tbuckley/cabot-search huggingface dataset:
Thermal ablation versus stereotactic body radiotherapy for stage I non-small cell lung cancer: A cost-effectiveness analysis.
Authors: Xiao Wu, Johannes Uhlig, Justin Blasberg, Scott N. Gettinger, Robert Suh, Stephen Barnett Solomon, Kevin Kim
Journal: Journal of Clinical Oncology (2020)

e21061 Background: Stereotactic body radiotherapy (SBRT) and thermal ablation are increasingly used to treat medically inoperable patients with non-small cell lung cancer (NSCLC). The purpose of this study is to assess the cost-effectiveness of microwave (MWA) and stereotactic body radiotherapy (SBRT) for patients with stage I NSCLC. Methods: A decision-analysis model was constructed over a 5-year of Medicare billing data from a health care sector’s perspective using TreeAge Pro Suite 2019 (TreeAge Software LLC, Cambridge, MA). The two evaluated strategies were SBRT and MWA. All clinical, cost and health utility parameters were derived from the literature with preference to long-term prospective trials and assigned appropriate statistical distributions. Costs and health utilities (quantified by quality-adjusted life years (QALY)) associated with procedure, short-term complications, long-term surveillance and disease progression were incorporated. A willingness-to-pay (WTP) threshold of $100,000/QALY was used. One QALY is equivalent to 1 year of life in perfect health. Strategies were compared using incremental cost-effectiveness ratio (ICER). Base case calculations, Monte Carlo Simulations with 10,000 iterations drawing parameters from their respective distributions, and multiple sensitivity analyses were performed. Results: Literature review and interpolation showed that average annual recurrence risk of SBRT and MWA were 4.64% and 10.4% respectively. SBRT yielded 2.33 QALY and MWA yielded 2.31 QALY. The difference in health benefit is equivalent to 1 week of life in perfect health. The overall costs were $225,271 and $195,331. The ICER of MWA in reference to SBRT was $1,480,597/QALY, which is more than 10 times of the WTP threshold currently used in the US, indicating that MWA is the more cost-effective strategy. MWA was the optimal strategy in 99.84% of the Monte Carlo simulations. One-way sensitivity analyses showed that MWA is more cost-effective than SBRT if recurrence risk of MWA is &lt; 18.4% per year or recurrence risk of SBRT is &gt; 1.44% per year, or cost of MWA is lower than or at most $7,500 more than SBRT. One-way sensitivity analysis showed that MWA would achieve a higher health benefit than SBRT if the overall survival after MWA was &gt; 76.9% per year or after SBRT was &lt; 75.6% per year. Conclusions: Our study showed that MWA is more cost-effective than SBRT for medically inoperable stage I NSCLC patients with comparable health benefits based on multiple robust probabilistic and deterministic sensitivity analyses.
The Xiamen model for community health service
Authors: Guo-bao Tang, Shu-yu Yang
Journal: BMJ (2009)

In February 2008 the  Municipal Government reorganized the health service in  City to create aXiamen Modelfor community health service.The community health service centers were divided into two parts:the public health service was directly undertaken by the loal government,and the medical service was affiliated to one of the tertiary hospitals.Both were financed by govemment budget,but operated separately.A recent survey showed that the Xiamen model promoted the vertical integration of  medical resources.increased the service efficiency,reduced the medical and drug cost,and improved the satisfaction of local residents.Nevertheless,there were still some problems;the tertiary hospital should change its service pattern and enhance general practice in the community,the finance compensating mechanism need to be improved.

