tbuckley/cabot-search huggingface dataset:
Radiofrequency ablation versus stereotactic body radiotherapy for painful osseous metastases: A comparative correlation meta-analysis of pain relief.
Authors: Tej Mehta, Caleb Heiberger, Stephanie Kazi, Boggy Anton, Mark Brown, Matthew Lommen, Simcha Weissman, Divyajot Sandhu, Kelvin Hong, Douglas Yim, Minesh P. Mehta
Journal: Journal of Clinical Oncology (2020)

e24156 Background: Osseous metastases (OMs), a common cause of cancer pain, are only partially palliated by analgesics. Stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are increasingly used, but the comparative effectiveness of SBRT vs. RFA for OMs has not been adequately evaluated. Herein we analyzed palliative benefits of SBRT and RFA in terms of pain relief from OMs. Methods: A systematic review was performed for all studies reporting palliative outcomes of SBRT (defined as five or fewer fractions of radiation) or RFA for palliation of OMs. Studies not reporting pain palliation were excluded. Random effects model determined the net Pearson correlation (R 2 ) for post-SBRT and post-RFA pain reduction over time. The pooled correlation coefficient and 95% confidence interval were calculated using Fisher r-to- z transformation. Risk of bias was assessed using sunset plots; heterogeneity was assessed using I 2 and meta-regression. Results: Seven full-text articles assessed a total of 1100 SBRT patients and 22 full-text articles assessed a total of 557 RFA patients. No studies directly compared SBRT to RFA. All included studies collected data on pain related to OM disease pre- and post-therapy. The scales used included the visual analog scale (2 SBRT, 15 RFA), brief pain inventory (4 SBRT, 4 RFA), numeric rating scale (0 SBRT, 2 RFA), QLQ-15 (1 SBRT, 0 RFA), or the memorial pain index card (0 SBRT, 1 RFA). Mean SBRT dose and fractions were 17.3 gy and 2.6. Median follow-up was 24 weeks for SBRT and 18 weeks for RFA, with median pain reduction of 59% (R 2 =0.83, 95%CI:0.80-0.87, I 2 =58.63%) and 64% (R 2 =0.52, 95%CI:0.41-0.62, I 2 =48.16%) respectively. Meta-regression by number of fractions and reporting metric fully accounted for heterogeneity in the SBRT and RFA data respectively. Sunset plots did not indicate significant publication bias. Conclusions: The published literature is predominately non-randomized, limiting the evidence level. Pain reduction and durability post-SBRT or post-RFA are comparable. Pre-SBRT or RFA therapies may obscure the full effect of either treatment modality. SBRT and RFA for painful OMs are associated with pain relief in a majority of patients, but the durability of this relief and the comparative efficacy of SBRT vs. RFA for this purpose has been inadequately reported in the literature. Future, combinatorial therapies as opposed to single-modality approaches may help to increase overall pain relief and durability as well as efficaciously palliating treatment-resistant patients.
Clinical characteristics of connective tissue disease-related interstitial lung disease: an analysis of 186 cases
Authors: Xiguang Yang, Weisong Chen, Jilin Xu, Hui Chen
Journal: BMJ (2019)

Objective
To analyze the clinical characteristics of connective tissue disease related interstitial lung disease (CTD-ILD).


Methods
The demographic data, clinical manifestations, blood gas analysis, lung function, chest high resolution CT (HRCT), histopathology of 186 patients with CTD-ILD admitted in Jinhua Central Hospital from January 2013 to December 2017 were retrospectively analyzed.


