tbuckley/cabot-search huggingface dataset:
Survey on teaching status of general practitioners in community health centers of Shanghai
Authors: Huiling Xia, Sunfang Jiang, Juan Shou, Shanzhu Zhu
Journal: BMJ (2015)

Objective
To survey the current situation of teaching for general practitioners (GPs) in community health centers of Shanghai.


Methods
A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai. The items of the survey included general background, previous teaching experience and self-evaluation on teaching ability.


Results
Among 742 GP mentors receiving the survey, the average age was (37± 6) years old. 49.8% (366/734) of mentors expressed their willingness of teaching, and the main reason was that it may upgrade themselves, while learning from teaching (58.6%, 419/715). Heavy work load, lack of teaching time (31.8%, 378/1 187) and teaching experience (30.7%, 364/1 187) were the main obstacles for teaching. Among 106 GP mentors who had teaching experience in community health center previously, 79.2% (80/101) made teaching plans, but only 8.9% (9/102) often prepared syllabus. Teaching plans were made mainly according to the work needs in community health care (54.2%, 52/96), the situation and demands students (29.1%, 28/96) or requirement of syllabus (17.7%, 17/96). The problems included lack of teaching experience (50.5%, 50/99) and time (42.4%, 42/99), monotonous instructional modality (24.1%, 25/104), and weak operability of the syllabus (21.2%). The self-reported results showed that 14.4% were not able to develop a teaching program and to execute, 18.3% were not able to use a variety of teaching methods, 31.2% were not able to engage in teaching for 1.5 days per week. Logistic regression analysis showed that mentors with higher education background (OR=2.027, P<0.05), community teaching experience (OR=3.069, P<0.05), higher self assessment of general personal quality and communication ability (OR=2.488, P<0.05), higher teaching ability (OR=2.399, P<0.05) and strong training wishes (OR=11.382, P<0.05) were more willing to engage in the teaching work.


Conclusions
Heavy work load, insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers. Educational theory and methods should be focus on teacher training so as to improve teaching abilities.


Key words: 
Education, medical; Questionnaire; General practitioners
Expression of the minichromosome maintenance 2 protein and the cell surface molecule CD24 and their prognostic significance in patients with non-small cell lung cancer
Authors: Xiu-hong Nie, Yu Chen
Journal: BMJ (2010)

Objective To explore expression of the minichromosome maintenance 2 (MCM2)protein and the mucin-like cell surface adhesion molecule CD24 in non-small cell lung cancer (NSCLC) and their relationship with its prognosis. Methods Seventy-three patients of NSCLC diagnosed for the first time and received surgical treatment in Xuanwu Hospital, Beijing were selected for the study. Expression of the MCM2 and CD24 in pathological specimens of the patients was measured by immunohistochemistry and their relationship with its prognosis was analyzed retrospectively. Results High-level expression of the MCM2 and CD24 was seen in 42 and 54 of 73 NSCLC patients, accounting for 57. 5 percent and 74. 0 percent,respectively. Risk of death for the patients with high-level expression of the MCM2 or the CD4 was significantly higher as compared to those with low-level expression ( P ＜ 0. 05 ). Risk of death for patients with both high-level expression of the MCM2 and CD24 was significantly higher than that in those with only high-level expression of the MCM2 or the CD24 (HR =2. 59, 95%CI 1.40 -4. 80, P=0. 002) and in those with both low-level expression of them ( HR = 15.32, 95 % CI = 2.07 - 113.41, P = 0. 008 ). But there was no significant difference in risk of death between patients with high-level expression of the MCM2 or CD24 and those with low-level expression of both of them ( HR = 5. 60, 95% CI 0. 79 - 44. 82, P = 0. 083 ), and cumulative survival rate of patients with both high-level expression of the MCM2 and CD24 was significantly lower than those with only high-level expression of the MCM2 or the CD24 ( P = 0. 001 ). Conclusions Both expression of the MCM2 and the CD24 are independent prognostic factors for NSCLC and combined detection of the two markers have higher prognostic value for it.

