tbuckley/cabot-search huggingface dataset:
Estimated clinical efficacy and radiographic response characteristics of PD1 inhibition in newly diagnosed and recurrent glioblastoma in clinical practice: A report from the iRANO Working Group.
Authors: Benjamin M. Ellingson, Raymond Yi-kun Huang, Javier Villanueva-Meyer, Mary Jane Lim-Fat, Elizabeth George, Bryan Iorgulescu, Geoffrey Young, Catalina Raymond, Talia Oughourlian, Jacob Schlossman, Tyler Gleason, Nancy Ann Oberheim Bush, Patrick Y. Wen, Timothy Francis Cloughesy, Susan Marina Chang, David A. Reardon, Michael Weller, Hideho Okada
Journal: Journal of Clinical Oncology (2020)

2521 Background: Despite concerns of immunotherapy-induced inflammatory response during PD1 inhibition, questions remain as to the true incidence of inflammatory response and potential clinical implications. The goals of the project were to use GBM patients pooled from academic centers to estimate radiographic PFS and OS, as well as determine the incidence of immunotherapy-induced inflammatory response. Methods: 152 patients with newly diagnosed (N = 57) or recurrent (N = 95) GBM treated with either nivolumab or pembrolizumab from Dana-Farber (N = 88), UCLA (N = 35) or UCSF (N = 29) were included in this study. Radiographic progression was defined by a 25% increase in bidirectional measurements according to RANO. Results: Median PFS and OS for newly diagnosed patients was 162 and 520 days, respectively, while median PFS and OS for recurrent patients was 72 and 225 days, respectively. No difference in OS was observed in recurrent patients treated with nivolumab vs. pembrolizumab (P = 0.58), but recurrent patients treated with nivolumab trended toward a longer PFS (P = 0.097). Of the recurrent patients with OS and PFS data available and radiographic progression, 95% of them progressed within 6 mos of starting treatment. Median post-progression survival (PPS) in recurrent patients with PFS &lt; 6 mos was 151 days, while PPS for patients with PFS &gt; 6 mos was 178 days (P = 0.51). In the 77 recurrent patients who progressed within 6 mos, 36.4% had an OS that was &gt; 9 mos, while 63.6% had an OS &lt; 9 mos, suggesting the majority of patients with “early progression” also died early and a minority of patients had what could be considered “immune-related inflammation”. Of the 81 recurrent patients with documented progression, only 2.5% showed stabilization within 3 mos of first progression, 30.9% died before the 3-month confirmation scan could be obtained, 24.7% showed continued tumor growth by 3 months, and 48.1% had no follow-up confirmatory imaging exams. Of the 70 patients who progressed within 6 mos and had documented death, 2.9% had disease stabilization, 31.4% died before the 3-month confirmation, and 75.7% had either documented tumor growth or had no follow-up confirmatory imaging exams. Conclusions: This study suggests immunotherapy-induced inflammation followed by a favorable PPS is uncommon in GBM. While patients treated with other types of immunotherapy may exhibit different imaging characteristics, these data provide an important basis to refine the iRANO criteria.
Attaching more importance to early identification and comprehensive prevention of diabetic peripheral neuropathy
Authors: Wei Li
Journal: BMJ (2019)

随着全球老龄化和人均寿命的提高，糖尿病已成为全球性公共健康问题，其中多数患者合并有糖尿病周围神经病（DPN），生命质量和预后受到严重影响。《糖尿病周围神经病基层诊治管理专家指导意见》旨在提高基层医务人员对DPN的认识，系统指导基层医务人员进行DPN的诊疗和管理，从而提高患者的生命质量。
Relationship between blood pressure changes in acute phase of cerebral infarction and its prognosis
Authors: 梁睿, 徐恩, 邓兵梅, 刘祖佑, 陆雪芬
Journal: BMJ (2006)