Results
In 186 patients with CTD-ILD,70 were males and 116 were females, with a mean age of 56.22±12.27. Among them, 61 cases were polymyositis/dermatomyositis (DM/PM)-ILD, 44 cases were rheumatoid arthritis (RA)-ILD, 26 cases were interstitial pneumonia with autoimmune features (IPAF), 16 cases were systemic sclerosis (SSc)-ILD, 14 cases were Sjogren syndrome (SS)-ILD, 11 cases were overlap syndrome (OS)-ILD, 7 cases were systemic lupus erythematosus (SLE)-ILD, 5 cases were undifferentiated connective tissue disease (UCTD)-ILD, and 2 cases were mixed connective tissue disease (MCTD)-ILD. The incidence of respiratory symptoms was higher than that of systemic symptoms, and the incidence of systemic symptoms was higher than that of skin symptoms. Cough was the most common symptom of respiratory system, and arthralgia was the most common symptom of systemic symptoms, accounting for 54.9% (101/186) and 48.9% (91/186) respectively. Blood gas analysis showed that hypoxemia accounted for 56.5% (83/147) and type Ⅰ respiratory failure accounted for 26.5% (39/147) . The proportion of restrictive ventilation dysfunction in pulmonary function tests was 70.9% (105/148) and the diffuse dysfunction was 81.1% (120/148) . The manifestations on HRCT were reticular linear shadow (44.1%), ground-glass opacity (54.3%), consolidation (23.1%), nodules shadow (20.9%) and cystic low density shadow (9.1%) . The histopathological diagnosis mainly was non-specific interstitial pneumonia (NSIP, 43.0%) and usual interstitial pneumonia (UIP,40.0%).


Conclusion
The arterial blood gas analysis, lung function and chest HRCT screening, and lung histopathological examination are important for early identification and diagnosis of CTD-ILD.


Key words: 
Connective tissue diseases; Lung diseases, interstitial; Blood gas analysis
Emergency management of 2019 novel coronavirus: implications for the dermatology department
Authors: J. Tao, Z. Song, L. Yang, C. Huang, A. Feng, X. Man
Journal: British Journal of Dermatology (2020)

Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan.
Mitochondria as a target for neuroprotection: role of methylene blue and photobiomodulation
Authors: Luodan Yang, Hannah Youngblood, Chongyun Wu, Quanguang Zhang
Journal: Translational Neurodegeneration (2020)

Abstract Mitochondrial dysfunction plays a central role in the formation of neuroinflammation and oxidative stress, which are important factors contributing to the development of brain disease. Ample evidence suggests mitochondria are a promising target for neuroprotection. Recently, methods targeting mitochondria have been considered as potential approaches for treatment of brain disease through the inhibition of inflammation and oxidative injury. This review will discuss two widely studied approaches for the improvement of brain mitochondrial respiration, methylene blue (MB) and photobiomodulation (PBM). MB is a widely studied drug with potential beneficial effects in animal models of brain disease, as well as limited human studies. Similarly, PBM is a non-invasive treatment that promotes energy production and reduces both oxidative stress and inflammation, and has garnered increasing attention in recent years. MB and PBM have similar beneficial effects on mitochondrial function, oxidative damage, inflammation, and subsequent behavioral symptoms. However, the mechanisms underlying the energy enhancing, antioxidant, and anti-inflammatory effects of MB and PBM differ. This review will focus on mitochondrial dysfunction in several different brain diseases and the pathological improvements following MB and PBM treatment.
Post-operative disposition and readmission rates in repeat resections for glioblastoma.
Authors: Alex Guzner, Omar Bushara, Alexander Hou, Denise M. Scholtens, Kirsten Bell Burdett, Matthew Tate, Priya Kumthekar
Journal: Journal of Clinical Oncology (2020)

