 (95% CI: 0.862-0.966). Multi-nodular validation cohort in this model shows an AUC of 0.891 (95% CI = 0.824–0.943). Comparing combined model and tumor-associated radiomic model, it is found that the AUC of combined model was improved from 0.865 (95% CI: 0.767-0.963) to 0.94 (95% CI: 0.767-0.963) for single-nodular validation cohort. Respectively, this combined model also performs well in multi-nodular validation cohort. Conclusions: This study demonstrated the potential of margin-related radiomic features based on preoperative CT scans to distinguish precancerous lesions from early stage lung adenocarcinoma. The constructed radiomic model provided an easy-to-use, preoperative tool for surgeons to develop accurate therapeutic strategies for multi-nodular patients.
Perioperative prophylactic use of antimicrobial agents after intensive management interventions
Authors: Jingjing Han, Yaqing Xu, Xianxi Guo, Fan Wu
Journal: BMJ (2014)

A total of 118 breast, thyroid and orthopedic physicians, pharmacists and nurses in operating room were selected as the intervention objects.After 8 cycles(2 years), the awareness rate increased from 6.78%(8/118)to 79.66%(94/118), the rationalization of indication increased from 36.52%(103/282)to 86.67%(247/285), the rationalization of kinds of antimicrobial agents increased from 8.57%(24/280)to 92.11%(140/152), the patients on antibiotics within 0.5-2 h pre-operation increased from 0.71%(2/280)to 96.05%(146/152), the average durations decreased from (6.3±3.9) to (2.9±0.7) days, the average hospitalization days declined from (10.3±5.5) to (7.6±3.1) days and the total rationalization increased from 1.06%(3/282)to 74.38%(212/285). No combined use was performed and there was no difference in nosocomial infection.Strengthening the management of antimicrobial agents is both feasible and effective.


Key words: 
Anti-bacterial agents; Pharmacy administration
A single-center, open-label clinical study to evaluate pharmacokinetics and pharmacodynamics of pegylated recombinant human granulocyte stimulating factor in pediatric patients with acute lymphoblastic leukemia.
Authors: Wenyu Yang, Tianfeng Liu, Xiaojuan Chen, Ye Guo, Ting Li, Benquan Qi, Fang Liu, Lixian Chang, Min Ruan, Xiaoming Liu, Li Zhang, Yao Zou, Yumei Chen, Xiaofan Zhu
Journal: Journal of Clinical Oncology (2020)

e22501 Background: The aims of the study were to investigate the pharmacokinetics and pharmacodynamics of pegylated recombinant human granulocyte colony stimulating factor(PEG-rhG-CSF) in pediatric patients with acute lymphoblastic leukemia(ALL), and compare the efficacy and safety of PEG-rhG-CSF (brand name:jinyouli) and rhG-CSF. Methods: Pediatric patients with newly diagnosed ALL who planned to use CAM (cyclophosphamide, cytarabine, 6-mercaptopurine) for chemotherapy were assigned to PEG-rhG-CSF group or rhG-CSF group. In the PEG-rhG-CSF group, PEG-rhG-CSF (100ug/kg) was injected subcutaneously once 48 hours after chemotherapy. In the rhG-CSF group, rhG-CSF (150ug/d) was injected subcutaneously daily from 48 hours after chemotherapy until the absolute neutrophil count (ANC) was≥1.0×10 9 /L. The serum concentration of PEG-rhG-CSF was detected by enzyme-linked immunosorbent assay (ELISA). Safety and efficacy of the two groups were evaluated. Results: Between November 2015 to April 2016, 17 pediatric patients were assigned to PEG-rhG-CSF(n = 9) or rhG-CSF(n = 8) groups. The main pharmacokinetic parameters (mean±SD) of PEG-rhG-CSF group were as follows: C max was 353.50±136.3 ng/ml, T max was 44.00±20.8 h, t 1/2 was 14.58± 2.2h. The PEG-rhG-CSF serum concentration and ANC curve were consistent with the mechanism of neutrophil mediated clearance. The average value of ANC nadir in PEG-rhG-CSF group was 0.18 (±0.32)×10 9 /L, and the rhG-CSF group was 0.08 (±0.09)×10 9 /L, there was no significant difference between the two groups ( P = 0.469). Compared with rhG-CSF, the average time of ANC recovery in PEG-rhG-CSF group was earlier (18.33±2.18 vs. 21.50±2.33, P = 0.021). There were no significant differences in the incidence of FN and infection, the duration of grade Ⅳ neutropenia and hospitalization, and the safety of the two groups. Conclusions: PEG-rhG-CSF had favorable efficacy in pediatric patients with ALL receiving chemotherapy, and there was no serious adverse event. Compared with rhG-CSF, PEG-rhG-CSF needed only once in each chemotherapy cycle, which is more suitable for pediatric patients. Clinical trial information: NCT02953730.
Bleeding and thrombosis outcomes in patients with acute leukemia.
Authors: Amar Harry Kelkar, Asha R. Dhanarajan, Mona Arti Kelkar, John R. Wingard
Journal: Journal of Clinical Oncology (2020)