目的 了解脑梗死发病急性期血压变化与预后的关系.方法收集广州医学院第二附属医院2001年1月至12月收住院的发病时间少于24 h的脑梗死患者232例的临床资料,其中男127例,女105例,平均年龄(68±10)岁;记录其发病时的血压以及住院第1～3天的平均血压,出、入院时的Barthel指数(Barthel Index,BI)评分、改良Rankin量表评分(Modification of Rankin Scale,MRS)、美国国立卫生研究所脑卒中评分(National Institute of Health Stroke Scale,NIHSS)和改善的分值以及住院天数,并对数据进行分析.结果脑梗死急性期合并原发性高血压的患者易出现高血压(P＜0.01),未合并原发性高血压的患者多出现低血压(P＜0.01).脑梗死急性期血压水平正常或者轻度升高的患者出院时NIHSS改善程度分别是(1±4)、(5±2)分,明显高于其余两组(P＜0.05).急性期明显低血压组患者的死亡率和继发症发生率明显高于其余各组(P＜0.05).结论脑梗死发病的急性期血压过低或者过高均有可能加重病情,而发病时血压偏低是脑梗死预后不良的原因之一.脑梗死急性期注意血压监护以及调整血压保持在正常或轻度升高水平具有重要意义。
Any Recent Stressors?—A Memoir of Transient Global Amnesia
Authors: Jeffrey M. Lyness
Journal: JAMA Neurology (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 Neurology 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 Neurology journal
临床常用脱毛方法
Authors: 白丽娜, 黄英, 朱威, 连石
Journal: BMJ (2011)

多毛是困扰大多数女士及少数男士的美容难题，由此产生了一系列的脱毛方法，一种是较为传统的治疗方法，有拔脱法、剃除法、蜡脱、电解、涂抹脱毛剂等[1]；一种是要由医生进行的治疗，主要有激光和强脉冲光。这些治疗方法的效果和不良反应各不相同。没有一种能够适用于所有患者，适用于身体的所有部位，一般需根据毛发的特点、数量、面积、年龄以及患者的意愿选择治疗方法[2]。
Phase I study of a novel S1P inhibitor, NOX66, in combination with radiotherapy in patients with metastatic castration-resistant prostate cancer.
Authors: Paul L. de Souza, Anne Louise Capp, Nana Chikhladze, Zaza Mezvrishvili, Marinella Messina, Gisela Mautner
Journal: Journal of Clinical Oncology (2020)

5533 Background: NOX66 is a new formulation of the small molecule, idronoxil. The primary mechanism of action of idronoxil stems from its binding to the transmembrane enzyme ENOX2 expressed on cancer cells, resulting in reduced S1P and increased ceramide levels, thereby promoting apoptosis. Additional intracellular effects include the inhibition of DNA repair mechanisms. There is growing evidence that S1P is a promotor of tumour resistance to immune cell infiltration, highlighting NOX66’s potential to modulate the immune response against cancer. Methods: This two-part phase 1b open-label study enrolled patients with late-stage progressive mCRPC. Part 1 was a dose-escalation safety assessment of three doses of NOX66 (400 mg, n = 4; 800 mg, n = 6 and 1200 mg, n = 15) administered daily for 14 days with radiation therapy (20 Gy) delivered in 5 fractionated doses to one or more symptomatic lesion/s. Part 2 was an expansion cohort with NOX66 at 1200 mg in conjunction with radiation therapy. The primary endpoint of safety was assessed by the frequency and grade of treatment-emergent adverse events (TEAEs). At 6 weeks, 3- and 6-month follow up, treatment response was assessed radiographically by RECIST1.1 and by PSA &gt;50% reduction. Results: 25 patients received and completed treatment. TEAEs considered related to NOX66 alone were mild (Grade 1) cases of dry mouth and oral mucositis; mild (Grade 1) fatigue was considered related to both NOX66 and radiation. None of the 21 Grade ≥3 TEAEs were considered related to NOX66. At 6 months, of the 15 evaluable patients by RECIST1.1, 9 had SD and 1 had PR and these same patients had maintained this response from 3 months. Five of the 16 PSA-evaluable patients achieved a PSA response (61-98% PSA reduction) at 6 months, which again was maintained from 3 months. Conclusions: NOX66 in combination with low-dose radiation therapy was found to be safe and well tolerated with promising signals of durable efficacy in patients with late-stage mCRPC. Responses of lesions outside the radiation field are being reviewed. Clinical trial information: NCT03307629 .
Chemoradiation versus chemotherapy after D2 gastrectomy: A meta-analysis including randomized and real-world trials.
Authors: Chai Hong Rim, In-soo Shin, Hye yoon Lee, Sunmin Park
Journal: Journal of Clinical Oncology (2020)

