tbuckley/cabot-search huggingface dataset:
Survey and evaluation of chronic obstructive pulmonary disease screening questionnaire suitable to the Chinese BMI classification
Authors: Zhe Shi, Shilin Wang, Haiyan Wang
Journal: BMJ (2014)

Objective
To evaluate the validity of a questionnaire for Chinese body mass index (BMI) classification of chronic obstructive pulmonary disease (COPD) community screening.


Methods
A sample of 629 subjects (254 in COPD group, 375 in non-COPD group) were enrolled to undergo pulmonary function test (PFT) at our hospital. All subjects complete a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <70% defined as COPD. A screening questionnaire was completed after PFT. And the data were collected and the measurement indices validated with the Chinese BMI classification.


Results
Area under curve-receiver operating characteristic (AUC-ROC) of original screening questionnaire was 0.901 and the best cut-off value 19.5(20) points. Modifying BMI, the measurement indices of the questionnaire were better than before. AUC-ROC of the modified questionnaire was 0.916. The cut-off value was 16.5(17) points. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, Youden's index, positive predictive value, negative predictive value were 88.2%, 77.3%, 3.89, 0.15, 0.655, 72.5% and 90.6% respectively.


Conclusions
The item of BMI in COPD screening questionnaire is modified according to the Chinese BMI classification standard. And a cut-off value of 17 points is recommended. And it enhances the ability of questionnaire screening.


Key words: 
Pulmonary disease, chronic obstructive; Questionnaires; Body Mass Index
Measuring team effectiveness in healthcare: A comprehensive and practical tool.
Authors: Stephanie Zajac, Andrew Griggs, Katelyn Cavanaugh, Elizabeth Hunter Lazzara, Courtney Holladay
Journal: Journal of Clinical Oncology (2020)

e19188 Background: Publication trends reveal that research on teams and teamwork in healthcare has surged over the past decade. Efforts to improve team effectiveness have also become pervasive, with team training being identified as a top strategy for improving patient outcomes. Unfortunately, measures of team effectiveness in the literature vary greatly and are aimed largely toward clinical teams. The aim of this effort, therefore, is twofold: (1) to provide a tool that can be adapted and used to diagnose performance and guide targeted team training across team types, and (2) to further our understanding of teams across all areas of a healthcare system (clinical, research, and administrative) by providing a standard measurement tool. Methods: We began with a comprehensive framework of team effectiveness developed through a top down (i.e., literature review) and bottom-up (i.e., focus groups, interviews) approach. The framework includes 23 constructs identified as critical to teams (e.g., clear roles, supportive culture, conflict management, shared mental models). Next, three subject matter experts (SMEs) identified and compiled measures of team effectiveness published in the healthcare teams literature. Items were reworded as needed to be generally applicable across healthcare team types. The three SMEs then matched each revised item to the framework by independently labeling each with the framework construct it best represents. Items on which 2 out of 3 experts agreed were kept, and new items were generated as needed for construct coverage resulting in a refined item bank. This item bank was again independently rated on quality of item (e.g., clarity, avoidance of double-barreled questions) and construct representativeness (i.e., ensuring the most important aspects of each construct were captured). Two additional subject matter experts then reviewed the ratings, and kept the top five rated items for each construct, ensuring full coverage of the construct (i.e., removing items that were duplicative and tapped the same part of a construct). Results: The processes above resulted in a measure with 115 items that capture 23 fundamental constructs for teams in healthcare. Conclusions: The measure developed is applicable across team types. It can be adapted and used to diagnose team performance, inform training, and further understanding of what facilitates effective teamwork in multi-team systems performing diverse functions across the healthcare system.
Clinical value of emergency gastroscopy in diagnosis and treatment for upper gastrointestinal hemorrhage
Authors: Zong-li Chen, Xiu-hong Zhao
Journal: BMJ (2010)

Emergency gastroscopy was performed for 146 patients with upper gastrointestinal hemorrhage admitted to Tieying Hospital, Beijing to identify causes of bleeding and establish diagnosis. One hundred and thirty-nine of them were cured with endoscopic treatment, but two failed so to change to surgical operation. It suggested that early gastroscopy is a convenient, easy and safe method in diagnosis and treatment of upper gastrointestinal hemorrhage.

