tbuckley/cabot-search huggingface dataset:
Re-introducing immunotherapy in patients surviving immune checkpoint inhibitors-mediated myocarditis.
Authors: Shira Peleg Hasson, Michal laufer-Perl, Ido Wolf, Ayelet Sivan
Journal: Journal of Clinical Oncology (2020)

e15228 Background: Immune checkpoint inhibitors (ICI) have transformed the standard care in cancer treatment. Recent case reports describe ICI-mediated myocarditis with an atypical presentation and fatal potential which lead to permanent interruption of immunotherapy. We aim to characterize ICI-mediated myocarditis and re-introduction to immunotherapy. Methods: We retrospectively evaluated the presentation, severity, and prognosis of patients diagnosed with ICI-mediated myocarditis during 2019, and presented the clinical course and outcomes of patients that were chosen for re-introduction. Results: Among seven patients, only one patient had a history of cardiac disease. The majority were diagnosed with lung adenocarcinoma and treated with anti-programmed death-1 antibody (57%). All patients were treated with single agent ICI. Most patients presented with cardiac symptoms, elevated troponin and typical magnetic resonance imaging; however only 43% had reduced ejection fraction. Five patients were defined as grade I-II and two as grade III-IV. Overall, three patients were chosen for re-introduction with concomitant low dose steroids and weekly troponin follow-up. Two patients diagnosed with grade I/II renewed therapy successfully with no recurrence of symptoms and improvement in disease burden, while the one patient diagnosed with grade III developed worsening of cardiac symptoms after the 1 st cycle and therefore therapy was interrupted permanently. Overall, survival was higher among the re-introduction patients (67% vs. 25%). Conclusions: ICI-mediated myocarditis is potentially fatal and leads to permanent interruption of life saving cancer therapy. We imply that re-introduction may be considered in low grade patients; however, better definition of the diagnosis and grading is needed.
Using triad test questions to examine diagnostic performance among general practitioners in Beijing
Authors: Hui-li Wang, Xiao-na Cao, Zhi-hong Zheng, Ya-li Zhao, Shao-jie Liu, Xiao-qin Lu, Juan Du, Shu-qi Cui
Journal: BMJ (2010)

Objective To understand symptom- and sign-based diagnostic performance among general practitioners (GPs) in Beijing. Methods A diagnostic triad test paper with 10 questions involving variety of clinical issues was used to evaluate diagnostic performance among GPs attended the training class for backbone GPs from community health-care service institutions of eight districts in urban Beijing. Results Totally, 152 GPs took the test, with 129 (84. 9% ) finished. The highest score of them was 16 credits of a full 20, and lowest was only one credit, with an average of 8. 5 credits plus or minus of 2. 9 (standard deviation, SD) credits. And, 78. 3 % and 72. 1 % of the GPs answered correctly diagnostic questions about meningitis and ectopic pregnancy, respectively, from all 10 kinds of illness, but only 2. 3% of them could correctly answer those about lead poisoning in children and hypothyroidism, respectively. Conclusions Structure of clinical knowledge is not so complete in GPs attended the training class with limited ability in disease identification. It is necessary to perfect and improve training for GPs. Triad test questions for disease diagnosis were a simple, rapid and effective way to evaluate their clinical performance in GPs training.

Key words: 
Vocational education;  General practitioners;  Diagnostic level
全科医生要考虑成本-效益原则
Authors: 周仲华
Journal: BMJ (2006)

有一个小患者,在3岁的时候出现了反复发作的咳嗽和喘息,每次发病均与感冒有关.发作开始打喷嚏、流鼻涕,有时发热,一、二天后出现咳嗽,常为干咳,伴有喘息.咳嗽、喘息症状常在夜间、晨起及运动后加重.体格检查没有发现鼻翼扇动和三凹征等呼吸困难的征象,但双肺布满哮鸣音.我给他做了支气管舒张试验,即吸人速效β2受体激动剂雾化剂,结果在吸入20分钟内,喘息、咳嗽就明显缓解了.根据这些临床表现及其最近1个月内喘息的频率、程度,我给这个孩子的初步诊断是儿童哮喘症,二级(轻度持续)。
Analysis on risk factors for metabolic syndrome in patients with maintaining hemodialysis
Authors: Chun-hua Zhang, Shen Shen, Ling Yu, Shi-xiang Wang
Journal: BMJ (2011)

