tbuckley/cabot-search huggingface dataset:
Randomized trial of a symptom monitoring intervention for hospitalized patients with advanced cancer (NCT03396510).
Authors: Ryan David Nipp, Nora K. Horick, Carolyn L. Qian, Emilia R. Kaslow-Zieve, Chinenye C. Azoba, Madeleine Elyze, Helen Perry Knight, Vicki A. Jackson, David P. Ryan, Joseph A. Greer, Areej El-Jawahri, Jennifer S. Temel
Journal: Journal of Clinical Oncology (2020)

12014 Background: Hospitalized patients with advanced cancer experience a high symptom burden, which is associated with poor clinical outcomes and increased health care use. Symptom monitoring interventions are increasingly becoming standard of care in oncology, but studies of these interventions in the hospital setting are lacking. We evaluated the impact of a symptom monitoring intervention in hospitalized patients with advanced cancer. Methods: We randomly assigned hospitalized patients with advanced cancer who were admitted to the oncology service to a symptom monitoring intervention or usual care. Patients in both arms reported their symptoms (Edmonton Symptom Assessment System [ESAS] and Patient Health Questionnaire 4 [PHQ4], higher scores on both indicate greater symptom severity) daily via tablet computers. Patients assigned to the intervention had their symptom reports presented graphically with alerts for moderate/severe symptoms during daily oncology rounds. The primary endpoint was the proportion of days with improved symptoms for those who completed two or more days of symptoms. Secondary endpoints included hospital length of stay (LOS) and readmission rates. Results: From 2/2018-10/2019, we randomized 390 patients (76.2% enrollment rate); 320 completed two or more days of symptoms (median age=65.6 [range 18.8-93.2]; 43.8% female). The most common cancers were gastrointestinal (36.9%), lung (18.8%), and genitourinary (12.2%). Nearly half of patients (48.5%) had one or more comorbid conditions in addition to cancer. We found no significant differences between intervention and usual care regarding the proportion of days with improved ESAS total (B=-0.05, P=.17), ESAS physical (B=-0.02, P=.52), PHQ4 anxiety (B=-0.03, P=.33), and PHQ4 depression (B=-0.02, P=.44) symptoms. Intervention patients also did not differ from usual care with respect to secondary endpoints of hospital LOS (7.50 v 7.59 days, P=.88) and readmission rates within 30 days of discharge (32.5% v 25.6%, P=.18). Conclusions: For hospitalized patients with advanced cancer, this symptom monitoring intervention did not have a significant impact on their symptom burden and health care use. These findings do not support the routine integration of this type of symptom monitoring intervention for hospitalized patients with advanced cancer. The positive outcomes seen in previous studies of symptom monitoring interventions may not be reproduced in other patient populations and care settings. Support: UG1CA189823; Clinical trial information: NCT03396510 .
Focus on the interrelationship of upper and lower airway inflammation
Authors: 顾之燕
Journal: BMJ (2008)

炎症反应是重要的病理生理反应,它不是一个疾病,而是疾病的一种表现.它具有有利的作用,如消灭入侵病原菌,从而防止感染的扩散;它也可引起疾病,如脑脓肿及其周围的炎症反应作为占位性病变,可致命地压迫周围的重要结构,慢性炎症反应导致的纤维化使组织变形并永久性失去或改变其功能。
Improving the delivery of team-based survivorship care after primary breast cancer treatment through a multi-level intervention.
Authors: Lauren P. Wallner, Paul Abrahamse, Archana Radhakrishnan, Lawrence C. An, Jennifer J. Griggs, Anne F. Schott, John Ayanian, Anne Sales, Steven J. Katz, Sarah T. Hawley
Journal: Journal of Clinical Oncology (2020)

