tbuckley/cabot-search huggingface dataset:
Cutaneous manifestations in patients with COVID‐19: a preliminary review of an emerging issue
Authors: A.V. Marzano, N. Cassano, G. Genovese, C. Moltrasio, G.A. Vena
Journal: British Journal of Dermatology (2020)

The infection caused by the recently identified SARS-CoV-2, called coronavirus disease-19 (COVID-19), has rapidly spread throughout the world. With the exponential increase of patients worldwide, the clinical spectrum of COVID-19 is being better defined and new symptoms are emerging. Numerous reports are documenting the occurrence of different cutaneous manifestations in patients with COVID-19.To provide a brief overview of cutaneous lesions associated with COVID-19.A literature search was performed in the PubMed, Scopus and Web of Science databases up to 30 April 2020. This narrative review summarizes the available data regarding the clinical and histological features of COVID-19-associated skin manifestations.The literature reports showed a great heterogeneity in COVID-19-associated cutaneous manifestations, as well as in their latency periods and associated extracutaneous symptoms. Pathogenic mechanisms are unknown, although the roles of a hyperactive immune response, complement activation and microvascular injury have been hypothesized. Based on our experience and the literature data, we subdivided the reported cutaneous lesions into six main clinical patterns: (i) urticarial rash; (ii) confluent erythematous-maculopapular-morbilliform rash; (iii) papulovesicular exanthem; (iv) chilblain-like acral pattern; (v) livedo reticularis-livedo racemosa-like pattern; and (vi) purpuric 'vasculitic' pattern. These six patterns can be merged into two main groups: the first - inflammatory and exanthematous - includes the first three groups listed above, and the second includes the vasculopathic and vasculitic lesions of the last three groups.The possible presence of cutaneous findings leading to suspect COVID-19 puts dermatologists in a relevant position. Further studies are needed to delineate the diagnostic and prognostic values of such cutaneous manifestations.
Trends in utilization of hypofractionated whole breast radiation in breast cancer: An analysis of the National Cancer Database.
Authors: Steven Gerard Woodward, Brandon George, Karan Varshney, Alliric Isaac Willis
Journal: Journal of Clinical Oncology (2020)

536 Background: Utilization of hypofractionated radiation (HR) as a component of breast conserving treatment (BCT) in breast cancer is lacking in the U.S. despite studies demonstrating its efficacy and guidelines supporting its use from the American Society for Radiation Oncology (ASTRO) in 2011 and 2018. Little is known regarding national trends in uptake and factors associated with uptake of HR in the U.S. since the 2011 ASTRO guidelines. Methods: We performed a retrospective review of the National Cancer Data Base (2012-2016) on patients undergoing BCT. Logistic regression modeling was used to identify relationships between patient, hospital, and tumor factors with the use of HR or traditional radiation (TR). Results: A total of 360,834 cases of BCT were identified with 65% (n=235,783) undergoing TR and 35% (n=125,051) undergoing HR. The odds of utilization of HR increased with year of diagnosis, patient age, higher median income, private insurance, treatment at an academic center, travel distance to treatment &gt;20 miles, smaller tumors, lymph node negative disease, and without use of chemotherapy (p-values &lt;0.0001, Table). Conclusions: Despite studies demonstrating the efficacy of its use and the support of ASTRO, HR utilization in the U.S. is still lacking. By understanding which patient populations are still not receiving the benefit of this therapy we can improve our utilization of HR in the U.S. leading to reduced healthcare costs and patient satisfaction. [Table: see text]
Community health management in Clmoyang district of Beijing
Authors: Bin Zhou, Yan Ma, Kai Wang, Yan Shen
Journal: BMJ (2009)

Questionnaire survey(n=147)and group interview(n=13)were used for this investigation.Our results showed that 66.7%of participants consideredheavy work burden and insufficient specialiststo be the main challenge.Half of comingnity healthcare providers were not satisfied with thepayment systerm.We suggest that the overall-consideration of community healthcare service development in urban and suburb areas and 4 kinds of performance pattems should be strengthened:the perfommnce appraisal and quality control schemes should be modified;and the employee headcount in community healthcare centers or transferred employees'salary should be moderately increased in the fumre.

