tbuckley/cabot-search huggingface dataset:
Radiofrequency ablation for treatment of giant hepatic hemangiomas
Authors: Guolin He, Bin Liang, Hangyu Zhang, Xiangqian Zhao
Journal: BMJ (2018)

The clinical data of 32 patients with giant hepatic hemangioma (GHH) who underwent radiofrequency ablation (RFA) treatment in the PLA General Hospital and Affiliated Peace Hospital of Changzhi Medical College from June 2011 to May 2016 were retrospectively analyzed, including 26 cases treated with laparoscopy-guided RFA and 6 cases treated with ultrasound-guided percutaneous transhepatic RFA+ laparoscopy. A Total of 41 lesions were ablated, the diameters of lesions ranged from 2.0 to 12.0 cm. The RFA time ranged from 18 to 72 min and the volume of intraoperative bleeding varied from 5 ml to 150 ml. The incidence of postoperative complications was 56%, which mainly were fever and hemoglobinuria. Patients were followed up for 12 to 60 months; the lesions were incompletely ablated in 3 cases. Radiofrequency ablation is an effective and safe method for the treatment of giant hepatic hemangiomas.


Key words: 
Radiofrequency ablation; Hemangioma, liver; Laparoscopy
Ixazomib vs placebo maintenance for newly diagnosed multiple myeloma (NDMM) patients not undergoing autologous stem cell transplant (ASCT): The phase III TOURMALINE-MM4 trial.
Authors: Meletios A. Dimopoulos, Ivan Spicka, Hang Quach, Albert Oriol, Roman Hajek, Mamta Garg, Meral Beksac, Sara Bringhen, Eirini Katodritou, Wee Joo Chng, Xavier Leleu, Shinsuke Iida, Maria-Victoria Mateos, Gareth Morgan, Alexander Vorog, Richard Labotka, Bingxia Wang, Antonio Palumbo, Sagar Lonial
Journal: Journal of Clinical Oncology (2020)

8527 Background: Maintenance therapy delays disease progression in non-ASCT NDMM patients. However, in practice, currently used maintenance therapies may be limited to fixed duration due to toxicity and route of administration; additional options are needed. Methods: 706 non-ASCT NDMM patients who received 6–12 months of standard-of-care induction therapy and achieved at least a partial response (≥PR) were randomized 3:2, double-blind, to the oral proteasome inhibitor (PI) ixazomib (n = 425; 3 mg, cycles 1–4, then, if tolerated, 4 mg, cycle 5 onwards) vs placebo (n = 281) on days 1, 8, and 15 of 28-day cycles for ≤2 yrs. Patients were stratified by prior PI exposure (yes vs no), pre-induction International Staging System (ISS) disease stage (I/II vs III), age ( &lt; 75 vs ≥75 yrs), and post-induction best response (complete or very good partial response [CR/VGPR] vs PR). Primary endpoint was progression-free survival (PFS). Results: Baseline characteristics were well balanced. Overall median age was 73 yrs, 38% of patients were aged ≥75 yrs, 35% were ISS stage III, and 22%/40%/38% had CR/VGPR/PR post induction. Overall, 82% of patients received a PI and 33% an immunomodulatory drug as part of their induction regimen. At a median follow-up of 21.1 months, median PFS was 17.4 months with ixazomib vs 9.4 months with placebo (hazard ratio [HR] 0.659, 95% confidence interval [CI] 0.542–0.801, p &lt; 0.001). Significant (p &lt; 0.001) PFS benefit was seen in patients who achieved CR/VGPR post induction (Table). Overall survival data are not yet mature (19% of events); follow-up is ongoing. Treatment-emergent adverse events (TEAEs) were mostly grade 1–2 (37% vs 23% of patients had grade ≥3 TEAEs with ixazomib vs placebo). Common TEAEs for ixazomib vs placebo included nausea (27% vs 8%), vomiting (24% vs 4%), and diarrhea (23% vs 12%); 5% vs 6% of patients had new primary malignancies. No cumulative toxicities were observed. Conclusions: Ixazomib maintenance therapy in non-ASCT NDMM patients showed a clinically meaningful 34% reduction in the risk of progression or death, with a well-tolerated safety profile. Ixazomib is the first oral PI maintenance option for non-ASCT NDMM patients. Clinical trial information: NCT02312258 . [Table: see text]
Terminal hepatic venule endothelialitis: an histopathological marker of steroid-resistant rejection, study of 165 brazilian patients
Authors: R. M. C. Leitão, E. R Figueira, A. C. L Costa, P. L Bittencourt, P Massarolo, Sérgio Mies, Silvano Raia, Luiz Carlos da Costa Gayotto
Journal: Hepatology (1998)
Hybrid Influenza Strain in Idaho
Authors: Bridget M. Kuehn
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Multicenter Study of Risk-Adapted Therapy With Dose-Adjusted EPOCH-R in Adults With Untreated Burkitt Lymphoma
Authors: Mark Roschewski, Kieron Dunleavy, Jeremy S. Abramson, Bayard L. Powell, Brian K. Link, Prapti Patel, Philip J. Bierman, Deepa Jagadeesh, Ronald T. Mitsuyasu, David Peace, Peter R. Watson, Wahid T. Hanna, Christopher Melani, Andrea N. Lucas, Seth M. Steinberg, Stefania Pittaluga, Elaine S. Jaffe, Jonathan W. Friedberg, Brad S. Kahl, Richard F. Little, Nancy L. Bartlett, Michelle A. Fanale, Ariela Noy, Wyndham H. Wilson
Journal: Journal of Clinical Oncology (2020)

