tbuckley/cabot-search huggingface dataset:
Recruitment and retention in a self-directed “walking” intervention: Feasibility study in women with metastatic breast cancer during active treatment.
Authors: Shlomit S. Shachar, Allison Mary Deal, Kirsten A. Nyrop, Emily Damone, Chad William Wagoner, Hyman B. Muss
Journal: Journal of Clinical Oncology (2020)

e13084 Background: Health related quality of life (HRQOL) and physical function are greatly impacted by the diagnosis and treatment of metastatic breast cancer (MBC). This study investigates the ability of women with MBC to engage in moderate walking during active treatment, with exercise monitored through a FitbitTM activity tracker. Methods: This is a single-site feasibility study of a home-based, self-directed physical activity intervention for women with MBC who could have had up to three lines of treatment. Questionnaires were completed at baseline, 12 weeks, and 24 weeks. Results: Sixty patients were consented, with mean age 55 (SD 11.1), 21% non-white, and 56% ECOG = 0. 36% were in their 3rd or 4th line of chemotherapy treatment. 65% had metastases to the bone, 46% to the lung, and 33% to the liver; mean number of metastasis sites was 2 (range 1 to 4). N = 52 completed all baseline measurements; N = 40 remained in the study at 3 months, and N = 29 at 6 months. Of the N = 31 (52%) lost to attrition, N = 6 were due to death, N = 5 due to deterioration, and N = 20 due to patient withdrawal from the study. Mean walking steps per day of at least 4000 was achieved in months 1, 2 and 3 by 41%, 50%, and 41% of participants. In months 4, 5 and 6, these percentages were 45%, 51% and 39%. On a scale from 1 = very confident to 10 = not at all confident about “continuing to walk or be physically active after completing the study”, confidence scores were 2.8 (SD 2.8) at 3 months and 2.9 (2.9) at 6 months. Conclusions: Forty-nine percent of women with MBC who signed up for a home-based walking program during active treatment were able to complete the 24-week intervention, with high proportions of these women walking more than 4000 steps per day. Moderate walking is feasible for women with MBC on active treatment.
颈横动脉颈段皮支预扩张皮瓣治疗瘢痕畸形11例
Authors: 杨加保, 李民, 李峰
Journal: BMJ (2005)

创伤或烧伤所致的面颈部、腋部严重瘢痕挛缩畸形及软组织缺损,游离植皮、局部瘢痕皮瓣转移往往不能较好的解决畸形及缺损问题.我科自1999年应用颈横动脉颈段皮支预扩张皮瓣修复面颈部及腋部瘢痕及软组织缺损11例,效果满意,现报告如下。
Clinical value of multiple organ dysfunction syndrome score in evaluating prognosis for patients with liver failure
Authors: Zhong-sheng Jiang, Xiao-feng Wen
Journal: BMJ (2009)

Objective To study clinical value of multiple organ dysfunction syndrome (MODS) score to evaluate prognosis for patients with liver failure. Methods A total of 189 patients with liver failure were recruited into the study, 125 deaths and 64 survivals. Their vital sign, platelets count (PLT), prothrombin time (PT) and international normalized ratio of PT (INRPT), fraction of inhaled oxygen (FiO2), arterial oxygen partial pressure (PaO2), serum levels of total bilirubin (TB), albumin (ALB), creatinine (Cr), pressure-adjusted heart rate (PAHR), glasgow coma score (GCS), degree of aacitic fluid (DAF) and stage of hepatic encephalopathy (SHE) were evaluated within 24 hours after admission. Each of the patients scored according to the criteria of MODS score, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score. Difference in MODS score between death and survival groups was compared and accuracy of prognosis of MODS score, CTP score and MELD score were evaluated by the area under receiver operating characteristic (ROC) curve. Survival time of patients in the two groups classified by their MODS scores was compared with Kaplan-Meier (K-M) survival curve. Results There was significant difference in PT, INRPT, PaO2, Cr, GCS, SHE between death and survival groups, but there was no difference in TB, ALB, PLT, FiO2, PHAR and DAF between them. Mean score of MODS in death group (9±2) was significantly higher than that in survival group (7±1) (t=9.076, P<0.01). The area under ROC curve (AUC) of MODS score (0.814) was close to that of MELD score (0.827), but higher than that of CTP score (0.714). There was significant difference in survival time between the varied groups classified by MODS score (χ2=72.451, P<0.01). Conclusions Clinical value of MODS score is equivalent to that of MELD score in evaluating prognosis for patients with liver failure, even better than that of CTP score, which can be used to evaluate short-term prognosis for patients with liver failure.