Key words: 
Community health services; Data collection
D-dimer levels and the numbers of micro-embolic signals in non-valvular atrial fibrillation patients as classified by thromboembolic risk score
Authors: Yun Xu, Xiao-ping Lu, Jian-gang Zhu, Quan-xing Lu
Journal: BMJ (2012)

To observe the D-dimer levels and the numbers of micro-embolic signals (MES) in atrial fibrillation patients with different thromboembolic risk scores. A total of 216 persistent atrial patients were classified according to their different scores with a range of 0 -6.They were also divided into two groups by ≥2 or ＜ 2 according to the CardiacFailure,Hypertension,Age,Diabetes,Stroke 2 (CHADS2) point system.D-dimer levels and the numbers of MES were detected in all patients.A rising trend of D-dimer level and the number of MES was observed with the increases of CHADS2 score. D-dimer level and the number of MES in group 0 or 1 score were significantly lower than those in other high score groups (P ＜ 0.05).And the number of MES in group 5 or 6 score was significantly higher than those in other low score groups (P ＜ 0.05).D-dimer level and the number of MES in the group of ≥ 2 score were significantly higher than those in group ＜ 2 score ( P ＜ 0.01 ).It suggests that D-dimer level and the nunber of MES may reflect the thromboembolic risks in atrial fibrillation patients.

Key words: 
Atrial fibrillation; Thromboembolic; D-dimer
Phase II trial of durvalumab plus tremelimumab with concurrent radiotherapy as bladder-sparing therapy in patients with localized muscle invasive bladder cancer: A SOGUG study.
Authors: M. Andres Cuellar, Ana Medina, Regina Girones, B.P. Valderrama, Albert Font, MJ Juan-fita, Guillermo de Velasco, Ferran Ferrer, Francesc Vigués, Xavier Garcia del Muro
Journal: Journal of Clinical Oncology (2020)

TPS5097 Background: Several studies have shown that long-term bladder preservation is feasible in selected patients with muscle-invasive bladder cancer, using a multimodal treatment, including transurethral resection (TUR), radiotherapy and chemotherapy. Durvalumab, a fully human monoclonal antibody against PD-L1, has shown activity in patients with advanced pretreated urothelial cancer. A preclinical study showed that the combination of radiation, anti-CTLA4 and anti-PD-L1 overcome- adaptive immune resistance and has superior activity than either therapy alone (Twyman-Saint Victor et al. Nature 2015). The purpose of the present study is to explore feasibility, toxicity and activity in terms of response and bladder preservation of the integration of TUR, immune double checkpoint inhibition with durvalumab and tremelimumab (a fully human monoclonal antibody against CTLA-4), and radiotherapy in the treatment of localized muscle-invasive. Methods: This is a multicenter prospective phase II study of multimodal therapy in patients with localized urothelial carcinoma of the bladder in clinical stages T2-4a N0 M0, ECOG 0- 1, without contraindications to immunotherapy, who either wish for bladder preservation or are ineligible for cystectomy. The primary endpoint is pathological response (≤T1) at post-treatment biopsy. A 2-stage sequential design (response rate P0=5, P1=0.7, α=0.10, β=0.20) requires at least 6 responses in the first 12 pts to expand to a second cohort of 20 patients. The treatment consists of initial TUR of the tumor, followed by durvalumab 1500 mg i.v. plus tremelimumab 75 mg i.v., every 4 weeks for 3 doses. Normofractionated external-beam radiotherapy is started 2 weeks later, at doses of 46 Gy to the minor pelvis and 64-66 Gy to the bladder. Patients with pathological response will be candidates to bladder preservation, whereas those with residual muscle invasive tumor will be candidates to salvage cystectomy. At present time, prespecified activity goal for the first stage of accrual was met; second stage accrual began in December 2019. Clinical trial information: NCT03702179 .
Relationship of infusion duration to safety, efficacy, and pharmacodynamics (PD): Second part of a phase I-II study using VSV-IFNβ-NIS (VV1) oncolytic virus in patients with refractory solid tumors.
Authors: Jaime R. Merchan, Manish Patel, Timothy P. Cripe, Matthew O. Old, James Fredric Strauss, Amber Thomassen, Rosa M Diaz, Kah Whye Peng, Stephen J. Russell, Luke Russell, Monica Reckner, Erol Wiegert, Alice Susannah Bexon, Steven Francis Powell
Journal: Journal of Clinical Oncology (2020)