Key words: 
Community health services; Health services administration
Treatment for female stress urinary incontinence with tension-free vaginal tape obturator procedure: clinical analysis of 38 cases
Authors: Xiao-hong Zhang, Dong Cao, Li Jiang, Jian-liu Wang, Shi-jun Wang, Li-hui Wei
Journal: BMJ (2008)

Objective To determine the effectiveness and complications of tension-free vaginal tape obturator procedure(TVT-O)as a new surgical treatment method for female stress urinary incontinence (SUI).Methods TVT-O was undergone for 36 female patients with established SUI(including 16 mild cases,18 moderate cases and two severe cases)and two cases with mixed urinary incontinence(MUI).Operation time and intra-operation bleeding in the patients were analyzed.The patients were followed-up to observe the effectiveness and complications of this new procedure.Results Age of the 38 patients undergone with this procedure averaged 56.4 years,with a mean operation time of 38.3 minutes,ranging from 30 to 50 minutes.Patients were followed up for two to 29 months(averaging 12.7 months),with four cases lost to follow-up.No bladder or urethral injuries,and no vascular(hematoma or bleeding)and neurological complications were encountered in 38 of them after the procedure.Among four cases(10.5percent)complicated with urinary retention,catheter was removed in ten to 14 days after its indwelling in three cases,with residual urine less than 100 ml.Only one patient still had dysuria nine days after catheter indwelling,but her symptoms improved by adjusting the position of sling to the middle of her urethra under local anesthesia.Twenty-seven cases(71.1 percent)were fully cured without any subjective symptoms left,symptoms improved in four cases(10.5 percent),no response in two cases(5.3 percent),and symptoms of SUI disappeared in one case of MUI,but no release in her urgency urinary incontinence.Conclusions TVT-O procedure is a mini-invasive,safe,effective,accurate and quick surgical operation in treatment for female SUI,unnecessary with regular cystoscopy during the procedure.But its long-term effectiveness is still under follow-up and observation.

Key words: 
Urinary incontinence,stress;  Gynecologic surgical procedures; Therapy
高位截瘫引起血压变异性改变及低血压晕厥一例
Authors: 徐波, 钟忠辉, 夏向南, 黄敏
Journal: BMJ (2005)

患者男,70岁,于1997年7月17日外伤致C6-7骨折伴脊髓损伤,并出现高位截瘫.患者长期卧床,多次在我院骨科行骨牵引、康复治疗.患者高位截瘫后,反复出现严重的血压波动,最低血压40/20 mm Hg(1mm Hg=0.133 kPa),最高血压200/110 mm Hg,并经常突然全身不适、面色苍白、心悸、胸闷、恶心、出冷汗等,发作时测血压68～40/30～20 mm Hg,脉搏细弱,心率52～66次/min,诊断:高位截瘫,低血压晕厥.患者出现低血压晕厥后,经吸氧、静卧及补液、静脉滴注参麦或口服黄芪生脉饮等治疗后,神志、血压可恢复正常。
赣州市社区居民对社区卫生服务的认知及利用
Authors: 周小军, 袁兆康, 万红, 肖云昌, 操秋阳, 蔡燕玲, 邓大安, 洪定香
Journal: BMJ (2006)

采用整群随机抽样的方法,对赣州市章贡区431位社区居民就社区卫生服务的认知与利用情况进行了调查.结果显示居民对社区卫生服务的知晓率为83.76%,76.57%的居民到社区卫生服务机构就诊过,满意率为67.58%.自费医疗者与退休职工对社区卫生服务的知晓率较高,科技人员和报销困难是影响居民到社区卫生服务机构就诊的主要因素,离家近、高年龄组、收费合理是促进居民到社区就诊的因素。
心力衰竭的诊断--您了解吗?
Authors: 刘岚
Journal: BMJ (2004)