Key words: 
Liver failure;  Evaluation studies;  Prognosis
早期识别危重症:休克
Authors: 吴东, 陈嘉林
Journal: BMJ (2011)

随着人口老龄化的加剧和社区慢性疾病的增多,全科医生也时常遇到危重急症,例如糖尿病酮症酸中毒、心源性休克、慢性阻塞性肺疾病急性加重、消化道大出血等.危重症来势凶,变化快,往往需要转诊至中心医院治疗,但这并不意味着我们对此就束手无策.须知,早期干预是提高危重症抢救成功率的前提,没有社区医生及时正确的判断和处置,危重症患者即使得到了转运,也可能延误了病情,失去最佳抢救时机。
人工关节置换术治疗股骨头坏死
Authors: 史振才
Journal: BMJ (2006)

股骨头坏死为临床常见的骨科疾病,多发生在青壮年,约65%～80%累及双髋.人工关节置换术是目前治疗晚期股骨头坏死的最佳手段,可以在短时间内缓解疼痛症状,恢复髋关节的功能,让患者重返工作岗位,获得正常的社会生活.美国每年约2万例患者因股骨头坏死而接受关节置换手术。
PD-L1 positive esophagogastric (EG) cancer is associated with distinct bacteria.
Authors: Steven Brad Maron, Chad Vanderbilt, Shalom Sabwa, Anita Bowman, Walid Khaled Chatila, Laura H. Tang, Vivian E. Strong, Daniela Molena, David Randolph Jones, Daniel G. Coit, Mark Schattner, Makoto Nishimura, Geoffrey Yuyat Ku, Hans Gerdes, David Paul Kelsen, David H. Ilson, Nikolaus Schultz, Ahmet Zehir, Christine A Iacobuzio-Donahue, Yelena Yuriy Janjigian
Journal: Journal of Clinical Oncology (2020)

4568 Background: Pembrolizumab is approved for chemotherapy-refractory PD-L1 CPS &gt;1 mEG cancer. In clinical trials, pts with MSI-H, EBV+ and PD-L1 CPS &gt;10 EG cancers derive the greatest benefit with immune checkpoint blockade (ICB). Pre-clinical data suggest that the gut microbiome modulates response to ICB; however, the EG cancer microbiome has not been characterized in EG cancer with respect to PD-L1 and MSI-H status. Therefore, we evaluated the EG tumor microbiome in the context of PD-L1 expression in order to define biologically unique EG tumor phenotypes for future therapeutic development. Methods: Clinical and pathologic characteristics, including age, stage at diagnosis, tumor PD-L1 CPS, HER2 IHC, EBV ISH, genomic analysis, treatment history and survival status were reviewed. CPS was stratified a priori using cutoffs of &gt;1/&gt;10/&gt;20 due to biologic differences. MSK-IMPACT, a capture-based next-generation sequencing platform that detects mutations, copy-number alterations, and select fusions was used to detect non-human bacterial reads identified in the NCBI NT database. Bacterial species found in &gt;2 pts were analyzed and stratified by highest PD-L1 CPS score for each individual patient (Vanderbilt, AMP 2018) and Bonferroni correction was used for odds ratio (OR) confidence intervals where each unique species was considered an independent hypothesis. Results: Molecular data from 311 pts was clinically annotated. PD-L1 results (Table) correlated with bacterial species identified on tumor sequencing. PD-L1 CPS &gt;1 was associated with Selenomonas sputigena (OR: 8.2, 95% CI:1.2-53.6), and PD-L1 CPS &gt;20 was associated with presence of Bifidobacterium dentium (OR: 7.4, 95% CI:1.1-48.5) and Prevotella denticola (OR: 4.2, 95% CI: 1.1-16.6) after multiple comparison correction for the 166 bacterial species identified in the cohort. No differences were seen between PD-L1 &lt; 10 vs &gt;10. Four patients were also found to have EBV+ tumors using this approach, including the 1/54 patients identified by EBER ISH. Conclusions: PD-L1 &gt; 20 EG cancer represents a biologically unique subset, enriched for Bifidobacterium dentium and Prevotella denticola. Correlation between PD-L1 expression, microbial and immune environment, and survival on ICB is underway. [Table: see text]
Phase II study of alisertib as a single agent in recurrent or progressive atypical teratoid rhabdoid tumors.
Authors: Santhosh Upadhyaya, Olivia Campagne, Giles W. Robinson, Arzu Onar-Thomas, Brent Orr, Catherine A Billups, Ruth G Tatevossian, Alberto Broniscer, Lindsay Baker Kilburn, Patricia Ann Baxter, Amy A. Smith, John Crawford, Sonia Partap, David W. Ellison, Clinton F. Stewart, Zoltan Patay, Amar J. Gajjar
Journal: Journal of Clinical Oncology (2020)

