tbuckley/cabot-search huggingface dataset:
Accuracy of sentinel lymph node biopsy in invasive lobular carcinoma of the breast.
Authors: Ruby Guo, Case E. Brabham, Kelly Fahrner-Scott, Mary Kathryn Abel, Jasmine Wong, Michael Alvarado, Laura Esserman, Cheryl Ann Ewing, Rita A. Mukhtar
Journal: Journal of Clinical Oncology (2020)

e12604 Background: The safety of the sentinel lymph node biopsy procedure (SLNB) in the surgical management of breast cancer relies upon a false negative rate (FNR) being less than 10%. The accuracy of SLNB in invasive lobular carcinoma (ILC), the second most common type of breast cancer, has not been evaluated. Because of high rates of false negative imaging and the diffuse growth pattern in ILC, less accurate pre-operative staging and a potentially unreliable lymphatic drainage pattern may impact the accuracy of SLNB in this tumor type. We therefore sought to characterize the accuracy of SLNB in a cohort of patients with ILC. Methods: We queried an institutional database of 707 patients with ILC and identified 196 patients who underwent SLN mapping with excision of both sentinel and non-sentinel nodes. A false negative was defined as having negative sentinel lymph nodes and a positive non-sentinel node. We calculated the FNR and sensitivity of SLNB and evaluated clinicopathologic variables. Results: Of 196 cases, 183 were clinically node-negative, 9 were clinically node-positive, and 4 had unknown clinical node status. Of the 183 clinically node-negative patients, 69 (37.7%) patients had node-positive disease at surgery. Overall, 7 of 196 cases had false negative SLNB, yielding an FNR of 8.97%. The sensitivity of SLNB was 91%. Patients with a false negative SLNB were significantly older than patients without (mean age 63 versus 54.7 years, p = 0.041). Significantly fewer sentinel and non-sentinel nodes were removed in women aged 50 years or older compared to those under 50 (1.9 vs. 2.5 sentinel nodes, p = 0.0158; 4.7 vs. 7.9 non-sentinel nodes, p = 0.0077). There were no differences in tumor receptor subtype, grade, stage, presence of lymphovascular invasion, or receipt of neoadjuvant therapy in those with a false negative SLNB compared to those without. Conclusions: The high rate of nodal positivity in clinically node negative patients highlights the challenges of clinical nodal assessment in ILC. Despite this, the SLNB procedure had a FNR that fell within the acceptable range, supporting its use in ILC. The relationship between number of sentinel nodes removed and FNR deserves further study, particularly in older women where extent of nodal surgery continues to decline.
急腹症的影像学诊断(一)
Authors: 徐辉, 谢敬霞
Journal: BMJ (2011)

急腹症是以急性发作剧烈腹痛为特征,常见的有急性阑尾炎、溃疡急性穿孔、肠梗阻、急性胆囊炎、急性胰腺炎、急性肾绞痛(泌尿系结石)、异位妊娠和卵巢囊肿扭转等.近年来,急性肠系膜血管栓塞也不少见.
Reasons and preventive measures for reoperations after laparoscopic radical cystectomy
Authors: Kun Liu, Junsong Meng, Zongyuan Xu, Guangbo Fu, Suo Gu
Journal: BMJ (2014)

The clinical data of 24 bladder cancer patients reoperated shortly after laparoscopic radical cystectomy were retrospectively analyzed. The reoperative reasons included intestinal injury, wound bleeding, intestinal anastomosis fistula, deep vein thrombosis, ileus and single-J tube slipping. All of them were cured after reoperation. The postoperative complications were infected incisional wound (n=2), urinary leakage (n=1) and pulmonary infection (n=1). All were cured by symptomatic treatments. The keys of reducing the rate of reoperation shortly after laparoscopic radical cystectomy included selecting indications strictly, standardizing operative procedures and adopting special measures.


Key words: 
Cystectomy, laparoscopy; Reoperation
Investigation of urinary incontinence among outpatients of the gynecological department
Authors: Li-mei Zhou, Xue-xian Xu, Yan-xiang Cheng
Journal: BMJ (2012)

Objective We investigated urinary incontinence (UI) among patients of the Gynecological Department of Renmin Hospital of Wuhan University,to observe characteristics of women with UI in our province,and to analyze preliminary factors affecting their treatment.Methods We evaluated 15 300 patients treated for UI from August 2009 to April 2011,using site information and questionnaires.We also compared them to 66 825 other gynecology outpatients at our hospital over the same period.Results We found that the incidence of UI tended to increase with age,and was associated with body mass index,parturition,and surgery history.But 54.63％ (8358/15 300) of them refused surgical treatment.Of these 8358 patients,29.78％ (2489/8358) because of economic factors,25.83％ (2159/8358) because of mental stress,and 24.30％ (2031/8358) because of lack of faith in the efficacy of surgical treatment,20.09％ (1679/8358) did so because of knowing little of the disease.Conclusions UI is inconvenient to patients,and seriously affects their physical and mental health. Many patients refuse surgical treatment.Medical staff should attempt to educate patients better with regard to treatment,and to offer them help to improve the quality of their lives.