医生会根据病史和完整的体格检查(包括测量血压、脉搏和心脏听诊)来诊断心力衰竭(以下简称心衰),他会寻找心衰的征象,如气短(呼吸困难)、下肢水肿、颈静脉怒张、腹部不适(如腹胀、腹痛或恶心)、精神萎靡、心悸、肾功能不全或肾功能衰竭(在心衰晚期)等症状以及一些体征,如病理性心脏杂音、肺部湿啰音、心动过速或心律失常、肝脏或胃肠肿胀淤血、心脏肥大或扩大等等.如果医生没有发现足够的证据来做出诊断,但又仍然怀疑患者有心衰的话,就需要做以下进一步的检查。
Inmunotherapy related hepatitis: A retrospective study of Chilean patients.
Authors: Carlos Salinas, Suraj Rajesh Samtani, Alex Renner, Osvaldo Rudy Aren, Carlos Rojas, Mauricio Emanuel Burotto Pichun
Journal: Journal of Clinical Oncology (2020)

e15144 Background: Immune checkpoint inhibitors (ICI) have shown dramatic efficacy in many trials of advanced solid cancer. Data of toxicity for these agents setting in Chilean patients is lacking and is of importance to confirm the tolerance of immunotherapy in different population. Immunotherapy-related hepatitis (liver irAEs) represents a diagnostic and management challenge, and its frequency varies according to various factors. We aim to report the incidence, features and treatments used to manage liver irAEs in Chilean population. Methods: A retrospective review of 139 patients with diagnosis of NSCLC, Renal Cancer, Urothelial, Melanoma, treated with ICI from April 2013 until November 2019. Baseline clinical factors (age, ECOG score, cancer type, stage, Type and number of cycles of immunotherapy, comorbidities), biochemistries and treatment received were recorded for all patients with liver irAEs. Checkpoint-inhibitor-associated liver disease was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) V.4 Treatment outcomes were analyzed by measuring progression free (PFS) and overall survival (OS). Results: 32 (23%) patients developed liver irAEs. Median age at diagnosis was 62 years (range 37-86). 62% patients were male, 59% ECOG 1, 96% had de novo metastatic disease. The most frequent primary sites of cancer were Renal Cancer 71% and NSCLC 9%. 78% of patients received treatment with both anti-PD-1/PD-L1 and CTLA-4 drugs. Liver irAEs G2 and G3 were 43.7% and 56.2% respectively. 31,2% and 12,5% of patients treated with single agent immunotherapy developed G2 and G3 Liver irAEs respectively. The total averages of cycles administered were 12, 4 cycles. 28% of patients developed liver irAEs after the first cycle of treatment and 12.5% after the second cycle. 6.2% patients required hospitalization and 78.1% required treatment with steroids. Conclusions: Liver irAEs was more frequent in Chilean population than data reported on previous clinical trials with a high incidence caused by ICI monotherapy and further reinforced by combination therapy. Local registries play an important role in recognizing different patterns of toxicity according to different population. Early recognition and management of liver irAEs should be of vital importance in clinical practice and as prescribing physicians we must maintain strict vigilance of liver irAES in Chilean population.
Preclinical study of oncolytic adenovirus-mediated cytotoxic gene therapy with gemcitabine for chemoresistance of desmoplastic tumor.
Authors: Bo-Kyeong Jung, Yan Li, JinWoo Hong, Eonju Oh, Chae-Ok Yun
Journal: Journal of Clinical Oncology (2020)

e15507 Background: Pancreatic cancer is a highly lethal disease. Excessive accumulation of tumor extracellular matrix (ECM) and epithelial-to-mesenchymal transition (EMT) phenotype are two main contributors to drug resistance in desmoplastic pancreatic tumors. Methods: To overcome the limitations of various conventional therapeutics against desmoplastic pancreatic cancer, we utilized an oncolytic adenovirus (oAd) for combination therapy with gemcitabine, a standard chemotherapeutic for pancreatic cancer treatment. Here, we report the results of preclinical pharmacology and efficology studies conducted in pancreatic cancer model. Results: Efficacy studies in orthotopic pancreatic xenograft tumor model demonstrated that oAd effectively attenuated tumor cell proliferation. oAd further prevented metastasis of pancreatic cancer and sensitized pancreatic tumor to gemcitabine treatment. Furthermore, oAd augmented drug penetration and dispersion within pancreatic tumor xenografts and patient-derived pancreatic tumor spheroids. These results suggest that oAd enhance the therapeutic effect of chemotherapeutic agent in chemo-resistant and desmoplastic pancreatic tumor, thus overcoming the preexisting limitations of standard treatments. Conclusions: Overall, these results demonstrate that local administration of an oncolytic adenovirus with gemcitabine is well tolerated and support moving this investigational approach into human trials.
The ratio of urine albumin to creatinine used in screening for albuminuria among the middle-aged and elderly at high-risk for diabetes in an urban community with casual and morning urine specimens
Authors: Sun-fang Jiang
Journal: BMJ (2009)

