tbuckley/cabot-search huggingface dataset:
Cost effectiveness analysis of additional NK-1 receptor antagonist to olanzapine, ondansetron, and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving high-dose cisplatin.
Authors: Wasamol Mahaparn, Chalermchai Lertanansit, Chanida Vinayanuwattikun, Suebpong Tanasanvimon
Journal: Journal of Clinical Oncology (2020)

e19398 Background: NK-1 receptor antagonist (NK1RA) is a standard anti-emetic agent in chemotherapy-induced nausea and vomiting (CINV) prevention in patients receiving high-dose (HD) cisplatin. However, in limited-resource settings, three-drug regimen including olanzapine, ondansetron and dexamethasone is affordable and effective in CINV prevention in these patients. Objectives: To evaluate cost effectiveness of additional NK1RA for CINV prevention in Thai patients receiving HD cisplatin in 3-cycle horizon, societal perspective. Methods: During January to December 2019, 20 patient receiving HD cisplatin were prospectively enrolled to receive standard three-drug regimen at King Chulalongkorn Memorial Hospital. Total medical resource utility, non-medical cost and clinical outcomes were actually collected and used for establishing decisional-tree model and cost-effectiveness analysis. Three arms decisional-tree model was constructed. First, standard strategy, a real-world practice in Thailand, patients received three-drug regimen in all cycles of chemotherapy. Second, NK1RA-rescue strategy, patients received three-drug regimen in the first cycle and additional NK1RA in subsequent cycles if the patients experienced CINV. Third, NK1RA upfront strategy, patients received four drug NK1RA-containing regimen in all cycles. Complete response (CR) rate was assumed to be 92.5% in NK1RA-containing regimen based on clinical trials. The study endpoint is to compare cost and QALYs in term of incremental cost-effectiveness ratio (ICER). Results: CR rates were 90% and 71% in first and second cycle in patients receiving standard regimen. The NK1RA upfront strategy produced greatest QALYs of 0.0351, followed by 0.0328 and 0.0292 in NK1RA-rescue strategy and standard strategy respectively. Mean total costs were 10420.46, 3332.19 and 2841.30 Thai baht (THB) respectively. The ICER of NK1RA-rescue strategy relative to standard strategy was 135,774 THB per QALY and the ICER of NK1RA upfront strategy relative to NK1RA-rescue strategy was 3,096,654 THB per QALY. Therefore, the ICER of NK1RA-rescue strategy but not NK1RA upfront strategy is considered to be cost effective at the willingness-to-pay level of 160,000 THB per QALY. Conclusions: Our findings suggested that the additional NK1RA as a rescue strategy is cost-effective in patients receiving HD cisplatin in Thai health care.
点穴治疗三叉神经痛58例
Authors: 谢从清, 李永莲
Journal: BMJ (2007)

为了探讨和分析点穴治疗三叉神经痛的治疗效果,我们以传统医学、经络学说和络病理论为指导,结合清代叶天士的治络思想,及久病入络、久痛入络、久瘀入络的病机特点[1]72-73,93,治疗原发性三叉神经痛患者58例,报告如下。
Using genetics to prioritize diagnoses for rheumatology outpatients with inflammatory arthritis
Authors: Rachel Knevel, Saskia le Cessie, Chikashi C. Terao, Kamil Slowikowski, Jing Cui, Tom W. J. Huizinga, Karen H. Costenbader, Katherine P. Liao, Elizabeth W. Karlson, Soumya Raychaudhuri
Journal: Science Translational Medicine (2020)

