tbuckley/cabot-search huggingface dataset:
Promoting patient health maintenance with cancer care planning at diagnosis and during treatment: baseline data of the Coleman Supportive Oncology Collaborative (CSOC).
Authors: Christine B. Weldon, Julia Rachel Trosman, Rosa Berardi, Al Bowen Benson, Betty Roggenkamp, Mary Ellen Hand, Michelle Stamp, Jean J Bao, Lawrence Eric Feldman, Mary Pasquinelli, William John Gradishar, Ami N. Shah, Sheetal Mehta Kircher, Kelly Danielle Foster, Valerie Nelson, Lauren Allison Wiebe, Rachel Podrazik Baer, Gale M England, Neil Dalal, Claudia Beth Perez
Journal: Journal of Clinical Oncology (2020)

e24051 Background: CSOC conducts quality improvements (QI) for cancer patients that facilitate delivery of appropriate health maintenance and supportive cancer care at diagnosis and during treatment. CSOC is implementing a care planning QI starting at diagnosis using the 4R oncology model (Right Info / Care / Patient / Time), which provides patients a formal personalized care plan called Patient Care Sequence. Each Care Sequence includes health maintenance, cancer treatments and supportive care. As part of CSOC, we conducted provider surveys as a pre-intervention baseline to inform QI opportunities. Methods: Online survey of cancer providers from 8 cancer centers (4 academic, 4 community) conducted July 2018 - October 2019, prior to 4R implementation. The survey focused on current care planning practices and inclusion of guideline recommended health maintenance in care plans. Results: Survey response rate: 80% (180/225); respondents were 53% physicians, 20% advanced practice, 27% nurses. Only 59% (107/180) of respondents give patients care plans at diagnosis: 61% (65/107) verbally, 22% (24/107) written, 17% (18/107) using a printed form. Providers reported considerable gaps in including guideline-based health maintenance and promotion activities in care plans given to patients (Table). Additionally, 61% of providers reported concerns that it is challenging for their patients to manage their own health maintenance activities. Providers who are concerned about patients’ challenges in managing their own health maintenance are significantly more likely to give their patients a written or printed plan (76%, 32/42) compared to those providing care plans to patients verbally or not at all (56%, 77/138), p = .02. Conclusions: Guideline based health promotion activities are not consistently included in care plans, and care planning is not sufficiently conducted at cancer diagnosis. The CSOC 4R Oncology Model, which implements Patient Care Sequences at diagnosis, will address these gaps and examine the impact of formal care planning on improving utilization of health maintenance and promotion activities. [Table: see text]
Clinical characteristics of mild and severe types of influenza A/H1N1
Authors: 欧强, 刘袁媛, 黄琴
Journal: BMJ (2011)

Clinical data of 150 patients with mild and 38 patients with severe confirmed influenza A/H1N1 were collected and retrospectively analyzed in this paper with descriptive epidemiology. Mild patients mainly presented with symptoms similar to seasonal influenza with few complications, however,persistent high fever, cough with bloody sputum expectoration, chest distress and short of breath manifested in severe patients with respiratory failure and acute respiratory distress syndrome in some cases. Proportion of obesity and underlying diseases in severe patients, who were at high risk for severe influenza A/H1N1, was higher than that in mild ones (P＜0. 05). Average course of the illness spanned five to 11 days in patient with mild influenza A/H1N1 with all cured, and 34 of severe cases discharged with better recovery and other four died with a case-fatality of 10. 5 percent.

Key words: 
Influence A virus,H1N1 subtype ;  Disease attributes ;
Anti-PD-1 antibody monotherapy or anti-PD-1 antibody combination with chemotherapy treated non-small cell lung cancer (NSCLC) patients with EGFR mutation: A retrospective analysis.
Authors: Shaorong Yu, Ran Hu, Meiqi Shi
Journal: Journal of Clinical Oncology (2020)

