tbuckley/cabot-search huggingface dataset:
脑脊液内检出多重耐药肺炎链球菌二例
Authors: 姜梅杰, 陈丽萍, 孙勇
Journal: BMJ (2009)

例1 女,6岁,因发热4 d,呕吐1 d于2008年2月人院.体格检查:体温38.7℃,脉搏131次/min,呼吸24次/min,血压110/70 mill Hg(1 mm Hg=0.133 kPa),神智淡漠,颈项强直,对光反射迟钝.血常规:白细胞计数20.58×109/L,红细胞4.18 ×1012/L,血红蛋白110 g/L,分类中性粒细胞0.48,淋巴细胞0.44,单核细胞0.08,血小板50×109/L。
Understanding of hierarchical medical mode in chronic diseases management among medical staff and residents in Xiamen
Authors: Yanbing Zeng, Lele Chen, Xiaoling Huang
Journal: BMJ (2017)

Objective
To estimate the status of understanding hierarchical medical mode in chronic disease management among medical staff and residents in Xiamen.


Methods
The multi-stage sampling was used in the study to select 49 physicians from the tertiary hospitals, 58 general practitioners (GPs) and health managers from 5 community health services centers, and 499 residents from 5 communities in Xiamen. We conducted a face-to-face survey to estimate their basic information, recognition for hierarchical medical mode, and patients' willingness for community first contact care. The data was described by mean value of frequency and constituent ratio, the chi-square test or Fisher's exact test was used for comparison among groups. Logistic regression was performed to analyze the factors influencing the residents' preference for treatment in community medical institutions.


Results
The physicians from tertiary hospitals or community health service centers were almost all familiar with Xiamen mode (91/107, 85%), and more than half of them knew about the hierarchical medical system (67/107, 62.6%), 86.9% (93/107) of them knew about the guide of hierarchical medical system, 58.9% (63/107) of them received the relative training before. The physicians from community had higher knowledge, more frequency training, more referral experiences and more effective evaluation than the physicians from hospitals (all P< 0.05). In our study, 86.2% (344/399) of residents were willing to see doctors in community health centers and 77.9% (311/399) of them were willing to return to community health service centers from tertiary hospitals for disease convalescence or chronic disease management; 53.6% (214/399) of residents preferred to utilize community first contact care when they got chronic diseases, and they were more satisfied with the consultation and diagnosis process in community. The residents who knew about the hierarchical medical system were more likely to utilize community first contact care and return to community for medical care. However, the female or the higher-income residents were less likely to see doctors in community. Patients who had experienced transfer to community or had higher satisfaction to community care were more willing to return from hospitals to community for disease convalescence. The mode showed that the system was more effective in measuring and controlling blood pressure or blood glucose for patients who joined the patients' network than for those did not join. (P<0.05).


Conclusion
Medical staff are familiar with hierarchical medical system, and the residents are likely to use community health service as their first contact care in Xiamen. The utilization of community first contact care is influenced by sex, family income, previous experience, knowledge of the system, and satisfaction to the system of patients.


Key words: 
Disease management; Questionnaires; Hierarchical medical system
Characterization of advanced hepatocellular carcinoma patients via a multi-omic cancer registry.
Authors: Joseph S Ryan, Xiaojun Xu, Pablo Tamayo, Adam Burgoyne
Journal: Journal of Clinical Oncology (2020)