Burkitt lymphoma is an aggressive B-cell lymphoma curable with dose-intensive chemotherapy derived from pediatric leukemia regimens. Treatment is acutely toxic with late sequelae. We hypothesized that dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (DA-EPOCH-R) may obviate the need for highly dose-intensive chemotherapy in adults with Burkitt lymphoma.We conducted a multicenter risk-adapted study of DA-EPOCH-R in untreated adult Burkitt lymphoma. Low-risk patients received three cycles without CNS prophylaxis, and high-risk patients received six cycles with intrathecal CNS prophylaxis or extended intrathecal treatment if leptomeninges were involved. The primary endpoint was event-free survival (EFS), and secondary endpoints were toxicity and predictors of EFS and overall survival (OS).Between 2010 and 2017, 113 patients were enrolled across 22 centers, and 98 (87%) were high risk. The median age was 49 (range, 18-86) years, and 62% were ≥ 40 years. Bone marrow and/or CSF was involved in 29 (26%) of patients, and 28 (25%) were HIV positive. At a median follow-up of 58.7 months, EFS and OS were 84.5% and 87.0%, respectively, and EFS was 100% and 82.1% in low- and high-risk patients. Therapy was equally effective across age groups, HIV status, and International Prognostic Index risk groups. Involvement of the CSF identified the group at greatest risk for early toxicity-related death or treatment failure. Five treatment-related deaths (4%) occurred during therapy. Febrile neutropenia occurred in 16% of cycles, and tumor lysis syndrome was rare.Risk-adapted DA-EPOCH-R therapy is effective in adult Burkitt lymphoma regardless of age or HIV status and was well tolerated. Improved therapeutic strategies for adults with CSF involvement are needed (funded by the National Cancer Institute; ClinicalTrials.gov identifier: NCT01092182).
神经病理性疼痛的诊断与治疗
Authors: 樊碧发
Journal: BMJ (2008)

国际疼痛学会将神经病理性疼痛(neuropathicpain)定义为周围和(或)中枢神经系统原发和(或)继发性损害、功能障碍或短暂性紊乱(transitory perturbation)引起的疼痛[1].临床主要特征为自发性疼痛(spontaneous pain)、痛觉过敏(Jayperagesia)及异样疼痛(allodynia)等.到目前为止,神经病理性疼痛的发病机制还不十分清楚,也缺乏较为满意的治疗方法.本文就其病因病理以及临床治疗现状作简单介绍。
药物的皮肤不良反应
Authors: 方红
Journal: BMJ (2007)