e19501 Background: Management of acute leukemia is often complicated by acute venous thromboembolism (VTE) and bleeding. However, it is unknown which risk factors contribute to these VTE and bleeding events, how they impact survival, or whether they warrant VTE prophylaxis. Methods: A retrospective study was conducted at the University of Florida Health Shands Hospital System. The study included patients aged 18 or older with acute leukemia who received induction chemotherapy between January 2000 and December 2011. Bleeding was defined as clinically significant non-major bleeding and major bleeding per the International Society on Thrombosis and Haemostasis guidelines. VTE was defined as pulmonary embolism, deep vein thrombosis of the upper or lower extremities, or visceral vein thrombosis. Results: Of the 250 patients with acute leukemia, 65 had VTE, 60 had bleeding, and 152 had no significant VTE or bleeding. There were 27 patients with both VTE and bleeding. There were no significant differences in demographics or disease types between these three groups. There was a total of 77 VTE events and 72 bleeding events. We performed a logistic regression analysis in a mixed model to identify risk factors for VTE and bleeding, considering leukemia type, presence of infection, chemotherapy, number of comorbidities, VTE prophylaxis, and transplant as covariates. Presence of infection and number of comorbidities were significantly associated with VTE (p = 0.0094 and 0.0009, respectively). We did not find any significant risk factor associated with bleeding. Kaplan-Meier survival analysis showed a non-significant difference in survival between the non-VTE, non-bleed group and the VTE group (Logrank test, p = 0.52). In contrast, survival in the non-VTE, non-bleed group was significantly higher than the bleed group (Logrank test, p = 0.0006). The table demonstrates higher two-year survival in the non-VTE, non-bleed group (68.7%) compared to the VTE and bleed groups (54.4% and 30.3%, respectively). Conclusions: Acute leukemia patients without VTE or bleeding had significantly higher duration of survival than patients with bleeding. Patients with acute leukemia and presence of infection or multiple comorbidities may warrant greater consideration of VTE prophylaxis. [Table: see text]
多伦多大学医学系家庭和社区医学科本科生、住院医生培训
Authors: 王健, 祝墡珠, 潘志刚
Journal: BMJ (2007)

在WHO的推动下,受过良好训练的初级卫生保健医务人员愈加被认为是建立高效率的卫生保健体系的关键.多伦多大学医学系家庭及社区医学科于1969年创建,现已发展成为加拿大最大的家庭医学科,其本科教育已获得Aikin奖(由加拿大会议理事会颁发,旨在奖励在工作领域有杰出贡献的组织).边远地区住院医生培训计划是其进行家庭医学培训的独特方法,为数量有限的家庭医生创造机会,为其今后能在边远地区开展医疗工作做准备。
Increasing incidence of autoantibody-negative RA is replicated and is partly explained by an aging population
Authors: Xanthe M E Matthijssen, Tom W J Huizinga, Annette H M van der Helm-van Mil
Journal: Annals of the Rheumatic Diseases (2020)