Key words: 
Gastroscopy;  Emergency treatment
Causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms
Authors: Tao Zhang, Xuemin Zhang, Wei Li, Xin Jia, Xiangchen Dai, Xiaoming Zhang
Journal: BMJ (2019)

Objective
Todiscuss the causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms.


Methods
This retrospective study included 7 patients with intimo-intimal intussusception who underwent endovascular repair of aortic dissecting aneurysms from January 2017 to June 2018. There were 5 males and 2 females aged 34 to 64 years (mean 47.1 years), with a clinical course from 8 hours to 3 months. Six cases presented with acute chest pain and 1 had abdominal pain. Preoperative CTA was performed in all patients to confirm the diagnosis. Six patients received thoracic endovascular aortic repair (TEVAR) and 1 receivedfenestration.


Results
The endovascular repairs were successful without converting to open surgery in all patients. Pathological classifications were 1 type Ⅰ, 5 type Ⅱ and 1 type Ⅲ. Four patients received another aortic stent at distal segment to cover the intimo-intimal intussusception and 1 patient at proximal site. One patients received another bare stent in the superior mesenteric artery, and 1 case received abdominal aortic stent implantation. Balloon was used in 2 cases to dilate the stenosis of aortic stents. The death occurred in 1 case at 3 days after surgery for metadata object description schema, and 1 patient needed continuous renal dialysis after discharge. The postoperative conditions (from 7 to 21 days) of other patients were normal without paraplegia, bowel necrosis, lower limb ischemia or arterial rupture.


Conclusions
The results indicate that the intimo-intimal intussusception in endovascular aortic dissecting aneurysms repair is rare and it is a severe complication. Re-endovascular aortic repair is a safe and reliable surgical approachbased on the type in early phase.


Key words: 
Aortic dissection; Endovascular repair; Arterial intima; Intussusception
Zero Echo Time–Based PET/MRI Attenuation Correction in Patients With Oral Cavity Cancer
Authors: Tetsuya Tsujikawa, Masafumi Kanno, Yumi Ito, Hiroshi Oikawa, Mahmudur G.M. Rahman, Norihiko Narita, Shigeharu Fujieda, Hidehiko Okazawa
Journal: Clinical Nuclear Medicine (2020)