药物既可治病也可致病,用于诊治和预防疾病的药物进入机体而造成的各种危害,称药物的不良反应(ADR),其对患者来说,无疑雪上加霜.药物的皮肤不良反应主要表现为药疹或称药物性皮炎,是临床上最为常见的不良反应,指药物通过各种途径进入人体引起皮肤黏膜的炎症反应,重者可伴有多个脏器功能受损.最常见的途径是口服和注射,较为隐蔽的途径有滴眼、滴鼻、含服、喷雾、吸入、灌注、药熏、阴道栓、肛门栓、膀胱冲洗、阴道冲洗以及外用等。
Combined 18F-naf and fluciclovine administration for PET imaging of prostate cancer.
Authors: Franklin W. Huang, Brian Trinh, Sunny Wang, Thomas A. Hope
Journal: Journal of Clinical Oncology (2020)

e17533 Background: 18F-fluciclovine is FDA approved for the detection of recurrent and metastatic prostate cancer. At our institution, 18F-fluciclovine PET had replaced 18F-NaF PET, but fluciclovine has mild to no uptake in dense sclerotic bony lesions. F18-NaF offers increased sensitivity and specificity in detection of osseous metastases and therefore we converted to using a combination of 18F-NaF and 18F-fluciclovine in patients with biochemical recurrence. In this study, we assessed the feasibility of performing a combined F18- fluciclovine and F18-NaF study, and evaluated the biodistribution of the combined radiotracers in patients with prostate cancer. Methods: We retrospectively reviewed 16 consecutive patients over a period of 3 months. 5 mCi of F18-NaF was injected, followed 45 minutes later by a 10 mCi injection of F18-fluciclovine. Patients were asked to hydrate after NaF injection and empty their bladder immediately prior to scanning. A non-diagnostic CT for attenuation correction and an emission PET scan were acquired on a time of flight Discovery 690 PET/CT (GE Healthcare) within 5 minutes of fluciclovine injection. We characterized the extent of soft tissue and osseous disease, as well as assessed the image quality, taking note for F18-NaF excretion in the bladder and the potential scatter artifact limiting evaluation of the prostate bed. Results: On average patients received 5.5 +/- 0.5 mCi of F18-NaF and 10.4 +/- 0.8 mCi of F18-fluciclovine. All 16 patients had diagnostic quality scans. None had limited evaluation of the prostate bed secondary to artifacts from bladder scatter. 10 patients (62.5%) had residual or recurrent prostate cancer within the prostate bed, of which 3 (18.8%) had distant nodal disease in the perirectal, pelvis, retroperitoneal, or periaortic lymph node regions. 7 patients (43.8%) demonstrated osseous metastatic lesions within the clavicle, sternum, iliac wing, vertebra, coccyx, or sacrum. Conclusions: Combined 18F-NaF and 18F-fluciclovine scans in patients with prostate cancer is a feasible method for detecting soft tissue recurrence and osseous disease. Bladder excretion from F18-NaF does not obscure the prostate bed nor degrades the diagnostic quality of the exam. The combined use of 18F-fluciclovine and F18-NaF in one PET/CT acquisition has the potential to increase the sensitivity for detecting prostate cancer and limit the time and radiation dose delivered compared to the conventional, separate acquisitions of the two radiotracers.
Trends in lung cancer mortality between 2001 and 2017: An observational study in USA and EU.
Authors: Chinmay Jani, Dominic C Marshall, Harpreet Singh, Joseph Shalhoub, Justin Salciccioli
Journal: Journal of Clinical Oncology (2020)