e21691 Background: Anti-PD-1/PD-L1 antibody has been approved as first- or second-line therapy in non-small cell lung cancer (NSCLC) patients and modified the management of patients with locally advanced or metastatic NSCLC. However, anti-PD-1 treatment shows less effective in patients with EGFR mutation than in those without driver gene mutation. To determine the activity of anti-PD-1 antibody in EGFR mutant NSCLC, we retrospectively evaluated response patterns among EGFR mutant NSCLC patients. Methods: We identified 58 patients with EGFR mutation who were treated with anti-PD-1 monotherapy or anti-PD-1 antibody combined with chemotherapy from March 2018 to December 2019. All of patients have received more than one treatment regimen including EGFR-TKI treatment. Objective response rates (ORR) were assessed using RECIST v1.1. Results: A total of 58 patients including 53 cases of lung adenocarcinoma, 4 cases of squamous cell carcinoma and 1 case of adenosquamous carcinoma were analyzed. Among them 26 patients received nivolumab treatment, 9 patients with pembrolizumab treatment, 9 patients with sintilimab treatment, 8 patients with JS001 treatment and 6 patients with camrelizumab treatment. Seven patients received anti-PD-1 monotherapy and the other 51 patients received anti-PD-1 combined chemotherapy. The main chemotherapeutic drugs contain docetaxel, pemetrexed, paclitaxel and paclitaxel-albumin. ORR was observed in 6 out of 58 (10%) patients. The disease control rate was 50% (29/58). The median PFS was 2.82 months. All six patients who achieved PR were received anti-PD-1 combined chemotherapy. Four patients died during treatment with anti-PD-1 therapy and we can’t confirm if these were due to cancer progress or immune related tumor hyperprogression. The adverse events were immune related pneumonia (two cases with grade 2 and one case with grade 3) and immune related hepatitis (one case with grade 2). Conclusions: Anti-PD-1 antibody combined chemotherapy seems showed moderate effect on NSCLC patients with EGFR mutation who have received anti-EGFR therapy.
Impact of preoperative magnetic resonance imaging (MRI) on conservative surgery (CSur) among curable breast cancer (BC) patients treated in a specialized center in Latin America.
Authors: Julianne Maria da Silva Lima, Thatyane Cunha, Thamyse Dassie, Sandro Melo, Lincon Mori, Gustavo Martha, Samir Hanna, Max S. Mano, Daniela Giannotti, Felipe Andrade
Journal: Journal of Clinical Oncology (2020)

e12595 Background: Preoperative breast MRI can provide important clinical information on the surgical management of BC patients (pts). However, there is no evidence that it can produce a statistical impact on surgical outcomes in the early BC setting. This retrospective study sought to evaluate whether preoperative MRI was significantly correlated with CSur among early BC pts. Methods: Digital and physical records from 532 pts treated in a specialized BC center in Brazil from 2005 to 2018 were analyzed. The institutional database registered pathological, radiological and clinical information. The categorical variables CSur and MRI were analyzed by Chi-squared coefficient of correlation, whereas significant correlations were included in a multivariate logistic regression model. All statistical analysis were performed in STATA version 15.1C. Results: The present analysis included 532 pts. The diagnosis was suspected through suspicious self-exam in 380 pts (71%), while 129 pts (24%) had altered mammary screening tests. Clinical T and N stages were: T0-1=154pts (29%); T2=179 pts (33%); T3=135 pts (25%); T4=49 pts (9%); N0=267 pts (50%); N1=172 pts (32%); N2=80 pts (15%). Neoadjuvant treatment was performed in 223 pts (42%). MRI was indicated in 248 pts (46%). CSur was performed in 149 pts (28%). Margins were positive in 15 cases. This study found a statistically significant correlation between CSur and MRI ( X 2 = 8.07; p=0.018). Although, when controlled for neoadjuvant treatment, T, N, and age, the independent variable MRI was not a statistical predictor of CSur (R=0.008; t=0.25; p=0.8; 95%CI -0.57 – 0.74). Advanced T and neoadjuvant treatment were inversely correlated with CSur in the multivariate analysis (R= -0.11; t= -7.8; p&lt;0.001 and R= -0.11; t= -2.88; p=0.004, respectively). One multivariate analysis to evaluate predictors of T stages showed that suspicious self-exam and N stage had a significant linear relationship with T stages when controlled for age (R=0.70; t=7.9; p&lt;0.001; and R=0.76; t=15; p&lt;0.001, respectively). Conclusions: Preoperative MRI can have impact on the conservative surgical management of curable BC patients and the present analysis showed a positive correlation. In the logistic regression model, MRI was not identified as a predictor of CSur, however the proportion of locally advanced BC may have influenced the results. Further studies must be strengthened for identifying in which subgroup of patients MRI may be a predictor of surgical outcomes.
Exploring multiple myeloma survivor interest in lifestyle interventions.
Authors: Allen Hodge, Alexis Williams, Anita D'Souza, Patricia M. Sheean, Parameswaran Hari, Binod Dhakal, Kathryn E Flynn, Melinda Stolley
Journal: Journal of Clinical Oncology (2020)