e16590 Background: The ARTIST trial failed to achieve positive result regarding benefit of chemoradiation (CRT) after D2 gastrectomy. In most of clinical guidelines and practices, postoperative CRT has been recommended only for those with R1 resection or lesser extent surgery than D2. Our study is to evaluate oncologic benefit of CRT after D2 gastrectomy, integrating data from randomized clinical trials (RCTs) and real-world studies so far. Methods: Systematic searches for Medline and Embase were performed for controlled trials comparing CRT and chemotherapy (CT) arms after D2 gastrectomy with R0 resection, for gastric cancer. Subgroup analyses were performed including RCTs, and balanced studies without significant difference regarding major clinical indicators. Primary endpoint was disease free survival (DFS), and secondary endpoints included overall survival (OS), locoregional recurrence rate (LRR), distant recurrence rate (DRR), and grade ≥3 complications. Results: A total of 13 studies, comprised of 6 RCTs and 7 non-RCTs, involving 2,603 patients were included. DFS benefit was found in overall pooled analysis [odds ratio (OR): 1.264, p = 0.053, I 2 = 37.5%], and more evident in subgroup analyses using RCTs (OR: 1.440, p = 0.006, I 2 = ~0%) and balanced studies (OR: 1.417, p &lt; 0.001, I 2 = ~0%). OS benefit was not significant. LRR reduction was noted in overall pooled analysis (OR: 0.559, p = 0.012, I2 = 46.1%), and clearer in the subgroup analyses with RCTs (OR: 0.495, p &lt; 0.001, I 2 = ~0%) and balanced studies (OR 0.472, p &lt; 0.001, I 2 = 9.2%). Pooled LRR rates were 11.3% (95% confidence interval: 7.5-16.8) and 18.1% (13.1-24.4) in CRT and CT arms. DRR was lower in CRT arms (OR: 0.768, p = 0.023, I 2 = ~0.0%), but the difference was less significant in subgroup analyses. A grade 5 complication was found in each of the two arms among all studies. Comparison of complications varies and will be shown descriptively in the manuscript. Conclusions: Benefit of DFS and LRR with CRT after D2 gastrectomy was well shown in the present study. Identifying subgroup population mostly benefitable from CRT might yield positive results regarding OS and DRR in future studies.
HER2 status and prediction of extended endocrine benefit with breast cancer index (BCI) in HR+ patients in the adjuvant tamoxifen: To offer more? (aTTom) trial.
Authors: John Bartlett, Dennis C. Sgroi, Kai Treuner, Yi Zhang, Tammy Piper, Ranelle C. Salunga, Ikhlaaq Ahmed, Lucy Doos, Sarah Thornber, Karen J. Taylor, Elena F. Brachtel, Sarah Pirrie, Catherine A. Schnabel, Daniel William Rea
Journal: Journal of Clinical Oncology (2020)