Objective To investigate prevalence of metabolic syndrome (MS) and its related factors in patients with maintaining hemodialysis (MHD). Methods A total of 162 cases on MHD in Beijing Chaoyang Hospital during June to December 2010, were enrolled in this study and divided into MS group and non-MS group according to the diagnostic criteria for MS set by the International Diabetes Federation. Anthropometric and blood biochemical characteristics of the two groups were compared with t-test and x2 test Risk factors for MS were explored with binary logistic regression analysis. Results Prevalence of MS was 40. 7% (66/162) . There was significant difference found in body mass index [(24. 2 ±3. 1) vs. (21. 6 ±2. 7) kg/m2], waistline circumference[(93 ±8) vs. (79 ±7)cm] , white blood cell count [(6. 8 ± 1. 5) × 109/L vs. (5. 6 ± 1. 4) × 109/L] , hypersensitive serum C-reactive protein [(7 ± 5)vs. (4 ±3) mg/L], high-density lipoprotein-cholesterol [(0. 99 ±0. 26)vs. (1.39 ±0.39) mmol/L], low-density lipoprotein-cholesterol [(2. 5 ± 0. 8) vs. ( 2. 1 ± 0. 7) mmol/L], triglyceride ( TG) [( 2. 1 ±1.1 )vs. (1.3±0.8) mmol/L], fasting blood glucose [(5.9±2. 7)vs. (4.8±1.3) mmol/L], serum level of iron [(16±7)vs. (13 ±5) μmol/L], uric acid [(429±114) vs. (388±88) (μmol/L], and carbon dioxide combining power (CO2CP) [(22 ±4)vs. (23 ±4) mmol/L]between MS group and non-MS group (All P   0.05). Binary logistic regressive analysis revealed that serum level of iron (OR = 1.058,95% CI = 1.001 -1. 119), white blood cell count ( OR = 1. 786,95% CI = 1. 346 - 2.371) and hypersensitive serum C-reactive protein (OR = 1. 101,95% CI = 1.010 - 1.201 ) were independent risk factors for MS in MHD patients. Conclusions Morbidity of MS is high in patients with MHD, involved with inflammation process. Serum level of iron, white blood cell count and hypersensitive serum C-reactive protein are independent risk factors for MS in patients with MHD and no inevitable connection between MS and nutritional status in them is found. 

Key words: 
Renal dialysis;  Metabolic syndrome X;  Risk factor;  Inflammation
Hyponatremia could be an important prognostic factor for oncology patients: Result of a retrospective study.
Authors: Prantik Das, Lalith Seneviratne, Emma Gore, Zin Mar Oo, Joshua Hulman, Luckni Sellahewa
Journal: Journal of Clinical Oncology (2020)

7055 Background: Hyponatraemia is the most common electrolyte disorder encountered in clinical practice. Hyponatraemia in hospitalized people is associated with an increased morbidity, mortality and longer hospital stay compared with people with normal serum sodium concentrations. It is a negative prognostic indicator for survival in oncology patients. Incidence of hyponatremia in malignancy is largely underestimated. Methods: Retrospective analysis of patients admitted to oncology ward in our institution between August to September 2018 was conducted. Patients were identified from admission register and data were analysed from electronic medical records. Primary aim was to evaluate the incidence of hyponatraemia in oncology in-patients and impact on survival. Data were also analysed for patients demography, cancer types, grade of hyponatremia and treatment approach. Results: 119 patients were admitted to oncology ward during study period. Out of them 38% were identified to be Hyponatraemic and 51 % patients were male. Lung cancer was the predominant cancer type followed by breast, upper GI and ovarian respectively. Of hyponatraemic patients, 63% were asymptomatic, among symptomatic patients vomiting, confusion and headaches are common. According to severity, 42% patients had grade 1, 40% grade 2 and 18% grade 3 hyponatraemia respectively. When it comes to status of hydration, 62.2% were noted to be euvolaemic, 6.66% were hypervolaemic and 15.5% were hypovolaemic and the hydration status of the rest of 15.5% were not known. Considering mortality, 53% patients died within 30 days of diagnosis of hyponatremia compared to 17% deaths among non-hyponatraemic patients. Median survival of patients with grade 3, 2 and 1 hyponatremia were 29, 35 and 62 days respectively. Out of 45 patients 14 (31.1%) had acute onset hyponatraemia and they had considerably poorer survival compared to their chronic hyponatraemic counterparts. 80% of acute hyponatraemic patients have died within 30 days of diagnosis, compared to 140 days for chronic hyponatraemics with similar death rate. Out of 48% non-hyponatraemic patients who died within next 6 months, 31% developed hyponatraemia at some point before their death and amongst them, 5.7% had severe, 8.5% had moderate and 17% had mild hyponatraemia respectively. Conclusions: Our study indicated that hyponatremia is poor prognostic factor among oncology patients, with mortality being significantly higher when the grade is higher and when acute in onset. Identifying and early intervention could improve patient outcome.
高血压的时间治疗学简介
Authors: 匡建华
Journal: BMJ (2005)