e20558 Background: Multiple Myeloma (MM) is the second most common hematological malignancy in the U.S., with higher rates observed in older adults and African Americans (AA). Given treatment advances, most individuals survive at least 5-10 years, making symptom management important. Many survivors struggle with pain, fatigue and limited physical function, all of which may be improved through lifestyle changes. Due to concerns about safety and patient interest, few efforts have considered such interventions. We report the results of an exploratory study to inform a lifestyle program tailored to the needs of the diverse MM survivor community. Methods: MM survivors at least 100 days post-auto transplant with ECOG status of 0-1 completed validated questionnaires and a qualitative interview assessing quality of life, physical activity patterns, social support and interests for a lifestyle program. Results: We recruited 20 survivors, mean age 70 (7.0) years, 70% women, 40% African American, 75% married, 60% college educated. Eighty-three percent were overweight or obese, mean Godin score was 17.56 (18.1) representing insufficient physical activity and 78% did not engage in resistance training at least twice weekly. PROMIS-29 scores indicated that MM survivors had worse physical function, fatigue and pain interference than the general population. However, they reported less social isolation and more social support (informational, instrumental, emotional, companionship). Qualitative data highlighted barriers to healthy lifestyles including “not knowing what dietary changes to make,” fatigue, and safety concerns related to physical activity. Although 67% reported that their oncology team had discussed lifestyle changes with them, most related minimal guidance was given, leaving them confused and wanting more information. All participants acknowledged the potential benefits of healthy eating and exercise on function, fatigue, pain and mood. Particular interests for a lifestyle program included: 1) focused dietary counseling with recipes and cooking guidance; 2) health coach to motivate, and to model and monitor safe exercise; 3) healthcare provider engagement to address health concerns; and 4) preference for in-person with opportunity for web-based program if unable to attend. Many were interested in joining an advisory group to inform intervention development and survivor engagement. Conclusions: MM survivors emphasized their strong interest in having a program where they could meet other MM survivors, discuss their concerns, but also focus on positive behavior changes.
Maternal glucose level and body mass index measured at gestational diabetes mellitus screening and the risk of macrosomia: results from a perinatal cohort study
Authors: 刘健, 冷俊宏, 唐宸, 刘功姝, Hay John, 王晶, 文师吾, 李振玲, 佘野
Journal: BMJ (2014)

目的
研究妊娠期糖尿病(GDM)筛查测量中的母亲血糖(BG)水平和体质指数(BMI)对巨大儿风险的影响。


设计
一项对妊娠妇女从接受围产期保健至分娩进行随访的围产期队列研究。


地点
中国天津北辰区，2011年6月至2012年10月间。


研究对象
1951名年龄在19～42岁间的妇女，通过妊娠期糖尿病(GDM)筛查(孕24～28周)获得有效BMI和BG水平测量值，均为单胎分娩且出生身体质量(BW)>2500 g。


主要结果和测量值
主要结果变量为巨大儿出生(BW>4000 g)。BG水平和BMI值在GDM筛查时测量。


结果
共有191名(9.7%)新生儿为巨大儿。多元Logistic回归结果显示，GDM筛查时的BMI对巨大儿出生影响的比值比(OR)值[95%可信区间(CI)]为1.14(1.10～1.19，P<0.0001)，BG影响的OR值(95%CI)为1.11(1.01～1.23，P＝0.03)。当BMI和BG水平(连续变量)同时进入模型，BMI影响的OR值保持不变，而BG影响的OR值的显著性减弱。受试者工作特征曲线(ROC)下面积BMI为0.6530(0.6258～0.6803)，BG为0.5548(0.5248～0.5848)(χ2＝26.17，P<0.0001)。分类变量BG(mmol/L，<6.7，6.7～7.8或≥7.8)和以五分位数形式的BMI(Q1～Q5)分别以BG<6.7和Q2 BMI为参照组进行评估。不管BG水平值如何，母亲的BMI在Q1或Q2分位组时对巨大儿出生影响的OR值并没有统计学差异，但当BMI≥Q3时其OR值具有显著的统计学意义；在BMI为Q5分位和BG水平≥7.8时，最高的OR值被观测到[6.93(2.61～18.43)，P<0.0001]。