10542 Background: We conducted a Phase II study of alisertib, small-molecule inhibitor of Aurora A kinase, as single-agent treatment in patients &lt; 22 y with recurrent or progressive atypical teratoid rhabdoid tumors (ATRT) (NCT02114229). Methods: Patients received alisertib once daily [80 mg/m 2 (enteric-coated tablets) or 60 mg/m 2 (liquid)] on Days 1–7 of a 21-day cycle for 2 y or until progressive disease (PD). Therapy was considered promising if ≥10 patients were without PD by MR imaging at 12 wk. Molecular groups were determined using Infinium Methylation EPIC BeadChips and the Heidelberg classifier. Alisertib plasma concentrations were measured in cycle 1, on Days 1 (single dose) and 7 (steady state) and analyzed using population-based modeling. Results: Data from 30 patients representing all 3 molecular groups [SHH (10/26), MYC (10/26), TYR (6/26), unknown (4/26)] was analyzed. One patient remains on therapy. The study did not meet the efficacy end point as only 8/29 patients were without PD after 12 wk, including 1 with partial response. Progression-free survival (PFS) was 31%±8.2% at 6 months and 15.8%±6.5% at 1 y. One- year overall survival (OS) was 42.1%±9.2%. One patient remained on treatment for &gt; 12 months, and another for &gt; 18 months. The median treatment duration was 44 days (range, 2–653 days). There was no difference in OS (p = 0.096) or PFS (p = 0.98) by molecular groups. Neutropenia was the most common adverse effect (77%). After single-dose alisertib, we observed higher mean maximum concentration (C max ) 10.1±3.0 µM and faster time to C max (T max = 1.2±0.7 h) in the 22 patients who received liquid formulation than those who received tablets (C max = 5.7±2.4 µM, T max = 3.4±1.4 h). Drug exposure did not differ between the formulations (AUC 0-∞ = 58.6±25 h·µM). Average apparent oral clearance was 2.32 L/h per m 2 , which was about half that reported in adults. Serial CSF samples were collected in 2 patients; the CSF/plasma AUC ratios were 1.2%-2.7%. Conclusions: Although the study did not meet the efficacy end point, alisertib was well tolerated as a single agent in children with recurrent ATRT. A third of the patients demonstrated disease stabilization for &gt; 6 months. Treatment response beyond 1 y was seen in 2 patients Clinical trial information: NCT02114229.
Survey on the quality of life of disabled people in Shanghai Jing′an district and analysis of influencing factors
Authors: Yahong Bi, Dingding Yang, Yanyan Zhou, Sunfang Jiang
Journal: BMJ (2017)

Objective
To survey the quality of life of disabled people in Shanghai Jing′an district and to analyze the influencing factors.


Methods
A face-to-face interview was conducted among 1 831 disabled people from 5 communities of Jing′an district between September 2015 and January 2016. The quality of life was evaluated with Modified Barthel Index (MBI), 12-Item Short Form Health Survey (SF-12) and Patient Health Questionnaire (PHQ).