522 Background: BCI is a validated gene expression-based assay that stratifies patients based on risk of overall (0-10y) and late (post-5y) distant recurrence (DR) and predicts likelihood of benefit from extended endocrine therapy (EET). The Trans-aTTom study established Level1B validation for BCI (H/I) to predict benefit from EET. 1 In this updated Trans-aTTom analysis including HER2 status, BCI (H/I) and prediction of endocrine benefit were further characterized. Methods: Centralized HER2 was determined for all cases according to current ASCO/CAP guidelines. Kaplan-Meier and Cox proportional hazards regression were conducted to assess primary and secondary endpoints of Recurrence-Free Interval (RFI) and Disease-Free Interval (DFI), respectively. A three-way interaction using likelihood ratio testing, which included treatment, BCI (H/I) and HER2, was performed to assess the effect of HER2 on BCI (H/I) prediction of EET benefit. Results: Of 789 N+ patients, 90% (N = 711) and 9% (N = 72) were HR+/HER2- and HR+/HER2+, respectively. In the HER2- subset, BCI (H/I)-High (48%) showed significant benefit from 10y vs. 5y of tamoxifen (9.4% RFI: HR = 0.35 [95% CI 0.15-0.81]; P = 0.047) while BCI (H/I)-Low patients did not (-2.1% RFI; HR = 1.15 [95% CI 0.78-1.69]; P = 0.491). For DFI, BCI (H/I)-High patients also showed significant benefit (10.3% DFI; HR = 0.41 [95% CI 0.18-0.91]; P = 0.047) while BCI (H/I)-Low patients did not (-1.7% DFI; HR = 1.10 [95% CI 0.75-1.62] P = 0.612). As demonstrated in the overall N+ cohort, significant interaction between BCI (H/I) and treatment was shown in the HER2- subset (RFI P = 0.045; DFI P = 0.044). Notably, three-way interaction evaluating BCI (H/I), treatment and HER2 status was not statistically significant (P = 0.85), indicating the ability of BCI (H/I) to predict benefit of EET activity was not significantly affected by HER2 status. Conclusions: In this updated Trans-aTTom analysis with HER2 data, BCI (H/I) showed similar predictive performance for EET response in the HER2- subset when compared to the overall N+ cohort. These data further support the clinical utility of BCI (H/I) as a predictive biomarker for informing EET benefit in HR+/HER2- and HR+/HER2+ disease. Clinical trial information: NCT00003678 . [Table: see text]
Changes in physical activity from pre-diagnosis to first five years post-diagnosis: A prospective cohort study in Chinese breast cancer patient.
Authors: Yuanyuan Lei, Winnie Yeo, Suzanne C. Ho, Ashley Chi Kin Cheng, Carol Kwok
Journal: Journal of Clinical Oncology (2020)

e24121 Background: The diagnosis of cancer can motivate patients to change their physical activity habits. No data has reported level of physical activity before and after breast cancer diagnosis in Chinese women. Methods: In an on-going prospective cohort study which involved 1462 Chinese women with early-stage breast cancer, a validated modified Chinese Baecke questionnaire was used to assess physical activity at baseline, 18-, 36- and 60-month after diagnosis. At baseline, patients recalled their habitual physical activity in the preceding 12 months before cancer diagnosis. At 18-, 36- and 60-month follow-up, patients reported their habitual physical activity over the previous 12 months. The level of physical activity at post-diagnosis was defined as the average value assessed at 18-, 36- and 60-month follow-up. Results: Breast cancer patients significantly increased level of physical activity, with median value of 0.6, 5.3, 4.4 and 3.9 MET-hours/week at baseline, 18-, 36- and 60-month follow-up. The average level of physical activity at post-diagnosis was also significantly higher than that at pre-diagnosis ( P &lt; 0.001), with median value of 5.8 MET-hours/week. However, there was no significant difference between any two follow-ups at post-diagnosis. The proportions of participant who met the exercise recommendation (according to WCRF/AICR, 10 MET-hours/week) were low at pre- and post-diagnosis, being 20.7% and 35.1%, respectively. Compared to pre-diagnosis, most of the patients improved or had no change on level of recreational physical activity at post-diagnosis, with the respective proportion being 48.2% and 43.8%. Multivariate analysis showed that higher increase in physical activity after cancer diagnosis was observed among breast cancer patients who were married or cohabitation, unemployed (compared to full time) and had no comorbidity (compared to patients who had one comorbidity). Conclusions: Chinese breast cancer patients reported significant and long-term changes in physical activity after cancer diagnosis, which was in line with current recommendation. However, the proportion of patients who met the exercise recommendation for cancer survivors was still low. Empowering patients on the importance of durable high level of physical activity in breast cancer survivorship is warranted.
Predicting cardiac adverse events in patients receiving immune checkpoint inhibitors: A machine learning approach.
Authors: Brian Dreyfus, Samuel P Heilbroner, Reed Few, Christine Kratt, Andres Gomez
Journal: Journal of Clinical Oncology (2020)

