tbuckley/cabot-search huggingface dataset:
Acceptance of preventive colonoscopy in rural areas in Germany.
Authors: Joerg Fahlke, Kai-Stephan Friedrichs, Sophie Fahlke, Peter Habermann, Lorenz Barroso da Fonseca, Hans Lippert, Karsten Ridwelski
Journal: Journal of Clinical Oncology (2020)

e16143 Background: Colorectal cancer is one of the most common types of cancer in Germany. Colonoscopy is certainly one of the most efficient diagnostic methods in preventing and early detection of colorectal cancer. Nevertheless, acceptance of colonoscopy as a useful screening method among the population in Germany is moderate, with around 22% of those entitled to claim. Methods: In order to better assess the reasons for the low level of acceptance, patients who presented themselves from March 2016 to June 2017 in the General Surgery Clinic of the Johanniter Hospital Stendal were randomly selected and interviewed using a questionnaire. These randomized patients did not suffer from colorectal cancer. The questionnaire asked whether the patients had participated in Colon Cancer Screening and if not for what reasons. Respondents were asked to choose among 8 preselected reasons or give their own. The options for not having participated in colorectal cancer screening were: lack of knowledge about the offer of colorectal cancer screening, fear of the examination, fear of cancer as an outcome, lack of time for the examination, didn't get an appointment for the exam, place of examination is too far away, excessive travel costs, examination makes no sense, and other (free text entry). Results: A total of 238 questionnaires were completed, 235 of which could be evaluated with regard to gender and age. The proportion between women and men was balanced (m 123, w 112). Surprisingly, contrary to expectations, significantly more respondents participated in colorectal cancer screening than not. There were no differences between females and males. The participation rate in colorectal cancer screening was 71%, which was significantly higher than expected. A significantly lower rate was found in respondents ages between 55 to 60 years old, with 41% of men and 67% of women having participated in a colorectal screening. Asked specifically about the reasons why they did not take advantage of the preventive medical check-up, the men of the affected age group (55-60 years) gave: fear of the examination, fear of cancer as an outcome, and examination makes no sense. Conclusions: The results underline the importance of determining why the acceptance of colorectal cancer screening has not yet reached the desired level. Considering and discussing these three main reasons show that there are opportunities to continuously increase awareness of the importance of participation rates in colonoscopy as a screening method for colorectal cancer through target public education.
Approach to anemia by primary care physician
Authors: 李蓉生
Journal: BMJ (2007)

贫血是临床上常见的主诉.由于血液与各系统器官关系密切,贫血时表现出的系统症状较广泛,同时可能还伴有由于机体对贫血代偿引起的症状,使贫血的病因诊断有一定的难度.因此,要求临床医生,特别是全科医生对贫血有较全面的认识和鉴别能力,才能从患者复杂的系统症状中逐步找出病因.只有针对不同的病因进行治疗,才能取得好的疗效。
Retrospective analysis of clinical outcomes of patients with advanced non-small cell lung cancer (NSCLC) exposed to immunotherapy: The experience of the Oncology Center of Hospital Moinhos de Vento.
Authors: Fernando Castilho Venero, Helena Andrade, Sergio Roithmann, Fernanda Cano Casarotto, Geraldine Eltz de Lima, Guilherme Geib
Journal: Journal of Clinical Oncology (2020)

e21720 Background: Lung cancer has the highest mortality rate among malignant neoplasms worldwide. Most cases present an advanced stages. From the last few years, the target drugs and immunotherapy (IO) have emerged as important therapeutic options in this scenario. In Brazil, in 2018, this disease was responsible for 8.7% of cases of malignant neoplasms in men and 6.2% of cases in women. When looking at data from our state, Rio Grande do Sul, the highest rates in the country are noted, with an estimated rate of 40.22 cases for every 100 thousand men and 20.49 cases for every 100 thousand women. Although the available trials point to significant improvements in the clinical outcomes, the real impact of using such treatments on patients in our community practice, real-world scenario, is unknown. Methods: Through the detailed analysis of the institutional electronic medical record, we included patients with metastatic NSCLC, followed up on an outpatient basis at the Oncology Center of Hospital Moinhos de Vento, who had received at least one dose of nivolumab, pembrolizumab or atezolizumab, either as monotherapy or in combination therapy with chemotherapy, in any line of cancer treatment, in the period from January 2015 to June 2019. Primary endpoint was overall survival (OS) and secondary endpoints were time-to-treatment discontinuation (TTD) and treatment-related toxicity (TRT). Results: 41 patients met criteria. The sample consisted of patients with a mean age at diagnosis of 67.7 years, the majority being male (53.7%), stage IVB disease (53.7%), previously smokers (61%) and with non-squamous NSCLC (75.6%). Central nervous system (CNS) metastases were present in 26.8% of patients. About 51.3% (n = 21) received IO as second line or later treatment. At this group, nivolumab was the main IO (81%). The median OS in the first line (1L) of treatment was not reached while in second line and beyond was 10.0 months (3.4 - 16.5), with no statistical difference (p = 0.071). The median TTD was higher in patients whose received IO at 1L (17.0 months vs 7.0 months, p = 0.045). Pneumonitis was the main toxicity being present in 7.1% of patients. Colitis, thyroiditis and hepatitis were seen in one patient each. Conclusions: in general, we were able to observe that in our real-world scenario, IO is well tolerated, regardless of the treatment line. In addition, OS met the findings of the landmark clinical trials.
2型糖尿病患者血浆胰岛素和醛固酮水平的测定
Authors: 陈奕名, 姜秋菊, 孙彦国, 张桂娟, 宁磊
Journal: BMJ (2008)