Results
There were 941 males and 870 females among 1 815 qualified participants. There were 433 cases of visual disability (23.86%), 222 cases of hearing disability (12.23%), 20 cases of language disability(1.10%), 742 cases of limb disability (40.88%), 169 cases of intelligent disability (9.31%), 198 cases of mental disability (10.91%) and 31 cases (1.71%)of multiple disabilities. The SF-12 showed that the mean scores of both physical aspect and mental aspect were 50.0±10.0. Multiple linear regression showed showed that the low self-care ability of daily life (β=0.24, P=0.00), depression (β=-9.65, P=0.00) and high serum lipids (β=-2.36, P=0.02) were associated with the quality of life.


Conclusion
The study indicates that the quality of life of the disabled people in Jing′ an district is generally low, which is affected by various factors.


Key words: 
Disabled persons; Health status; Quality of life; Questionnaires
Association between health belief and medication adherence in hypertensive patients
Authors: Yue Zhao, Weilin Qi
Journal: BMJ (2015)

Objectives
To investigate the association between health belief and medication adherence in hypertensive patients.


Methods
A total of 232 hypertensive patients who visited Outpatient Department of Huashan Hospital between October 2013 and May 2014 were recruited in this cross-section study. The degree of medication adherence was measured with Morisky scale and health belief was evaluated with questionnaires of Health Belief Model (HBM).


Results
Of the 232 participants, 61 (26.3%), 51 (22.0%) and 120 (51.7%) showed low, medium and high medication adherence in Morisky scale, respectively. Logistic analysis showed that the perceived susceptibility (P<0.001), and cues to action (P=0.004) were positively correlated, and perceived barriers (P<0.001) was negatively correlated with medication adherence of patients.


Conclusion
Effective interventions to improve antihypertensive medication adherence should increase perceived susceptibility, cues to action, and reduce the barriers to medication adherence of patients.


Key words: 
Hypertension; Patient compliance; Health behavior
Analysis on structural characteristics of poison system in acute poisoning of Guangxi
Authors: Dong-fang Jiang, Zhen-ming Zhang
Journal: BMJ (2013)

A total of 6004 cases of acute poisoning with 532 kinds of related poisons from 63 hospitals were analyzed. According to the classification of pharmaceutical, pesticide, chemical, animal, plant and other poisons, the numbers of poison categories were 217, 148, 61, 34, 36 and 36 kinds accounting for 40.8%, 27.8%, 11.5%, 6.4%, 6.8%, 6.7% of total number of poisons respectively. According to the case count, they were divided into three groups of low, medium and high morbidity and their poison numbers were 462, 59 and 11 kinds accounting for 86.8%, 11.1%, 2.1% of total number of poisons respectively. According to the types of poisons, they were divided into five groups of poisoning 1, 2, 3, 4, 5 years and their poison numbers were 320, 91, 34, 33 and 54 kinds accounting for 60.2%, 17.1%, 6.4%, 6.2%, 10.1% of total number of poisons respectively. According to the time of poisoning, they were divided into three groups of 1-year, discontinuous and perennial poisoning and their poison numbers were 320, 158 and 54 kinds accounting for 60.2%, 29.7%, 10.1% of total number of poisons respectively.


Key words: 
Acute poisoning; Poison classificstion
Application of preimplanted angiography catheter with digital subtraction angiography for surgical treatment of acute lower gastrointestinal bleeding
Authors: Yankui Li, Jianqiu Chen, Xuedong Li, Bo Chen, Hongmei Jin
Journal: BMJ (2015)

To evaluate the application of preimplanted angiography catheter with digital subtraction angiograply(DSA) for surgical treatment of acute lower gastrointestinal bleeding. Clinical data of 17 patients with acute lower gastrointestinal bleeding admitted from June 2011 to December 2014 were retrospectively reviewed. The angiography catheter was implanted and methylene was injected to find the bleeding sites with DSA, then emergency laparotomy was performed. The results showed the bleeding sites in small intestine in 8 cases and in large intestine in 9 cases. Postoperative pathology revealed vascular malformation in 4 cases, 2 in small intestine and 2 in colon; ulcerative colitis in 3 cases; colon cancer in 1 case; colonic diverticula in 3 cases and small intestinal stromal tumor in 6 cases. Results indicate that if the conservative therapy is not effective, surgical treatment assisted by preimplanted angiography catheter with DSA is safe and effective for patients with lower gastrointestinal bleeding.