Key words: 
Carcinoma, non-small cell, lung;  MCM2 protein;  Antigens, CD24
First-in-human phase I study of ALT-P7, a HER2-targeting antibody-drug conjugate in patients with HER2-positive advanced breast cancer.
Authors: Yeon Hee Park, Hee Kyung Ahn, Ji-Yeon Kim, Jin Seok Ahn, Young-Hyuck Im, Seol-Hee Kim, Sunbae Lee, HYE-SHIN CHUNG, Soon Jae Park
Journal: Journal of Clinical Oncology (2020)

3551 Background: ALT-P7 is an antibody-drug conjugate, in which two molecules of monomethyl auristatin E (MMAE) are site-specifically conjugated to a cysteine-containing peptide motif of trastuzumab variant. This is the first-in-human study evaluating safety and pharmacokinetics of ALT-P7 in patients with HER2-positive advanced breast cancer. Methods: This was an open label, 3+3 dose-escalation phase 1 trial. Eligible patients were with HER2-positive advanced breast cancer progressive to at least two kinds of prior anti-HER2 treatment. ALT-P7 at doses from 0.3mg/kg to 4.8mg/kg were intravenously administered once every 3 weeks. Dose limiting toxicities were evaluated over the first cycle of 21 days. Primary objective was to define the maximum tolerated dose. Results: ALT-P7 were administered in 27 patients (n=4 at 0.3mg/kg, n=3 at each of 0.6, 1.2, 2.4, 3.6, 4.2, 4.5 mg/kg, n=5 at 4.8mg/kg) between Jan 2018 and Feb 2020. The median number of previous line of systemic therapy was six, including median four prior anti-HER2 agents. The most common grade (G) 3/4 adverse event (AE) was neutropenia (n=4). The other common drug-related AEs of all grade were myalgia (n=9), fatigue (n=7), sensory neuropathy (n=6), alopecia (n=6), pruritus (n=6), and neutropenia (n=6). Dose limiting toxicities(DLTs) were observed in three patients at 4.8mg/kg (G4 febrile neutropenia, G4 thrombocytopenia, G4 hyperbilirubinemia, G3 myalgia, G4 hyponatremia). No DLTs have been observed up to 4.2mg/kg, and safety evaluation at 4.5mg/kg is currently ongoing. Toxicokinetic analysis for total antibody, drug-conjugated antibody, and free payload suggested that there were no accumulation of ALT-P7 upon repeated injection. In 22 patients with response evaluation, disease control rate at 6 weeks of ALT-P7 treatment was 77.3%(17/22) and partial response was achieved in two out of fifteen patients with measurable lesion. The median PFS at doses from 2.4 to 4.8mg/kg was 6.2 months (95% CI 2.5-9.9 months). Conclusions: ALT-P7 was well tolerated to a dose of 4.2mg/kg in heavily pretreated HER2-positive advanced breast cancer. DLTs were observed at 4.8mg/kg, and 4.5mg/kg is under evaluation. The observed clinical activity warrants further evaluation in a phase 2 trial. Clinical trial information: NCT03281824. Clinical trial information: NCT03281824 .
Anlotinib, a multitarget tyrosine kinase inhibitor, for advanced lung cancer patients: Efficacy in real-world study.
Authors: Jifeng Feng, Lei Qian
Journal: Journal of Clinical Oncology (2020)

e15652 Background: Anlotinib is an novel small molecule multi-target tyrosine kinase inhibitor, which has been approved as a third-line therapy for patients with advanced NSCLC by CFDA in May 2018, and also approved as third-line therapy for patients with advanced SCLC in China in 2019. The objective of this study was to assess the efficacy of Anlotinib for patients with advanced lung cancer in the real world. Methods: We reviewed the patients who were diagnosed as advanced lung cancer and had received anlotinib in Jiangsu Caner Hospital from May 2018 to Sep 2019. The primary endpoint was progression-free survival (PFS) and the secondary endpoint was objective response rate (ORR), disease control rate (DCR) and safety. Results: A total of 465 patients were included in our study, containing 384 cases of NSCLC and 81 cases of SCLC. Among patients with NSCLC, 85 cases received anlotinib alone or anlotinib based therapy as first-line and second-line treatment, whereas 299 cases received anlotinib alone or anlotinib based therapy as third-line or later treatment. There were no significant differences in PFS, ORR and DCR between cohort of 1 st /2 nd line treatment and those with 3 rd /later treatment. However, patients received combination therapy (including anlotinib combined with PD1 inhibitors such as Nivolumab, pembrolizumab, or chemotherapy such as platinum, docetaxel, pemetrexed, paclitaxel, tegafur, etc.) showed a significant longer PFS and higher ORR and DCR (P &lt; 0.001, table). In patients with SCLC, 44 cases received anlotinib alone or anlotinib based therapy as first-line and second-line treatment. There were no significant differences in PFS, ORR and DCR between cohort of anlotinib monotherapy and other combination therapies (P &gt; 0.05, table). No additional safety profile was observed. Conclusions: Anlotinib shows similar effect in patients with NSCLC and SCLC in real world. Anlotinib provides more significant benefits when combining with PD1 inhibitor or chemotherapy comparing with monotherapy in patients with advanced NSCLC. [Table: see text]
From basic research to the clinic: innovative therapies for ALS and FTD in the pipeline
Authors: Rajka Maria Liscic, Antonella Alberici, Nigel John Cairns, Maurizio Romano, Emanuele Buratti
Journal: Molecular Neurodegeneration (2020)