Key words: 
Urinary incontinence ;  Quality of life ;  Questionnaires
Impact of adherence to National Comprehensive Cancer Network (NCCN)-recommended first-line therapy on treatment duration for patients with advanced non-squamous non-small cell lung cancer (NSCLC).
Authors: Ani K John, Baiyu Yang, Roma Shah
Journal: Journal of Clinical Oncology (2020)

e21727 Background: Identification of molecular alterations can provide essential information to guide personalized treatment selection for advanced non-small cell lung cancer (aNSCLC) patients. However, in routine oncology practice, not all eligible patients receive biomarker testing and receive treatment according to the testing results following the National Comprehensive Cancer Network (NCCN) guideline. We aim to examine the impact of adherence to guideline-recommended therapy on the duration of treatment in a real-world setting. Methods: Patients diagnosed with non-squamous aNSCLC (stage IIIB and above) and received the first-line of therapy (FLOT) between 2011 and 2019 from the nationwide Flatiron Health electronic health record-derived de-identified database were included in this analysis. Adherence was defined as using any NCCN guideline-recommended FLOT consistent with a patient’s biomarker testing results (EGFR, ALK, ROS1, BRAF and PD-L1) assessed up to 90 days before and/or 14 days after the FLOT start date. Non-adherence was defined as not receiving guideline-recommended FLOT based on the above-mentioned biomarker results, or patients treated without evidence of biomarker testing. Median time to treatment discontinuation (TTD) of FLOT was calculated using Kaplan-Meier analysis. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the association between guideline adherence and TTD. Results: A total of 17,137 eligible patients were included (67.5% adherent, 32.5% non-adherent). Mean age at diagnosis was 67 years (SD: 10 years). The majority of patients (92%) received care at a community clinic, and 73% reported having insurance plans. Overall, 87.2% had discontinuation of FLOT, including 84.9% in the adherent group and 92.0% in the non-adherent group. The median TTD was 155 days (95% CI 153-159) in the adherent group and 128 days (95% CI 125-132) in the non-adherent group. Adherent patients had a lower risk of FLOT discontinuation in the unadjusted analysis (hazard ratio [HR] 0.78, 95% CI 0.76-0.81), which remained significant after adjusting for potential confounders including age at FLOT start, sex, history of smoking, and stage at initial diagnosis (HR 0.76, 95% CI 0.74-0.79). Conclusions: Among non-squamous aNSCLC patients, the majority of patients were adherent to NCCN guidelines. Adherence was associated with lower risk of discontinuation and longer duration of FLOT.
The application of Bispectrai index in pediatric radio frequency catheter ablation
Authors: Rong Wang, En-ming Qing, Xue-feng Ding, Qiu-xia Li, Xiu-hua Dong
Journal: BMJ (2009)

The aim of the study is to evaluate the feasibility and safety of Bispectral index (BIS) monitoring in pediatric radio frequency catheter ablation. One hundred and six children aged 0. 6-12 years, scheduled for radio frequency catheter ablation, were randomly divided into two groups. In group A patients received BIS monitoring during the operation (n = 50), and the group B received modified Observer's Assessment of Alertness/Sedation (OAA/S) scaling (n = 56). The anesthesia was maintained with propofol target-controlled infusion. The intraoperative propefol target concentration was adjusted to maintain the BIS values between 55-65 in group A and OAA/S scale about 1 in group B respectively, The heart rate (HR), mean arterial pressure (MAP) and pulse oximetric saturation (SpO2) were measured before anesthetic induction, 1 min after induction, catheter puncturing and the end of operation respectively. The requirements of propofol, the times of supporting ventilation and recovery, the respiratory depression, nausea and vomiting postoperatively were also recorded. The intraoperative HR, MAP and SpO2 showed no differences between two groups, but the requirements of pmpofol, the times of supporting ventilation and recovery were less in group A than that of group B (P<0.05). All children didn't have nausea, vomiting and respiratory depression. The results suggest that in pediatric radio frequency catheter ablation, BIS monitoring has the advantages of timely adjustment of anesthetic depth, reducing anesthetic requirements, shortening the time of recovery, so as the perioperative safety can be improved.