结论
GDM筛查中测量的高BMI是巨大儿出生风险的最重要的决定因素。这一发现提示GDM筛查时间可能是对妊娠妇女高BW采取干预措施以降低巨大儿出生风险的孕期关键时间点。
Attach importance to the cognition of venous thromboembolism
Authors: 王乐民
Journal: BMJ (2006)

静脉血栓栓塞症(venous thromboembolism,VTE)是全身静脉系统的血栓性疾病,其中对机体危害程度较大的是肺栓塞(pulmonary thromboembolism,PE)和深静脉血栓形成(deep vein thrombosis,DVT).近年来,国内医务界有关它们的传统观念发生了重大变化,PE已被认为是国内的常见病,DVT也不再是传统外科系统独立的疾病,而属循环系统疾病的一部分。
EF-19, a post-approval registry study of tumor treating fields (TTFields) in recurrent glioblastoma (rGBM).
Authors: Jay-Jiguang Zhu, Robert O'Donnell, Zvi Ram
Journal: Journal of Clinical Oncology (2020)

e14536 Background: Tumor Treating Fields (TTFields) are an anti-mitotic non-invasive therapy of low intensity alternating electric fields delivered to the tumor via a portable medical device. In phase 3 studies that led to FDA approvals, TTFields plus maintenance temozolomide significantly extended survival in newly diagnosed GBM, and achieved comparable survival outcome to best standard of care (BSC) as monotherapy in recurrent GBM (rGBM). The EF-19 study aimed to confirm efficacy of TTFields vs BSC in rGBM in post-approval real-life setting. Methods: This non-inferiority, prospective, non-randomized, post approval registry trial enrolled 192 rGBM patients (&gt;21 yrs, KPS &gt; 70). Patients were treated with TTFields (200 kHz, &gt; 18h/day). Eligibility criteria: histologic GBM, past treatment per Stupp protocol for primary disease and radiological evidence of progression in the supratentorial region. Primary endpoint was overall survival (OS); secondary endpoints were OS in the per protocol (PP) population ( &gt; 1 course of TTFields or BSC in each respective arm), time to treatment failure and adverse events. The TTFields patient registry data were compared to OS of all 117 rGBM patients in the BSC group of the EF-11 trial (Stupp R, EJC 2012). The sample size of 192 patients (10% loss to follow up) was based on non-inferiority log-rank test with a two-sided alpha level of 0.05 and a power of 80%, comparing time to event (i.e., death) between patients treated with TTFields and BSC. The analysis was based on true hazard ratio (HR) of 1.0 comparing TTFields to control with an upper one-sided 95% confidence bound of HR not exceeding 1.375. Results: Median OS with TTFields versus EF-11 BSC was 7.4 vs. 6.4 months, p = 0.053; HR = 0.64 (95%CI 0.46-0.91, Cox-test P = 0.012). Median OS (PP population) with TTFields versus EF-11 BSC was 8.1 months vs. 6.5 months; p = 0.045; HR 0.65. The results showed a significant superiority in HR of OS between the 2 groups, as the 95% confident interval upper limit of the HR was lower than the pre-defined threshold for non-inferiority for interval bound of 1.375. The overall incidence of adverse event was lower with TTFields than EF-11 BSC (67% vs. 95%). The median time to treatment failure was longer in the TTFields arm (3.3 months (95% CI 2.6, 3.9) versus BSC arm (1.6 months; 95% CI 1.1, 1.9); HR = 0.53 (95% CI 0.41, 0.68, p &lt; 0.0001). Skin AE was the most frequently reported AEs in TTFields arm; no unexpected adverse events were reported with TTFields. Conclusions: The results of the EF-19 registry study confirm the effectiveness and safety of TTFields monotherapy in rGBM.
A phase I dose escalation study evaluating the safety and tolerability of a novel anti-HER2 antibody-drug conjugate (PF-06804103) in patients with HER2-positive solid tumors.
Authors: Funda Meric-Bernstam, Emiliano Calvo, Victor Moreno, Hyun Cheol Chung, Yeon Hee Park, Yung-Jue Bang, Lee S. Rosen, Monica M. Mita, Ignacio Garrido-Laguna, Abraham C.F. Leung, Harman Dube, Wei Zhong, Xiaoying Chen, Rula Dawaher, Giuseppe Curigliano
Journal: Journal of Clinical Oncology (2020)

