tbuckley/cabot-search huggingface dataset:
Antibacterial antibiotic exposures and cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation.
Authors: Shijia Zhang, Ryan Shanley, Armin Rashidi
Journal: Journal of Clinical Oncology (2020)

7541 Background: Cytomegalovirus seropositive (CMV+) recipients of CMV seronegative (CMV-) hematopoietic cell allografts are at the highest risk for CMV reactivation. Inspired by the recently described effect of antibiotic (abx)-induced dysbiosis on anti-viral immunity, we retrospectively evaluated whether antibacterial abx exposures influence the risk of CMV reactivation after CMV- to CMV+ cord blood (CB) or matched sibling donor (MSD) transplantation, the serologic setting with highest risk of CMV reactivation. Methods: We identified 213 eligible patients (pts; 146 CB, 67 MSD, mean age 50, range 18-73). Exposures to fluoroquinolones (FQN), 3rd or higher generation cephalosporins (CPN3+), intravenous vancomycin (Vanc), piperacillin-tazobactam (Pip-Tazo), carbapenems, and metronidazole/clindamycin (Metro/Clinda) from day (D) -7 to D +14 (binary variables) or until CMV reactivation (or D +100, whichever occurred first; time-varying variables) were included in multivariable Fine-Gray regression models with competing risk for non-CMV death to estimate the risk of CMV reactivation by D +100. Other pre-defined covariates were ATG use during conditioning, anti-CMV abx exposure for other viruses, and acute GVHD. Results: 91% of pts received FQN, 67% CPN3+, 56% Vanc, 21% Pip-Tazo, 22% carbapenems, and 28% Metro/Clinda until D +14. These numbers increased to 94%, 81%, 76%, 31%, 38%, and 39% by D +100 (or CMV reactivation), respectively. 83 pts (39%: 66 CB, 17 MSD) had CMV reactivation by D +100. Vanc exposure by D +14 almost doubled the risk of CMV reactivation (HR 1.96, 95%CI 1.11-3.46, P = 0.02). With abx exposures up to D +100 modeled as time-varying covariates, Vanc exposure predicted a higher risk for CMV reactivation (HR 1.86, 95%CI 0.99-3.52, P = 0.06). The table below summarizes the results, excluding non-abx covariates for brevity. Conclusions: Our results suggest that vancomycin-sensitive bacteria may protect against CMV reactivation. Identifying the specific taxa and their location (intestinal vs. extraintestinal) requires more research. Microbiota considerations and abx exposure patterns can help personalize CMV prophylaxis. [Table: see text]
Influence of thoracic duct ligation on lipid metabolism after esophagectomy
Authors: Yong-heng Zhang, Bo Yang, Zhen-zhen Yuan, Quan Chen
Journal: BMJ (2009)

Objective To explore influence of thoracic duct ligation on lipid metabolism after esophagectomy. Methods Seventy-four patients with esophageal cancer received esophagectomy were divided into two groups by their thoracic duct ligation, 39 in ligation group and 35 in non-ligation group. All the patients were fed with nutrients through nasal-duodenal tube placed during operation from the 1 st day to the 8th day after surgery, and started taking liquid diet on the 6th day. Blood specimens were collected from the patients on the 1st day after admission, the 9th day, one month and three months after surgery,respectively for biochemical analysis,including determinations of total cholesterol(TC),triglyeeride(TG),high-density lipoprotein-cholesterol ( HDL-C) and low-density lipoprotein-cholesterol ( LDL-C) . Databetween the two groups were compared with statistical analysis. Results No significant difference in plasma levels of TC, TG and HDI.-C was found between the two groups at varied time points. Plasma level of LDL-C in the ligation group significantly decreased on the 9th day after surgery, as compared with that in the nonligation group ( P ＜ 0. 05), and went down to the lowest level one month after surgery. Conclusions Chylomicron was blocked to enter blood stream and production of LDL-C decreased by thoracic duct ligation,which affect lipid absorption and metabolism leading to poor early nutrition in patients with esophagealsurgery due to slower establishment of collateral circulation.