7056 Background: The delivery of team-based survivorship care after primary cancer treatment remains challenging, in part due to a lack of effective interventions. We developed a multi-level intervention for breast cancer patients and their primary care and medical oncology providers to improve the delivery of team-based survivorship care called ConnectedCancerCare (CCC). CCC includes a patient-facing, personalized mobile website, and tailored feedback letters to providers. Methods: We conducted a pilot randomized controlled trial in a breast oncology clinic to establish the feasibility and acceptability of CCC. Women within one year of completing primary treatment for stages 0-II breast cancer were randomized to CCC (intervention) or a static online survivorship care plan (control). Participants completed online surveys at baseline and 3 months, ascertaining their knowledge about PCP roles in their survivorship care, their communication with their PCP about team-based care, and whether they scheduled a follow-up visit with their PCP. Multiple measures of acceptability were collected among women in the intervention arm (n = 28). Qualitative interviews were conducted at the completion of the study with 5 PCPs, 6 oncology providers, and 10 intervention patients to identify barriers and facilitators to implementing CCC. Results: Among 160 eligible women invited to participate, 66 women completed the baseline survey and were randomized (41% participation rate), and 54 completed the 3-month follow-up survey (83% response rate). Women in the intervention arm found the content of the CCC website to be highly acceptable, with 82% reporting it was easy to use, and 86% reporting they would recommend it to other patients. A greater proportion of women randomized to CCC (vs. control) reported scheduling a PCP follow-up visit (64% vs. 42%) and communicating with their PCP about provider roles (67% vs. 18%). Women in the CCC arm also reported higher mean knowledge scores regarding team-based cancer care (3.7 vs. 3.4). Providers noted challenges to implementing CCC, including integration into electronic medical records, and supporting sustained engagement with CCC over time. Conclusions: Our findings suggest deploying CCC in medical oncology practices is feasible, and the intervention content is acceptable among breast cancer patients. CCC shows promise for improving understanding and communication about provider roles in survivorship care, and facilitating patients to follow up with their PCP early in the survivorship period. Clinical trial information: NCT03618017 .
Staphylococcal scalded skin syndrome in patients with hematologic malignancy: a report of 4 cases
Authors: Jing-zhi Wang, Lan-ping Xu, Huan Chen, Dai-hong Liu, Kai-yan Liu, Xiao-jun Huang
Journal: BMJ (2009)

Objective To investigate the development of Staphylococcal scalded skin syndrome (SSSS) in patients with hematologic malignancy. Methods The clinical data of 4 cases of SSSS admitted from November 2006 to June 2008 were analyzed, and the related literatures were reviewed. Results Four patients developed SSSS all under severe immunosuppression. Two of them were in neutropenia, and the others had been intensively treated for severe graft versus host disease. They presented high fever and erythema, followed by the formation of flaccid bullae and exfoliation. Three patients recovered successfully with the treatment of vancomycin and intravenous administration of immunoglobulin. Withdraw of mmunosuppressive agents in patients following hematopoietie stem cell transplantation was helpful. Conclusions SSSS should be considered when high fever and erythema suddenly occur in patients with hematologic malignancy.

Key words: 
Staphylococcal scalded skin syndrome;  Hematologic neoplasms;  Graft vs host disease
Clinical analysis of 69 cases of non-HIV-related cryptococcal meningitis
Authors: Xuejiao Qi, Hui Bu, Xiaoming Fan, Yueli Zou, Junying He
Journal: BMJ (2020)

The clinical data of 69 patients with non-HIV-related cryptococcal meningitis admitted in the Second Hospital of Hebei Medical University from January 2013 to May 2019 were analyzed retrospectively.The main presentations of 69 patients are headache,fever,nausea,vomiting, visual impairment, hearing damage.Among them, 36 cases (52%) had underlying diseases, 30 cases (43%) were misdiagnosed, and 38 cases (55%) were complicated with high intracranial pressure. Cerebrospinal fluid examination showed that leukocytes increased in 47 cases, protein increased in 55 cases, chloride decreased in 41 cases, glucose decreased in 34 cases. The imaging findings were cerebral ischemia, hydrocephalus, meningeal or cerebral parenchyma enhancement. During the induction period, 63 cases were treated with combined antifungal drugs and 6 cases were treated with single antifungal drugs. The clinical symptoms were improved in 54 cases, 9 cases were discharged automatically and 6 cases died. The clinical manifestations, routine and biochemical examination of cerebrospinal fluid, imaging findings are not specific for patients with non-HIV-related cryptococcal meningitis.So early and multiple lumbar puncture should be performed to find etiological evidence to reduce misdiagnosis. The combination of antifungal drugs during the induction period is safe and effective.