e16617 Background: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and has significant cancer-related mortality worldwide. Molecularly matched therapy has an emerging role in HCC treatment; however, HCC poses a unique challenge as patients are frequently diagnosed radiographically rather than by tissue biopsy, limiting our ability to utilize tumor tissue data for therapy selection. The purpose of this study is to establish a multi-omic database with matched demographic and clinical data to identify patterns of shared molecular aberrations in HCC tumors. Methods: An institutional HCC cancer registry was created, and a retrospective review was performed using data from 2017-2020 at a tertiary cancer center. 56 patients with advanced HCC were identified, and tissue samples were analyzed with multi-omic profiling assays (next generation DNA sequencing, RNA sequencing, protein expression via immunohistochemistry) versus ctDNA from peripheral blood. Results: Next generation sequencing was obtained for 38 (76%) patients using either tissue or ctDNA. While the results were similar, a higher number of total mutations were identified using tumor tissues rather than ctDNA. The average variant allele fraction for tumor tissues was approximately 10x higher than the variant allele fractions identified by ctDNA. However, ctDNA sequencing identified a higher number of potentially actionable mutations, on average, than did tissue testing. The most commonly mutated genes included TERT (42% of patients), TP53 (47%), CTNNB1 (34%), ARID1A (18%), CCND1 (16%), and NEF2L2 (13%). Several patients had serial ctDNA sequencing, which showed an increase in actionable and total mutations over time as well as changes in variant allele fractions in response to therapy. Conclusions: Next generation sequencing of ctDNA can be used in lieu of tumor tissue in patients diagnosed with HCC radiographically to identify actionable mutations, but it may underestimate the mutational burden of HCC tumors. Serial analyses with cell free DNA may be useful to monitor clonal evolution in response to targeted treatment and may identify new actionable mutations as patients progress on systemic therapies. [Table: see text]
Registry Data and Conditioning Therapy for Allogeneic Hematopoietic Cell Transplant and Lymphoma
Authors: Tobias Berg, Hira S. Mian, Ralph M. Meyer
Journal: JAMA Oncology (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Oncology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Oncology journal
PET-directed chemoradiation (CRT) with induction FOLFOX compared to induction carboplatin/paclitaxel (CP) in patients with locally advanced esophageal adenocarcinoma (EA).
Authors: Rebecca Carr, Meier Hsu, Kay See Tan, Manjit S. Bains, Matthew Bott, David H. Ilson, James M. Isbell, Yelena Yuriy Janjigian, Steven Brad Maron, Bernard Park, Valerie W. Rusch, Smita Sihag, Abraham Jing-Ching Wu, David Randolph Jones, Geoffrey Yuyat Ku, Daniela Molena
Journal: Journal of Clinical Oncology (2020)

4554 Background: Induction chemotherapy with PET-directed CRT and surgery is the standard treatment for locally advanced EA at our institution. Following results of the CALGB 80803 trial, FOLFOX has recently replaced CP as the preferred induction regimen. Methods: We retrospectively evaluated patients with locally advanced EA treated with induction CP vs FOLFOX, followed by trimodality therapy between January 2010 and June 2019. Patients treated with CP with RT followed by surgery without induction chemo were also included. We compared pathological complete response (pCR) and near pCR (ypN0 with ≥90% response) rates in the induction FOLFOX group to the induction CP and no-induction groups. Univariable and multivariable analyses were used to adjust for confounding factors. Disease-free survival (DFS) was estimated by the Kaplan-Meier method and compared between groups using max-combo weighted log rank test. Results: 445 patients were included. Patients in the induction FOLFOX group had significantly higher pCR and near pCR rates vs induction CP patients. Notably, pCR rate was 38% among FOLFOX PET responders vs 19% in non-responders. In multivariable analysis, compared to induction CP, induction FOLFOX administration was an independent predictor of near pCR (OR: 2.22, 95%CI: 1.20-4.20, p = 0.012). Compared to 24% pCR rate among no-induction patients, induction FOLFOX pCR rate was slightly higher at 32%. DFS by 2-years was higher in induction FOLFOX compared to no-induction-treated patients (62% vs. 42%, p = 0.05). Postoperative complication rates were similar among the three groups. Conclusions: PET-directed CRT with FOLFOX instead of CP improves pCR and near pCR rates. Improved DFS was observed in the FOLFOX vs no-induction patients. Longer follow-up is needed to confirm any survival benefits. [Table: see text]
Patient-reported pain and pain medication impact in patients with HR+ Her2-neg advanced breast cancer: A U.S. FDA pooled analysis.
Authors: Bellinda King-Kallimanis, Jennifer J Gao, Christine Hodgdon, Pradeep Bandaru, Andrew Girvin, Christy Osgood, Gwynn Ison, Laleh Amiri-Kordestani, Richard Pazdur, Vishal Bhatnagar, Paul Gustav Kluetz, Julia A. Beaver
Journal: Journal of Clinical Oncology (2020)