Key words: 
Thoracic duct;  Esophageal neoplasms;  Lipid metabolism disorders;  Lateralcirculation
Analysis of the sex ratio of reported gonorrhoea incidence in Shenzhen, China
Authors: 熊明洲, 蓝丽娜, 冯铁建, 赵广录, 王峰, 洪福昌, 吴肖冰, 张春来, 文立章, 刘爱忠, Best John McCulloch, 唐卫明
Journal: BMJ (2016)

目的
通过评估中国淋病临床诊断和上报的过程，分析淋病报告发病率和真实发病率的差异。


研究地点
来自深圳市34家医院的26个皮肤性病科、34个妇产科和28个泌尿科门诊是研究的调查点。


研究对象
研究共纳入2 754名研究对象，2 534名完成了问卷调查且提供了生殖道分泌物拭子。男性1 106名，女性1 428名。入选标准为在2012年10月首次在调查点接受诊疗服务的18岁以上的就诊者，且自愿参加研究。


结果指标
应用淋病漏检率、真阳性率、假阴性率、漏报率，以及淋病报告发病率性别比和真实发病率性别比描述研究结果。


结果
共有2 534名患者参与了研究。女性淋病漏检率显著高于男性（女性88.1%，男性68.3%，P=0.001）。漏检率、真阳性率、假阴性率和漏报率男女性别比分别为：1∶1.3、1.2∶1、1∶1.6和1∶1.4。淋病患者报告发病率男女性别比为19.8∶1 (87/1 106比5/1 420），真实发病率男女性别比为2.5∶1（161/1 106比84/1 420）。淋病报告发病率男女性别比较真实发病率男女性别比夸大了7.9倍（19.8/2.5）。


结论
深圳市男女性淋病发病率均被严重低估，其中女性被低估程度远高于男性。
老年前列腺增生症患者焦虑抑郁情绪的调查分析
Authors: 赵学英, 张喜庄, 刘学伟, 李凤鸣, 杨永军
Journal: BMJ (2005)

采用Zung's焦虑量表和抑郁量表,以问卷方式调查558例老年前列腺增生症患者中焦虑抑郁情绪的发生频率、严重程度.结果提示老年前列腺增生症患者较未患前列腺增生症的老年人焦虑和抑郁情绪发生率高,尤以伴有急性尿潴留者严重。
Cervical pedicle screw fixation for multisegmental cervical spondylotic myelopathy with flexibility type kyphosis
Authors: Qingshan Zhuang, Zhaowan Xu, Guoxia Sui, Qinmin Wu, Dengxing Lun
Journal: BMJ (2014)

Objective
To evaluate the efficacy of unilateral open door laminoplasty and individualized cervical pedicle screw fixation for multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.


Methods
Twenty one cases of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis received surgical treatment. Unilateral open door laminoplasty and individualized cervical pedicle screw fixation. The Japanese Orthopaedic Association (JOA) scoring system and disability index (NDI)were applied to evaluate the neurological function and axial neck/shoulder pain before and after surgery. The Borden' method was employed to measure the cervical curvature. CT plain scan of cervical pedicle and sagittal two-dimensional imaging of transpedicular on the axial was examined. The unilateral open door laminoplasty and individualized cervical pedicle screw fixation was performed.


Results
A total of 168 pedicle screws were fixed successfully in 21 patients, the accuracy of screw placement reached 93.5%. The cervical curvature measured by Borden' method showed significant differences before and after operation. Compare to those before surgery, the JOA scores at 1 week after operation and at final follow-up were decreased and NDI scores were significant increased(P<0.05).


Conclusion
Unilateral open door laminoplasty and individualized cervical pedicle screw fixation is effective for treatment of multisegmental cervical spondylotic myelopathy with flexibility type kyphosis.