e19277 Background: The lung is the commonest site of cancer and has the highest worldwide cancer-related mortality. Past two decades has seen advancements in screening technologies and guidelines, as well as new modalities for treatment. Few studies have reported on lung cancer trends in the 21 st century. Our study reports and compares trends in lung cancer mortality in the USA and European Union (EU). Methods: We utilized the World Health Organization (WHO) Mortality Database and Center for Disease Control (CDC) Wonder database. We extracted Lung Cancer mortality data from 2001 to 2017 based on ICD 10 system. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population and USA Standard Population. Lung cancer mortality trends were compared using Joinpoint regression analysis. Results: We analyzed a data from a total of 26 EU countries and USA, of which 6 countries had data till 2017, 12 till 2016, 7 till 2015 and 2 till 2014. We observed that mortality in men was down-trending in all countries except Cyprus and Portugal. In females, there was an increase in mortality in 22 countries. Amongst EU nations, most recently (2017) Hungary had the highest ASDRs for both males and females (64.5/100,000 and 31.0/100,000), whereas the lowest mortality was in Sweden for males (17.3/100,000) and Lithuania for the females (7.58/100,000). Latvia had the highest Estimated Annual Percentage Change (EAPC) in male mortality (-9.6%). Based on recent most data, we saw that there was a significantly lower mortality in males amongst European nations that joined the EU pre-2004 as compared to those that joined the EU post-2004 (p = 0.006). In USA, ASDRs in males and females were 44.3/100,000 and 30.6/100,000, respectively, with EAPC of -5.1% and -4.2% in males and females, respectively. Conclusions: For the study period, we observed expected decrease in lung cancer mortality in males. In contrast, there was a gradual rising trend in lung cancer mortality amongst females. In addition, there was substantial variation between nations. USA has shown consistent downtrend since 2001 where as there have been fluctuations in trends in other EU nations.
Letrozole + ribociclib versus letrozole + placebo as neoadjuvant therapy for ER+ breast cancer (FELINE trial).
Authors: Qamar J. Khan, Anne O'Dea, Aditya Bardia, Kevin Kalinsky, Kari Braun Wisinski, Ruth O'Regan, Yuan Yuan, Cynthia X. Ma, Mohammad Jahanzeb, Meghna S. Trivedi, Laura Spring, Issam Makhoul, Jamie L. Wagner, Onalisa Winblad, Amanda Leigh Amin, Sibel Blau, Gregory James Crane, Manana Elia, Mia Hard, Priyanka Sharma
Journal: Journal of Clinical Oncology (2020)