Key words: 
Meningitis,cryptococcal; Antifungal agents; Intracranial pressure; Neurosurgical procedures
Ability of cell-cycle progression score to predict risk for progression to metastatic disease and disease-specific mortality in prostate cancer patients after prostatectomy.
Authors: Gregory P. Swanson, Steven Stone, Lauren Lenz, Todd Cohen
Journal: Journal of Clinical Oncology (2020)

5524 Background: Prostate cancer treatment aims to prevent metastatic disease (METS) and disease-specific mortality (DSM). A major challenge is to identify those at highest risk so additional intervention can be initiated earlier when it has a better chance of success. Pathologic parameters alone have limited ability to predict METS and DSM, but data suggests biomarkers can improve risk discrimination. Methods: Eligible patients had: (1) prostate cancer treated with radical prostatectomy (RP; 1988-1995); (2) available tissue for cell-cycle progression (CCP) testing that resulted in a valid score; (3) preoperative prostate-specific antigen (PSA); (4) no neoadjuvant therapy; and (5) clinical follow-up (N = 360). Cancer of the prostate risk assessment post-surgical (CAPRA-S) was combined with CCP into a combined cell-cycle risk score (CCR = 0.38 × CAPRA-S + 0.57 × CCP). Results: Median follow-up was 23.5 years for patients alive at last follow-up. Overall, 11% (41/360) developed METS and 9% (33/360) had DSM. CCP score added significant information to CAPRA-S when predicting METS (p = 0.001) and DSM (p = 0.001). CCR score was also a significant predictor of METS and DSM (p-values &lt; 1×10 −8 ). CCP and CCR scores were prognostic of METS in patients with rising post-RP PSA. Of patients with biochemical recurrence (BCR), 25% (41/163) developed METS. CAPRA-S alone was predictive of these events (p = 0.01) but was significantly improved with the addition of CCP (Hazard Ratio [HR] = 1.69 [95% Confidence Interval (CI) 1.13, 2.52], p = 0.014). CCR was also highly prognostic (HR = 1.56 [95% CI 1.20, 2.03], p = 0.001). CCR score discriminated risk of METS both post-RP and after post-RP BCR (Table). Conclusions: Overall, the CCR score significantly predicted METS and DSM in prostate cancer post-RP and was also highly prognostic in those with a post-RP rising PSA. It is therefore a useful tool for determining who is at greatest risk of treatment failure and may benefit from earlier intervention. [Table: see text]
Characteristics of patients who visited smoking cessation clinic
Authors: Hong-xia Yu, Jiang-tao Lin, Guo-liang Liu, Yuan Jiang, Yan Yang
Journal: BMJ (2009)