It is challenging to quickly diagnose slowly progressing diseases. To prioritize multiple related diagnoses, we developed G-PROB (Genetic Probability tool) to calculate the probability of different diseases for a patient using genetic risk scores. We tested G-PROB for inflammatory arthritis-causing diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathy, psoriatic arthritis, and gout). After validating on simulated data, we tested G-PROB in three cohorts: 1211 patients identified by International Classification of Diseases (ICD) codes within the eMERGE database, 245 patients identified through ICD codes and medical record review within the Partners Biobank, and 243 patients first presenting with unexplained inflammatory arthritis and with final diagnoses by record review within the Partners Biobank. Calibration of G-probabilities with disease status was high, with regression coefficients from 0.90 to 1.08 (1.00 is ideal). G-probabilities discriminated true diagnoses across the three cohorts with pooled areas under the curve (95% CI) of 0.69 (0.67 to 0.71), 0.81 (0.76 to 0.84), and 0.84 (0.81 to 0.86), respectively. For all patients, at least one disease could be ruled out, and in 45% of patients, a likely diagnosis was identified with a 64% positive predictive value. In 35% of cases, the clinician's initial diagnosis was incorrect. Initial clinical diagnosis explained 39% of the variance in final disease, which improved to 51% (P < 0.0001) after adding G-probabilities. Converting genotype information before a clinical visit into an interpretable probability value for five different inflammatory arthritides could potentially be used to improve the diagnostic efficiency of rheumatic diseases in clinical practice.
Pituitary acromegalic cardiomyopathy: a report of 4 cases and literature review
Authors: Chenguang Yang, Huiping Zhang
Journal: BMJ (2014)

Four cases of pituitary acromegalic cardiomyopathy were reported and relative literature was reviewed in this article. Four patients were all males aged 45-63 y. The patients were diagnosed as pituitary adenoma, then NYHA grade Ⅲ-Ⅳ heart failure developed. One patient had both acromegaly and coronary heart disease, and all patients had arrhythmia attacks. The growth hormone levels were not under control in 3 patients, and for the remaining patient with normalized growth hormone the end-stage heart failure also developed. The onset of pituitary acromegalic cardiomyopathy is hidden; when the disease progresses to advanced heart failure, the prognosis would be poor in most cases. So early diagnosis and timely treatment is of great importance in acromegalic cardiomyopathy.


Key words: 
Acromegaly; Cardiomyopathies
Identification of kinase domain duplications across diverse cancer types in Chinese population by comprehensive genomic profiling (CGP).
Authors: Baohua Wang, Ruoying Yu, Qiuxiang Ou, Hua Bao, Xue Wu, Yang Shao, Tao Zhang
Journal: Journal of Clinical Oncology (2020)

e13522 Background: Kinase domain duplication (KDD) has recently been recognized as oncogenic and targetable mutations in some cancers. EGFR KDD was identified as an oncogenic driver in lung cancer showing partial response to EGFR TKI. BRAF KDD was reported in diverse tumor types with clinical response to RAF-targeted therapy. We retrospectively investigated the prevalence of KDDs in multiple cancer types of a large Chinese population. Methods: 50742 unique cancer cases were analyzed by comprehensive genomic profiling (CGP). DNA was extracted from formalin-fixed paraffin-embedded specimens (FFPEs), fresh tissue, blood or plasma samples and sequenced with gene panels targeting 400+ cancer-relevant genes. Among them, 53 cases were detected with KDD of various kinases. Results: In this Chinese cohort, KDD was identified in 0.1% of the total population across multiple cancer types including lung cancer (39), breast cancer (5), gastric cancer (3), colorectal cancer (2), mucoepidermoid carcinoma (1), unknown (3). The median age at diagnosis was 54 which was younger than the 60 yrs median age of total population. The distribution of KDDs was in EGFR(34) MET(5), JAK1(2), BRAF(2), FGFR2(2), FGFR1(1), JAK2(1), LYN(1), MAP3K1(1), RAF1(1), RET(1), AKT3(1), and CDK8(1). Thirty-one lung cancer cases were detected with EGFR-KDD, including kinase duplications of exon18-25 (22), exon17-25 (6), exon18-26 (2), exon14-26(1). Three patients with EGFR-KDD exon18-25 showed partial anti-tumor response to target therapy. MET-KDD was exclusively found in lung cancer involving the duplication of MET exon15-21 (2), exon14-17 (1), exon15-16 (1) and exon12-21 (1) while FGFR1/2-KDD was observed only in gastric cancer. Two female patients with breast cancer were detected with JAK1-KDD at age of 45 and 37, respectively. The canonical BRAF-KDD of exon 10-18 was identified in one female patient diagnosed of lung adenocarcinoma at age of 49. Frequently altered genes in patients with KDD were TP53(72%), EGFR (23%), FAT1(13%), BRCA1(10%). MCL1 amplification, a known oncogenic alteration, was identified in fifteen patients (11 EGFR-KDD,2 MET-KDD, 1 BRAF-KDD, 1 JAK2-KDD), representing the most common copy number variation observed. Conclusions: Kinase KDDs were rare but potentially oncogenic mutations in diverse cancer types with clinical outcome of EGFR-KDD to target therapy in lung cancer. Cancer-type specific KDDs were identified including MET-KDD in lung cancer, FGFR1/2-KDD in gastric cancer and JAK1-KDD in breast cancer.
腹部卒中六例临床分析并文献复习
Authors: 李全平, 何亮, 董鑫昌, 刘欢, 狄长安
Journal: BMJ (2010)