3090 Background: VV1 (Voyager V1) is derived from VSV, an RNA virus with low human seroprevalence, engineered to replicate selectively in and kill human cancer cells. In Part 1 of this study, we demonstrated the safety of intratumoral VV1 and dose-response, using serum IFNβ as a biomarker; we observed viral replication in tumor and concomitant lymphocyte/neutrophil trafficking (SITC 2018). 2 other studies suggested greater efficacy and higher IFNβ levels with IV administration. Longer infusion durations were reported to mitigate infusion reactions (IRRs) for another oncolytic. Methods: We studied 3 different infusion durations of VV1 monotherapy at the recommended phase 2 IV dose (1.7 x 10 10 TCID 50 ) in patients with advanced solid tumors. Endpoints included safety, preliminary anti-tumor activity, viral titers, IFNβ PD and shedding. Patients received IV VV1 once on D1 and were monitored for DLT over 21 days with efficacy assessments every 6 weeks. IRRs were classified using Lee 2014 criteria for CRS as either constitutional symptoms only (G1) or involving hypotension (G2). Results: 18 patients were treated at 30, 60 and 180-minute durations (n = 7, 5 and 6, respectively). No DLTs, deaths or G3-4 related IRR AEs were observed. Most pts were female (67%), white (100%), with ECOG PS 0 (61%) and median 4 lines of prior systemic therapy (range 1-14) for colorectal (CRC; 56%), squamous cell carcinoma (11%), pheochromocytoma (11%), sarcoma (11%) or other (11%) cancers. The table shows results (number of patients) by infusion duration. Conclusions: There was no difference in safety between the 3 infusion durations, while efficacy and PD markers suggested better anti-tumor effect with 30-minute infusion. VV1 is safe for caregivers, with no viral shedding. Part 3 of this study will now treat CRC patients with VV1 in combination with a checkpoint inhibitor (avelumab). A 5-arm phase 2 basket study in combination with cemiplimab is proceeding with 30-minute infusions. Clinical trial information: NCT02923466 . [Table: see text]
The impact of adjuvant therapy for non-metastatic thymic carcinoma: An analysis of the surveillance, epidemiology, and end results (SEER) database.
Authors: Richard Lee O'Neal, OIga Vsevolozhskaya, Zhonglin Hao
Journal: Journal of Clinical Oncology (2020)