e14543 Background: Glioblastoma Multiforme is an aggressive primary brain tumor that will inevitably recur despite initial resection and maximal medical treatment, and re-resection is often pursued. Surgical resection has been shown to impact survival both in the upfront and recurrent settings, but it is unknown if subsequent resections impart worsened neurologic outcomes. The goal of this study was to evaluate patient’s post-operative disposition, hospital length of stay, and readmission within 30 days of discharge as a function of number of resections. Methods: This project was a retrospective chart review. Demographic information was collected regarding patients’ age, sex, IDH-1 mutation, and MGMT methylation status, and each patient’s discharge summary and hospital encounters were reviewed to determine length of hospital stay, location of disposition (home, acute rehabilitation facility, or skilled nursing facility), and readmission within 30 days of initial release. Univariate associations between each clinical predictor and outcome of interest were evaluated. Results: 162 patients with Glioblastoma as indicated on initial surgical pathology report met the inclusion criteria. 108 patients underwent two resections, 48 underwent three resections, and 6 underwent four resections. No statistically significant associations were observed between resection number and age, sex, MGMT methylation status, IDH-1 mutational status, disposition category, hospital length of stay, or readmission within 30 days. Disposition category after first resection was significantly associated with disposition category after second resection (p = 0.041) and readmission within 30 days after second resection was significantly associated with readmission within 30 days after third resection (p = 0.003). Hospital length of stay after second or third resections was not significantly different than a patient’s length of stay after first resection. Conclusions: These data demonstrate for the first time that subsequent resections are not associated with worse patient outcomes and that patient disposition after initial resection is an important predictor of disposition with subsequent resections.
Early results of TROPHY-U-01 Cohort 2: Sacituzumab govitecan (SG) in platinum-ineligible patients (pts) with metastatic urothelial cancer (mUC) who progressed after prior checkpoint inhibitor (CPI) therapy.
Authors: Daniel Peter Petrylak, Scott T. Tagawa, Rohit K. Jain, Manojkumar Bupathi, Arjun Vasant Balar, Arash Rezazadeh, Saby George, Phillip Lee Palmbos, Luke T. Nordquist, Nancy B. Davis, Nicholas J. Vogelzang, Chethan Ramamurthy, Cora N. Sternberg, Yohann Loriot, Neeraj Agarwal, Quan Hong, Allison Gladden, Charu Kanwal, Trishna Goswami, Petros Grivas
Journal: Journal of Clinical Oncology (2020)

5027 Background: SG is an antibody-drug conjugate consisting of a humanized monoclonal anti–Trop-2 antibody coupled to the cytotoxic agent, SN-38, via a unique hydrolyzable linker. The epithelial cell surface antigen, Trop-2, demonstrates greater expression between UC vs normal tissue, and is a promising target. In a phase 1/2 basket study (IMMU-132-01), SG showed an overall response rate (ORR) of 31% and manageable toxicity in 45 pts with mUC who had a median of 2 (range 1–6) prior therapy lines (Tagawa 2019 ASCO GU). Recent interim results for cohort 1 of the TROPHY-U-01 study in 35 pts with mUC who progressed on platinum and CPI therapy demonstrated an ORR of 29% in pts with a median of 3 prior treatment lines (range 2–6) (Tagawa 2019 ESMO). The most common grade ≥3 treatment-related AE (TRAE) was neutropenia. Methods: TROPHY-U-01 (NCT03547973) is a global, open-label, phase 2 trial evaluating the antitumor activity of SG (10 mg/kg, days 1 and 8 of 21-day cycles) in pts with advanced UC with measurable disease and ECOG PS 0 or 1. Cohort 2 includes platinum-ineligible pts who progressed after CPI therapy in the first-line metastatic setting. The primary objective is ORR evaluated with RECISTv1.1 by central review. Secondary objectives include progression-free survival, overall survival, and duration of response. Results: 18 pts with baseline tumor assessment (50% male; median age 79 y [range 57–87], 67% visceral metastases; 28% liver metastases) received a median of 2 (range 1–5) prior therapies. At a median follow-up of 6 months, ORR was 28% (5/18) with 4 confirmed PRs, and 1 PR pending confirmation. The majority of pts (61% [11/18]) had target lesion reduction. The safety profile was consistent with prior reports. Key grade ≥3 TRAEs were neutropenia (39%), fatigue (33%), diarrhea (28%), leukopenia (22%), anemia (17%), and febrile neutropenia (11%). No events of interstitial lung disease, ocular toxicities, or grade &gt; 2 neuropathy were reported. There were no treatment-related deaths. Conclusions: In cisplatin-ineligible pts, the ORR for currently approved first-line CPI treatments is ~23–29% (Balar 2017 Lancet; Vuky 2018 ASCO). These preliminary data with SG show a manageable safety profile with an encouraging ORR of 28% and support the development of SG in platinum-ineligible pts with mUC who have progressed after CPI therapy. Clinical trial information: NCT03547973 .
欧洲血脂异常管理指南解读
Authors: 刘靖, 胡大一
Journal: BMJ (2012)