腹部卒中(abdominal apoplexy)是指腹壁、腹腔内、腹膜后脏器与组织血管自发性破裂出血,以突发腹痛、失血性休克为主要表现的临床急腹症.本病起病急骤,临床症状及体征不典型,容易误诊.现就我院收治的6例患者临床资料结合文献进行总结如下。
Study on compensation standard of basic public health service in Fujian province
Authors: Ce Zhou
Journal: BMJ (2012)

To study the compensation standard of basic public health service a series of meetings were carried out,university faculty,scholars and public health workers as well as health administrators and policy makers actively joined the discussion.Based on the cost calculation of each items of public health service a preliminary proposal was developed.The proposal was disseminated for soliciting opinions widely and finalized.Finally the compensation standard of basic public health service both for urban and rural conununity health service centers and health stations were issued by Provincial Health Bureau.The compensation standard will provide support for implementation of basic public health policy in Fujian province.

Key words: 
Public health ;  Cost allocation
成人肝豆状核变性17例的临床特点及误诊分析
Authors: 崔现敏, 王蔚虹
Journal: BMJ (2009)

肝豆状核变性系常染色体隐性遗传铜代谢障碍引起的全身性疾病,由于铜在各脏器沉积的先后顺序、程度和分布不同,临床表现复杂多样,但以青少年发病居多.我们对北京大学第一医院17例成人肝豆状核变性患者的临床资料进行回顾性分析,以提高对本病成年患者的认识。
Imaging findings and clinical manifestations of pelvic lipomatosis: a report of 3 cases
Authors: Chao Chai, Qian Ji, Shuang Xia, Lixiang Huang
Journal: BMJ (2014)

The imaging findings of pelvic lipomatosis as confirmed by operation and pathology were examined in 1 case and two follow-up asymptomatic cases retrospectively analyzed.The imaging findings included a compressed and deformed bladder with a superior displacement.Its shape was like an inverted tear and pear in coronal view and a banana in sagittal view.Bilateral ureters were both compressed with a medial deviation.And bilateral ureters were dilated with hydronephrosis in 1 case.Rectum and sigmoid were both compressed and became narrowed.The clinical manifestations included frequent urination, urgent urination, urination pain, dysuria, constipation, nausea, vomit and fever in 1 case while another 2 cases stayed asymptomatic.


Key words: 
Pelvic lipomatosis; Diagnostic imaging
Survival of older patients with advanced biliary tract cancers by disease site.
Authors: Sarah Bobiak, Deborah P. Lubeck, Jennifer Duryea, Mark D. Danese
Journal: Journal of Clinical Oncology (2020)