醛固酮在糖尿病领域的研究是近几年逐渐形成的一个热点.有研究提示,血浆醛固酮在2型糖尿病的发病过程中影响着血糖的变化[1],并与慢性并发症的发生有关[2],但对胰岛β细胞分泌胰岛素有何影响,尚待进一步研究。
Clinical anti-lymphoma effect of T cells expressing an anti-CD19 chimeric antigen receptor in synthetic biology optimizing system.
Authors: Hong-jiu Dai, Yanyun Li, Lan Shi, Hui Dai, Yan Li, Hui Xu, Jingjing Zhu, Pei-xian Zhang
Journal: Journal of Clinical Oncology (2020)

e20021 Background: Anti-CD19 chimeric antigen receptor (CAR) T cells for relapse/refractory B-cell malignancies has been remarkably effective in previous clinical trials. However, most of subjects has severe adverse effect even though the infusion of CAR T cells is at the low dose. Herein, we investigated the safety of administering CAR T cells which express the anti-CD19 chimeric antigen receptor in synthetic biology optimizing system. Methods: We designed an anti-CD19 CAR with FMC63 Scfv (KD-019). This CAR has a CD8 hinge and transmembrane domains and a 4-1BB costimulatory domain; T cells expresses CAR in synthetic biology optimizing system. A phase I dose-escalation trial was conducted to investigate the safety of KD-019 CAR T cells and to assess efficacy for patients with previously treated B-cell lymphoma. The patient at the 76 years old received Flu/Cy chemotherapy to enhance CAR T cells activity. Two days after the completion of chemotherapy, about 3 million KD-019 CAR T cells were infused. Results: The patient who has chemotherapy-refractory lymphoma has received KD-019 CAR T cells infusion. Post infusion KD-019 CAR T cells expansion were observed; peak CAR T cells level occurred between Day 3 and 10, and CAR T cells were still detected on Day 243. In addition, we found that CD3+CD8+ T cells level peaked on Day 15. Moreover, after infusion of CAR-T cells, the right peripheral pulmonary lymphaden and visible nodules were respectively shrunk by 53% and 85% on Day 28; and some peripheral pulmonary nodules were obviously reduced and nearly disappeared. We also found that pelvic effusion was significantly reduced, and pain symptoms of the left hip and leg were reduced by 50%. Exhilaratingly, our KD-019 CAR therapy has no obvious cytokine release syndrome (CRS) and central nervous system toxicity. Conclusions: KD-019 CAR T cells express an anti-CD19 chimeric antigen receptor in synthetic biology optimizing system. this innovative KD-019 product can offer significant clinical benefit for NHL patients at the low dose without fever and neurotoxicity. Clinical trial information: NCT03854994. Clinical trial information: NCT03854994 .
Application of microvascular Doppler ultrasonography in microsurgical varicocelectomy
Authors: Yufeng Yang, Xuan Zhuang
Journal: BMJ (2018)

From January 2015 to June 2016, 107 patients with varicocele underwent microsurgical varicocelectomy in the First Affiliated Hospital of Xiamen University. The clinical outcomes of microsurgical varicocelectomy with (n=56) or without (n=51) microvascular Doppler ultrasonography were compared. All patients were treated successfully by both methods and no postoperative complications such as testicular atrophy and/or hydrocele were found during 12 months postoperative follow-up. For the group without microvascular Doppler, accidental artery ligation occurred in 2 cases and the internal spermatic vessels were unidentifiable in 4 cases, and recurrence occurred in one case. By contrast, no artery injury or ligation occurred during the operation with microvascular Doppler, and no recurrence occurred postoperatively. Microvascular Doppler ultrasonography, which is reliable for discerning arteries and veins, can effectively and safely assist microsurgical varicocelectomy for treatment of varicocele.