一、正常人及高血压患者血压的昼夜节律与时间生物学 正常人血压以24 h为周期反复发生昼夜节律性变化.一般说来,正常人血压日间高于夜间,日间血压波动较大,尤其是收缩压,在凌晨2:00～3:00时处于最低谷,以后呈上升趋势,早晨起床活动后迅速上升,约上午8:00～9:00时达到第一峰值,下午5:00～6:00时可略高,此为第二峰值,之后开始缓慢下降,所以24 h动态血压监测曲线呈双峰一谷.
Rapid expansion of M-MDSCs and association with high levels of plasma TSLP and primary resistance to PD-1 inhibitors in metastatic NSCLC.
Authors: Sally CM Lau, Stephanie WY Wong, Ben X Wang, Devalben Patel, Aline Fusco Fares, Ming-Sound Tsao, Penelope Ann Bradbury, Geoffrey Liu, Natasha B. Leighl, Frances A. Shepherd, Pamela S Ohashi, Adrian G. Sacher
Journal: Journal of Clinical Oncology (2020)

3084 Background: Elevated frequency of peripheral myeloid cell populations has consistently been associated with poor response to immune checkpoint inhibitors (ICI) in metastatic non-small cell lung cancer (mNSCLC). The mechanisms underlying this relationship remains poorly understood. Thymic stromal lymphopoietin (TSLP), a cytokine involved in T-cell maturation, has been implicated in a complex feedback loop leading to tumor growth and expansion of myeloid populations. We hypothesized that TSLP levels directly correlate with the presence and expansion of myeloid derived suppressor cell (MDSC) populations and sought to explore their association with response to PD-1 inhibitors in mNSCLC. Methods: mNSCLC patients treated with ICIs underwent baseline and serial blood collection. Peripheral blood mononuclear cells (PBMC) were analyzed by high-dimensional flow cytometry using validated panels to evaluate T/B/NK-cell, Treg and myeloid populations. Plasma cytokines including TSLP were analyzed using ELISA and Luminex assays. Cox and logistic regressions were utilized to correlate biomarkers with progression-free survival (PFS), overall survival (OS) and radiographic response. Results: 30 mNSCLC patients treated with single-agent ICI were included in the analysis. TSLP level was significantly associated with expansion of monocytic(M)-MDSCs in response to ICI treatment (p=0.02). M-MDSC frequency after a median of 20 days of ICI treatment was significantly associated with progressive disease (PD), reduced PFS and OS (all p&lt;0.05) whereas no correlation was seen with baseline M-MDSC frequency. Patients with a doubling of M-MDSCs (n=11) after treatment had a primary PD rate of 64% vs 24% (OR 7.0, p=0.04) and significantly worse median PFS (2.5 vs 7.8 months, HR 2.6 p=0.04). Conclusions: Early expansion of circulating M-MDSCs after treatment with PD-1 inhibitors is associated with elevated baseline TSLP levels and primary disease progression following ICI therapy in mNSCLC. These findings suggest that elevated TSLP and early expansion of myeloid populations may represent an important mechanism of primary resistance to PD-1 inhibitors in mNSCLC.
Prognosis of Asymptomatic Intracranial Stenosis in Patients With Transient Ischemic Attack and Minor Stroke
Authors: Robert Hurford, Frank J. Wolters, Linxin Li, Kui Kai Lau, Wilhelm Küker, Peter M. Rothwell
Journal: JAMA Neurology (2020)