In conclusion, we found an increasing incidence of ACPAnegative RA that was absent in ACPA-positive RA, which is line with the findings of Myasoedova et al.Moreover, we showed that the increase in ACPA-negative RA was in part explained by ageing of the population.This will make ACPA-negative RA more prevalent the coming years and promotes the need for research in this subset of RA.
The role of FOXOs and autophagy in cancer and metastasis—Implications in therapeutic development
Authors: Mohd Farhan, Marta Silva, Shuai Li, Fengxia Yan, Jiankang Fang, Tangming Peng, Jim Hu, Ming‐Sound Tsao, Peter Little, Wenhua Zheng
Journal: Medicinal Research Reviews (2020)

Abstract Autophagy is a highly conserved intracellular degradation process that plays a crucial role in cell survival and stress reactions as well as in cancer development and metastasis. Autophagy process involves several steps including sequestration, fusion of autophagosomes with lysosomes and degradation. Forkhead box O (FOXO) transcription factors regulate the expression of genes involved in cellular metabolic activity and signaling pathways of cancer growth and metastasis. Recent evidence suggests that FOXO proteins are also involved in autophagy regulation. The relationship among FOXOs, autophagy, and cancer has been drawing attention of many who work in the field. This study summarizes the role of FOXO proteins and autophagy in cancer growth and metastasis and analyzes their potential roles in cancer disease management.
Clinical value of serial blood lactic acid monitoring in prognostic prediction for ICU patients
Authors: Wen-zhong Jiang
Journal: BMJ (2009)

Objective To investigate the clinical value of serial blood lactic acid monitoring in predicting prognosis for ICU patients. Method Physiological parameters and arterial blood lactate level of 110 patients suffered from respiratory failure (RF), acute myocardial infarction (AMI), infectious shock, and so on admitted to ICU of the 12th Hospital, Guangzhou during January 2004 to December 2005 were measured 24 h within admission, as well as their acute physiology and ehronie health evaluation Ⅱ (APACHE Ⅱ) score was evaluated according to their worst physiological parameters or results of laboratory examinations at the same time. Those measurements were repeated every 24 h. Relationship between lactate clearance rate and APACHE Ⅱ scores was evaluated for predicting prognosis of the patients. Results Forty-eight of 110 patients died during hospitalization, with a case-fatality of 43.6%. There were 89. 7% (26/29), 66. 7% (18/27) and 7.4% (4/54) fatalities for those with progressive increasing, stable and progressive reducing blood lactate levels, respectively. Lactic acid clearance rate correlated with difference of APACHE Ⅱ scores at the same times (r =0. 836, P =0. 000). Lactate clearance contributed more than APACHE Ⅱ scores in predicting the patients'prognosis, with ORs of 2.21 and 1.26, respectively, and with areas under the ROC curve of 0. 863 and 0. 900 for the APACHE Ⅱ score and blood lactic acid level, respectively. Condusions Both serial blood lactic acid monitoring and APACHE Ⅱ scoring can reflect the prognosis of ICU patients sensitively. And, they correlate each other well in evaluating patients'prognosis. But, APACHE Ⅱ scoring system is not so convenient and too complicated for clinical use because too many variables are needed in evaluation. Serial blood lactic acid monitoring is simple, easy and practical to use in predicting prognosis of ICU patients sensitively.