e13027 Background: Despite the ubiquitous prescribing of pain medications (PMs) in cancer clinical trials, the impact of such prescribing patterns and reporting on the experience of pain is not often investigated. We examined patient-reported pain before initiation of PM reporting and at the next available pain assessment. Our aim was to understand change in patient-reported pain. Methods: We pooled data from 7 phase 3 randomized, controlled, registration trials of CDKI with endocrine therapy in patients with hormone receptor positive, human epidermal growth factor receptor-2 negative MBC. We restricted our analyses to patients who started therapy with no PM reported and looked at patients who had NSAID or opioid medication documented. We calculated change between 2 assessments in patient-reported pain before and after PM using the pain occurrence item (Q9) on the EORTC Quality of Life questionnaire (QLQ-C30). Results: Of the 4200 patients who received at least 1 dose of CDKI/placebo, 1488 started with no documented PM, with 48% reporting none at all when asked about pain at baseline. Subsequently, 185 patients had documented NSAID and 43 an opioid and had a pain PRO assessment before and after. NSAIDs documentation occurred on average 11 weeks into trial and opioids 5. Before documentation of NSAIDs, 45% of patients reported no pain compared to 23% of patients with an opioid. Patients who had documented NSAIDs, 29% experienced an improvement in their self-reported pain, whereas 32% of patients with documented opioids improved. On average the time between the 2 pain assessments was around 58 days for both PMs. Conclusions: In this analysis in patients who had a pain assessment before and after documentation of a PM, there is a small group whose pain improved. It is important to note that patients’ response to the pain item was not provided to the clinical care team, which may explain why there may have been suboptimal pain control. Further study is needed to examine how pain management can be achieved in patients with advanced breast cancer. Future analysis should be performed with patients whose PRO pain results are communicated with the clinical care team in real-time. [Table: see text]
Do we consider to apply the value framework of cancer drugs to clinical practice and health insurance coverage in Korea?
Authors: Do Yeun Kim, Hyerim Ha, Hee Yeon Lee, Dong-Hoe Koo, Hye Sook Han, Hee JUN KIM, Sung Yong Oh, SeungJin Bae, Green Bae, Jae-Young Cho, Jin-Hyoung Kang
Journal: Journal of Clinical Oncology (2020)

e19391 Background: Emerging oncology drugs such as targeted agents and immune checkpoint inhibitors (ICIs) have brought dramatic advances in cancer treatment, while rapid rise in the drug cost. In Korea, the policy of expansion of health insurance coverage has improved accessibility to high-priced oncology drugs through their registrations in reimbursement list. However, this made a considerable impact on the financial burden of national health insurance. The objective of this study was to assess the awareness and perceptions of medical oncologists about the value frameworks of cancer drugs in Korea. Methods: We collected the data from survey for 102 medical oncologists at cancer conference. They were asked about prioritization among multiple considerations when they prescribe cancer drugs, The second question was awareness of value frameworks such as American Society of Clinical Oncology (ASCO) value framework and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Additionally, potential application of value framework to the decision on reimbursement coverage was included. Results: The majority of respondents (90%) chose clinical efficacy as the most important factor when they selected oncology drug for cancer patients. Safety/tolerability and drug cost were followed as 5.9% and 1%, respectively. Meanwhile, the order of priority of considerations for ICIs treatment was as follows: clinical efficacy (74.5%), drug costs (13.7%), and safety/tolerability (9%). More than half of those questioned (53.9%) were already aware of ASCO value framework and ESMO-MCBS, while 26.5% did not recognize them at all. Over 90% of respondents agreed with the need for development of new value framework tool which can be complementary to current valuation system for oncology drugs. Oncologists responded positively to the necessity of the assessment tool as a criterion for reimbursement registration (84.3%) as well as post-reimbursement re-evaluation (89.2%). Conclusions: Our results suggest that value assessment tool of oncology drug be necessary for providing medical evidences for clinical decision and for determination to health insurance reimbursement in Korea.
宁波市海曙区居民糖尿病防治认知与行为现状调查
Authors: 吕书红, 李曼春, 鲍科臻, 张学军, 周澹明
Journal: BMJ (2005)