Asymptomatic intracranial stenosis (ICS) is a frequent finding on imaging results, particularly in the assessment of acute stroke. Although the management of symptomatic ICS is informed by randomized trials, to our knowledge there are few data on the prevalence and prognosis of asymptomatic ICS in patients with stroke and transient ischemic attack (TIA).
抢救重症有机磷中毒合并电击伤一例
Authors: 刘庆辉, 鞠中斌
Journal: BMJ (2005)

患者男,28岁,农民.于2004年1月10日16时被行人发现躺在离断的电线旁(220 V),身边有呕吐物,左手掌有灼伤痕,伤后0.5 h送急诊科.患者呈深度昏迷状态,呼吸微弱,急诊经口气管插管,球囊辅助呼吸;心电监护示心室纤颤,给予电击除颤4次,期间静脉推注肾上腺素3 mg、氟美松10 mg,心电图转为窦性节律,收入重症监护室.给予佩戴冰帽、呼吸机控制呼吸、多功能监护仪监护.查体:体温35.0℃,心率120次/min,无自主呼吸,血压140/100 mm Hg(1 mm Hg=0.133 kPa);深昏迷,全身皮肤干燥,肢端凉,双瞳孔直径1 mm,双肺呼吸音粗,可闻及少量干湿啰音,心音弱,四肢肌张力低,无肌束震颤,一切反射消失。
Development of referral indications for low back pain with RAND-UCLA consensus panel method
Authors: Xiao-na Cao, Zhi-hong Zheng, Shu-qi Cui, Ya-li Zhao, Juan Liu, Juan Du, Xiao-qin Lu, Da-hong Gao, Hui-li Wang, Ya-dong Wang
Journal: BMJ (2010)

Objective To study the validity of RAND-UCLA (Rand Corporation and University of California at Los Angeles) consensus panel method in developing guidelines of referral indications for low back pain (LBP).Methods Evidence-based clinical guidelines for LBP management at community level and its referral guidelines published since 2001 and other tools were retrieved with varied tools.All clinical guidelines met inclusion criteria were evaluated with clinical studies and evaluation tools (AGREE).An pool of indication items was established based on evidence for developing referral indications for LBP, which were added by RAND-UCLA consensus panel method, and alternative referral indications were selected and clinical guidelines for LBP referral were established.Results A total of 15 copies of clinical guidelines from nine countries or regions were included in it after critical appraisal.Four copies of referral guidelines from two countries were included.Referral indications for LBP were derived directly from the RAND-UCLA consensus panel process, consisting of 44 referral indications for three groups (immediate, urgent and routine referral).Conclusions The RAND-UCLA consensus panel method is a more useful and practical tool in developing clinical guidelines, referral guidelines, which is worthwhile being recommended and spread.

Key words: 
Patient transfer;  Clinical guidelines;  Low back pain;  Consensus panel method
More concern on the management and research of male climacteric syndrome
Authors: Hongjun Li
Journal: BMJ (2017)