Key words: 
Varicocele; Ligation; Microscopy, acoustic
Diagnostic algorithm for gastrointestinal stromal tumor (GIST) using patient registry data impacts pathology guidelines.
Authors: Sara Rothschild, Jerry Call, Christopher L. Corless, Anthony Gill, Markku Miettinen, Brian Rubin
Journal: Journal of Clinical Oncology (2020)

e23519 Background: The Life Raft Group (LRG) identified that succinate dehydrogenase (SDH) deficient GISTs are under-recognized. In the LRG Registry only 30% of KIT/PDGFRA wildtype patients had received the advanced mutational testing (or SDHB staining) required to identify this unique subtype of GIST with a different natural history and response to treatment, and very strong familial associations. We proposed that two changes would significantly increase the diagnosis of SDH-deficient GIST patients: 1. SDHB staining for all GIST patients with a stomach primary tumor at initial biopsy, 2. Initial pathology report should contain strong recommendations for specific mutational testing. Methods: The LRG collaborated with key medical opinion leaders on a diagnostic algorithm that illustrated the need for wider use of targeted diagnostic procedures and submitted the algorithm to the College of American Pathologists (CAP) GIST editorial board. Results: Because SDH-deficient GISTs require germline genetic analysis and, if mutation related, subsequent surveillance for paragangliomas/pheochromocytomas, and cascade genetic testing for family members, it is necessary to screen all gastric GISTs for loss of SDH by immunohistochemistry. This is best accomplished by immunohistochemical staining for SDHB, which is lost in all genetic subtypes of SDH-deficient GISTs. If SDHB is absent, additional staining for SDHA may be performed, as this protein is selectively lost in SDHA-mutant GISTs and this may help focus genetic analysis. All patients with SDH-deficient GIST should be referred to a genetic counselor. The CAP incorporated both SDHB and SDHA testing paradigms into the updated GIST protocols which were published in August 2019. Conclusions: We believe this will result in significantly better diagnosis and treatment for SDH-deficient GIST patients. We encourage other groups that advise on guidelines to develop similar recommendations. This is a great example of a patient advocacy group utilizing real world evidence derived from a patient registry to influence protocols for treatments that affect GIST patients on a large scale.
双足挤压伤致远达性视网膜病变一例
Authors: 王富华, 孙英, 修彩梅, 东长霞
Journal: BMJ (2008)

患者男,41岁,因双足车祸伤3 d、右眼视物不清2 d于2007年10月22日入住我院眼科.患者于3 d前被倒行的汽车挂倒,车轮碾压双足,伤后双足疼痛.当地医院X线摄片发现左足舟骨骨折,给予静脉滴注抗生素治疗2 d(具体药物不详)。
Three times of intratumor injection of the sustained released by ROS with penicillin-combined chemotherapy drugs for the long of survival period of the tumor-bearing mouse.
Authors: Dong Chen, Qiang Fu, Jian Zhang, Yan Han, Bian Li, Guoqin Zheng, Ming Zhao, Baofa Yu
Journal: Journal of Clinical Oncology (2020)

e22098 Background: To study the effect of sustained release by ROS with hapten for three intratumoral injections of chemical drugs on the survival of tumor-bearing mice. Methods: Mice bearing solid tumors of H22 liver cancer were randomly divided into groups with the longest tumor diameter of about 4-7 mm. They were administered intratumorally the next day, with a second interval of 7 days and an interval of 14 days (the 15th day of the experiment). During the period of administration and observation, the death of mice was observed daily, and the time of death was recorded to calculate the life extension rate. Results: The weight of mice in group Ⅲ and group Ⅳ was lower than that in control group, suggesting that chemotherapeutic drugs caused damage of mice and did not significantly increase body weight. Tumor size: Tumor volume experimental groups were different from the Control group, showing a significant anti-tumor effect; but there was no difference compared with Dox Control. Survival The survival rate of each group of mice is closely related to the tumor progression and drug treatment. The survival rate of each group after 45 days of treatment is significantly higher than that of the Control group. The average survival time of group Ⅳ, group Ⅰ and group Ⅱ was longer than that of control group with significant difference. Conclusions: After intratumoral injection 3 times, the survival time of mice is been prolonged.
Clinical efficacies of Jiangzhi Decoction for lipid metabolism disorder patients with traditional Chinese medicine syndrome of phlegm and turbidity retardation
Authors: Tie Shen, Zhijie Shen, Yingjie Wang
Journal: BMJ (2014)