采用两阶段整群抽样方法对海曙区常住居民2 043人入户问卷调查,结果显示糖尿病自报患病率5.1%,相关危险因素正确认知率37.7%,患者中同时采纳5项控制措施的占52.8%,空腹及餐后2 h血糖控制良好的分别仅占26.0%和15.4%.提示糖尿病宣传教育和行为干预的必要性。
Open label phase I trial using SPL-108 in combination with weekly paclitaxel final report with molecular correlates.
Authors: Eugenia Girda, June YiJuan Hou, Alexandre Buckley De Meritens, Ruth Stephenson, Aliza L. Leiser, Mihae Song, Malcolm Finlayson, David M Nelson, Lorna Rodriguez-Rodriguez
Journal: Journal of Clinical Oncology (2020)

e18040 Background: Therapeutic options for patients with recurrent platinum resistant ovarian cancer are scarce and represent an unmet need in ovarian cancer. Chemotherapy resistance has been linked to many CD44 pathways including P-glycoprotein mediated efflux of chemotherapeutic agents. Our working hypothesis was that chemotherapy resistant ovarian tumors that expressed CD44 would revert drug resistance by using a CD44 inhibitor SPL-108, that had proven safe as a single agent. Methods: Patients with platinum refractory or resistant CD44+ ovarian tumors were eligible. We used a standard 3+3 phase I design, open-label, 2-arm trial of the combination of SPL-108 and IV paclitaxel (PTX): Arm 1 (2 cohorts) Safety Phase: Cohort 1: SPL-108 150 mg SQ Daily +80 mg PTX weekly Cohort 2: SPL-108 300mg daily +80 mg PTX weekly Arm 2 (1 cohort) Exploratory Phase: Cohort 3: SPL-108 daily dose 300 mg +80 mg PTX weekly Days 1-15 in 28 day cycles Primary end points were safety and tolerability. Secondary endpoints included determining molecular signatures of response using NGS. Tumors were sequenced at the time of recurrence or initial diagnosis. Results: Fourteen patients were enrolled in the study. Prior number of treatments ranged from 2-6, except for one patient with platinum refractory disease that progressed during first line of therapy. There was no DLT and all cohorts were completed as designed. The treatment was well tolerated. There was one instance of a bowel micro-perforation that was treated medically. This patient had platinum refractory disease and eventually underwent an interval cytoreduction. There was one patient with grade 3 neurotoxicity. Sixty-two% of the patients had clinical benefit with 36% having a PR. Forty-three % of patient had a PFS of more than 6 months. Two patients enjoyed a PR of 12 months. Molecular profiling of the tumors revealed that all tumors had TP53 alterations and the 4 patients that did not have a response had tumors with TP53 truncations or a lack of function alteration. Conclusions: Daily SPL-108 300mg SQ in combination with weekly PTX is safe and feasible. The promising clinical activity on drug resistant ovarian tumors warrants further investigation. Resistance to SPL-108 are characterized by lack of function of TP53, mostly early truncations. It is possible that SPL-108 may be reactivating TP53 by promoting its active conformation. Once TP53 is active CD44 expression is abrogated at the promoter. Therefore SPL-108 is effectively acting on CD44 through 2 different mechanisms to promote chemotherapy sensitivity. Clinical trial information: NCT03078400.
心肌缺血的心电图改变
Authors: 刘文玲, 金小燕
Journal: BMJ (2009)

心肌缺血的心电图改变主要表现为ST-T的改变,如T波高尖、T波倒置、ST段抬高和ST段压低.另外,还可以表现为Q-T间期延长和U波的改变. 一、心肌缺血心电图ST-T改变的机制 心肌缺血心电图改变主要表现为复极改变.正常情况下,心外膜处的动作电位时程较心内膜短,心外膜完成复极早于心内膜,因此心室肌复极过程可看作是从心外膜开始向心内膜方向推进。
Association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes
Authors: Wen Wu, Yuxin Huang, Jieyuzhen Qiu, Xiaoming Tao, Jiao Sun
Journal: BMJ (2019)

Objective
To investigate the association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes mellitus (T2DM).


Methods
Three hundred and ninety-six T2DM patients aged 60-80 years were recruited from Department of Endocrinology, Huadong Hospital from January 2014 to January 2017. All cases used oral hypoglycemic drug more than 3 months, their glycosylated hemoglobin (HbA1c) was lower than 8.5% and underwent continuous glucose monitoring for 72 h. The Pittsburgh sleep quality index (PSQI) scale was applied to evaluate sleep quality, and the PSQI>7 was defined as the sleep disorder. There was dawn phenomenon in 165 cases (group Ⅰ) and no dawn phenomenon in 231 cases (group Ⅱ) . The clinical data, blood glucose related indicators, homeostasis model assessment of insulin resistance (HOMA-IR) and PSQI scores were compared between two groups. The correlation between dawn phenomenon and sleep disorder was analyzed with Logistic regression.