Key words: 
Bispectral Index;  Child;  Radio frequency catheter ablation
Early-stage KRAS G12C-mutated non-small cell lung cancer (NSCLC) in Australia.
Authors: Paul Mitchell, Devisri Dharmaraj, Simon Knight
Journal: Journal of Clinical Oncology (2020)

e21053 Background: KRAS is frequently mutated in NSCLC, especially in Caucasian populations. Until recently there have not been effective targeted therapies against KRAS but the recent advent of active agents has thrown a spotlight on this disease. Methods: A database of NSCLC cases undergoing lobectomy or pneumonectomy with curative intent at Austin Health, Victoria, Australia was examined. Analysis for KRAS mutations was carried out using the LungCarta panel. Results: Four hundred and fifty nine cases underwent mutation analysis and 203/459 (44%) were wild type. KRAS mutations were identified in 100/459 cases (21.8%), including 3 cases where the specific mutation was not specified. KRAS G12C cases comprised 40/97 (8.5% of all cases, 41% of specified mutation KRAS cases) and other KRAS mutations comprised 57/97 (59%) - most commonly G12V (25 cases) and G12D (13 cases). Additional mutations were identified in 14/40 (36%) G12C mutation cases (10 dual and 4 triple – most commonly TP53 9, STK11 3 and PIC3CA 2). In non-G12C cases, multiple mutations were identified in 24% of cases. Considering the 40 G12C cases, histology was squamous cell in 21 cases, adenocarcinoma 13 and other 5. Males comprised 21/40 cases, median age at diagnosis was 61 year (range 34 – 78), with stage I 22 cases, stage II 12; stage IIIA 5 and one stage 4 (solitary brain metastasis). Thirty six patients (90%) had smoked tobacco with median exposure of 44 pack years (range 13-100) including 18 ex-smokers who had ceased a median 9 years (range 1 - 28) prior to the diagnosis of lung cancer. PD-L1 expression was analysed using the 28-8 antibody. For the 38 cases analysed, PD-L1 expression was ≥ 50% in 6 (16%), ≥ 5% in 12 (32%) and &lt; 1% in 24 (63%). The estimated median overall survival was 4.9 years with 27% 10 year survival. Twenty three patients (58%) died from the index lung cancer, 8 (20%) remain alive and 9 (23%) died of other causes: 4 from a 2 nd lung cancer, 4 from a non-lung cancer and one from liver failure. Data on sites of recurrence were available for 16 of the 23 cases who died from the index lung cancer, with initial recurrence sites being lung/local 7 patients, brain 6, bone 2, liver 1. A total of 9 patients (56%) developed brain metastases at some time. Conclusions: KRAS G12C is a common subgroup of NSCLC in the Australian population and almost all of cases were tobacco smokers. Additional mutations were identified in over a third of cases. Locally recurrent disease or brain metastases are the most frequent sites of relapse and over half of patients with recurrent disease develop brain metastases.
Assessing overall patient satisfaction among cancer patients: A radiotherapy survey.
Authors: JoAnne Meng, Elisabeth Cisa-Pare, Katelyn Balchin, Julie Renaud, Linda Bunch, Paul Wheatley-Price, Angela McNeil, Shelagh Murray, Rajiv Samant
Journal: Journal of Clinical Oncology (2020)

e19249 Background: Healthcare providers (HCPs) strive to maximize the experience for cancer patients. Published reports suggest a variety of characteristics that are considered important. We decided to survey our patients undergoing radiotherapy to determine what they considered desirable traits and characteristics. Methods: An ethics approved 35-item patient satisfaction survey evaluating respondent experience was developed by an interdisciplinary team of HCPs working in the radiation medicine program. It was an anonymous, voluntary, paper-based survey for self-completion. It evaluated a variety of domains with respect to the quality of care patients received, and was administered to patients undergoing radiotherapy. Results: A total of 199 patients completed the survey. The median age was 68, with approximately 54% women and 45% men (1% unreported). Most patients (85%) had been diagnosed with their cancer within the previous year, and the commonly reported malignancies (61%) were breast, prostate and lung cancers. Almost all (95%) “agreed" or "strongly agreed" about the importance of physicians being sensitive and compassionate. Over 90% felt they received adequate explanations about their treatment, and had their questions answered. The vast majority (93%) felt included in the decision-making process. They reported the 5 most important qualities among the HCPs as follows (in descending order): knowledge, kindness, honesty (answering questions/giving information), good communicator and cheerful attitude. Most (&gt;70%) reported feeling connected with their HCPs. Although overall satisfaction was high, there were areas for improvement identified. These included patients being offered future appointments to discuss their diagnosis and treatment, receiving information about clinical trials and other treatment options, and being given contact information for psychosocial and community resources. Also, HCPs tended to focus mainly on the physical needs of patients and to a lesser degree on their emotional needs, but spiritual and cultural needs were not routinely addressed (&lt;10%). Conclusions: Reassuringly, cancer patients receiving radiation report high rates of satisfaction across many aspects of their care. The qualities most appreciated serve as a reminder to clinicians that their role is more than just that of a medical expert. These findings also reinforce the different aspects of holistic care that can be improved.
Application of wire-reinforced epidural catheter in combined spinal-epidural anesthesia for cesarean section
Authors: Huanhuan Ni, Yuling Yang, Liang He
Journal: BMJ (2016)