e15075 Background: Many oncology treatments have been associated with cardiovascular (CV) adverse events. Cases of CV events, including myocarditis have been reported for PD-1 and PD-L1 therapies. We created a machine learning model to predict potential CV events in PD-(L)1 patients using the CancerLinQ database. Methods: A XGBoosted decision tree model was trained to predict a patient’s risk of serious CV adverse events. The model was trained on 80% of all advanced non-small cell lung cancer (NSCLC), melanoma, and renal cell carcinoma (RCC) patients from our database including those who received PD-(L)1 therapy. Index date was defined as date of first PD-(L)1 administration or date of advanced diagnosis if no PD-(L)1 drug was given. The model contained approximately 400 potential risk factors for cardiac disease including elements of past medical history, social history, vitals, common labs, cancer history (e.g. stage, cancer type), medication history, and PD-(L)1 specific factors including PD-(L)1 expression status and PD-(L)1 therapy administered. The model was tested on two separate validation sets (patients not used in training): one using advanced NSCLC, melanoma, and RCC patients and another with PD-(L)1 patients only. Each factor’s importance to the model’s predictions was calculated using SHAP summary plots, a qualitative technique for interpreting machine learning models. Results: A total of 27,172 advanced cancer patients were included in our study. 4,966 received PD-(L)1 therapy. The model was trained on 21,758 patients and 5,414 patients were set aside for testing. The model predicted serious cardiac events within 100 days of index with an AUC-ROC of 0.75 in all patients and 0.79 in PD-(L)1 patients. The top predictors of cardiac risk in PD-(L)1 patients included a history of heart disease, weight loss, the % lymphocyte count, and median LDH. The % lymphocyte count and weight loss were noticeably more predictive in PD-(L)1 patients than in non-PD-(L)1 patients. However, in general SHAP summary plots of all and PD-(L)1 patients were nearly identical, suggesting that both cohorts’ cardiac risk is determined in a similar way. PD-(L)1 and autoimmune disease associated factors did not appear in the top 40 most predictive risk factors. Conclusions: Using traditional cardiac risk factors, our model was able to predict potential cardiac events in PD-(L)1 patients. Our model found that high lymphocyte count may be protective while weight loss and a history of cardiac disease (e.g. heart failure) could indicate a poor prognosis.
个人健康管理在健康保险中的应用现状与发展趋势
Authors: 陈君石, 李明
Journal: BMJ (2005)

慢性非传染性疾病在世界范围内的广泛流行、医疗费用的不断上升以及所带来的沉重家庭和社会负担,促进了现代医学服务模式的转变,医生从单纯的诊治疾病发展到对人群健康和疾病进行管理.与单纯诊治疾病所不同的是,健康和疾病管理服务模式的重点是为具有慢性疾病高危险度的人群服务,与患者相比,高危人群应该是医疗卫生服务资源低利用的人群,管理好这些人有利于资源用于控制疾病的患病危险,而不是将资源侧重于那些资源高利用的患者.这种服务模式称之为健康管理[1,2]。
她的病情愈来愈重
Authors: 曾昭耆
Journal: BMJ (2007)