Results
There were no significant differences in age, BMI, blood lipids, liver and kidney function, hypersensitive CRP (hCRP) , serum cystatin and serum cortisol between the two groups (all P>0.05). Patients in group Ⅰ presented a higher ratio of urinary protein/creatinine [1.3 (0.7, 5.4) mg/mmol vs. 1.1 (0.5, 3.4) mg/mmol, t=-2.105, P=0.04], PSQI scores [(7.3±3.3) vs. (5.4±2.7),t=3.587, P<0.01] and the incidence of sleep disorders [57.0% (94/165) vs. 25.1% (58/231),χ2=3.765,P<0.01] than those in group Ⅱ. The HbA1c [(7.4±0.9)% vs. (7.0±1.0)%,t=3.384,P<0.01] and fasting glucose [(8.3±1.6) mmol/L vs. (7.0±1.4) mmol/L,t=8.778, P<0.01] were significantly higher in group I than those in group Ⅱ; while the fasting insulin [(8.2±7.2) mU/L vs. (10.3±10.2) mU/L,t=-2.286,P=0.02] and nocturnal nadir [(5.7±1.3) mmol/L vs. (6.6±1.4) mmol/L,t=-6.331,P<0.01] were lower than those in group Ⅱ. Pearson correlation analysis showed that dawn phenomenon was positively correlated with sleep disorders (r=0.323, P<0.01). Logistic regression analysis showed that sleep disorders were associated with increased risk of dawn phenomenon (OR=4.143,95%CI:1.69-10.16,P<0.01).


Conclusion
Sleep disorders may play a relevant pathological role in the occurrence of dawn phenomenon in elderly T2DM patients.


Key words: 
Hyperglycemian, dawn; Diabetes mellitus, type 2; Sleep disorders
Methylated DNA marker panel for metastatic melanoma: Discovery and tissue validation.
Authors: Alexander Meves, William R. Taylor, William R Bamlet, Douglas W. Mahoney, Karen A Doering, Kelli Burger, Patrick H. Foote, Enrica Quattrocchi, Julia S. Lehman, David A. Ahlquist, John B. Kisiel
Journal: Journal of Clinical Oncology (2020)

e22024 Background: Disease surveillance in high risk melanoma patients using PET/CT is recommended every 6 months, an algorithm that is extremely expensive and often difficult to access. Biomarkers capable of detecting recurrence and low volume metastasis have application in tools to improve the cost effectiveness of surveillance. Towards this long term goal, our aim was to discover melanoma-specific methylated DNA markers (MDMs). Methods: Candidate MDMs were identified by reduced representation bisulfite sequencing of selected age- and sex-balanced snap frozen metastatic melanoma, benign control skin and white blood cells. Sequences were filtered for highest methylation difference, lowest control methylation background ( &lt; 1%), and highest discrimination by variance inflated logistic regression. Using formalin-fixed tissues, the top 32 MDMs were further evaluated in metastatic melanoma from 35 patients, primary melanoma from 26 patients, and 73 control samples (47 benign precursor lesions or normal skin, and 26 healthy buffy coat samples to assess for background DNA in circulation). Candidate markers were blindly assayed by quantitative methylation specific PCR. After normalization by within sample ACTB level, random forest modeling with cross-validation identified marker combinations with greatest predictive accuracy. Results: On receiver operator characteristics analyses of individual marker candidates, areas under the curve (AUCs) ranged from 0.43 to 0.97. Median AUC was 0.835. At 100% specificity, a cross-validated panel of five MDMs (see Table), yielded a sensitivity of 33/35 cases (94.3%; 95% CI, 86.6-100%) for metastatic melanoma and 22/26 cases (84.6%; 95% CI, 70.7-98.5%) for primary melanoma. Furthermore, none of the 5 markers were detected in normal buffy coat samples. Conclusions: A panel of five novel MDMs assayed on tissue and undetectable in normal buffy coat achieves very high discrimination between melanoma and benign control tissues. This panel can be assessed in blood or other bodily fluids for application in melanoma surveillance. [Table: see text]