Abstract Amyotrophic lateral sclerosis (ALS) and Frontotemporal Degeneration (FTD) are neurodegenerative disorders, related by deterioration of motor and cognitive functions and short survival. Aside from cases with an inherited pathogenic mutation, the causes of the disorders are still largely unknown and no effective treatment currently exists. It has been shown that FTD may coexist with ALS and this overlap occurs at clinical, genetic, and molecular levels. In this work, we review the main pathological aspects of these complex diseases and discuss how the integration of the novel pathogenic molecular insights and the analysis of molecular interaction networks among all the genetic players represents a critical step to shed light on discovering novel therapeutic strategies and possibly tailoring personalized medicine approaches to specific ALS and FTD patients.
胰岛素注射细节关系血糖控制成败
Authors: 傅汉菁
Journal: BMJ (2012)

在胰岛素治疗中,不仅要选择合适的胰岛素制剂,更要重视胰岛素注射装置和注射技术.从开始注射胰岛素时,医护人员就要指导糖尿病患者正确掌握胰岛素注射技术当中的每一个细节,包括注射部位的选择、轮换,注射时是否捏皮、进针角度、针头在皮下的留置时间,注射后器材的规范废弃等.只有医护人员和患者都关注胰岛素治疗中的每一个细节,才能更好地实现血糖控制达标。
可回收食管支架治疗良性食管瘢痕狭窄
Authors: 贾柳萍, 黄鹤, 智发朝, 古雨平, 王海霞
Journal: BMJ (2005)

43例食管良性狭窄患者经食管扩张后置入可回收食管支架,4周后回收支架,每3个月定期随访患者的症状及胃镜检查.结果显示支架置入成功率100%,置入支架后患者症状改善;4周后回收食管支架时显效40例,有效3例,总有效率100%;随访观察18～24个月,发现43例患者只有12例在日后需要行食管扩张治疗,其中大部分是发生在回收食管支架后的12～18个月;反流性食管炎组无一例需要扩张,但3组回收支架后食管扩张的累计发生率比较差异无统计学意义(P＞0.05).提示置入可回收食管支架对良性食管瘢痕狭窄有较好的治疗作用。
Malondialdehyde and inflammatory factors testing for patients with autoimmune thyroid diseases
Authors: Pei-yi Du, Bei-chun Huang
Journal: BMJ (2008)

One hundred and seventeen patients with newly diagnosed autoimmune thyroid diseases(AITDs)and 30 normal controls(NCs)were selected.All the patients were divided into 5 groups:hyperthyroidism group(n=33),subclinical hyperthyroidism group(n=21),hypothyroidism group(n=25),subclinical hypothyroidism group(n=23)and euthyroidism group(n=15).Plasma malondialdehyde(MDA),superoxide(SOD)and inflammatory factors levels were measured.Our results showed that plasma MDA level in dysthyroidism groups was significantly higher than that in NCs group(P＜0.05 or P＜0.01).SOD/MDA ratio in AITD groups Was significantly lower than that in NCs group(P＜0.05 or P＜0.01).In a multiple step-wise regression analysis,serum hishly sensitive C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)were independent factors of MDA.This study might suggest that plasma MDA level in AITD patients receiving no treatment may increase.MDA may be correlated with hs-CRP or TNF-α levels.

Key words: 
Thyroid diseases; Malondialdehyde
Effect of maternal psychological status and family structure on social emotional development of toddlers
Authors: Ping Sun, Yunxia Qu, Ce Zhang
Journal: BMJ (2018)

Objective
To investigate the effect of maternal psychological status and family structure on the social emotional development of toddlers.


Methods
The study was conducted in January 2016, 50 toddlers aged 12 to 36 months from one kindergarten in Dalian were selected with cluster random sampling. The parents of toddlers were interviewed, and the questionnaire for background condition, the social-emotional assessment scale for children and SCL-90 for maternal psychological status were applied. The effect of maternal psychological status and family structure on the social-emotion development of toddlers was analyzed.