2004年12月7日门诊时,来了一个满面痛苦表情的女病人,请求加号. 病人52岁,某旅行社导游.称平日消化功能不佳,3个月前陪旅行团到新疆,因水土不服,消化不良症状加重,由当地医生看后给予维吾尔民族药.
KEAP1/NFE2L2 as a prognostic biomarker on immunotherapy and correlation with immune infiltrates in non-small cell lung cancer (NSCLC).
Authors: Hongyuan Zhu, Yunfang Yu, Yating Zheng, Bin Xu, Shaopeng Zheng, Fanjun Zeng, Wenzhuan Xie, Luyu Huang, Fasheng Li, Weihuan Lin, Guoqing Liao, Shaowei Wu, Xinyi Liu, Mengli Huang, Haiyu Zhou
Journal: Journal of Clinical Oncology (2020)

e21551 Background: Molecular characterization studies revealed recurrent KEAP1/ NFE2L2 alterations in non-small cell lung cancer (NSCLC). Previous studies have confirmed that KEAP1/NFE2L2 mutations are a poor prognostic factor for chemotherapy in patients with NSCLC. Nevertheless, it is unclear whether KEAP1/NFE2L2 mutations (MUT) of liquid biopsy can predict the efficacy of immunotherapy in NSCLC. Methods: Two independent cohorts (the OAK and POPLAR study cohort) with data from approximately 853 patients with advanced NSCLC were used to analyze the prognostic effect of KEAP1/NFE2L2 on immunotherapy. In addition, based on a deconvolution algorithm (known as CIBERSORT), we comprehensively analyzed the tumor-infiltrating immune cells present in NSCLC. The fraction of 22 immune cells subpopulations was evaluated to determine the associations between each cell type and KEAP1/NFE2L2 mutation status utilizing data from 1268 patients by lung adenocarcinoma (LUAD) and squamous cell lung carcinoma (LUSC) in TCGA pan-cancer cohort. Results: The OAK and POPLAR study cohort of NSCLC patients showed that KEAP1/NFE2L2 MUT was associated with poorer overall survival (OS), and progression-free survival (PFS) (OS: HR = 1.7, P &lt; 0.001; PFS:HR = 1.4, P &lt; 0.001) on immunotherapy, even after EGFR and ALK mutations were excluded, significant difference can also be gained (OS:HR = 1.8, P &lt; 0.001; PFS:HR = 1.5, P &lt; 0.001). Then, the NSCLC patients were subdivided into LUAD and LUSC, the OS and PFS of patients with KEAP1/NFE2L2 MUT is lower than wild-type (WT) (OS:HR = 1.8, P &lt; 0.001; PFS:HR = 1.4, P = 0.0014) in LUAD, significant differences were obtained even when EGFR and ALK mutations were excluded (OS:HR = 1.9, P &lt; 0.001;PFS:HR = 1.6, P &lt; 0.001). In LUSC, patients with KEAP1/NFE2L2 MUT have lower OS (HR = 1.4, P = 0.0473),and there was no difference on PFS (HR = 1.2, P = 0.1588) between KEAP1/NFE2L2 MUT and WT, when EGFR and ALK mutations were excluded, the survival results did not change significantly. In addition, KEAP1/NFE2L2 MUT was positively correlated with infiltrating levels of plasma cells, T cells CD4 memory activated, T cells follicular helper, and Macrophages M1, but negatively correlated with infiltrating levels of T cells CD4 memory resting, monocytes, Dendritic cells activated, Mast cells resting, and Neutrophils in NSCLC. The immunoinfiltration of LUAD was significantly different from that of LUSC. Conclusions: These findings suggest that KEAP1/NFE2L2 can be used as a poorer biomarker for determining prognosis on immunotherapy and immune infiltration in NSCLC.