e16598 Background: Biliary tract cancers (BTC) arise from the epithelial lining of the biliary tree and include intrahepatic and extrahepatic cholangiocarcinoma, gallbladder cancer, and sometimes cancer of the ampulla of Vater. Although this is a closely related group of diseases, comparisons of risk factors, treatment, and mortality by disease site are limited. Methods: This retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked with Medicare claims. Patients aged ≥66 years with a pathologically confirmed diagnosis of advanced (stage III or IV) BTC from 2010 to 2015 were included and followed up through 2016. Patients with any SEER-reported cancer in the prior 2 years were excluded. Any outpatient systemic treatment during follow-up was identified using Medicare claims. Patients were followed up until death, end of follow-up, subsequent primary cancer, or switch to managed care. The Kaplan-Meier estimator was used to estimate unadjusted median survival. A Cox proportional hazards model was used to identify factors associated with survival. Results: There were 2,891 patients in the cohort (Table). Factors significantly associated with worse survival included older age, presence of mobility limitations, living in an area with &gt; 30% of the people below poverty, higher comorbidity burden, and stage IV BTC (vs stage III). Factors significantly associated with better survival included history of cancer, intrahepatic BTC (vs extrahepatic), or ampulla of Vater BTC (vs extrahepatic). Conclusions: Survival in BTC is poor and many patients do not receive outpatient systemic therapy. Patients with gallbladder and extrahepatic BTC had worse median survival and were less likely to receive systemic therapy than those with intrahepatic or ampulla of Vater BTC. Fewer ampulla of Vater patients present with Stage IV disease which could be a contributing factor to the significantly longer survival. Prior work has demonstrated an association between history of some types of cancer and survival; additional research is needed to better understand this finding. [Table: see text]
Varicocele in young males: a report of 231 cases
Authors: Chenyi Jiang
Journal: BMJ (2015)

We collected the medical data of conscription physical examination from a certain county, Shandong Province, in August 2013.A cohort of 711 young males aged from 17 to 24 years were included.Among them, 231 cases were diagnosed with varicocele (VC) with a prevalence of 32.49% (231/711). Its grades were Ⅰ° VC(n=5, 2.2%), Ⅱ° VC (n=165, 71.4%) and Ⅲ° VC(n=54, 23.4%). And 7 cases (3.0%) had surgical intervention.Our reported prevalence was significantly higher than that in the literature.Further researches are waranteed.


Key words: 
Varicocele; Prevalence
Dynamic changes in circulating PD-1<sup>+</sup>CD8<sup>+</sup> T lymphocytes for predicting treatment response to PD-1 blockade in patients with non-small cell lung cancer.
Authors: Chang Gon Kim, Min Hee Hong, Kyung Hwan Kim, Kyoung-Ho Pyo, Chun-Feng Xin, Byoung Chul Cho, Eui-Cheol Shin, Hye Ryun Kim
Journal: Journal of Clinical Oncology (2020)

e21690 Background: The predictive value of dynamic changes in the expression of programmed cell death-1 (PD-1) among circulating CD8 + T lymphocytes for treatment response to PD-1 inhibitors has not been explored in non-small-cell lung cancer (NSCLC). This study aimed to investigate whether dynamic changes in PD-1 + CD8 + T lymphocytes have predictive value with respect to durable clinical benefit (DCB) and survival after PD-1 blockade. Methods: Patients with recurrent and/or metastatic NSCLC treated with PD-1 inhibitors were enrolled between March 2016 and August 2018 (discovery cohort; n = 94). Peripheral blood was obtained immediately before and after one cycle of treatment with PD-1 blockade. Phenotyping of circulating CD8 + T lymphocytes was conducted using multi-color flow cytometry. Predictive values of dynamic changes in circulating PD-1 + CD8 + T lymphocytes during the first cycle were validated in an independent cohort (validation cohort; n = 54) of a prospective trial with PD-1 inhibitor (NCT03486119). Results: Circulating PD-1 + CD8 + T lymphocytes were enriched with effector/memory populations with elevated expression of activation- and exhaustion-related markers. Reduction in the frequency of PD-1 + cells among CD8 + T lymphocytes after one cycle of treatment was associated with a higher probability of DCB and superior survival outcomes in the discovery cohort. Similar results were obtained in analysis of tumor antigen NY-ESO-1-specific CD8 + T lymphocytes and in the validation cohort. Conclusions: Dynamic changes in circulating PD-1 + CD8 + T lymphocytes predict clinical and survival benefit from PD-1 blockade treatment in NSCLC. Thus, tracking these changes may be useful for identifying NSCLC patients who will optimally benefit from the treatment.
Survey on training needs for key general practice trainers in Shanghai
Authors: Minghui Peng, Shanzhu Zhu
Journal: BMJ (2016)

Objective
To survey the training needs for key general practice (GP) trainers.