Objective To analyze the characteristics, smoking status, smoking quitting experience, severity of nicotine dependence, withdrawal symptoms of the patients who visited the smoking cessation clinic at China-Japan Friendship Hospital, Beijing.Methods Data of 452 smoking patients who visited the clinic during January 2005 to July 2007 were retrospectively analyzed for their smoking status, nicotine dependence, symptoms of withdrawal, and so on.Results The patients studied included 397 men and 55 women, with mean age of 42 years and average length of 21 years of smoking 20 cigarettes per day, and 45.1 percent of them were white collars with higher education and incomes.Their Fagerstrom Tolerance (nicotine dependence) Questionnaire (FTQ) score averaged 5.4.Three hundred and eighty of them (84.1%) had ever tried to quit smoking, but 335 of them (74.1%) did not get any help in their quitting attempts and relied only on their own efforts.Most of them smoked after meals and the most difficult thing for them was craving for cigarettes during their smoking quitting Two hundred and sixty-three of them (58.2%) knew smoking cessation clinic from newspaper or other media.Conclusions Smokers who visited smoking cessation clinic focused in those with higher levels of education and incomes, and their motivation of clinic visits mainly was for their benefit of health.Banning cigarette smoking in public places and publicity of hazards caused by smoking in media play active roles in promoting smokers to visit smoking cessation clinic.

Key words: 
Smoking cessation ;  Behavior addictive;  Nicotine replacement therapy
胃肠道肿瘤患者围手术期的营养评估与支持
Authors: 马恒, 于建勇
Journal: BMJ (2010)

恶性肿瘤是人类死亡的第二大主要因素,消化系统的恶性肿瘤占全身恶性肿瘤的60%～70%.胃肠道肿瘤患者营养不良比一般肿瘤患者发生时间更早,大部分胃肠道肿瘤患者术前存在不同程度的蛋白质及热量营养不良(PEM),患病率高达30%以上[1]。
Gender disparities in anal cancer incidence and mortality: A long-term US population-based analysis.
Authors: Firas Baidoun, Anas M Saad, Mohamed Gad, Mohammad Maysara Asfari, Muhammad Talal Sarmini, Yasmine Elkeraie, Yazan Alkehef, Muneer J. Al-Husseini, Muhamad Alhaj Moustafa
Journal: Journal of Clinical Oncology (2020)

e16059 Background: Anal cancer is an uncommon malignancy accounting for less than 3% of gastrointestinal malignancies in the US. In this large database study, we aimed to re-evaluate the difference in the incidence and mortality trend in both genders. Methods: We used SEER 18 database to study anal cancer cases in the US during 2000-2016. Incidence and mortality rates of anal cancer were calculated by gender and were expressed by 1,000,000 person-years. Annual percent change (APC) was calculated using join point regression software. Results: We reviewed 25,418 patients with anal cancer, of which 61.4% were females. Incidence of anal cancers was 14.375 and 19.427 per 1,000,000 person-years, in males and females, respectively. Incidence rates of anal cancer significantly increased over the study period, but this increase was sharper in females (APC = 2.220%, 95%CI [1.924-2.517], P &lt; .001) when compared to males (APC = 0.915%, 95%CI [0.303-1.531], P = .006). Mortality rates from anal cancer over the study period were 7.425 and 7.532 per 1,000,000 person-years, in males and females, respectively. Overall anal cancer mortality rates did not change between 2000-2009 but started to decrease starting from 2010 and this decrease became sharpest between 2014-2016; APC = -44.905%, 95%CI [-57.572- -28.457], P = .001). Mortality rates followed the same trend in both genders. Conclusions: Anal cancer incidence is increasing with significant increase in the incidence trend is noticed in females compared to males which is a change from the previous trend that was seen from 1973-2000. On the other hand, anal cancer mortality has started to decrease for the first time starting from 2010 with no difference in the mortality trend between males and females. This improvement in mortality rate can be explained by the improvement in early detection rate and possibly improvement in the treatment approach for these high-risk patients.
急性腹痛的现场快速判断和初步诊断
Authors: 冯庚
Journal: BMJ (2004)