Key words: 
Angiography, digital subtraction; Gastrointestinal hemorrhage
Association of impaired glucose tolerance with carotid atherosclerosis in patients with cerebral ischemia
Authors: Jin-jing Pang, Wei Zhang, Jing Ding, Bin-bin Ma, Xiao-yan Sun
Journal: BMJ (2009)

One hundred and sixty non-diabetic patients with cerebral ischemia of primary onset were enrolled in the study. The patients were divided into impaired glucose tolerance (IGT) group and normal glucose tolerance (NGT) group according to the oral glucose tolerance test (OGTT). Carotid atherosclerosis and carotid artery stenosis were examined with vascular Doppler ultrasonic detection. The incidence rates of carotid atherosclerosis in IGT group and NGT group were 87. 5% (70/80)and 63.8% (51/80)respectively (χ2= 12.240,P <0.001);the incidence rates of carotid stenosis in IGT group and NGT group were 63.8% (51/80) and 47. 5 % (38/80), respectively(χ2 =4. 279, P =0. 039);the degree of carotid artery stenosis in IGT group was higher than that in NGT group(χ2= 21.95, P < 0. 01). The results indicate that IGT may be related to atherosclerosis and stenosis of carotid artery in cerebral ischemic patients.

Key words: 
Brain infarction;  Glucose metabolism disorders
Pregnancy and lactation-associated osteoporosis in a patient with rheumatoid arthritis: case report and literature review
Authors: Qiqi Chen, Mei Li, Zhuozhuo Ren, Qian Wang, Wei Ji, Lin Cui, Xuejun Zeng
Journal: BMJ (2019)

Clinical data of a 33-year-old rheumatoid arthritis patient accompanied with pregnancy and lactation-associated osteoporosis (PLO) was retrospectively reviewed. The patient had two pregnancies within three years, and bone pain occurred during lactation of the second pregnancy after 2 months of delivery. Dual-energy X-ray (DEXA) showed decreased bone density, while thoracolumbar spine and pelvic X-ray film suggested osteoporosis. Her rheumatoid arthritis was stable and previous treatment did not include glucocorticoids. Other causes of metabolic bone diseases were excluded and the diagnosis of PLO was confirmed. The breastfeeding was stopped; calcium, active vitamin D, alendronate sodium were administrated, and the treatment was effective. Domestic and international literature from January 2000 to January 2019 was searched and no cases of PLO accompanied with rheumatoid arthritis were reported. There were only 100 cases of PLO retrieved in the literature, including 19 cases of PLO in China reported by four articles. It is suggested that PLO should be considered in RA patients presenting with arthragia during the lactation, in addition to relapse of disease. Awareness of PLO should be increased in physicians, especially rheumatologists, and anti-osteoporosis therapy is effective in patients with PLO.


Key words: 
Rheumatoid arthritis; Osteoporosis; Pregnancy; Lactation
Metabolic Disorders across Hepatocellular Carcinoma in Italy
Authors: F. Morisco, M. Guarino, R. Valvano, N. Caporaso, F. Farinati, E.G. Giannini, F. Ciccarese, F. Piscaglia, G.L. Rapaccini, M. Di Marco, E. Caturelli, M. Zoli, F. Borzio, R. Sacco, C. Cammà, M. Felder, A. Gasbarrini, G.S. Barone, F.G. Foschi, G. Missale, A. Masotto, R. Virdone, F. Trevisani
Journal: Journal of Hepatology (2016)
过量服用氧氟沙星致血尿一例
Authors: 吴茂林
Journal: BMJ (2005)

患者女,52岁.因受凉后咳嗽于2004年6月13日18:00自服氧氟沙星6片(0.1 g/片),未服其他药物,0.5 h后出现尿频、尿急并伴全程血尿,约每15 min 1次,量不多,尿痛不明显,2 h后来我院就诊.体格检查:急性病容,双肺呼吸音粗,双肾区叩击痛(±),双下肢无水肿,余无异常.患者既往无特殊病史.急诊查尿常规示红细胞(+ + + +),白细胞(±),蛋白(-);血常规正常.即刻予血凝酶2 000单位快速静脉滴注对症治疗,0.5 h后尿频症状缓解,小便颜色转淡,2 h后肉眼血尿消失,嘱患者口服云南白药胶囊巩固疗效.次日8:00复查尿常规及肝肾功能均正常,腹部B超未见异常。
The diagnosis and cure advancement of microvascular angina
Authors: 陈彬, 王玮, 黄从新
Journal: BMJ (2008)