Objective To compare the value of clinical application of the ratio of urine albumin to creatinine (ACR) in the community-dwelled middle-aged and elderly at high-risk for diabetes in screening for albuminuria with casual and morning urine specimens. Methods Totally, 443 middle-aged and elderly people (234 men and 209 women) at high-risk for diabetes, with an average age of (59±8) years, were recruited from Changfeng Community of Shanghai in screening for albuminuria with casual and morning urine specimens collected on the same day, as well as another two morning urine specimens collected at an interval of two weeks, for determination of urine ACR. Albuminuria was defined as ACR equal to or more than 30 mg (albumin)/g (creatinnine) in two or more of the three urine specimens collected. Results Overall prevalence of albuminuria was 6. 3% ( 28/443 ) in the middle-aged and elderly according to diagnostic standard mentioned above, significantly higher in casual urine specimens than in morning urine specimens (14. 9% vs. 5.9%, P  0. 05). Specificity and negative predictive value (NPV) of casual urine specimens was significantly lower than those of morning urine specimens (90.6% vs. 100.0%, and 40.9% vs. 100.0%, respectively, P<0.05). The optimal cut-off value of ACR by casual urine specimens was 40. 0 mg/g in screening for albuminuria, based on receiver operating characteristic (ROC) curve, with sensitivity of 96. 4%, specificity 95.2%, PPV 57.5% and NPV 99. 8%. The middle-aged and elderly with negative albuminuria in morning urine but positive in casual urine had more risk factors for cardiovascular and chronic kidney diseases than those with negative albuminuria in both morning and casual urine specimens. Conclusions Morning urine specimen is better than casual urine for albuminuria screening in the middle-aged and elderly people with risk factors for diabetes in urban community, but casual urine used in screening for albuminuria is very convenient for collection. It is suggested that urine ACR of 40. 0 mg/g be used as an optimal cut-off value for casual urine in albuminuria screening among them.

Key words: 
Albuminuria; Mass screening; Diagnosis services
A phase I study of ALX148, a CD47 blocker, in combination with standard anticancer antibodies and chemotherapy regimens in patients with advanced malignancy.
Authors: Laura Quan Man Chow, Justin F. Gainor, Nehal J. Lakhani, Keun Wook Lee, Hyun Cheol Chung, Jeeyun Lee, Patricia LoRusso, Yung-Jue Bang, F. Stephen Hodi, Rafael Santana-Davila, Philip Fanning, Pierre Squifflet, Feng Jin, Hong Wan, Tracy Kuo, Jaume Pons, Sophia Randolph, Wells A. Messersmith
Journal: Journal of Clinical Oncology (2020)