9071 Background: Thymic Carcinoma is a rare malignancy with an aggressive clinical course. While the importance of surgery in the non-metastatic setting has been well defined, the optimal role of radiation and/or systemic therapy in this setting remains controversial. This study utilized the Surveillance, Epidemiology, and End Results (SEER) database to investigate the impact of adjuvant therapy on overall survival in patients with thymic carcinoma. Methods: We identified adults in the SEER database with thymic carcinoma diagnosed between 1989 to 2015 for analysis. As the primary treatment for non-metastatic thymic carcinoma is surgery, we excluded patients who did not have surgery as a component of their treatment Patients were categorized into Masaoka-Koga stage groups (I-IIa, IIb, III, and IV). Kaplan-Meier estimates of 10-year OS and multivariate Cox proportional hazards regression analyses were performed. Results: 515 patients met the inclusion criteria, of which 125 were stage I-IIa, 46 were stage IIb, 191 were stage III, and 143 were stage IV. A multivariate analysis was performed, adjusting for age, sex, race, and tumor size. When compared to surgery, no statistical improvement in survival was seen with adjuvant radiation or chemotherapy in stage I-IIa or IIb thymic carcinoma. In stage III disease, standard of care surgery was compared with adjuvant radiation (hazard ratio 0.69 (95% confidence interval 0.29 – 1.63], p = 0.39), adjuvant chemotherapy (hazard ratio [HR] 0.84 [95% confidence interval 0.28 – 2.53], p = 0.76), and adjuvant chemo-radiotherapy (HR 0.40 [0.18 – 0.93], p = 0.03). On Kaplan-Meier analysis, triple therapy (surgery + chemo-radiotherapy) was also associated with a marked improvement in 10-year overall survival at 55.3%, compared to 39.8%, 23.9%, and 20.8% (adjuvant radiation, adjuvant chemotherapy, and surgery alone, respectively). Conclusions: This study finds that in stage III thymic carcinoma, surgery followed by chemo-radiotherapy is associated with improved overall survival compared to single or dual-modality treatments. Because of the rarity of this disease, there are no large randomized studies evaluating the most appropriate treatment modalities, therefore this data may assist with clinical decision making in non-metastatic thymic carcinoma.
Effect of tailored and supervised therapeutic exercise in metastatic breast cancer patients: A prospective study.
Authors: Sofía Ruíz, Bella Pajares, Maria-Jose Bermejo-Perez, Cristina Roldán Jiménez, Antonio Cuesta Vargas, Emilio Alba Conejo
Journal: Journal of Clinical Oncology (2020)

e13075 Background: The safety, feasibility and benefit of physical activity is robust in adjuvant breast cancer, but as far as we know, there is little information on the feasibility and benefit of exercise in women with advanced breast cancer. The objective of our study is to analyze the feasibility and impact on fatigue, quality of life and functionality of an individualized, prospective and supervised exercise program in a group of patients with metastatic breast cancer. Methods: A prospective study on 30 metastatic breast cancer patients who were recruited as volunteers between February 2018 and April 2019 by Medical Oncologists from the Medical Oncology Unit at University Clinical Hospital Virgen de la Victoria (Malaga, Spain). Participants included in this study were patients aged between 34 and 71 years old and all had metastatic breast cancer, not amenable to curative treatment. The intervention was a twelve-week Therapeutic Exercise and Education Programme delivered by a physiotherapist. The intervention was preceded by a physical assessment of the musculoskeletal system. The outcomes were cancer-related fatigue, quality of life and functional outcomes (patient- reported and other measured by investigators). Results: Of the 30 patients initially recruited, only 11 of them completed the program with an attendance greater or equal to 17 sessions (75% of assistance). Most of patients who dropped (19), did it because of personal matters, not related to disease progression. Regarding patients who completed the completion of physical activity program (n = 11), the majority were treated on first line of treatment with hormonal receptors positive tumors and bone metastasis. After the intervention, no major changes were observed in cancer-related fatigue, quality of life and several patients-reported outcomes, although an improvement in functionality was observed, in investigator-measured parameters (30-STS and adapted burpees). Conclusions: Our study shows that a supervised and individualized tailored physical activity program in metastatic breast cancer patients is safe and feasible, although more studies are needed to analyse its impact on improving functional parameters, fatigue and quality of life.
荨麻疹的诊断与治疗
Authors: 刘全忠
Journal: BMJ (2010)

荨麻疹,又称风疹块,是由于皮肤、黏膜小血管反应性扩张及渗透性增加而产生的一种局限性水肿性风团样反应,一般无全身症状,严重者可有低血压、呼吸困难及过敏性休克样.治疗首先应寻找并消除病因,采用抗组胺药物,重者使用糖皮质激素。
以过敏性休克为首发表现口服中毒二例
Authors: 张金桥, 李品银
Journal: BMJ (2011)