Methods
The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai. The contents of questionnaire used for the survey included training needs of GP relevant knowledge, teaching ability and modes of assessment. The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.


Results
Total 151 key trainers completed the questionnaire (male/female: 48/103) with average age of (38±6) years. Among them 67.5% (102/151) were from community teaching bases and 29.8%(45/151)from hospital teaching bases; 60.9% (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP). According to the survey,general practice clinical kills(72.2%, 106/151) andgeneral practice clinical thinking(70.2%, 106/151) were most required relevant knowledge; whilegeneral practice basic conceptwas least required (25.8%, 39/151). The rate with need ofpolicy system related GP trainingin hospital trainers was higher than that in community teaching base trainers (66.7% vs. 44.1%, P<0.05). For teaching ability needs, 85.4% (129/151) selected teaching methods, 75.5% (114/151) chose teaching assessment and evaluation methods. The participants showed more interesting in new-type teaching and evaluation methods, such as PBL, OSCE, mini-CEX and DOPS, and would use them in future teaching work (P<0.01). Workshop (58.3%, 88/151), demonstration (57.0%, 86/151) and experience exchange (50.3%, 76/151) were three most interested modes in current training; meanwhile theoretic teaching was lease interested (38.4%, 58/151). Study tour was most interested training models for the future (71.5%, 108/151), followed by short-term courses (49.0%, 74/151), overseas study (39.1%, 59/151) and distance learning (27.8%, 42/151).


Conclusion
There are different needs for GP trainers from hospital and community teaching bases. To meet the different requirements, the focused training course and training method should be adapted.


Key words: 
Teacher training; Questionnaire; General Practice
卡提素致过敏性休克一例
Authors: 张爱珍
Journal: BMJ (2005)

患者男,19岁,因肌内注射卡提素(唯尔本,陕西安泰药业有限公司生产,批号011201)0.5 mg后出现意识丧失8 min收入我院急诊科.患者既往有慢性哮喘病史15年,入院前3个月病情稳定,未服任何药物。
A phase II study of larotrectinib for children with newly diagnosed solid tumors and relapsed acute leukemias harboring TRK fusions: Children’s Oncology Group study ADVL1823.
Authors: Theodore Willis Laetsch, Kathleen Ludwig, Donald A. Barkauskas, Steven G. DuBois, Joan Ronan, Erin R. Rudzinski, Amanda Memken, Joel Sorger, Joel M. Reid, Teena Bhatla, April Nesin, Brian D. Crompton, Alanna J. Church, Elizabeth Fox, Brenda Weigel
Journal: Journal of Clinical Oncology (2020)