Results
The positive rates of externalizing, internalizing, deregulation and competence in 50 toddlers were 24%(12/50), 14%(7/50), 20%(10/50)and 22%(11/50), respectively. The scores of obsession and anxiety in high school and college graduate mother group were higher than junior high school group(F=6.488, 5.834, all P<0.05 ) .The scores of obsession, interpersonal relationship, depression and anxiety in unhappy mother group were higher than those in happy mother group (t=7.812, 3.860, 5.871, 6.843, all P<0.05). Compared to happy mother group, the abnormality rates of externalizing behavior [42%(10/24)vs. 8% (2/26), χ2=10.667, P=0.001], internalization behavior [25%(6/24)vs. 4% (1/26), χ2=0.000, P=0.008] and behavior disorder [33%(8/24)vs. 8% (2/26), χ2=7.200, P=0.007] were significantly higher in unhappy mother group. There were significant differences in positive rate of externalized behavior among mothers with different educational levels (junior high school, high school and college graduate)(8/15, 3/17 and 1/18, F=9.757, P<0.05). There were significant differences in respond ability of children among families with different structure (single-parent family, joint family, direct family and nuclear family) (3/5, 1/4, 7/28 and 0/13, F=8.134, P=0.026).


Conclusion
The abnormal rates of children′s externalization, internalization and deregulation behavior are higher for mothers with emotional unhappiness, and the abnormal rate of children′s competence in single-parent family, joint family and direct family are higher than that in nuclear family.


Key words: 
Child; Emotions; Mothers; Family
20q amplification defined by genomic and clinical characteristics as a subgroup with increased prevalence and better survival in metastatic colorectal cancer.
Authors: Satish Maharaj, RuoBing Xue, Anmol Cheema
Journal: Journal of Clinical Oncology (2020)

e16003 Background: Genomic instability from 20q amplification is an oncogenic pathway in colorectal cancer (CRC). Several genes have been implicated, including BCL2L1, AURKA, SRC, ASXL1, GNAS and TOP1. There is a lack of data regarding 20q amplified group and one study implicating these genes suggested these patients have better overall survival. Next Generation Sequencing (NGS) has become widely used in metastatic CRC (mCRC) and easily identifies patients with 20q amplification. Nevertheless, most oncologists do not routinely consider 20q amplification status and this subgroup remains underinvestigated. This study aims to investigate genomic and clinical characteristics of 20q amplified mCRC using a single-center retrospective cohort and a multi-center genomic dataset. Methods: A cohort was identified comprising patients with mCRC who had NGS testing of tumor DNA and were treated between 2014-2019. Cases with and without 20q amplification were identified. Genomic, clinical and survival data were analyzed. Significant genomic findings were compared with all-stage CRC data using the AACR Genomic Evidence Neoplasia Information Exchange (GENIE) and The Cancer Genome Atlas (TCGA) databases. Results: Of the mCRC cohort ( n= 72), 15% ( n= 11) had 20q amplification. Amplified and non-amplified groups had no significant differences in age, sex or follow-up time. Patients with 20q amplification were more likely to have never smoked, and less likely to have treatment with targeted therapy. Survival analysis showed clear separation with longer overall survival for the amplified group. Eight genes at loci 20q11 to 20q13 were amplified - in order of frequency: ASXL1, GNAS, ARFRP1, ZNF217, AURKA, BCL2L1, SRC and TOP1. 20q amplification was significantly associated with wild-type RAS and BRAF, microsatellite stability, mutant TP53 and mutant APC. Using the GENIE and TCGA databases, it was found that metastatic disease had increased prevalence of all 20q amplified genes except TOP1, when compared to all-stage CRC. Conclusions: Clinical use of NGS identifies the 20q amplification subgroup that has increased prevalence in mCRC (compared to all CRC). Compared to non-20q amplified mCRC, this group had better survival, suggesting genomic pattern in mCRC is a novel independent prognostic marker. We believe mCRC patients would benefit from further studies defining a genomic prognostication model and development of therapy targeting the 20q amplification pathway.
Implementation of the Institute of Medicine treatment plan in oncology practice.
Authors: Shanthi Sivendran, Lalan S. Wilfong, Elizabeth Horenkamp, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2020)