3056 Background: CD47 is a myeloid checkpoint upregulated by tumor cells to evade the host immune response. ALX148 (A) is a fusion protein comprised of a high affinity CD47 blocker linked to an inactive immunoglobulin Fc region. ALX148 enhances innate and adaptive immune responses against cancer and has previously been shown to be well tolerated in combination with the checkpoint inhibitor (CPI), pembrolizumab (P), and trastuzumab (T) in a range of solid tumors (ASCO 2019 #2514). ALX148 safety and activity in combination with T or P and standard chemotherapy regimens are reported in patients (pts) including head and neck squamous cell cancer (HNSCC) and HER2 positive gastric/gastroesophageal cancer (GC). Methods: Pts with advanced malignancy were administered AP or AT. Patients with ≥2L HNSCC progressed on platinum therapy received AP, while those with untreated advanced disease received AP+5FU (FU)+platinum. Pts with ≥2L GC progressed on T+FU+platinum received AT +/- ramucirumab (ram)+paclitaxel (pac). Safety, response, pharmacokinetic and pharmacodynamic (PD) markers were assessed. Data are reported as of 21, Jan. 2020. Results: Patients received AP (n=52); AP+FU+platinum (n=1); AT (n=30); or AT+ram+pac (n=3) as of data cutoff. Eighty-two pts experienced any adverse event (AE). Fifty-seven pts administered AP or AT regimens reported mostly low grade ALX148 treatment related (TR) AEs, the most common being fatigue (18%), AST increase (11%), platelets decreased (10%), ALT increase (8.5%), anemia (8.5%), and pruritus (8.5%). Pts receiving AP+FU+platinum or AT+ram+pac reported no TRAEs as of data cutoff. Anticancer activity was observed in response-evaluable pts. AP: HNSCC CPI-naïve (n=10) 40% ORR, mPFS 4.6 [95% CI:0.5;7.5], mOS not reached with 14.4m median follow-up; AP: HNSCC CPI-experienced (n=10) 0% ORR, mPFS 2.0 [95% CI:0.9;3.6], mOS 7.4 [95% CI:3.1;NC]; and AT: GC (n=20) 20% ORR, mPFS 2.2 [95% CI:1.9;5.4], mOS 8.1 [95% CI:3.4;12.8]. Full peripheral CD47 target occupancy and increased infiltrating immune cells in tumor biopsies were seen. Exploratory analysis of biomarkers associated with response is ongoing. Conclusions: Initial data suggests ALX148 demonstrates excellent tolerability in combination with anti cancer antibodies and standard chemotherapy. Clinical activity in pts with advanced CPI naïve HNSCC (including PD-L1 negative) and GC compares favorably with historic controls. Final data from AP and AT cohorts and initial data from chemotherapy combination cohorts will be presented. Clinical trial information: NCT03013218 .
Multislice CT in diagnosis of associated carpal bone fractures in distal radial fractures
Authors: Huixia Li, Jin Qu, Xinwei Lei
Journal: BMJ (2016)

Clinical data and radiological findings of 78 patients with distal radial fractures, who underwent plain X-ray film and multislice CT (MSCT) examinations, were retrospectively analyzed. Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases; while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P<0.05). The missed diagnosis rate of X-ray was 38%. Results indicate that MSCT can significantly improve the detect rate, which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.


Key words: 
Carpal bones fractures; MSCT; Imaging, three-dimensional
Awareness and knowledge about COPD among community general practitioners and general practice residency trainees
Authors: Jie Gu, Yuting Jiang, Zhigang Pan, Shanzhu Zhu, Yao Shen
Journal: BMJ (2016)

Objective
To assess  awareness and knowledge about chronic obstructive pulmonary disease (COPD) among  general practitioners and general practice residency trainees in Shanghai.


Methods
Questionnaire was designed and used to investigate  knowledge of  among 59 general practitioners from 10  health centres and 75 general practice trainees in Shanghai from July to September 2012.