Key words: 
Spinal diseases, cervical vertebrae; Surgical procedllres, operative; Treatment outcome
Effects of intervention on the prevention of ischemic stroke recurrence in a local community
Authors: Jie Xu, Hai-ying Wang, Wei-bo Lu, Jie Liu, Ying-qi Gao
Journal: BMJ (2013)

A total of 120 patients with initial stroke at a community health service center in Shanghai from January 2009 to March 2011 were divided randomly into intervention group (n=60) and control group (n=60). Individual comprehensive rehabilitation was carried out based on the evaluations in the intervention group. Routine therapy was given to the patients in the control group. General data evaluations were conducted at pre-intervention and 1 year post-intervention respectively. The levels of blood pressure, blood glucose and blood lipid (LDL-C) were all lower in the intervention group than those in the control group (P<0.05). The rates of proper behavior were all higher in the intervention group than those in the control group (P<0.05). And the rates of recurrence and mortality were lower in the intervention group than those in the control group (P<0.05).


Key words: 
Cerebrovascular accident; Health education
Prevalence of chemotherapy-induced nausea and vomiting with moderately emetogenic chemotherapy in platinum-based regimens.
Authors: Nilomi Shah, Kris Nishimura, Evelyn Tan, Hana Hsu
Journal: Journal of Clinical Oncology (2020)

e24131 Background: Kaiser Permanente East Bay considers cisplatin ≤40 mg/m2, carboplatin at any AUC, and oxaliplatin at any dose as moderate emetogenic risk where patients are administered 5-hydroxytriptamine type 3-receptor antagonist (5-HT3 RA) and dexamethasone. However, national guidelines differ in their management with cisplatin and carboplatin of AUC ≥4. Moreover, it has been noted within our institution that patients receiving oxaliplatin often require escalation of antiemetic regimen despite 5-HT3 RA and dexamethasone prophylaxis. The objective of the study was to determine the prevalence of CINV in patients receiving platinum-based chemotherapy despite moderate prophylaxis for cycle 1. Methods: The study was a retrospective single-center cohort-control analysis assessing patients from Kaiser Permanente East Bay initiated on cycle 1 with carboplatin AUC ≥4, low dose cisplatin ≤40 mg/m2, or any dose of oxaliplatin. Evaluation of CINV was defined as rates of no complete response (emesis or use of rescue) during the acute (0 – 24 hours), delayed (24 – 120 hours) and overall periods (0-120 hours) after cycle 1 of treatment. A descriptive analysis was performed for the primary endpoint where the rate of no complete response (emesis or use of rescue) was expressed using the percentage of patients with the outcome. For the secondary endpoint, the patient-related risk factors associated with no complete response were determined by chi-squared for univariate covariates. Results: Between January 2016 to August 2019, 90 patients on cisplatin ≤40 mg/m2, 243 patients on carboplatin AUC ≥4, and 204 patients on any dose of oxaliplatin were enrolled in the study. The percentages of patients who had no complete response were 16%, 13%, 11% in the acute phase; 39%, 34%, and 38% in the delayed phase; 47%, 36%, and 39% in the overall phase, respectively. Univariate analysis using chi-squared revealed that age less than 60 years and females were associated with an increased risk for no complete response in the overall phase. In contrast, prior chemotherapy was significantly associated with a decreased risk in the overall phase. Conclusions: The prevalence of CINV despite moderate antiemetic management at Kaiser Permanente East Bay is more prominent in the delayed phase compared to the acute phase and consistent with trends determined in literature. Patients who are younger than 60 years of age, who are female, or had no prior history of chemotherapy are relevant risk factors associated with CINV in our patient demographics.
中国在支气管哮喘和慢性阻塞性肺疾病患者生命质量研究中问题的分析
Authors: 李凡, 蔡映云
Journal: BMJ (2004)