2010年7月至8月我院急诊科先后成功救治了2例以过敏性休克为首发表现的木耳和核桃皮中毒患者. 例1 患者女,51岁,因头昏、口舌及颜面肿胀5 h就诊.患者中午11:00左右与众人一起进食水发人工木耳,约13:00感头昏,伴颜面、口唇及舌头肿胀,无呕吐及腹痛腹泻症状,在当地卫生院按过敏处理(具体不详)后因无效果接入我科.入院体检:体温36.7℃,心率115次/min,呼吸21次/min,血压75/55 mm Hg(1 mm Hg=0.133 kPa),血氧饱和度90%,神志清楚,急性病容,精神差,面部及舌体水肿明显,口唇肿胀外翻呈香肠状,双眼睑极度水肿,颈软,双肺呼吸音清晰,无啰音,心律齐,无杂音,腹软,无压痛及反跳痛,肠鸣音活跃,神经系统未见异常。
纵隔原发性脂肪肉瘤一例及临床病理分析
Authors: 朱燕, 张晓娟, 杨其昌, 刘宏斌, 沈屹
Journal: BMJ (2011)

纵隔原发性脂肪肉瘤极为罕见,占纵隔肿瘤的1％以下[1-2],术前较难与纵隔其他肿瘤鉴别,故正确的病理诊断对临床治疗及预后尤为重要.本文报道一例并进行临床病理分析.一、临床资料患者女性,54岁.因“反复胸闷、气促一年余,发热、咳嗽4d”,在当地医院诊断为“支气管炎”行抗炎治疗一周,仍咳嗽、咳痰,于2009年9月9日转入我院进一步治疗.人院后胸部CT检查:前左上纵隔一6.3 cm×5.5 cm×3.0 cm低密度影,边界清楚,密度均匀,平扫CT值约15.0 HU,增强扫描病灶轻度强化;前右下纵隔一12.4 cm×7.3 cm× 10.0 cm不规则软组织密度影,CT值约25.0 HU,界限尚清,增强扫描病灶可见明显强化. 关键词：脂肪肉瘤
Role of color Doppler ultrasonography in the differentiation of vein thrombosis and regional hematoma of hemodialysis arterio-venous fistula
Authors: Qing-hong Jing, Guang Xu
Journal: BMJ (2013)

A total of 62 cases with autogenous arteriovenous fistulas were examined by color Doppler ultrasonography. Venous thrombotic manifestations (n=13) and large local hematoma (n=3) were detected. The diameter ranges were around (1.8±0.7) cm for arteriovenous fistula and (2.0±0.8) cm for local hematoma. And there was no statistical significance (t=1.63, P>0.05). According to edge shape, presence or absence of flow signal and fistula searching, it could be used to identify venous thrombosis and local hematoma of arteriovenous fistula. Color Doppler ultrasound is helpful for the differential diagnosis and the mass properties of arteriovenous fistula so that it provides useful diagnostic information for the clinicians.


Key words: 
Ultrasonography, doppler, color; Arteriovenous fistula
Tocilizumab, but not dexamethasone, prevents CRS without affecting antitumor activity of bispecific antibodies
Authors: Joseph Kauer, Sebastian Hörner, Lukas Osburg, Stefanie Müller, Melanie Märklin, Jonas S Heitmann, Latifa Zekri, Hans-Georg Rammensee, Helmut R Salih, Gundram Jung
Journal: Journal for ImmunoTherapy of Cancer (2020)

Bispecific antibodies (bsAb) and chimeric antigen receptor (CAR) T cells allow for antibody guided recruitment of T cells against tumors. Both are successfully used for treatment of CD19 expressing leukemias, but may cause cytokine release syndrome (CRS) as a major dose-limiting side effect. For CRS prevention, steroids are recommended prior to bsAb treatment, despite their well-known lymphotoxic activity. The IL-6 receptor antibody tocilizumab is established for treatment of CRS induced by CAR T cells, but was not considered for CRS prevention in bsAb therapy. We here compared the influence of dexamethasone and tocilizumab on bsAb-mediated T cell proliferation and tumor lysis in vitro and in vivo and found that dexamethasone profoundly inhibited T cell proliferation and antitumor activity as induced by two different bsAb, particularly at low effector:target ratios, whereas tocilizumab did not affect efficacy. When we applied tocilizumab early during treatment of three patients with a newly developed PSMAxCD3 bsAb, significant CRS attenuation despite high IL-6 serum levels was observed. Thus, early IL-6 blockade may reduce the undesired sequelae of CRS upon bsAb therapy without affecting therapeutic activity, allowing in turn for safe application of effective doses.
Phase II study of pembrolizumab plus olaparib in the treatment of patients with advanced cholangiocarcinoma.
Authors: Aiwu Ruth He, Benjamin Adam Weinberg, Marcus Smith Noel, Violeta P Milic, Petra Prins, Hongkun Wang, Marion L. Hartley, John Marshall
Journal: Journal of Clinical Oncology (2020)