1967年Likoff等[1]首先报告了一组女性患者,有典型劳累性心绞痛症状且运动试验阳性,但冠状动脉(冠脉)造影正常.1973年Kemp[2]将冠脉造影正常时出现的劳累性心绞痛称为X综合征。
Further discussion on objective structured teaching evaluation: two key questions
Authors: Jie Gu, Zhigang Pan
Journal: BMJ (2017)

The objective structured teaching evaluation (OSTE) is a new method for training and objective assessment of the teaching ability of clinical faculty by using standardized students and teaching scenario. It is mainly used to evaluate training programs, train teaching skills and assess teaching ability of clinical faculty. The differences and association between teaching ability, teaching skills and teaching scenario should be clarified before designing OSTE. Although there are some differences in various studies, OSTE can be summarized into two aspects: teaching administration knowledge and special teaching skills. Given the great potential of OSTE in training and assessing faculty, medical educators in general should actively explore its concept and application.


Key words: 
Teaching; Objective structured teaching evaluation
FDG Uptake in Brown Adipose Tissue Activated by a β3-Adrenergic Receptor Agonist Prescribed for Overactive Bladder
Authors: Chio Okuyama, Ryutaro Kikuchi, Takashi Ikeuchi
Journal: Clinical Nuclear Medicine (2020)

Brown adipose tissue (BAT), which produces energy and is known to play a role as a hibernating gland, is sometimes visualized on F-FDG PET in children or in slender young adults in a cold environment. Because BAT is activated by catecholamines, FDG uptake in BAT is also observed in patients with pheochromocytoma or paraganglioma. We present the case of an elderly woman with remarkable FDG uptake in BAT. Activation of BAT by a β3-adrenergic receptor agonist (mirabegron) prescribed for overactive bladder was suspected as the cause of the marked visualization of BAT in this patient.
The master observational trial–a novel method to unify precision oncology data collection.
Authors: Dane J. Dickson, Jennifer Maria Johnson, Raymond C. Bergan, Rebecca Owens, Vivek Subbiah, Razelle Kurzrock
Journal: Journal of Clinical Oncology (2020)

e19313 Background: The Master Observational Trial (MOT) was recently created as a new master protocol that hybridizes the power of master interventional trials with the richness of real-world data (Cell, 2020). The MOT can be described as a series of prospective observational studies that are tied together through a common protocol, infrastructure, and organization. The MOT has broad application in many disease states but is particularly powerful in oncology. We herein expand our prior work to describe key details regarding how the MOT concept can fill multiple unmet needs in oncology. Methods: Through published information, white papers, and expert opinions we identified key unmet needs of oncology stakeholders. We reviewed the publicly available information of structure, organization, and data availability of the five largest genomic-outcome real-world data efforts. Common concerns included variability and reliability of biomarkers, the scientific rigor in real-world data, data silos, patient consent, and duplicated or disparate activities. We then determined how a specific application of the MOT in oncology could answer stakeholder concerns, integrate with current efforts, and also how to provide a model that would be equally valuable to academic and community clinics. Results: We identified significant scientific challenges with many of the current oncology real-world datasets in answering key concerns of stakeholders. We developed the Master Registry of Oncology Outcomes Associated with Testing and Treatment (ROOT) as the first national implementation of an oncology-centric MOT. We modeled how ROOT could fill scientific gaps in current data efforts and integrate with interventional and real-world efforts and help answer key concerns of stakeholders. We also identified solutions that would allow community and academic groups to participate in the same effort. Conclusions: An oncology-centric MOT has the potential to improve the quality of RWD in oncology and advance precision oncology in ways that are not fully addressed by current retrospective efforts. Reference Dickson DJ, Johnson J, Owens R, Bergan R, Subbiah V, Kurzrock R. (2020). The Master Observational Trial: A New Class of Master Protocol to Advance Precision Medicine. Cell 180, 9-14. Clinical trial information: NCT04028479 .