1039 Background: PF-06804103 is an anti-HER2 immunoglobulin G1 antibody-drug conjugate (ADC), comprising an anti-HER2 monoclonal antibody conjugated with a cleavable linker to the cytotoxic agent Aur0101. PF-06804103 demonstrated strong activity in low to high HER2-expressing preclinical tumor models. In this study, the safety and tolerability of PF-06804103 was assessed in patients with advanced breast cancer (BC) or gastric cancer (GC). Methods: This multi-center, open-label, first-in-patient, phase I study (NCT03284723) has two parts: dose escalation (Part 1) and dose expansion (Part 2). In Part 1, groups of adult patients (pts) with HER2+ BC or HER2+ GC, who are resistant or intolerant to standard therapy or for which no standard therapy is available, received PF-06804103 intravenously once every 21 days (Q3W); dosage was escalated per cohort. Primary objectives were to evaluate the safety and tolerability of PF-06804103, characterize its dose-limiting toxicities (DLTs), and determine the recommended phase 2 dose. Response was assessed using RECIST v1.1. Objective response rate (ORR) was calculated for response-evaluable pts with target lesions at baseline and ≥1 post-baseline assessment (including unconfirmed responses). Results: A total of 35 pts (BC: n = 20; GC: n = 15) received PF-06804103 at escalating dose levels (0.15 mg/kg: n = 2; 0.5 mg/kg: n = 2; 1.2 mg/kg: n = 2; 2 mg/kg: n = 4; 3 mg/kg: n = 10; 4 mg/kg: n = 9; 5 mg/kg: n = 6). The median (range) number of prior therapies was 6 (3–18) and 3 (1–6) for BC and GC groups, respectively (all pts had prior HER2-targeted therapy). The 3 most common, drug-related adverse events (any grade) were alopecia (n = 17, 48.6%), fatigue (n = 15, 42.9%), and neuropathy (n = 9, 25.7%). DLTs (mostly grade 3) occurred in 3 pts and included arthralgia, neuropathy, myalgia, fatigue, and osteomuscular pain. Preliminary ORR in the patients treated with doses ≥3mg/kg was 52.4% (11/21). Conclusions: The PF-06804103 ADC demonstrated manageable toxicity and promising anti-tumor activity in this small, heavily pretreated study population. Clinical trial information: NCT03284723 .
Interpretation of the guidelines for the diagnosis and treatment of drug-induced liver injury
Authors: Ying Fan, Hong Zhao
Journal: BMJ (2016)

药物性肝损伤(DILI)是最常见和最严重的药物不良反应之一，重者可致急性肝衰竭甚至死亡。迄今仍缺乏简便、客观、特异的诊断指标和特效治疗手段的现状，是各科临床医师在疾病治疗用药过程中必须面对的问题，本文主要针对全科医师应掌握的关于DILI的重点内容，对中国首部《药物性肝损伤防治指南》进行解读。
综合性教学医院开展毕业后全科医学教育的探索
Authors: 祝墡珠, 寿涓
Journal: BMJ (2006)

WHO和世界家庭医师组织(WONCA)在1994年至1995年的一份合作文件中明确指出:任何国家的医疗保健系统若不以受过良好训练、采用现代方法的全科医师为基础,便注定要付出高昂的失败代价.[1].我国的全科与社区卫生服务事业起步较晚,20世纪80年代后期才从国外系统引进全科医学的理论.全科医学教育的全面启动则始于1998年全国全科医学教育工作会议的召开.[2].我国目前合格的全科医师为数寥寥,全科医师人才的匮乏已成为影响社区卫生服务可持续发展的重要因素。
Macrophage Subpopulation Dynamics Shift following Intravenous Infusion of Mesenchymal Stromal Cells
Authors: Nina Kosaric, Waracharee Srifa, Clark A. Bonham, Harriet Kiwanuka, Kellen Chen, Britta A. Kuehlmann, Zeshaan N. Maan, Chikage Noishiki, Matthew H. Porteus, Michael T. Longaker, Geoffrey C. Gurtner
Journal: Molecular Therapy (2020)