A total of 101 lipid metabolism disorder patients with traditional Chinese medicine (TCM) syndrome of phlegm and turbidity retardation were collected and randomly divided into group A: Jiangzhi Decoction (JZF) alone (n=30), group B: atorvastatin (ATV) alone (n=39) and group C: JZF plus ATV (n=32). Lipid level, liver and kidney function, total effective rate and TCM scores were observed after a course of 2 weeks.Total effective rate: Group C was significantly superior to group B (90.62% vs. 76.92%, u=1.97, P<0.05); TCM score: Group C had a statistically superior advantage over groups A and B (C vs. A, 90.62% vs. 80.00%, u=1.98, P<0.05; C vs. B, 90.62% vs. 51.28%, u=4.11, P<0.01); TC and Improvements of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C): Group C demonstrated marked decreases in both TC and LDL (CTC & CLDL-C vs. group A, P<0.01; CTC & CLDL-Cvs. group B, P<0.01), no abnormal liver or kidney function occurred during the follow-up period.Thus JZF and ATV may have synergic lipid-lowering effects.And single uses of JZF and ATV have no marked differences in short term efficacy.


Key words: 
Lipid metabolism disorders; INTEGRATED TCM WM
Prolongation of the average survival time in pancreatic cancer (a new measure of effect): Pooled analysis of adjuvant chemotherapy trials.
Authors: Eduardo Ceballos Barbancho, Galo Sánchez Robles
Journal: Journal of Clinical Oncology (2020)

e16723 Background: With the aim of improving the prognosis of the disease, in recent years attempts have been made to optimize the adjuvant treatment of pancreatic cancer, having demonstrated the usefulness of chemotherapy in several phase III trials: CONKO-001, JASPAC-01, ESPAC -4 and PRODIGE. Methods: The method to measure the Area Under the Curve (AUC) is universally known. When the curve is not homogeneous, the AUC is calculated using the traditional method of breaking down the total area into a sum of many polygons. We have calculated the AUC through pixel counting using Image J, which is an image processing application, programmed in Java, developed in the National Institutes of Health and free to access. To estimate the consistency between the pixels and the sum of polygons, we have performed several curves with linear edges to measure the AUC through the sums of the polygons, and then by counting pixels with the Image J application. We have verified that the results are similar, so the pixel count can be used to replace the sum of polygons, especially when the curves are not homogeneous. Entering the areas obtained with Image J in the worksheet, made for this purpose, and available for free at evalmed.es, the measures of the effect are automatically obtained: prolongation of the average surival time (PtS), prolongation of the average event free time (PtSLEv) and time lived without an event (PtvSEV). Results: The median follow-up in all studies was 60 months, with the exception of CONKO-001, for which we have data at an average follow-up time of 136 months, however for our comparative purpose we cite the results in the first 60 months. -CONKO-001: PtS was 5.1 months (24.2 observation vs 29.3 gemcitabine). PtSLEv was 9.6 months (13 observation vs 22.6 gemcitabine). PtvSEv was 22.57 months. -JASPAC-01: PtS was 9.04 months (32.4 gemcitabine vs 41.5 gemcitabine + S1). PtSLEv was 9.75 months (21.6 gemcitabine vs 31.4 gemcitabine + S1). PtvSEv was 31.38 months. -ESPAC-4: PtS was 3.2 months (34 gemcitabine vs 37.2 gemcitabine + capecitabine). PtSLEv was 2.7 months (25.6 gemcitabine + 28.3 gemcitabine + capecitabine). PtvSEv was 24.92 months. -PRODIGE: PtS was 6 months (37 gemcitabine vs 43 FOLFIRINOX). PtSLEv was 8.9 months (22.4 gemcitabine vs 31.2 FOLFIRINOX). PtvSEv was 31.23 months. Conclusions: In the adjuvant treatment with chemotherapy in pancreatic cancer, the transit from observation to gemcitabine, and from here to the most intensive schedules, has meant or contributed an important advance for patients in terms of PtS, PtSLEv and PtvSEv.
Relationship between the detection of carotid plaque's micro flow signals by B-flow imaging and acute cerebral infarction
Authors: Gong-xian Yuan, Jiang-hua Ren
Journal: BMJ (2012)

Objective To detect the micro flow signals of carotid plaque by ultrasound B-flow imaging (BFI) and elucidate its relationship with acute cerebral infarction.Methods A total of 63 patients with carotid plaques were divided into 2 groups.acute cerebral infarction (ACI,n =48) and control (n =15).BFI was used to detect the micro flow signals of plaques and comparisons were made with the categorizing results of contrast enhanced ultrasound (CEU).The data were analyzed between two methods.Results The micro flow signals were detected in 15.7％ (22/140)patients in the ACI group vs.2.3％(1/44) in the control group.There were more signals in hypoechoic plaques.The detection percentage of micro flow in grade Ⅲ was significantly higher than that in grades Ⅰ and Ⅱ with CEU (P =0.005,P =0.027).No significant differences existed between grades Ⅲ and Ⅳ (P =1.000).Conclusion BFI can detect effectively the micro flow signals of carotid plaques and this characteristic is correlated with the symptoms of ACI.