2011年6月28日,欧洲心脏病学会(European Society ofCardiology,ESC)和欧洲动脉粥样硬化学会(EuropeanAtherosclerosis Society,EAS)联合发布了血脂异常管理指南(以下称ESC/EAS血脂指南)[1].该指南汇集并整合了当今血脂及相关领域的流行病学及循证医学的最新证据以及动脉硬化与血脂专家的意见,反映了血脂异常评估与干预治疗的新观点、新动向.指南分为完整版及口袋版( porketguideline)两种,供全科医师、心血管专科医师、血脂或代谢专家临床决策时参考.现将新指南中的要点总结如下,希望为全科医师系统地管理血脂异常患者提供借鉴。
冠心病患者介入术后的社区随访
Authors: 赵明中
Journal: BMJ (2006)

自上个世纪70年代开展首例冠状动脉狭窄病变的经皮球囊扩张术以来,冠心病的介入治疗得到迅速发展.我国的冠心病介入手术开展较晚,但进展迅速.特别是近10年来,据全国注册登记资料显示,经皮冠状动脉介入干预(PCI)的例数每年以30%的速度递增,去年我国冠心病PCI病例达8万余例,今年预计还会继续增多.但在介入技术取得蓬勃发展的今天,我们不能够对这类患者只救不管,只注重救治过程而忽略救治后的随访与管理.冠心病的整体防控是一个系列工程,包括院前的多重危险因素的积极防治、院中的合理救治与出院后的随访与管理.我们应树立疾病的整体意识,体现以人为本,全方位服务于患者.大型的中心医院及社区医院是冠心病防治的两个重要场所.冠心病患者,尤其是在中心医院进行介入术治疗后的患者,回到社区后应得到科学、规范的随访与管理。
Willingness to attend assistant general practitioner training among junior medical college students in Yunnan Province and its influencing factors
Authors: Weiming Li, Dan Yuan, Rong Zi, Qunqin Shu, Qiaoyun Huang, Min Zhang, Yuechao Chen, Xingli Huang
Journal: BMJ (2018)

Objective
To survey the current situation and influencing factors of willingness to attend assistant general practitioner training among junior medical college students in Yunnan Province.


Methods
A questionnaire survey and interview on the willingness to attend the training of assistant general practitioner was conducted from May 2017 to June 2017 in Yunnan Province, 1 800 students from 6 junior medical colleges were selected as participants by stratified cluster sampling method.


Results
A total of 1 800 questionnaires were distributed and 1 710 were collected, of which 1 634 were valid with a recovery rate of 95.00% and an effective rate of 95.56%. The results showed that 43.21% (706/1 634) participants were not aware of the relevant training policies, while there were significant differences among participants in the different grades and types of college (public or private) (Z=-0.899,8.658,-13.954;P<0.05); 83.17% (1 379/1 634) participants were willing to sign up for an assistant general practitioner training after graduation, while there were significant differences among participants in different ethnic groups, grades, household register sites, types of college, and family income (P<0.05). Total of 1 300 (79.56%) chose to work as a general practitioner in rural grassroots institutions after graduation, and 984 (60.22%) chose to become a specialist after graduation. Unconditional logistic regression analysis showed that the types of medical college, attitude towards the training policy, the intension to work in grassroots level or to work in private hospitals were influencing factors for willingness to attend the assistant general practitioner training among medical students(B=1.654, 3.764, 1.361, -0.569; P<0.05).


Conclusion
The survey shows that the policy awareness and the willingness to attend assistant general practitioner training for student in junior medical college in Yunnan Province are not high, and the policy publicity and the career guidance need to be strengthened.


Key words: 
Clinical medical students; Training; General practitioner, assistant
新生儿缺氧缺血性脑病的治疗
Authors: 肖昕
Journal: BMJ (2009)

迄今为止,新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)发生发展的病理生理机制尚未完全阐明,其治疗也未取得突破性进展,但包括综合治疗和亚低温疗法在内的一些干预手段仍能明显改善其预后[1-3]。
发热-憋气
Authors: 尚程辛, 沙悦
Journal: BMJ (2012)