Purpose The aims of this study were to demonstrate the feasibility of zero echo time (ZTE) MRI for jawbone identification, and to evaluate the quantitative performance of 18 F-FDG PET/MRI with ZTE-based attenuation correction (ZTE-AC) compared with PET/CT and PET/MRI with Dixon MR–based AC (Dixon-AC) in patients with oral cavity cancer (OCC). Materials and Methods Thirteen OCC patients underwent whole-body 18 F-FDG PET/CT and subsequent regional PET/MRI with Dixon-AC and ZTE-AC in 1 day. SUVs of the primary OCC and metastatic cervical lymph nodes (CLNs) were measured on PET/CT (SUV CT ), PET/MRI with Dixon-AC (SUV Dixon ), and ZTE-AC (SUV ZTE ). The SUVs were then compared. Results The ZTE MRI scans minimized the effects of metal artifacts from dentures, and ZTE-AC maps correctly delineated the jawbones. SUV Dixon and SUV ZTE had significant positive correlations with SUV CT (Pearson r = 0.97 and r = 0.99 for OCC, and r = 0.98 and r = 0.98 for CLNs, respectively). The mean ± SD of SUV CT , SUV Dixon , and SUV ZTE were 14.4 ± 8.0, 14.5 ± 8.6, and 15.6 ± 8.8 for OCC, and 6.3 ± 3.0, 8.0 ± 4.0, and 7.6 ± 3.9 for CLNs, respectively. For OCCs, SUV ZTE was significantly higher than SUV CT ( P &lt; 0.05), whereas there was no significant difference between SUV CT and SUV Dixon or between SUV Dixon and SUV ZTE . For CLNs, SUV Dixon and SUV ZTE were significantly higher than SUV CT ( P &lt; 0.01 and P &lt; 0.05, respectively), and SUV Dixon was significantly higher than SUV ZTE ( P &lt; 0.01). Conclusions ZTE MRI can correctly identify jawbones while minimizing the effects of metal artifacts. The ZTE-AC method in 18 F-FDG PET/MRI reduces the underestimation of tracer uptake due to Dixon-AC jawbone errors and improves the quantitative performance of PET for OCC patients.
Impact of antibiotics (ATB) on the recurrence of resected colorectal cancer (CRC): Results of EVADER-1 a nation-wide pharmacoepidemiologic study.
Authors: Benoit Rousseau, Marc Hilmi, Ines Khati, Anthony Turpin, Antoine Andremont, Charles Burdet, Nathalie Grall, Joana Vidal, Philippe Jean Bousquet, Christine Le Bihan
Journal: Journal of Clinical Oncology (2020)

4106 Background: Recent studies suggest that ATB increase the overall risk of CRC incidence through disruption of gut microbiota. Impact of ATB on the risk of CRC recurrence after curative resection remains unknown. Methods: Using the French nation-wide Institut National du Cancer (INCa – Système National des Données de Santé) database of cancer patients, all newly diagnozed localized CRC patients resected between 01/2012 and 12/2014 were involved. The perioperative ATB intake (6 month before until 1 year after surgery) was classified according to the spectrum, doses and period of use. The primary endpoint was 3-year Disease-Free Survival (3-DFS), stratified on chemotherapy (chemo) administration (yes/no), and assessed using multivariate Cox models. Results: Out of 219,884 CRC patients, the present study included 36,640 patients: male 53%, age≥75 years 39%, left colon/rectal 59%, exposure to chemo 44%, at least one ATB intake 74%. At 3-years, 29% of patients had recurred and 18% had died. In multivariate analysis, in patients not receiving chemo, ATB intake as an out-patient was significantly associated with better 3-DFS [HR (one ATB only) = 0.88 (0.82-0.94)]. This effect remained in the same range whatever the number of ATB or cumulative exposure to ATB. In patients receiving chemo, ATB intake as an out-patient had a significant detrimental effect on 3-DFS [HR (one ATB only) = 1.15 (1.08-1.23)], increasing with the number of ATB [HR (≥5 ATB) = 1.54 (1.39-1.71)] and longer exposure [HR ( &gt; 30 days) = 1.39 (1.31-1.48)]. Penicillin A, quinolones and ATB combinations were associated with worse 3-DFS. The timing of ATB intake related to chemo revealed that the strongest deleterious effect was observed when ATB were taken during chemo [HR = 1.64 (1.53-1.75)]. No difference in the mean number of chemo cycle was observed comparing patients receiving ATB or not. Conclusions: This nation-wide study is the first to suggest that ATB modulate 3-DFS in resected CRC with a differential impact according to chemo exposure. Importantly, ATB intake with chemo is detrimental in a dose- and time-dependent manner suggesting that dysbiosis of gut microbiota during adjuvant chemo might increase risk of recurrence.
Real-world (RW) systemic treatment patterns and clinical outcomes in locally advanced (LA) and recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC) patients (pts).
Authors: Thao Vo, Marley Boyd, Janet L. Espirito, Burak Gumuscu, Diana Romana Chirovsky, Nicholas J. Robert, Ramona F. Swaby, Wei Zhou, Charles Lance Cowey
Journal: Journal of Clinical Oncology (2020)