Key words: 
Ultrasonography; Cerebrovascular accident; Atherosclerosis
Bortezomib induction prior to autologous hematopoietic cell transplantation (AHCT) for newly diagnosed light chain amyloidosis (AL): A study of 426 patients.
Authors: Robert F. Cornell, Parameswaran Hari, Stacey Goodman, Luciano J. Costa, Raphael Fraser, Noel Estrada-Merly, Shaji Kumar, Muzaffar H. Qazilbash, Anita D'Souza
Journal: Journal of Clinical Oncology (2020)

8515 Background: AL is a clonal plasma cell (PC) disorder causing multiorgan dysfunction from amyloid fibril deposition. While bortezomib (B) induction has been used prior to AHCT recently, AHCT without prior induction has been a common practice. The primary objective of this study was to compare outcomes of AL patients who proceeded to AHCT without induction to those receiving pre-AHCT induction with B. Methods: Outcomes of 426 systemic AL AHCT recipients between 2014-2018 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) were reviewed. Patients receiving induction with therapy other than B, AHCT occurring &gt; 9 months after diagnosis, no documented AL end-organ involvement, myeloma-defining events and conditioning other than melphalan (MEL) monotherapy were excluded. Multivariate analysis (MVA) was conducted to identify prognostic factors associated with relapse, PFS and overall survival (OS). Results: 286 patients received B induction therapy vs 140 patients receiving no induction. Age, gender, number and type of organs involved, and AL AHCT center volume were similar between the groups. Patients receiving induction had greater PC burden compared with no induction (PC ≥ 10%, 41% vs 11%, p &lt; 0.01). Induction was B, cyclophosphamide and dexamethasone (D) in 83% followed by B, lenalidomide and D (10%) or B+D (7%). Median follow-up was 24.9 months. At 2 years, B induction vs. no induction was associated with 13% (95% CI 10-17%) vs 22% (95% CI 15-30%) relapse risk (p = 0.03); 83% (95% CI 79-87%) vs 74% (95% CI 66-81%) PFS (p = 0.04); 93% (95% CI 90-95%) vs 94% (95% CI 89-97%) OS (p = 0.7). On MVA, the B induction group had improved PFS (HR 0.46, 95% CI 0.3-0.7, p &lt; 0.001) with similar OS (HR 0.6, 95% CI 0.3-1.2, p = 0.1) compared with no induction. Creatinine &lt; 2 mg/dl (HR 0.55, 95% CI 0.3-0.9, p = 0.02) and Karnofsky score ≥90 (HR 0.51, 95% CI 0.33-0.78, p &lt; 0.01) were also associated with improved PFS. MEL dose &lt; 180 mg/m 2 was associated with inferior PFS (HR 2.17, 95% CI 1.31-3.61, p &lt; 0.01) and OS (HR 3.6, 95% CI 1.5-8.6, p &lt; 0.01). No deaths were seen in the first 100 days post-AHCT. At last follow-up, 32 deaths occurred, 26 (81%) due to AL. Conclusions: Compared with prior CIBMTR analyses, B induction use has increased in AL AHCT recipients and a higher PC burden was the only clinical determinant. Furthermore, B induction was associated with lower relapse and improved PFS at 2 years with no OS difference despite higher proportion of patients with &gt; 10% PC, which has been associated with poor outcomes.
Development and current status of cardiovascular disease risk assessment at home and abroad
Authors: Liping Chen, Jian Wang
Journal: BMJ (2018)

Cardiovascular risk assessment tool can assist clinicians to identify people of different risk levels of cardiovascular disease, to implement classified intervention, and to provide personalized preventive and therapeutic measures. Various cardiovascular risk assessment tools have been reported based on different ethnic groups both at home and abroad. This article reviews cardiovascular risk assessment tools currently used at home and abroad, to provide reference for prevention and control strategies of cardiovascular diseases.


Key words: 
Cardiovascular disease; Risk assessment