TPS10560 Background: In children, fusions of the NTRK1/2/3 genes (TRK fusions) occur in soft tissue sarcomas, including infantile fibrosarcoma (IFS), congenital mesoblastic nephroma, high- and low-grade gliomas, secretory breast carcinoma, and papillary thyroid cancer. Rarely, TRK fusions also occur in Ph-like acute lymphoblastic leukemia and acute myeloid leukemia. Larotrectinib is a selective TRK inhibitor FDA-approved for the treatment of TRK fusion solid tumors in patients with no satisfactory alternative treatments or whose cancer has progressed following initial treatment. In children, larotrectinib demonstrated a 94% overall response rate (ORR) with a 12-month progression free survival rate of 75% (1). Methods: Patients &lt;30 years with any newly diagnosed unresectable solid tumor or relapsed/refractory acute leukemia with TRK fusions are eligible. TRK fusions must be locally identified in a CLIA/CAP laboratory and are confirmed centrally using a targeted RNA sequencing panel. Patients with high-grade gliomas are excluded. Patients receive larotrectinib 100 mg/m 2 /dose BID (max of 100 mg/dose) continuously in 28-day cycles. Patients with solid tumors who achieve CR will discontinue larotrectinib at the completion of at least 12 total cycles of therapy and 6 cycles after achieving CR. Those whose tumors become surgically resectable may undergo on study resection and discontinue therapy if an R0/R1 (IFS) or R0 (other tumors) resection is obtained. All other patients will receive 26 cycles in the absence of unacceptable toxicity or progressive disease. The primary endpoint is the ORR to larotrectinib according to RECIST 1.1 in children with IFS. The study uses a Simon 2-stage minimax design, and the regimen will be considered of sufficient interest if 16 of 21 (76%) patients with IFS demonstrate response. Patients with other solid tumors and leukemias will be analyzed in separate cohorts as secondary objectives. Correlative studies include serial sampling of circulating tumor DNA and neurocognitive assessments. This is the first Children’s Oncology Group study to assign frontline therapy based on the presence of a molecular marker independent of histology, and the first clinical trial to evaluate larotrectinib for the treatment of leukemia. Enrollment began in October 2019 (NCT03834961). 1. Tilburg CMv, DuBois SG, Albert CM, et al: Larotrectinib efficacy and safety in pediatric TRK fusion cancer patients. Journal of Clinical Oncology 37:10010-10010, 2019 Clinical trial information: NCT03834961.
Immune checkpoint inhibitors combined with chemotherapy/radiotherapy, for EGFR wild-type lung cancer: Efficacy in real-world study.
Authors: Jifeng Feng, Yue Shi
Journal: Journal of Clinical Oncology (2020)

e15117 Background: The role of immune checkpoint inhibitors (anti-PD-1 antibody, ICI) combined with chemotherapy/radiotherapy for EGFR wild-type lung cancer is controversial, especially in 2 nd -line or later treatment. The purpose of this study was to investigate the possible beneficial factors for immunotherapy for EGFR wild-type lung cancer. Methods: A total of 279 patients with EGFR wild-type lung cancer who received ICI were retrospectively analyzed, including 138 adenocarcinoma, 76 squamous carcinoma and 31 SCLC patients. Beneficial factors were determined by multivariable Cox proportional hazards model for PFS. PFS and ORR were compared between different therapies. Results: The specific results are shown in table. In multivariable analysis, ICI combined radiotherapy (P = 0.018; HR, 0.152(95% CI: 0.032, 0.727)) was identified as an effective independent factor for EGFR wild-type lung adenocarcinoma. PFS in patients who received ICI combined radiotherapy was significantly longer than that in those who received ICI monotherapy ((p = 0.032; not reached vs. 9.6 m (95% CI: 5.627, 13.640))). Among lung adenocarcinoma patients who received ICI as 2 nd -line treatment, patients treated by ICI combined chemotherapy showed more benefit than those treated by ICI monotherapy (P = 0.003; HR, 0.012(95% CI: 0.001, 0.213)).ICI combined chemotherapy can significantly prolong PFS compared with those treated by ICI monotherapy (p = 0.015; 14.3 m [95% CI: 8.711, 19.822] vs. 1.1 m (95% CI: 0.25, 1.883)) in the 2 nd -line treatment. However, ORR showed no significant different between ICI monotherapy and ICI combined chemotherapy(P = 0.626). Conclusions: ICI combined with radiotherapy showed better result than those who didn’t receive radiotherapy for EGFR wild-type lung adenocarcinoma. The addition of chemotherapy to ICI for the 2 nd -line treatment in EGFR wild-type lung adenocarcinoma patients seems get more clinical benefit than ICI monotherapy. [Table: see text]
Lowering cholesterol,Preventing coronary heart disease
Authors: 胡大一
Journal: BMJ (2005)

循证医学是心血管领域的一次革命,对治疗学产生了深刻而持久的影响.尤其在调脂方面,循证研究更是硕果累累.十几年来,随着大规模临床试验的不断发表以及调脂指南的制定并不断更新、完善和发展,调脂治疗取得了长足进步,是当前冠心病研究和防治的热点和重点之一。