e19284 Background: Data is limited on RW systemic treatments, objective response rate (ORR), response duration (DOR), overall survival (OS), and time-to-treatment discontinuation (TTD) for cSCC. Clinical trials (CTs) use RECIST criteria for response assessment; however, frequency of follow-up imaging and availability/precision of tumor lesion measures outside of trials can vary across pts. Understanding the types of image-informed responses and outcomes available in clinical practice may inform RW study design and interpretation. Methods: Adults with LA and R/M cSCC receiving first-line (1L) systemic treatment from 09/04/2014 to 06/30/2017 in US Oncology community practices, with follow-up to 06/30/2018, were included. Baseline radiologic scan was required; pts in CTs or who had concurrent cancers or immunosuppressive disorders/treatments were excluded. The primary endpoint was RW ORR using RECIST 1.1, based on tumor lesion sizes (if available) in imaging reports from the iKnowMed electronic health record. If RECIST could not be applied, physician-assessed responses were used. Pts not evaluable for response were classified as non-responders. DOR, OS, and TTD were assessed using Kaplan-Meier methods. Results: 51 (11 LA + 40 R/M) cSCC pts were eligible. Median age was 76 yrs, 80% male, 86% Caucasian, 65% ECOG PS of 0/1. The primary location was head/neck in 67%. The most common 1L regimens were cetuximab (51%), carboplatin + paclitaxel (22%), and cisplatin (6%). Conclusions: Cetuximab was the most common treatment. OS and TTD in advanced cSCC were short. RW ORR was lower using RECIST than with physician assessment; however, few pts were evaluable by RECIST due to differences in available data in prospective vs. retrospective settings. [Table: see text]
Change in cardiac function with CPX-351 in relapsed pediatric AML: A Children’s Oncology Group (COG) report from AAML1421.
Authors: Kasey J. Leger, Michael Absalon, Biniyam G Demissei, Robert B Gerbing, Todd Allen Alonzo, Betsy A Hirsch, Jessica Anne Pollard, Bassem I. Razzouk, E. Anders Kolb, Richard Aplenc, Bonnie Ky, Todd Michael Cooper
Journal: Journal of Clinical Oncology (2020)

10532 Background: Anthracyclines (AC) are highly effective in treating acute myeloid leukemia (AML), but limited by cardiotoxicity (CTX). CPX-351, a liposomal preparation of daunorubicin (DNR) and cytarabine, may provide therapeutic benefit with less CTX. We evaluated acute changes in cardiovascular (CV) function and biomarkers after 1 cycle of CPX-351 in children with relapsed AML within the phase 1/2 study, AAML1421. Methods: Patients (pts) received 135 units/m 2 /dose of CPX-351 on days 1, 3, and 5. Echocardiograms were centrally quantified at baseline (BL) and day 29 (end of cycle (EOC)). High sensitivity troponin (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured at BL and days 5, 8, 15, 22, and 29. Differences between BL and post-CPX-351 echo/biomarker measurements were analyzed using pre-specified Wilcoxon signed rank tests. The relationship between EOC ejection fraction (EF) and clinical variables was assessed using repeated measures linear regression. Results: In 32 included pts, the median AC exposure prior to study entry was 337 mg/m 2 DNR equivalents. At baseline, markers of CV function and stress were abnormal (Table). Over 1 cycle, there was a statistically significant decrease in EF and circumferential strain (Table). NT-proBNP and cTnT did not increase significantly over time. In multivariable analysis, only increasing body surface area was significantly associated with lower EOC EF (b:-5.9, 95% CI -10.8,-0.9). Cancer therapy–related cardiac dysfunction, defined as ≥10% decline in EF to &lt; 50%, occurred in 6/32 pts at EOC. Conclusions: In this single arm study of AC pre-treated children, baseline abnormalities in CV function were common. CPX-351 was associated with a statistically significant decline in CV function without a rise in cardiac biomarkers. Absent a comparator population, it is not known how these cardiac trends compare to non-liposomal AC or non-AC salvage regimens. The COG AAML1831 trial will determine if CPX-351 offers cardioprotection compared to standard AC in pts with de novo AML. Clinical trial information: NCT02642965. [Table: see text]
Differential effects of epirubicin and docetaxel on the immune system in patients with breast cancer (BC).
Authors: Kerstin Wimmer, Monika Sachet, Hanna Birnleitner, Ruth Exner, Martin Filipits, Michael Gnant, Florian Fitzal, Rudolf Oehler
Journal: Journal of Clinical Oncology (2020)