Two hundred women with singleton pregnancy at full term undergoing cesarean section with combined spinal-epidural anesthesia were randomly assigned into 2 groups (n=100 in each group). During anesthesia the polyvinyl chloride epidural catheter was used in control group and the wire-reinforced epidural catheter was used in study group. The results showed that the number of patients in whom blood or blood-tinted fluid was withdrawn from epidural catheter was significantly lower in study group than that in control group. The domestic wire-reinforced epidural catheter can reduce the incidence of blood vessel injury induced by insertion of epidural catheter.


Key words: 
Domestic wire-reinforced epidural catheter; Vascular injury
青岛胶南市居民糖尿病流行现状与五年流行变化
Authors: 李发贵, 丁仲华, 于艳丽, 韩红梅, 丁立功
Journal: BMJ (2007)

于2006年对2001年抽查的糖尿病(DM)流行病学调查点的人群进行调查,DM标化患病率为12.66%,5年增长131.87%;5年前后DM知晓率差异无统计学意义;DM患病率随年龄的增加而增加,标化患病率峰值增高、前移,文化水平越低DM患病率越高.说明胶南市居民DM患病率高,增长迅猛,趋向年轻化,知晓率与治疗达标率低。
Expression and significance of peripheral blood CD4 + CD28 - T cells in patients with autoimmune hepatitis
Authors: Qun-ying Wang, Yun Xu
Journal: BMJ (2010)

The percentage of peripheral blood CD4 + CD28 - T cell in 59 patients with autoimmune hepatitis (AIH) (36 with active disease and 23 stable) and 30 normal individuals was evaluated by twocolor flowcytometry. IL-10 and TNF-α levels were assayed by double-antibody sandwich ELISA. Serum immunoglobulin were also analyzed. Patient with active AIH had significantly higher peripheral blood CD4 + CD28 - T cell and TNF-α levels than normal individuals ( P ＜ 0. 05 ), while in patients with remission they were only slightly higher than normal controls. If remission was induced in patients with active AIH,peripheral blood CD4 + CD28 - T cell percentage would be significantly reduced ( P ＜ 0. 05 ) while IL-10 increased ( P ＜ 0. 05 ). The percentage of peripheral blood CD4 + CD28 - T cell in patients with relapse was significantly higher than newly diagnosed patients and normal controls; Peripheral blood CD4 + CD28 -T cell percentage in patients with abnormal serum immunoglobulin ( IgA, IgG and IgM ) levels was significantly higher than those with normal levels and normal controls. We concluded that abnormal peripheral blood CD4 + CD28- T cells and cytokine in patients with AIH may be related to disease activity and clinical manifestations, which may also play a role in the pathogenesis of AIH.

Key words: 
Hepatitis, autoimmune;  T-lymphocytes
A preliminary investigation on two-way referral care for type-2 diabetics
Authors: 葛军, 陈允硕, 吴敏生, 孙卫东, 金立钢, 王希淳, 李智, 陈孝善, 张黎红, 刘钧钧, 韩君华, 王宝珍, 史京衡, 史虹莉
Journal: BMJ (2004)