急性腹痛(acute abdominalgia)是急诊患者最常见的主诉之一,由腹腔内器官病变产生的腹痛称为真性腹痛,腹壁和腹部临近部位病变以及全身性疾病引发的腹痛称为假性腹痛.急性腹痛的特点是起病急骤、病因复杂多变、病情严重程度不一,如果诊断不及时或处理不当将产生严重后果.约有15%～40%的人患过急性腹痛,25%的急性腹痛需要紧急处理.一般情况下患者不会因轻度或中度的腹痛立即寻求治疗,他们希望腹痛能够缓解或自己服药治疗,因此院前急救部门和社区医师处理的以腹痛为主诉的医疗急救求助大都是突发的严重腹痛。
Initial safety run-in findings with bavituximab plus pembrolizumab in patients with advanced gastric or gastroesophageal cancer.
Authors: Ian Chau, Haeseong Park, Jeeyun Lee, Jessicca Martin Rege, Kerry Culm-Merdek, Johanna C. Bendell
Journal: Journal of Clinical Oncology (2020)

e16537 Background: Bavituximab, an investigational, chimeric monoclonal antibody designed to inhibit the immunosuppressive effects of phosphatidylserine (PS), is being evaluated in combination with pembrolizumab in patients with advanced gastric and gastroesophageal junction (GEJ) cancer. Bavituximab binds in a high-affinity complex with β2-glycoprotein and PS to reverse immunological non-responsiveness and activate multiple immune cell receptors. Post-hoc data from the Phase III Sunrise second-line lung cancer study indicated that patients who progressed on study treatment with bavituximab plus docetaxel and continued with a checkpoint inhibitor showed significantly improved overall survival. Cumulative data suggest that bavituximab may potentiate pembrolizumab-mediated checkpoint inhibition, potentially increasing overall clinical benefit. ONCG100 is a phase 2, multicenter, open-label, single-arm global study designed to assess the safety, tolerability and efficacy of bavituximab and pembrolizumab when administered in combination to advanced gastric or GEJ adenocarcinoma patients, regardless of PD-L1 status, who have progressed on or after at least one prior standard therapy (NCT04099641). Methods: The safety run-in phase of the trial evaluated the safety and tolerability of de-escalating doses of bavituximab when administered in combination with the approved dose and schedule of pembrolizumab (200mg, Q3W). Adverse events were evaluated by CTCAE v5.0. Results: Three patients enrolled and completed the safety-run in phase of the study where bavituximab was administered at the starting dose of 3 mg/kg QW in combination with pembrolizumab. There were no dose-limiting toxicities observed during the 21-day monitoring period. A total of 4 treatment emergent adverse events were observed; 2 of which were reported as related to treatment with bavituximab (arthralgia and fatigue, both grade 1). There was one treatment-unrelated SAE reported (chylous ascites, grade 2), which resolved allowing the patient to continue treatment. Conclusions: The 3 mg/kg dose of bavituximab was readily combined during the safety run-in phase of the study with the approved dose of pembrolizumab. The AE profiles for this combination were manageable and expected given the known profiles of each agent. Based upon these findings, the recommended dose for expansion for the combination was declared and the expansion phase of the study opened. Updated safety data from the study will be presented. Clinical trial information: NCT04099641 .
Brachial artery endothelial function and carotid intima-media thickness of H-type hypertensive patients
Authors: Lei Li, Li Qin, Qiujun Lu, Hailong Lu, Pingjing Li
Journal: BMJ (2017)

Objective
To investigate brachial artery endothelial function and carotid intima-media thickness (IMT) in patients with H-type hypertension.


Methods
One hundred and twenty patients with newly-diagnosed mild to moderate hypertension were enrolled in the study, including 58 cases with normal homocysteine (HCY) level (<10 μmol/L, non H-type group) and 62 cases with high HCY (≥10 μmol/L, H-type group). Systolic pressure, diastolic pressure, blood lipid (TC, TG, LDL-C, HDL-C), fasting plasma glucose and two hours postprandial plasma glucose were measured in all patients. Brachial artery endothelial function and carotid IMT were determined with ultrasonography and compare between two groups. The factors related to brachial artery endothelium-dependent dilation (EDD) and carotid IMT were analyzed with multiple linear stepwise regression.