Key words: 
Lactic acid;  Metabolic clearance rate;  Forecasting
CONTESSA TRIO: A multinational, multicenter, phase (P) II study of tesetaxel (T) plus three different PD-(L)1 inhibitors in patients (Pts) with metastatic triple-negative breast cancer (TNBC) and tesetaxel monotherapy in elderly pts with HER2-metastatic breast cancer (MBC).
Authors: Sara M. Tolaney, Igor Bondarenko, Arlene Chan, Noshir Anthony Dacosta, Yann Izarzugaza, Gun Min Kim, Mei-Ching Liu, Maria EVA Perez, Yen-Shen Lu, Mafalda Oliveira, Samuel Guan Wei Ow, Michel Pavic, Hope S. Rugo, Lee S. Schwartzberg, Agostina Stradella, Tira Jing Ying Tan, Vance Wright-Browne, Joseph P. O'Connell, Thomas Wei, Elizabeth A. Mittendorf
Journal: Journal of Clinical Oncology (2020)

TPS1111 Background: Chemotherapy treatments with robust efficacy that preserve quality of life are needed. T is a novel, oral taxane that has potential advantages over currently available taxanes, including: oral administration with a low pill burden and once every 3 week (Q3W) dosing; no observed hypersensitivity reactions; preclinical evidence of central nervous system (CNS) penetration; and improved activity against chemotherapy-resistant tumors. More than 600 pts have been treated with T in clinical studies. T had robust monotherapy activity in a P2 study in 38 pts with HER2-, HR+ MBC, with a confirmed objective response rate (ORR) per RECIST 1.1 of 45%. Methods: CONTESSA TRIO is a 2-cohort, multinational, multicenter, P2 study. In Cohort 1, 90 pts (potential expansion to up to 150 pts) with metastatic TNBC who have not received prior chemotherapy for advanced disease will be randomized 1:1:1 to receive T at 27 mg/m 2 Q3W plus either: (1) nivolumab at 360 mg Q3W; (2) pembrolizumab at 200 mg Q3W; or (3) atezolizumab at 1,200 mg Q3W. Nivolumab and pembrolizumab (PD-1 inhibitors) and atezolizumab (a PD-L1 inhibitor) are approved for the treatment of multiple types of cancer; atezolizumab, in combination with nab-paclitaxel, was recently approved in the US for the treatment of metastatic TNBC. The dual primary endpoints for Cohort 1 are ORR and progression-free survival (PFS). A sample size of 30 pts in each PD-(L)1 inhibitor treatment group has approximately 70% power to detect an ORR difference of ≥ 35% between the treatment group with the highest ORR and the treatment group with the lowest ORR. Secondary endpoints include duration of response (DoR) and overall survival (OS). Efficacy results for each of the 3 PD-(L)1 inhibitor combinations will be assessed for correlation with the results of each of the 3 approved PD-L1 diagnostic assays. CONTESSA TRIO is the first randomized clinical study to compare 3 approved PD-(L)1 inhibitors. In Cohort 2, 40 elderly pts (potential expansion to up to 60 pts) with HER2- MBC who have not received prior chemotherapy for advanced disease will receive T monotherapy at 27 mg/m 2 Q3W. The primary endpoint for Cohort 2 is ORR. A sample size of 40 will allow the ORR to be estimated with a maximum standard error of &lt; 8%. Secondary endpoints include PFS, DoR and OS. Pts with CNS metastases are eligible for both cohorts. The study was initiated in March 2019. Clinical trial information: NCT03952325 .
Is there a benefit of immune checkpoint inhibitors for patients over 75 years of age with advanced cancer in first and second line setting: A meta-analysis.
Authors: Thierry Landre, Gaetan Des Guetz, Christos Chouaid, Jean F. Morere, Kader Chouahnia, Virginie Fossey-Diaz, Stephane Culine
Journal: Journal of Clinical Oncology (2020)