目的 探索糖尿病治疗的有效模式,提高社区糖尿病患者的治疗达标率,相对减少不必要的费用.方法选择某综合性医院(二级甲等)为转诊中心,选择若干个社区街道医院(一级甲等)为转诊点,将294例糖尿病患者按有关代谢指标及属地化管理的原则随机分组,设进行双向转诊的患者为转诊组(100例),设不参加转诊,在一级甲等医院就诊的为对照Ⅰ组(92例),在二级甲等医院就诊的为对照Ⅱ组(102例).结果转诊组;空腹血糖(FPG)值平均控制为(6.7±1.4) mmol/L,餐后2小时血糖(2hPG)值平均控制为(8.1±3.2) mmol/L,糖化血红蛋白(HbA1c)值控制为(6.8±1.1)%;对照Ⅰ组FPG平均为(7.8±1.1) mmol/L, 2hPG平均为(9.3±2.3)mmol/L,HbA1c为(7.6±1.1)%(P＜0.01);对照Ⅱ组FPG平均为(6.6±1.8)mmol/L,2hPG为(8.2±1.5)mmol/L,HbA2c为(6.8±0.6)%. 在医疗费用方面:转诊组平均为(233±39) 元/月,对照Ⅰ组平均为(222±45) 元/月(P>0.05).两者均低于对照Ⅱ组的(272±48) 元/月(P<0.01),使总费用下降14.3%.结论糖尿病的双向转诊模式初步疗效确切,费用与一级医院无明显差异,但可能取得与二级医院相同的疗效。
血脂在缺血性脑卒中发病中的作用及调脂治疗
Authors: 龚涛
Journal: BMJ (2012)

血脂异常导致动脉粥样硬化,进而导致缺血性脑卒中.血清TC、LDL-C升高,HDL-C降低是缺血性脑卒中的危险因素.其中LDL-C的升高与其发生密切相关,降低LDL-C是减少脑卒中风险的肯定有效手段之一.只有他汀类药物可降低脑卒中的危险.血脂异常的治疗应根据患者的血脂水平以及血脂异常的分型决定。
Interdisciplinary risk assessment and delay of chemotherapy.
Authors: Juliana Souza, Monica Santos, Ana Paula Coutinho, Natalia Gil, Alessandra Silva, Maria Carolina Fernandes, Larissa Souza, Vilceia Souza, Daniele Ferreira Neves
Journal: Journal of Clinical Oncology (2020)

e14033 Background: In 2015, in our outpatient clinic, we implemented a breast cancer interdisciplinary team with the goal of identifying risk factors for chemotherapy delay. Evaluation of individual cases and care plans were made by a medical oncologist, clinical pharmacologist, psychologist, dietician and oncology nurse. Methods: 81 patients with breast cancer in neoadjuvant/adjuvant chemotherapy were prospectively evaluated from July 2018 until July 2019 for clinical risk: age, anthracyckine use, presence of symptoms grade &gt;3, ASGPPP questionnaire for nutritional risk, psychological risk for pre existent issues or induce by treatment and IRPO questionnaire for screening, nursing evaluation for comunication, organization and understanding issues, and pharmacologist evaluation of polypharmacy and unknown drugs or routine use. Results: Of 81 patients evaluated and had finish treatment, 55 pts (67.9%) received adjuvant chemotherapy. Median age was 57.9 years (range:29-90.6y). We defined as risk factors for delay chemotherapy treatment: anthracycline-based chemotherapy (9.34 vs 2.58 d p:0.002), psychological risk (both risks combined) (8.1 vs 4.7 p:0.047), comunication, organization and understanding issues (15.25 vs 5.83 d p: 0.004), and unknown drugs that routinely uses (11 vs 5.34d p:0.012). Patients who needed extra nutritional and psychological appointment had greater delay in chemotherapy (Dietician: 9.636 vs 4.7 d P:0.01; Psyc: 9.1 vs 4.2d p:0.008). Conclusions: The chemotherapy scheme, psychological risk, difficulty in understanding and organizing, and unaware of the drugs used routinely uses were high risk factors for delayed chemotherapy and these patients should be handled more carefully.
COVID in NYC: What We Could Do Better
Authors: Tia Powell, Elizabeth Chuang
Journal: The American Journal of Bioethics (2020)

New York City hospitals expanded resources to an unprecedented extent in response to the COVID pandemic. Thousands of beds, ICU beds, staff members, and ventilators were rapidly incorporated into hospital systems. Nonetheless, this historic public health disaster still created scarcities and the need for formal crisis standards of care. These were not available to NY clinicians because of the state's failure to implement, with or without revision, long-standing guidance documents intended for just such a pandemic. The authors argue that public health plans for disasters should be well-funded and based on available research and expertise. Communities should insist that political representatives demonstrate responsible leadership by implementing and updating as needed, crisis standards of care. Finally, surge requirements should address the needs of both those expected to survive and those who will not, by expanding palliative care and other resources for the dying.