患者女,15岁,发热3周入院.3周前患者淋雨后出现发热,伴咽痛,体温最高38.0℃,无咳嗽、咳痰、腹痛、腹泻,于当地诊所查“扁桃体肿大”,予“头孢”抗生素治疗2d后体温降至正常,遂停药.停药2d后再次发热,体温最高39.0℃,伴畏寒.当地医院查血常规:WBC 12.80×109/L,分类中性粒细胞0.706,Hb 114 g/L,PLT164×109/L.尿常规正常,便潜血(+),肝肾功能、凝血功能正常,ESR83 mm/1 h.肌酸激酶(CK)416 U/L.先后予“头孢类抗生素(不详)、阿奇霉素、亚胺培南、替考拉宁”等治疗,效果不佳,仍每日发热. 关键词：红斑狼疮;系统性
Comparative efficacy of chemoimmunotherapy versus immunotherapy alone in the front-line treatment of advanced non-small cell lung cancer: A systematic review and network meta-analysis.
Authors: Ranjan Pathak, Gilberto Lopes, Han Yu, Wenyan Ji, Madan Aryal, Katherine Stemmer Frumento, Christopher J.D. Wallis, Zachary William Abraham Klaassen, Henry Soo-Min Park, Sarah B. Goldberg
Journal: Journal of Clinical Oncology (2020)

9552 Background: Immune checkpoint inhibitors (ICI) and combination chemotherapy (chemo) plus ICI (Chemo-ICI) have been shown in RCTs to have improved OS compared to chemo in the 1L treatment of advanced NSCLC. However, the benefit of chemo-ICI compared with ICI alone is unknown. Methods: Systematic review using MEDLINE, Embase and Cochrane CENTRAL was done to identify relevant studies up to December 2019. Phase 3 RCTs that evaluated the efficacy of 1L ICI or chemo-ICI and reported outcomes stratified by PD-L1 status (&lt;1%, 1-49%, ≥50%) were included. ICI was defined as single-agent PD-1 axis inhibitor or dual checkpoint blockade with PD-1 axis inhibitor plus CTLA-4 inhibitor. Comparison for PD-L1&lt;1% included chemo-ICI vs ipi/nivo and for PD-L1 1-49% and PD-L1&gt;50% included chemo-ICI vs ipi/nivo or single-agent ICI. OS, PFS, and ORR were extracted. Network meta-analysis (NMA) was done in Bayesian random-effects regression models. Results: Ten phase 3 RCTs (7971 screened) involving 7,218 patients assigned to ICI (pembro or atezo or ipi/nivo) or chemo-ICI (platinum-doublet + atezo, pembro, or nivo) were included. In PD-L1 &lt;1% patients, NMA comparing chemo-ICI with ipi/nivo failed to show a statistically significant difference in OS, PFS or ORR. In PD-L1 1-49% patients, there was no significant difference between chemo-ICI vs ICI in OS or ORR; PFS could not be analyzed due to lack of available data. In PD-L1 &gt;50% patients, chemo-ICI was associated with improved PFS and ORR compared to ICI alone, but without any OS difference (Table). Conclusions: Although the addition of chemo to ICI appears to improve ORR and PFS in PD-L1 ≥50% patients when compared to ICI alone, chemo-ICI does not confer an OS benefit in the 1L treatment of NSCLC patients regardless of PD-L1 status. Prospective trials comparing chemo-ICI, ICI monotherapy, and combination ICI are needed to confirm these findings. OS, PFS and ORR with chemo-ICI vs ICI. [Table: see text]
Comparative effectiveness of second-line (2L) single-agent atezolizumab (A), nivolumab (N), and pembrolizumab (P) in patients (Pts) with locally advanced or metastatic urothelial cancer (aUC) who progressed on platinum-based systemic chemotherapy (plat-chemo): Results from a real-world dataset.
Authors: Umang Swami, Ben Haaland, Benjamin Louis Maughan, Roberto Nussenzveig, John Esther, Adam Kessel, Sumanta K. Pal, Petros Grivas, Neeraj Agarwal
Journal: Journal of Clinical Oncology (2020)