将1979年1月～2002年9月在中国生物医药文献数据库中有关支气管哮喘和慢性阻塞性肺疾病的论文摘要中提及生存质量、生活质量或生命质量的论文入选，分析其疾病分布、QOL(quality of life)的中文译名以及QOL评估表的应用情况。
Adjuvant chemotherapy impact on the overall survival of completely resected small bowel adenocarcinoma: An updated meta-analysis.
Authors: Philip A. Haddad, Dalia A. Hammoud, Kevin M. Gallagher
Journal: Journal of Clinical Oncology (2020)

e16806 Background: While the small intestine represents around 75% of the length and more than 90% of the gastrointestinal tract mucosal surface, it contributes around 2% of gastrointestinal tumors. Adenocarcinoma which constitutes 40% of all small bowel tumors is the most common histology. Complete surgical resection of early-stage small bowel adenocarcinoma (SBAC) is the only proven potentially curative therapy. Due to the rarity of this disease and the absence of randomized trials, the benefit of postoperative adjuvant chemotherapy (ACT) in patients with completely resected localized SBAC has been controversial. A meta-analysis conducted in 2018 found no survival benefit for adjuvant therapies in SBAC. However, this meta-analysis combined studies that used adjuvant chemotherapy and chemoradiotherapy and included studies contaminated by other less chemosensitive histologies and more advanced and sometimes metastatic disease. The purpose of this meta-analysis is to evaluate the impact of ACT on the overall survival (OS) of patients with completely resected SBAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected small bowel adenocarcinoma, English language, publications from 2000 to the present, and comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACT versus those that did not. Adjuvant chemoradiotherapy studies and those that reported aggregate OS for a cohort with mixed histologies were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Nine retrospective series which included 2082 patients were selected and analyzed. The majority of SBAC patients that received ACT belonged to stages II &amp; III. ACT was found to be significantly associated with better OS in patients with completely resected SBAC (HR 0.66, 95%CI: 0.56-0.78, p &lt; 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemotherapy is associated with a survival benefit in patients with completely resected small bowel adenocarcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACT in this patient population.
Nonalcoholic fat liver disease and familiar partial lipodystrophy: a strong association
Authors: Ana de Lourdes Candolo Martinelli, Cyntia F. G. Viana, Renan Magalhães Montenegro Júnior, Marcellus H. Souza, Leandra Naíra Zambelli Ramalho, Valdair Francisco Muglia, Jorge Elias Júnior, Milton César Foss, Sérgio Zucoloto, Rendrik França Franco
Journal: Hepatology (2001)
Pattern of disease in recurrent cervical cancer associated with response to pembrolizumab.
Authors: Kathryn Miller, Olga T. Filippova, Sara A. Hayes, Nadeem Abu-Rustum, Carol Aghajanian, Vance Broach, Lora H Ellenson, Elizabeth Lin Jewell, Chrisann Kyi, Yulia Lakhman, Jennifer Jean Mueller, Roisin Eilish O'Cearbhaill, Kay J. Park, Yukio Sonoda, Dmitriy Zamarin, Mario M. Leitao, Claire Frances Friedman
Journal: Journal of Clinical Oncology (2020)

e18006 Background: Pembrolizumab received accelerated FDA approval for treatment of metastatic or recurrent PD-L1 positive cervical cancer in 6/2018. Since then, the clinical characteristics of patients who best respond to this immunotherapy have remained undefined. We sought to describe patients with advanced cervical cancer who derived durable clinical benefit (DCB) from pembrolizumab therapy. Methods: Patients with advanced or recurrent cervical cancer who received pembrolizumab from 8/2017-12/2019 at our institution were assessed. Reviewed data included patient demographics, treatment history, baseline pattern of metastatic disease at initiation of anti-PD-1 treatment, and outcomes. Kaplan-Meier survival analysis was performed to determine progression-free survival (PFS). Treatment response was evaluated by computed tomography using RECIST 1.1 criteria. Results: 14 patients with recurrent cervical cancer received pembrolizumab. Median age was 55 years (range, 21-76); 79% (n = 11) had squamous cell carcinoma (SCC). The 3 non-SCC histologies included endocervical adenocarcinoma, high-grade endometroid adenocarcinoma, and mesonephric adenocarcinoma. 93% (n = 13) expressed PD-L1; 1 patient whose tumor was MSI-H did not undergo PD-L1 testing. 93% (n = 13) had received prior radiation, and 86% (n = 12) had received 1 or more prior lines of chemotherapy. Median duration of treatment was 4.9 months (range, 1.4-15.2), and median follow-up was 7.9 months (range, 2.1-29.9). On RECIST review, the overall response rate was 21% (n = 3), including 2 partial responses and 1 complete response. Two patients (14%) had stable disease of ≥6 months for an observed DCB of 36%. Of the 5 patients with DCB, 4 remain on pembrolizumab, with observed antitumor activity of up to 15.4 months. On univariable analysis, a lymph node and/or lung only baseline pattern of metastasis was associated with improved response to pembrolizumab (n = 7, P= 0.02). On survival analysis, patients with lymph node and/or lung pattern of disease had a 6-month PFS rate of 86%, compared to a 6-month PFS rate of 0% in patients with visceral or multi-site disease ( P&lt; 0.001). Conclusions: Pembrolizumab showed promising activity in our patient cohort, with a DCB rate of 33%. Patients with lymph node and/or lung only patterns of metastasis at baseline had the greatest radiologic response compared to patients with visceral or multi-site disease. Our results suggest that there may be an underlying pathophysiology of metastatic patterns that confer improved response to anti-PD-1 therapy in advanced cervical cancer.
Malignant arrhythmia caused by intravenous drip of levofloxacin in a young woman
Authors: Zhaoping Zeng, Yifei Li, Feng Li, Lijia Dong, Songhai Wen
Journal: BMJ (2019)