12031 Background: The impact of aging on Immune Checkpoint Inhibitors (ICIs) effectiveness is controversial. Currently, data from clinical studies do not show any difference between patients over 65 years and those under 65 years. We propose to compare the clinical benefit of ICIs in those over 75 and in those under 75. Methods: We performed a meta-analysis of published randomized control trials (RCTs) concerning ICIs versus standard therapy in patients with advanced solid tumours. Overall Survival (OS) among the older (≥75 years) was compared with that of younger patients ( &lt; 75 years) in first and second line setting. Hazard ratios (HRs) with their 95% confidence interval (CI) were collected from the studies and pooled. Results: Fifteen phase III studies evaluating anti-PD-1 (nivolumab or pembrolizumab), anti-PD-L1 (atezolizumab or avelumab) or anti-CTLA-4 (ipilimumab) were included. Patients were enrolled for Non-Small-Cell-Lung-Cancer, Renal-Cell-Carcinoma, Melanoma, Head-and-Neck-Squamous-Cell-Carcinoma or Gastric-Cancer. Eight studies assessed treatment in first line setting and seven in second line. The median age was 64 years, with 906 patients over 75 years of age and 5233 younger. In first line setting, HRs for death were 0.78 (95% CI: 0.61-0.99) in patients ≥75 years versus 0.84 (95% CI: 0.71-1.00) in younger. In second line setting, HRs for death were 1.02 (95% CI: 0.77-1.36) in patients ≥75 years versus 0.68 (95% CI: 0.61-0.75) in younger with a statistically significant difference observed between subgroups (p interaction = 0.009). Conclusions: ICIs appears to be effective in patients over 75 years of age. However, the survival benefit comes mainly from the first line of treatment. This result encourages the use of ICIs early in the therapeutic management of patients over 75 years of age.
Regionalization of Pancreatectomy for Pancreatic Cancer—Reply
Authors: Adrian Diaz, Timothy M. Pawlik
Journal: JAMA Surgery (2020)

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Clinical outcomes between patients with and without RET fusions in advanced/metastatic non-small cell lung cancer in the United States.
Authors: Anthony Sireci, Lisa M. Hess, Yimei Han, Yajun Emily Zhu, Naleen Raj Bhandari, Ricardo Martinez
Journal: Journal of Clinical Oncology (2020)

e21693 Background: Fusions involving the REarranged during Transfection ( RET) gene are known oncogenic drivers in non-small cell lung cancer (NSCLC). The patient profile is distinct from a genomically-unselected population of NSCLC patients and may lead to the potentially confounded conclusion that RET fusion-positive patients have a better prognosis. This study characterized clinical outcomes in patients with RET fusion-positive NSCLC versus those without when correcting for known demographic differences. Methods: The Flatiron ClinicoGenomics Database, electronic medical record data linked to Foundation Medicine, Inc genomic test results, was used to identify individuals diagnosed with advanced or metastatic NSCLC who initiated anti-cancer systemic therapy between JAN2011 and JUN2019 in the US. Follow up data were available through JUN2019. Patients were considered RET+ if a fusion was reported and RET- if no fusion was reported. Baseline characteristics and tumor response were compared using Fisher’s exact, chi-squared or t-tests; unadjusted and adjusted COX models were used to compare progression-free survival (PFS) and overall survival (OS). Results: There were 5,807 eligible patients with NSCLC; 46 (0.8%) and 5,761 (99.2%) were RET+ and RET-, respectively. Patients with RET+ tumors were significantly younger (63 vs 67 yrs), better performance status, less likely to have smoking history (37% vs 82%), more likely to have non-squamous tumors (98% vs 76%) (all p &lt; 0.05), and less likely to have ALK, ROS1, KRAS or BRAF alterations, which were each 0% in the RET+ group. There were no differences in total lines of therapy received; treatment regimens were comparable. In unadjusted analyses, patients with RET+ tumors had no significant differences in tumor response (p = 0.17) or PFS (p = 0.06) but significantly better OS outcomes (p = 0.005) from the start of first-line therapy. After adjusting for all available baseline covariates, survival outcomes were not significantly different between RET- and RET+ groups (PFS hazard ratio [HR] = 1.24, 95% confidence interval [CI] = 0.86, 1.78, p = 0.26; OS HR = 1.53, 95% CI = 0.95, 2.44, p = 0.08). Conclusions: Patients with RET fusion-positive NSCLC have different baseline characteristics than patients without these fusions. The unadjusted differences in OS between groups appear to be driven by baseline demographic features and not the presence of the RET fusion, however further research is needed. Conclusions are limited by the rarity of RET fusions in NSCLC and subsequent small sample size.