5032 Background: Five PD-1/L1 inhibitors (PDi) are approved for 2L therapy (Rx) for aUC after progression on plat-chemo, but none compared with each other in randomized trials. Here, we assessed comparative effectiveness of 2L PDi in real-world setting. Methods: Pt level data of Pts with aUC were extracted from Flatiron Health EHR-derived de-identified database. Inclusion criteria: 1L Rx with plat-chemo; receipt of single agent PDi in 2L; initiation of 2L PDi 6 mos before data-cut off. Exclusion criteria: &gt;90 days from diagnosis to date of next visit to ensure active engagement of Pts with data providing site; initiation of 2L after 7/31/2016 to ensure uptake of PDi for aUC. OS was compared from the date of initiation of 2L Rx. Comparative effectiveness was examined by Cox proportional hazards model, stratified by treatment propensity score. Each Pts’ propensity of receiving each 2L PDi was modeled via a random forest based on Pt and disease characteristics potentially driving Rx selection for a PDi (gender, smoking status, race/ethnicity, relapsed vs de novo disease, time between 1L &amp; 2L Rx, cis vs carboplatin in 1L; year of Rx with PDi &amp; following characteristics before 2L Rx: ECOG, Hb, age, ICD codes for liver or CNS mets, albumin &amp; PD-L1 status when available). Results: 703 Pts with aUC who initiated 2L Rx between 8/1/2016 to 10/31/2019 were eligible. 2L Rx were A (n=322), N (n=127) &amp; P (n=254). Durvalumab &amp; avelumab were excluded due to low utilization in this dataset. Median follow up from 2L initiation was 4.8 mos. Median OS (mos; 95% CI) with A (6.4 mos; 5-8.7), N (8 mos; 6.3-11.3) and P (8.5 mos; 6.1-11.6) were similar (propensity stratified log rank p=0.19; simple log-rank p=0.34). Over time proportion of Pts receiving 2L A decreased, P increased &amp; N increased then decreased (p&lt;0.001). Propensity stratified comparative effectiveness estimates are below. Conclusions: In this real-world cohort of Pts with aUC, OS with 2L Rx with A, N, &amp; P were similar on both univariate and propensity stratified analyses. These results agree with prior trial level meta-analysis (PMID 31200951). Strength of this analysis includes large Pt level data from a real world cohort. Limitations include retrospective nature of this study. [Table: see text]
肺结节病36例的临床分析
Authors: 张家祺, 王迎难, 黄怡, 牟宗娟
Journal: BMJ (2009)

由于结节病临床表现无特异性,常被误诊.对我院确诊的36例肺结节病资料做回顾性分析. 一、临床资料 1996年2月至2007年5月,我院呼吸科及胸外科确诊收住入院的肺结节病患者36例,平均年龄47.9岁,男性16例,平均年龄42.6岁,女性20例,平均年龄51.8岁.病程10 d至14年。
Transformation of main surgical hole during laparoscopic exploration of common bile duct
Authors: Guolin He
Journal: BMJ (2015)

During June 2012 to October 2014, a total of 48 patients with stones in common bile duct diagnosed by ultrasound and magnetic resonance cholangiopancreatography (MRCP) were randomly divided into two groups (n=24 each). The general group underwent conventional common bile duct exploration by laparoscopy (LCHTD) at left side. For improvement group, the operator timely transfered from left side to right side during laparoscopy. And two auxiliary holes of right side were used for suturing common bile duct. All patients successfully completed common bile duct exploration by laparoscopy. The suturing times of common bile duct were (13.6±2.5) & (7.6±2.7) min (t=11.365, P=0.000), intraoperative bleeding volume (77.52±12.49) & (74.91±13.66) ml (t=2.627, P=0.008), average peak temperature at day 3 post-operation (38.6±0.5) & (37.4±0.5) ℃ (t=9.954, P=0.000) and average postoperative hospitalization length (9.2±3.4) & (7.1±2.1) days (t=8.730, P=0.000). Compared with general group, the suturing time of common bile duct was significantly shorter in improvement group, the average highest temperature at day 3 post-operation were lower and complications (bile leakage, bile duct stricture & biliary tract bleeding) decreased significantly. The main hole conversion during common bile duct exploration by laparoscopy offers the advantages of flexibility, convenience and applicability.


Key words: 
Choledocholithiasis; Laparoscopy