报道1例因患双肾结石的23岁女性患者在静脉滴注左氧氟沙星注射液过程中，出现室性心动过速、晕厥等恶性心律失常及严重不良心血管事件，提示在临床工作中，应重视抗菌药物的心脏毒性，加强对抗菌药物的不良反应的监测。
APC and TP53 as potential biomarkers for EGFR sensitivity in colorectal cancer.
Authors: Ramya Thota, Mingli Yang, Thomas Davis, Michael J. Schell, Warren Jack Pledger, Timothy Joseph Yeatman
Journal: Journal of Clinical Oncology (2020)

4094 Background: The Consensus Molecular Subtypes (CMS) of colorectal cancer (CRC) have prognostic and predictive value in identifying patients that derive benefit from EGFR targeted therapies. The CMS2 cohort was specifically noted to predict response to cetuximab. Besides CMS classification, we recently reported a two-gene mutation signature of APC and TP53 (AP) that predicts potential response to cetuximab. In this study, we hypothesize AP mutations, in addition to CMS cohorts, predict cetuximab sensitivity. Methods: A prespecified and validated 203 gene expression signature score measuring cetuximab sensitivity (CTX S-score) was used as a surrogate for response to cetuximab sensitivity. A cohort of 458 patients with colorectal cancer was accrued between October 2006 and September 2011. The population classified into CMS cohorts, and CTX-S scores were determined across each of the cohorts based on AP mutation status. Results: Among 458 tumor samples sequenced, AP mutations were identified as significantly associated with higher CTX-S scores. Among the CMS 1-4 cohorts identified, AP mutations were noted in 13 of 77 (17%) patients in CMS1 cohort, 87 of 116 (75%) patients in CMS2 cohort, 15 of 64 (23%) patients in CMS3 cohort, 46 of 112 (41%) patients in CMS4 cohort, indicating that AP mutations are dominant in CMS2 cohort. Further CTX-S score comparisons across CMS cohorts based on AP status show that AP mutated tumors have higher CTX-S scores than non-AP mutated tumors—irrespective of the CMS cohorts (p&lt;0.05 unpaired, two-tailed t tests). Conclusions: In our study, we noted CMS2 cohort has high predicted sensitivity to cetuximab. Across other CMS cohorts, AP mutations were associated with higher CTX-S scores compared to those with AP wild-type tumors, suggesting both CMS2 and AP mutations contribute to CTX sensitivity.
Changes of plasma GARP-LTGFβ1 complex during chemoradiotherapy may predict survival in non-small cell lung cancer (NSCLC).
Authors: Yishan Yu, Anqi Li, Weili Wang, Pingfu Fu, Shruti Jolly, Theodore Steven Lawrence, Mitchell Machtay, Zihai Li, Feng-Ming Spring Kong
Journal: Journal of Clinical Oncology (2020)