Intravenous infusion of mesenchymal stromal cells (MSCs) is thought to be a viable treatment for numerous disorders. Although the intrinsic immunosuppressive ability of MSCs has been credited for this therapeutic effect, their exact impact on endogenous tissue-resident cells following delivery has not been clearly characterized. Moreover, multiple studies have reported pulmonary sequestration of MSCs upon intravenous delivery. Despite substantial efforts to improve MSC homing, it remains unclear whether MSC migration to the site of injury is necessary to achieve a therapeutic effect. Using a murine excisional wound healing model, we offer an explanation of how sequestered MSCs improve healing through their systemic impact on macrophage subpopulations. We demonstrate that infusion of MSCs leads to pulmonary entrapment followed by rapid clearance, but also significantly accelerates wound closure. Using single-cell RNA sequencing of the wound, we show that following MSC delivery, innate immune cells, particularly macrophages, exhibit distinctive transcriptional changes. We identify the appearance of a pro-angiogenic CD9+ macrophage subpopulation, whose induction is mediated by several proteins secreted by MSCs, including COL6A1, PRG4, and TGFB3. Our findings suggest that MSCs do not need to act locally to induce broad changes in the immune system and ultimately treat disease.
A phase I dose-escalation and expansion study of intratumoral CV8102 as single-agent or in combination with anti-PD-1 antibodies in patients with advanced solid tumors.
Authors: Thomas Eigentler, Franz G Bauernfeind, Jürgen C. Becker, Peter Brossart, Michael Fluck, Lucie Heinzerling, Jürgen Krauss, Peter Mohr, Sebastian Ochsenreither, Jutta Sylvina Schreiber, Patrick Terheyden, Benjamin Weide, Carsten Weishaupt, Fatma Funkner, Anke Muth, Sarah-Katharina Kays, Claudia Stosnach, Angelika Daehling, Gianluca Quintini, Senta Ulrike Gnad-Vogt
Journal: Journal of Clinical Oncology (2020)

3096 Background: CV8102 is a non-coding, non-capped RNA that activates the innate (via TLR7/8, RIG-I) and adaptive immunity dose-dependently. CV8102 injected intratumorally (i.t.), as a single agent or combined with systemic anti-PD-1 antibody (Ab) led to tumor growth inhibition in animal models and showed synergism with PD-1 blockade. Methods: An open-label, cohort-based, dose escalation and expansion study in patients with advanced cutaneous melanoma (cMEL), cutaneous squamous cell carcinoma (cSCC), head and neck squamous cell carcinoma (hnSCC) or adenoid cystic carcinoma (ACC) is ongoing investigating i.t. CV8102 as single agent and in combination with anti-PD-1 antibodies. [NCT03291002]. Results: As of December 2019, 23 patients in the cohort A (single agent) and 13 patients in cohort C (combination with anti-PD-1 Ab) were exposed to at least one dose of CV8102 at dose levels of 25-600 µg (single agent) and 25-450 µg (combination). No dose limiting toxicities (DLTs) were observed within the first two weeks of study drug treatment. Most frequent TEAEs were G1/2 fatigue, fever, chills and headache. 4 (17%) patients (pts) in cohort A and 3 (23%) pts in cohort C experienced related G3 TEAEs that were manageable with supportive treatment (liver enzyme increases (3), abscess at injection site (1), hypertension (1), asymptomatic elevation of pancreatic enzymes (2)). In cohort A, 2 cMEL patients experienced an objective response according to RECIST 1.1 (1 CR in a PD-1 naïve pt and 1 PR in a PD-1 refractory pt) and 2 further pts (cMEL, hnSCC) showed SD with shrinkage of tumor lesions. Conclusions: CV8102 i.t. was well tolerated without dose limiting toxicities to date and showed evidence of single agent activity. Updated results on safety, efficacy and serum biomarkers will be presented. Clinical trial information: NCT03291002 .