588 Background: Neoadjuvant chemotherapy (NAC) with epirubicin/cyclophosphamid (EC) followed by docetaxel (D) is currently a standard of care therapy in women with early, high-risk breast cancer (BC). New approaches aim to improve the outcome by combining chemo- with immunotherapy. It is therefore of great interest if chemotherapeutics differ in their effect on the immune system and if some substances are superior combination partners than others. Methods: 79 BC patients, who participated in the ABCSG-34 trial, were included. 39 patients were treated with 6 cycles of EC followed by 6 cycles of D and 40 received the reverse sequence (D→EC). Blood was collected before and after 6 cycles. The plasma levels of a variety of immune mediators were determined by multiplex bead array assay. The response to therapy was measured by Residual Cancer Burden (RCB)-score. A score of ≤1.36 was determined as good response. Lymphocyte activation was assessed after stimulation with phytohaemagglutinin (PHA) by flow cytometric analysis of IFNgamma. Additionally, lymphocytes of 6 healthy probands were stimulated with PHA and treated with E or D. The stimulation was quantified by measuring cluster formation after 5 days. Further, a human BC cell line (SK-BR3) was treated with E or D. The induced cell death was determined morphologically as well as by flow cytometry after staining of phosphatidylserine, Sub-G1 DNA and active caspase-3. Results: The treatment of BC patients with 6 cycles of EC resulted in a decrease of lymphocyte stimulation whereas 6 cycles of D had no effect. The plasma levels of most immune mediators decreased significantly after six cycles EC when compared to baseline. Under the influence of D, the effect was much weaker. The changes of Eotaxin and OPG during the first 6 cycles of D correlated with the RCB-score in the reverse group. A decrease in Eotaxin (p = 0.0136) or in OPG (p = 0.0487) correlated with good response. The in vitro lymphocyte stimulation assay showed that E and D have similar inhibitory effects on lymphocytes.The annexin V/PI analysis confirmed that E more often leads to apoptotic cell death in SK-BR3 cells than D (E:53% vs. D:14%). SK-BR3 cells formed more often polyploid cells when treated with D. This suggests that D induces a regulated form of necrosis whereas E apoptosis. Conclusions: This study is the first to compare the immunomodulatory effect of E and D in BC patients. E inhibits lymphocyte activation in vitro and in vivo and suppresses many soluble immune mediators. This suggests that it is not suited for combination with immunotherapies. D showed a much weaker effect.
腰痛的原因及诊断
Authors: 刘宪义
Journal: BMJ (2011)

腰痛是临床常见症状,而非疾病.腰痛的发生率随着年龄的增加而上升,腰痛患者成为各级医生工作中经常面对的人群,但相当多的患者未能真正确诊.幸运的是多数患者腰痛在6周内可自然恢复,但仍有许多患者反复就医,疗效并不满意。
Arrhythmia induced by acute organophosphorous pesticide poisoning: a literature review
Authors: Dan-dan Xuan, Shu-cong Zheng, Wei-guo Wan, Hao-min Qiu, He-jian Zou
Journal: BMJ (2011)

Literatures on arrhythmia induced by acute organophosphorous pesticide poisoning published in domestic journals from 1979 to 2010 were searched. Total 3468 cases of acute organophosphorous poisoning were collected and analyzed. The average abnormal ECC rate was (53 ±15)%(35. 4% -68. 4% ) in acute organophosphorous poisoning, the most common ECG abnormalities were ST-T segment changes (26. 5% ) and sinus tachycardia (16. 6% ). The rate and severity of ECG abnormalities were increased with the severity of organophosphorous poisoning(x2 = 33. 253,P < 0. 01). The most common causes of death in acute organophosphorous poisoning were ventricular tachycardia and ventricular fibrillation (26.2%).