Results
Of  134 respondents, 49 were male and 85 were female with average age of (30.4±8.0) years.In  self-evaluation of the knowledge about  , the diagnosis of  , the differential diagnosis of  and asthma , the interpretation of  function report , aerosol using  , method about absorption apparatus , the side effects of bronchodilator , COPD rehabilitation and long term oxygen therapy,  rates of knowledge mastery were 61.9% (83/134), 81.3% (108/133), 83.6% (112/134), 59.0% (79/134), 83.6% (93/134), 35.8% (48/134), 61.2% (82/134), 56.7% (76/134) and 61.2% (72/134). Except interpretation of lung function report ,  sores of all items in self-evaluation of   general practitioners were higher than those of residency trainees (all P<0.01). Among   related questions,  hightest accuracy rate was 93.3% (125/134) (smoking cessation can attenuate  declined  function) and  lowest accrurcy rate was 16.4% (22/134)(the differential diagnosis of  and asthma). Compared with  general practice residents,  general practitioners got lower scores in question how differentiate  from asthma (6.8% vs. 24.0%, χ2=7.136, P=0.008) and got higher scores in question the treatment of moderate  (55.9% vs. 30.7%, χ2=8.655, P=0.003). More than half [56.7% (76/134)] of respondents thought that it is  to develop  screening in community , and 20.1% (27/134)thought that absolutely necessary .


Conclusion
The awareness and knowledge about  among   general practitioners and general practice residency trainees are not satisfectory. The future training should focus on  risk factors,  differential diagnosis and treatment of COPD.


Key words: 
Chronic obstructive pulmonary disease; Questionnaire; General practitioner
Updated safety/feasibility study of concurrent tumor treating fields (TTFields) and radiation therapy for newly diagnosed glioblastoma.
Authors: Rachel Grossman, Felix Bokstein, Deborah T. Blumenthal, Dror Limon, Carmit Ben Harush, Zvi Ram
Journal: Journal of Clinical Oncology (2020)

e14535 Background: Tumor Treating Fields (TTFields), a non-invasive, loco-regional, anti-mitotic treatment comprises low-intensity alternating electric fields. In the phase III EF-14 study in newly diagnosed glioblastoma (ndGBM), TTFields in combination with temozolomide (TMZ) significantly improved survival compared to TMZ alone. In preclinical studies TTFields had a radiosensitizing effect and increased the efficacy of radiation therapy (RT). This pilot study [NCT03780569] evaluated the feasibility and safety of TTFields administered concurrently with RT and TMZ in ndGBM patients. Methods: Patients with histologically confirmed ndGBM were treated with TTFields/RT/TMZ followed by adjuvant TMZ/TTFields. TTFields (200 kHz) were delivered for ≥18 hours/day with transducer arrays removed during RT delivery. RT was administered to the tumor bed in 30 fractions (total dose 60 Gy) in combination with daily TMZ (75 mg/m 2 ). In the adjuvant phase, patients received monthly TMZ (150–200 mg/m 2 for 5 days) plus TTFields. The primary outcome was safety of the combined therapies; secondary outcomes included progression-free survival (PFS) and overall survival (OS). Adverse events (AEs) were graded per CTCAE v4.0. Results: Ten patients were enrolled at a single center between April and December 2017. Median age was 60.2 years, median Karnofsky Performance Score was 90.0, and eight (80%) patients were male. Five (50%) patients had undergone tumor resection while the remainder had biopsy only. Eight patients experienced ≥1 RT treatment delay; delays were unrelated to TTFields treatment. All patients experienced ≥1 AE. Three patients suffered from serious AEs (urinary tract infection, confusional state, and decubitus ulcer) that were considered unrelated to TTFields. The most common AE was skin toxicity, reported in eight (80%) patients; all were of low severity (CTCAE grade 1–2) and were reported as related to TTFields treatment. Median PFS from enrollment was 8.9 months; median OS was not reached at the time of study closure. Conclusions: Eighty percent of patients experienced grade 1–2 TTFields-related skin toxicity. No other TTFields-related toxicities were observed and there was no increase in RT- or TMZ-related toxicities as a result of combining TTFields with these therapies. Based on the safety and preliminary efficacy results of this pilot study, a phase 2 randomized trial (N = 60; NCT03869242) and the Phase 3 TRIDENT trial have been initiated to further investigate the efficacy of concomitant RT/TMZ/TTFields in ndGBM. Clinical trial information: NCT03780569.