505 Background: Ribociclib (R) + letrozole (L) is superior to L in metastatic breast cancer (BC). Preoperative endocrine prognostic index (PEPI) score 0 after neoadjuvant endocrine therapy (NET) is associated with low risk of relapse without chemotherapy in ER+ BC. On-therapy change in Ki-67 predicts adjuvant recurrence. FELINE is a biomarker-based multicenter randomized trial comparing changes in Ki-67 and PEPI between L+ Placebo (P) &amp; L+R. Methods: Postmenopausal women with &gt;2 cm or node+ ER+ HER2- BC were randomized 1:1:1 between L+P, L+R 400 mg continuous dose (Rc) and L+R 600 mg, 3 weeks on/1 week off - intermittent dose (Ri). Treatment was continued for six 28-day cycles. Core biopsies, blood samples were obtained at baseline, Day 14 cycle 1 (D14C1), and surgery. Clinical measurement, mammogram and US were obtained at baseline, surgery; MRI at baseline, week 8. Primary endpoint was rate of PEPI score 0 between L+P and L+R (i+c combined). Other endpoints were change in centrally performed Ki-67, complete cell cycle arrest (CCCA): Ki-67 &lt;2.7%, clinical/imaging response, and difference in response &amp; toxicity between the two R (Rc and Ri) arms. Results: From 2/2016 to 8/2018, 120 women were enrolled at 9 US centers. Thirty-eight were randomized to L+P and 82 to L+R groups (41 in Ri and Rc). Treatment groups were balanced at baseline. PEPI score of 0 was equal (25%) in L+P &amp; L+R groups. CCCA at D14C1 was observed in 52% vs. 92% in L+P, L+R respectively (p &lt; 0.0001). CCCA at surgery was observed in 63.3% vs. 71.4% in L+P, L+R respectively (p = NS). A significant increase in Ki-67 was observed between D14C1 and surgery in 66% vs. 33% in L+R, L+P respectively (p = 0.006). There was no difference in clinical, mammographic, US or MRI response between L+P and L+R. CCCA at D14C1 and surgery was similar in Ri &amp; Rc arms. Grade &gt;3 AEs were observed in 4 (10%) patients in L+P, 23 (56%) in L+Ri, 19 (46%) in L+Rc arms. Conclusions: Addition of R to L as NET did not result in more women with a PEPI score of 0. At D14C1 twice as many women on L+R had CCCA compared to L+P (92% vs 52%). However, significantly more women on L+R had increased proliferation between D14C1 and surgery , resulting in similar CCCA at surgery. Correlative studies are being performed to determine mechanisms of on-therapy acquired resistance to ribociclib. Continuous and intermittent doses of R have similar efficacy, toxicity. Clinical trial information: NCT02712723 . [Table: see text]
Impact of an immuno-oncology (IO) education/monitoring program on patient’s self-efficacy and adverse event reporting from immune checkpoint inhibitors (ICIs).
Authors: Parneet Kaur Cheema, Massey Nematollahi, FeRevelyn Berco, Janet Papadakos, Deepanjali Kaushik, Priscilla Matthews, Marco Iafolla, Kirstin Perdrizet, Margaret Balcewicz, William Raskin, Stephen Reingold, Juhi Husain, Philip Kuruvilla, Henry Jacob Conter
Journal: Journal of Clinical Oncology (2020)

2032 Background: ICIs have unique side effects of immune related adverse events (irAEs). For early detection and management of irAEs, at a large community hospital we implemented a standard IO nursing baseline assessment, education and monitoring program. We studied it’s impact on a patient’s irAE reporting and self-efficacy (confidence to manage symptoms) of ICIs. Methods: Prospective study conducted at William Osler Health System, Brampton, Canada from May 2018-December 2019. Patients aged &gt; = 18, English speaking that received an ICI for cancer were included. Patients underwent a standardized baseline nursing assessment and education class. Patients identified at the assessment as high risk (risk of grade 3/4 irAE &gt;20%) had weekly nurse proactive calls. Cancer Behaviour Inventory – Brief Version (CBI-B) (Heitzmann et al, 2011) was used to evaluate patient’s self-efficacy. Results: Eighty patients were enrolled. Median follow up of 4.1 months. Baseline demographics: median age 69, 70% males, 77% Caucasian, 81% ECOG 0/1, 66% had English as their first language and 19% highest education was elementary, 30% high school, 26% trade diploma and 21% post-secondary. Fourty-one percent had limited cancer health literacy (measured by CHLT6 (Dumenci et al, 2014)). ICIs prescribed were 70% monotherapy anti-PD1/PDL1, 13% combination nivolumab/ipilimumab, 17% anti-PD1/PDL1 + chemotherapy/other therapies. Majority had a diagnosis of non-small cell lung cancer (55%), melanoma (19%) and renal cell carcinoma (9%). A statistically significant improvement in the average CBI-B scores were found pre and post baseline assessment/education (p &lt; 0.001) and this improvement was maintained over time at follow-up visits (non-significant change in scores from post education results). Fourty-three percent of patient’s experienced &gt; 1 irAE. Most were grade 1/2 at time of detection (65%). Method of detection was mainly by patient self-reporting (62%), followed by proactive calls (27%). Only 3 patients had detection of an irAE with an ER visit. Rate of discontinuation of ICIs due to toxicity was 8.8%. Conclusions: In this diverse patient population with almost half of patients having limited cancer health literacy, a standardized IO baseline assessment, education and monitoring program resulted in improved patient self-efficacy with most irAEs detected by self-reporting and proactive calls. Our IO program can be a model for other oncology programs.
Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China
Authors: Wu Dan, Wang Yun, Lam Kwok Fai, Hesketh Therese, 陈钟鸣, 肖月
Journal: BMJ (2015)