Key words: 
Organophosphorous compounds;  Arrhythmia
妊娠和产后甲状腺疾病诊治指南(节选三)
Authors: 中华医学会内分泌学分会, 中华医学会围产医学分会
Journal: BMJ (2012)

(上接2012年第11期第808页)七、妊娠期甲状腺毒症问题34:妊娠期甲状腺毒症的病因妊娠期甲状腺毒症患病率为1％,其中临床甲状腺功能亢进症(甲亢)占 0.4％,亚临床甲亢占0.6％.分析病因,Graves病占85％,包括妊娠前和新发Graves病;妊娠甲亢综合征(SGH)也称为一过性甲亢,占10％;甲状腺高功能腺瘤、结节甲状腺肿、葡萄胎等仅占5％。
The role of fibroblast growth factor receptor 4 (FGFR4) signaling in anti-EGFR resistance in colon cancer.
Authors: Sang Hee Cho, Jo-Heon Kim, Chang-Soo Hong, Eun-Gene Sun, Kyung-Hyun Ryu, Jun Eul Hwang, Woo Kyun Bae, Ik-Joo Chung, Hyun-Jin Bang
Journal: Journal of Clinical Oncology (2020)

4060 Background: Anti-EGFR therapy has been used as a standard treatment for metastatic colon cancer, but the innate resistance is still issues of increasing significance. Fibroblast growth factor receptor 4 (FGFR4) plays an important role in cell proliferation, invasion and anti-apoptosis, through the pathway of MAPK-ERK and PI3K-AKT. We investigated potential crosstalk between FGFR4 and EGFR signaling to identify new resistant mechanism of anti-EGFR therapy and how to overcome it in colon cancer. Methods: RNA-Seq was used to identify the associated signal pathway and down targets induced by FGFR4. Molecular studies including RTK array, RT-qPCR, western blotting were performed to validate the interaction between FGFR4 and EGFR signaling in vitro and in vivo. Next, the effect of FGFR4 in cetuximab resistance was investigated in vitro and in colon cancer patients. Results: FGFR4 overexpression in colon cancer cells activates downstream signaling, such as, PI3K/Akt and RAS/RAF/Erk pathway. Gene Ontology (GO) analysis from RNA-seq revealed that differentially expressed genes (DEGs) altered by expression of FGFR4 were related to biological functions, including cell proliferation, epidermal growth factor receptor signaling, NIK/NF-kB signaling, interferon-gamma signaling, wound healing. RT–qRCR showed that FGFR4 promotes the EGFR and ErbB3 by inducing the expression of EGFR ligands such as AREG, BTC, EREG, HBEGF. In vivo tumorigenesis, we found that FGFR4 promotes tumor growth and high expression of AREG in xenograft tumors. FGFR4 expression reduced the sensitivity to cetuximab in colon cancer cells and synergistic effect was shown when treated with FGFR4 inhibitor with cetuximab. A positive correlation between FGFR4 and AREG expression was observed in cancer, but not in normal tissues and high FGFR4 or AREG expression showed significantly inferior overall survival than low expression in patients treated with cetuximab for metastatic colon cancer. Conclusions: We demonstrated a pivotal mechanism of FGFR4 in colon cancer progression and cetuximab resistance through inducing AREG. Our data point to FGFR4 as a new biomarker to predict cetuximab response and dual targeting of FGFR4 and EGFR may be a promising treatment modality for colon cancer.