Results
Compared with non H-type group, the brachial artery EDD was reduced [(6.85±0.77)% vs.(5.98±0.85)%, t=2.552, P=0.041 ] and carotid IMT was increased [(0.90±0.13)mm vs.(1.01±0.17)mm, t=2.426, P=0.048] in H-type group. The multiple linear stepwise regression analysis showed that EDD was negatively correlated to systolic pressure, diastolic pressure, fasting plasma glucose, two hours postprandial plasma glucose and HCY (r=-0.685, -0.654, -0.571, -0.627, -0.529, respectively, all P<0.05). IMT was positively related to systolic pressure, diastolic pressure, TC, TG, LDL-C and HCY (r=0.596, 0.584, 0.652, 0.665, 0.673, 0.541, respectively, all P<0.05).


Conclusion
Patients with H-type hypertension are at a higher risk to arteriosclerosis than those with non H-type hypertension, which may be related to high HCY levels.


Key words: 
Hypertension; Homocysteine; Endothelial function; Intima-media thickness
Dental Calculus as a Tool to Study the Evolution of the Mammalian Oral Microbiome
Authors: Jaelle C Brealey, Henrique G Leitão, Tom van der Valk, Wenbo Xu, Katia Bougiouri, Love Dalén, Katerina Guschanski
Journal: Molecular Biology and Evolution (2020)

Dental calculus, the calcified form of the mammalian oral microbial plaque biofilm, is a rich source of oral microbiome, host, and dietary biomolecules and is well preserved in museum and archaeological specimens. Despite its wide presence in mammals, to date, dental calculus has primarily been used to study primate microbiome evolution. We establish dental calculus as a valuable tool for the study of nonhuman host microbiome evolution, by using shotgun metagenomics to characterize the taxonomic and functional composition of the oral microbiome in species as diverse as gorillas, bears, and reindeer. We detect oral pathogens in individuals with evidence of oral disease, assemble near-complete bacterial genomes from historical specimens, characterize antibiotic resistance genes, reconstruct components of the host diet, and recover host genetic profiles. Our work demonstrates that metagenomic analyses of dental calculus can be performed on a diverse range of mammalian species, which will allow the study of oral microbiome and pathogen evolution from a comparative perspective. As dental calculus is readily preserved through time, it can also facilitate the quantification of the impact of anthropogenic changes on wildlife and the environment.
Effects of community nursing interventions on rehabilitation of stroke patients with attention disorders
Authors: Hong-yan Qi, Jian-bo Yu, Xue-fang Li, Xiao-fen Wu
Journal: BMJ (2013)

Objective
To study the effects of community nursing interventions on stroke patients with attention disorders.


Methods
A total of 60 stroke patients fulfilling eligibility were divided randomly into two groups. Their data were collected between December 2010 and February 2012. The intervention group was treated by community nurses while the control group trained by family members. Attention was assessed by simple reaction time (SRT) and number cancellation test (NCT). Modified Barthel index was used to assess the activities of daily living (ADL). Both groups were evaluated before and after a 2-month intervention.


Results
Before treatment, the control group had (0.71±0.25), (662.8±152.7) and (31±8) scores at SRT, NCT and MBI respectively. And the intervention group yielded (0.69±0.19), (652.7±131.0) and (30±8) scores at SRT, NCT and MBI respectively. There were no significant differences in average value of SRT, NCT and MBI between training and control groups at pre-treatment (P>0.05). After 2 months, the control group had (0.68±0.20), (637.4±151.7) and (33±8) scores at SRT, NCT and MBI respectively. And the intervention group yielded (0.56±0.16), (540.3±125.9) and (37±8) scores at SRT, NCT and MBI respectively. Very significant difference existed in attention scale scores at Month 2 (P<0.01) and the difference in ADL scale scores was also significant (P<0.05).


Conclusion
For stroke patients with attention disorders, strengthening community nursing interventions may help to improve attention and boost activity of daily living.


Key words: 
Hospital, community; Cerebrovascular accident; Intervention studies; Attention