e19233 Background: Participation in the Center for Medicare and Medicaid Services (CMS) value-based payment reform, The Oncology Care Model, requires that every beneficiary has a documented 13-point Institute of Medicine (IOM) treatment plan (TP) when commencing antineoplastic therapy. The intent of this document is to enhance shared decision making between the patient and care team by providing transparent treatment recommendations and engaging patients and caregivers in meaningful discussion. There is limited discussion in the literature on how to adapt the CMS recommendations to diverse practice settings while maintaining fidelity to the intent of the TP. Methods: We compare how three clinically and geographically unique OCM participating institutions implemented the TP in their respective institutions within the domains of the Consolidated Framework for Implementation Research (CFIR). Settings include a community cancer institute in the northeast, an academic hospital setting in the southeast, and a large community cancer network in the southern United States. Results: We identified similar themes in implementation including engaging stakeholders, leveraging information technology, structuring the TP, development of clinic processes and considering scalability. We also describe adaptations unique to the culture and setting of each site. Conclusions: Although studies have shown patients do not feel informed of their diagnosis, there are currently many approaches to improving shared decision making including utilizing the 13 points of the IOM TP as mandated by the OCM. We provide practical strategies for incorporation of the TP into clinical care with lessons from diverse settings. As shown by the wide variability in implementing shared decision making, further research is needed to optimize illness understanding. Additionally, optimal implementation of CMS’s IOM TP would ideally include concrete metrics measuring impact on shared decision making, illness understanding, or patient satisfaction.
Utility of neutrophil to lymphocyte ratio in predicting colorectal cancer prognosis at a VA hospital: Do stage and sidedness matter?
Authors: Kee-Hwan Michael Kim, Darren Gemoets, Maithao N. Le
Journal: Journal of Clinical Oncology (2020)

e16110 Background: Pretreatment neutrophil-lymphocyte ratio (pNLR) has been shown to associate with prognosis in patients with colorectal cancer (CRC). We asked if pNLR equally predicted prognosis in CRC regardless of stage and tumor location. We also asked if pNLR changed with time, especially within one year of diagnosis. Methods: Retrospective clinical data including age at diagnosis, pathological stage, location of tumors, treatments, disease free survival, NLR at one week, three months, and one year (if available) pretreatment of 934 veterans treated for CRC at one Veteran Affair Medical Center between July 1995 and December 2011 were collected. Disease-free survival (DFS) were analyzed using Kaplan-Meier analysis and compared using the log-rank test. pNLRs were grouped into three categories: less than or equal to three, greater than three and less than or equal to five, and greater than five. Univariate and multivariate Cox regression analyses were used to identify the prognostic value of pNLR. Boxplot analysis was used to evaluate the changes in pNLR over time. Results: In patients with stage 1 or stage 4 CRC, pNLRs of more than 5 and not between 3 and 5 predicted worse prognosis. In patients with stage 2 or 3 CRC, pNLRs did not correlate with prognosis. Interestingly, for patients with recurrent CRC after curative treatment, NLRs obtained prior to treatment of recurrent disease of more than 3 associated with worse prognosis. In subgroup analysis, we found that in patients with stage 1 or 4 left side colon or rectal cancer (LCRC), pNLRs of more than 5 but not between 3 and 5 predicted worse prognosis. In patients with stage 2 or 3 LCRC, NLRs obtained prior to treatment of recurrent disease did not correlate with prognosis. Similarly, for patients with recurrent LCRC after curative treatment, NLRs obtained prior to treatment of recurrent disease of more than 3 associated with worse prognosis. pNLRs did not correlate with prognosis in patients with right side colon cancer (RCC) regardless of stage. When comparing NLRs obtained at 1 year, 3 months, and 1-week pretreatment, boxplots showed a gradual increase leading up to the time of treatment suggesting that NLR changes according to the time of collection. Conclusions: In our large retrospective study, the role of pNLR in predicting oncologic prognosis differed according to the stage and the sidedness of the CRC. In addition, the value of pNLR varied depending on the time of collection. These findings suggested a complex relationship between immunologic parameters and oncologic survival.
Venous Thrombosis Among Critically Ill Patients With Coronavirus Disease 2019 (COVID-19)
Authors: Julien Nahum, Tristan Morichau-Beauchant, Fabrice Daviaud, Perrine Echegut, Jérôme Fichet, Jean-Michel Maillet, Stéphane Thierry
Journal: JAMA Network Open (2020)

mg/dL [to convert to milligrams per liter, multiply by 10]).Prothrombin activity (mean [SD], 85%[11.4%]) and platelet count (mean [SD], 256 [107] × 10 3 /μL) were normal (Table 1). DiscussionMortality of patients with COVID-19 admitted to ICUs has been reported to be high, at 50%. 6 Frequent venous and arterial thrombotic events have been reported, with rates from 27% to 69% of peripheral venous thromboembolism and up to 23% of pulmonary embolism. 4,5 The occurrence of pulmonary embolism might be favored by deep vein thrombosis.The main limitations of this study were its monocentric nature and the relatively small size of our cohort.In view of the high rate (ie, 79%) of deep vein thrombosis reported in this study, prognosis might be improved with early detection and a prompt start of anticoagulant therapy.Despite anticoagulant prophylaxis, 15% of our patients developed deep vein thrombosis only 2 days after ICU admission.Systematic anticoagulant therapy for all ICU patients with COVID-19 should be assessed.