e21042 Background: Glycoprotein-A repetitions predominant protein (GARP), a cell surface docking and activating receptor for latent transforming growth factor β1 (LTGFβ1), has been implicated in promoting oncogenesis. We report recently that GARP-LTGFβ can be clipped by thrombin but its clinical significance remains unclear. Herein, we hypothesized that 1) the baseline plasma GARP-LTGFβ1 complex is associated with clinical stage of cancers; 2) the baseline and/or changes of plasma GARP-LTGFβ1 complex during chemo-radiotherapy is associated with overall survival (OS) in patients with NSCLC. Methods: This is a correlative study for patients with stage I-III NSCLC receiving chemo-radiotherapy. Levels of GARP-LTGFβ1 complex in platelet-poor plasma were determined by a modified ELISA at pre-RT, 2,4 weeks during-RT and post-RT. Values were calculated based on the following formula: (OD test -OD negative control )/OD postive control -OD negative control ). The primary endpoint was OS, analyzed using the Kaplan-Meier method and Cox proportional hazard model. Platelet-poor plasma samples from healthy subjects were used as normal controls. Results: A total of 155 patients were included: 41 stage I-II, 111 stage III. There were 115 male, 50 female with a median age of 66 years. Compared to 13 normal controls (0.638, 95% CI:0.477-0.799), NSCLC patients had a significantly higher plasma GARP-LTGFβ1 (0.965, 95%CI: 0.881-1.048, p = 0.014). The same trend was observed for stage, higher level in more advanced stage (1.037, 95%CI: 0.930-1.145) vs for stage I-II (0.854, 95%CI: 0.720-0.988) (p = 0.0375). Univariate analysis demonstrated that age, gender, clinical stage, smoking history, histology, KPS, and radiation dose were significantly associated with OS. Post/pre RT GARP-LTGFβ1 complex (high vs. low HR = 0.384, p = 0.043) instead of pre-RT (p = 0.538), during RT (p = 0.739 for 2 weeks, p = 0.570 for 4 weeks) or post-RT (p = 0.507) plasma GARP-LTGFβ1 complex during the course of radiation therapy correlated significantly with OS under univariate analysis. On multivariate Cox regression models after adjusting for above significant clinical factors, the changes of plasma GARP-LTGFβ1 level had significance in correlating with OS (HR = 0.359, p = 0.0087). Conclusions: Baseline plasma GARP-LTGFβ1 were significantly associated with presence of cancer and advanced stages in NSCLC patients. Changes of GARP-LTGFβ1 level in plasma could be useful to predict outcomes and reflect the changes of immune status after chemoradiation.
Willingness of medical undergraduate students choose general practitioners in community health-care service as their career
Authors: Qing Guo, Chen-jia Mao, Zhi-xin Jiang, Lei Yang, Jian-chun Yuan
Journal: BMJ (2008)

Objective To understand willingness of current medical undergraduates to work at community health-care service(CHS)institutions after their graduation to provides information for professional training for them.Methods Totally,2714 medical undergraduate students were recruited from three medical schools in east,middle and west China by multi-level sampling methods for questionnaire survey on their basic information and willingness to be employed at CHS institutions.results of the survey were described by relative numeric and tested by chi-square test for smtistical inference.Results About 60.6%of medical undergraduate students were willing to work at CHS organizations permanently or temporarily.Their willingness to work there differed with their native living areas and grades they were studying significantly(P＜0.01).Reason for those they would work at CHS organizations after graduation included work less stress and easier,and that for those reluctant to work there included low-income and lack of social respect for general practitioners.Conclusions Nowadays,few medical undergraduate students would like to work at CHS organizations after their graduation,which was influenced mainly by traditional ideas and concepts of employment,personal career devdopment,economic income,and so on.It is suggested that ideas of community work be strengthened for medical undergraduate students and their employment concepts be changed in the future.

Key words: 
Students,medical; Community health services; Career choice