目的
研究新医疗卫生体系改革和医患关系恶化背景下医生工作满意度及士气的影响因素。


设计
运用自行设计的调查问卷进行横断面调查。


地点
调查开展于2012年3—5月，主要调查对象是中国浙江省的省级和县级医院以及基层医疗卫生机构。


结果
共调查202名医生。导致工作满意度低的主要原因是收入低、工作时间长。省级医院医生的满意度最低，基层医疗卫生机构医生的满意度最高。3%的医院医生以及27%的基层医疗卫生机构医生对工资满意。医院中仅有7%的医生对工作时间满意，基层医疗卫生机构中43%的医生对工作时间满意。医院只有不到10%的医生对带薪休假时间(3%)和带薪病假时间满意(5%)，而基层医疗卫生机构人员对这两项的满意度则分别为38%和41%。总体而言，87%的医生表示患者投诉的可能性比以前更高了，针对医生的暴力事件不断增加。仅有4.5%的医生愿意自己的子女成为医生，在125个提供原因的医生中，34%表示因为收入太低，17%表示因为职业风险太高，9%考虑到患者暴力威胁和人身安全问题。


结论
总体而言医生的工作满意度较低。医生的招聘与保持成为中国医疗卫生系统的重大挑战。应采取相应的应对策略，以保障将来医生的招聘与保持。具体措施包括：减少医生的工作量，尤其是省级医院医生的工作量，可以通过鼓励患者到基层医疗卫生机构就诊来实现。提高医生工资以及有效的处理患者对医生的暴力伤害。
Development of stroke knowledge instrument for middle-aged and aged people in community general outpatient clinics
Authors: Yiqian Zhu, Hua Yang, Zhijie Yu
Journal: BMJ (2019)

Objective
To develop a stroke knowledge instrument for middle-aged and aged people in community general outpatient clinics.


Methods
A stroke knowledge measurement tool was developed and the reliability and validity of the tool were evaluated. The developed measurement tool was applied for patients aged 45 to 75 years old from 10 community health service centers of three Shanghai districts, and the knowledge scores of the target population were analyzed.


Results
A total of three dimensions and 14 items were made up of the stroke knowledge instrument. A total of 1 750 subjects, including 709 males and 1 041 females with an average age of (65.93±3.67) years, were included in the survey. The standardized Cronbach′s coefficient was 0.742, and split-half correlation coefficient was 0.686 (P<0.01) for instrument test performance. There was a positive correlation between the sub-instrument and the overall-instrument, and the correlation coefficient was 0.448-0.728 (P<0.01) for content validity. The full score rate of overall stroke knowledge instrument was 8.46%(148/1 750), the full score rate for disease early symptomswas 46.00%(805/1 750), that for drug-related knowledge was 54.40%(95/1 750) and that for high risk factors was 17.94%(314/1 750). Logistic regression analysis showed that females, subjects with higher education level and married/cohabitation state had higher knowledge scores (P<0.01).


Conclusions
The developed stroke knowledge instrument has good reliability and validity for the middle-aged and aged population of community general outpatient clinic. The stroke knowledge levels are less satisfactory for this study population.


Key words: 
Stroke; Knowledge; Instrument; Reliability; Validity
Diagnosis and treatment of chronic diarrhea
Authors: Kaijie Liu
Journal: BMJ (2018)

慢性腹泻是消化系统常见疾病之一，其病因复杂，发病人群分布广泛。慢性腹泻影响患者的体力、精神状态、营养吸收、日常工作，大大降低患者的生命质量，造成较大的社会负担。通过阐述成人慢性腹泻的发病机制、分型、诊断和治疗,旨在提高临床医生对慢性腹泻的认识和诊治水平。