TPS4659 Background: Lack of an effective second-line treatment of patients (pts) with advanced cholangiocarcinoma (CC) necessitates the development of new therapies. Preclinical studies suggest CC susceptibility to PARP inhibition (PARPi): ERCC1 is underexpressed in 74% of CCs, and olaparib is selective for ERCC1 deficiency, profoundly inhibiting DNA repair. Additionally, PARPi exploits IDH mutation-related DNA damage repair deficiency, which is found in about 25% of CCs. Unfortunately, PARPi also upregulates PD-1-PD-L1 receptor-ligand binding, which attenuates anticancer immunity and counteracts the efficacy of PARPi. However, this can be prevented by PD-1 inhibition—blockade of PD-1-PD-L1 acts to re-sensitize cancer cells to T-cell killing. Hence, we hypothesize that the combination of olaparib and pembrolizumab will produce a durable anti-tumor response against CC by synergistically inducing DNA damage and increasing immune response. Methods: Thirty-six pts with advanced CC, who either failed to respond to or progressed on first-line therapy, will be enrolled to receive olaparib (300 mg PO bid) daily plus pembrolizumab (200 mg IV Q3 weeks) for 12 months, unless unacceptable toxicities or cancer progression occur, in which cases therapy will cease. MRI or CT tumor assessment will occur just before therapy, every 6 weeks for the first 6 months of therapy, and then every 9 weeks for the next 6 months of therapy (total, 12 months). Three tumor biopsies will be collected: at baseline; at week 4; and at time of progression. In each biopsy, ERCC1, PD-1, and PD-L1 expression, IDH1/2 mutation status, and immune cell (CD3 and CD8) response will be assessed. The total study duration will be 20-36 months. The primary endpoint will be overall response rate; the secondary endpoints will be PFS, OS, duration of response, and safety and tolerability. It is hypothesized that in pts with advanced CC, second-line therapy with olaparib plus pembrolizumab will improve the response rate from 17.5% to 35%, as well as increase PFS and OS compared to cytotoxic chemotherapy. Study enrollment began in Q1 2020. NCI number pending at time of abstract submission. Clinical trial information: pending at time of submission .
General practitioner plays an important role in detecting early gastric cancer
Authors: Dong Wu
Journal: BMJ (2016)

胃癌发病率和死亡率位居我国恶性肿瘤前列，严重威胁人民健康。我国胃癌患者预后较差与早期诊断率过低有关。早期胃癌患者常因非特异性消化不良而首诊于全科医师。熟悉胃癌的危险因素有助于全科医师作出合理的临床决策。通过识别胃癌高危人群，并应用先进的染色和放大内镜技术，有望提高我国早期胃癌的诊断率。
Application of quality of life assessment scale in Chinese elderly population
Authors: Dingding Yang, Jing Zhou, Juan Shou, Zhaohui Du
Journal: BMJ (2016)

It is critical to chose appropriate instruments to assess the quality of life in elderly population. There are two types of assessment instruments applied at the present: the universal instruments and special instrument for elderly. However, the universal instruments are designed for general population and not always fit for elderly population. This article reviews the current status of application of quality of life assessment scales for the elderly; and suggests that it is necessary to develop health-related quality of life assessment scales, which are suitable for the elderly population in China.


Key words: 
Quality of life assessment; Aged