更年期是由中年步入老年之际的过渡时期，接近40%的中老年男性可出现不同程度的更年期症状和体征，并有多器官系统的功能损害。许多内在因素与环境因素均可影响到男性更年期综合征的发生，是多病因、多因素性疾病，是由于老龄化以及同时伴发的多种疾病等因素共同作用的结果，并导致了体内多种内分泌激素水平的改变，主要是获得性的性腺功能低下。现代医学可以为男性更年期综合征患者提供综合的诊断、治疗和预防方案，来防止其发生、改善临床症状、提高生命质量。
HLA-B Leader and Survivorship after HLA-Mismatched Unrelated Donor Transplantation
Authors: Effie W Petersdorf, Philip Stevenson, Mats Bengtsson, Dianne De Santis, Valerie Dubois, Ted Gooley, Mary M Horowitz, Katharine C. Hsu, Alejandro J Madrigal, Mari Malkki, Caroline McKallor, Yasuo Morishima, Machteld Oudshoorn, Stephen Spellman, Jean Villard, Mary Carrington
Journal: Blood (2020)
Radiation-induced changes in the inflammatory microenvironment composition of lung cancer brain metastases.
Authors: Ariane Steindl, Maximilian Mair, Angelika Martina Starzer, Karin Dieckmann, Georg Widhalm, Johannes A. Hainfellner, Manuela Schmidinger, Matthias Preusser, Anna Sophie Berghoff
Journal: Journal of Clinical Oncology (2020)

2528 Background: Radiotherapy was postulated to impact the inflammatory microenvironment composition in patients with lung cancer brain metastases (BM). Methods: Formalin fixed and paraffin embedded BM specimens from treatment naïve patients (group 1) and from patients treated with radiation therapy including whole brain radiotherapy and/or stereotactic radiosurgery (group 2) or prophylactic cranial irradiation (group 3) before BM resection were identified from the Vienna Brain Metastasis Registry. T cell subsets (CD3+,CD8+,CD45RO+,FOXP3+,PD-L1+) were investigated using the Ventana Benchmark Ultra system Definiens software. Results: Specimens from 41 patients (28/41;68.3% NSCLC, 13/41;31.7% SCLC) were included in the study. A significant difference in CD3+TIL density between group 1 (median: 964.5cells/mm2) and group 2 (median: 283.4cells/mm2; p-value=0.021; Mann-Whitney-U test), as well as group 3 (median: 168.8 cells/mm2; p-value= 0.028; Mann-Whitney-U test) were observed. Furthermore, CD8+ and FOXP3+TIL densities of group 2 (CD8+ median: 172.1cells/mm2; FOXP3+ median: 210.7cells/mm2) were numerically lower compared to group 1 (CD8+ median: 190.1 cells/mm2; FOXP3+ median: 221.2 cells/mm2). Of 10/41 (24.4%) patients further resected BM tissue specimens after initial resection were available. Here, the inflammatory microenvironment of BM treated with radiation therapy between the resections was significantly associated with lower densities of CD3+ (median: 105.1 cells/mm2) and CD8+ (median: 20.3cells/mm2) compared to radiation-naïve patients (CD3+ median: 825.4cells/mm2; CD8+median: 105.5cells/mm2; p=0.037; Mann-Whitney U-test). Conclusions: Radiation treatment was associated with lower densities of TIL subsets in our BM cohort. Although results have to be interpreted with caution due to the limited sample size, further studies investigating the sequencing of radiotherapy and immune modulating therapies might be of interest. [Table: see text]
Watch-and-wait policy versus robotic resection in locally advanced rectal cancer patients after clinical complete response following chemoradiotherapy: A cost-effectiveness study (RECCOSTE).
Authors: Jesus Rodriguez-Pascual, Javier Nuñez-Alfonsel, Benedetto Ielpo, Mercedes Lopez, Rafael Alvarez-Gallego, Cesar Gregorio Muñoz, Yolanda Quijano, Emilio De Vicente, Antonio Cubillo Gracián, Carlos Saborido
Journal: Journal of Clinical Oncology (2020)

e19374 Background: Chemoradiotheray (CR) followed by standard Surgical Resection (SR) is the standard treatment for distal locally-advanced rectal cancer (LARC) patients after a clinical compete response (cCR). Some novel approach suggested better functional results using robotic rectal resection (RRR) or avoiding surgical procedure, called Watch and Wait (WW) strategy. Methods: A Markov model-based, cost-utility analysis estimating mean costs and QALYs per patient was performed to compare SR, RRR and WW strategies for patients achieving a cCR to CRT. Rates of local regrowth, recurrence and distant metastasis were derived from series comparing WW to SR and from our previous comparative study of RRR versus SR. Lifetime incremental cost-utility ratio was calculated between strategies, and sensitivity analysis were performed to study model uncertainly. A willingness-to-pay of 30.000 per Quality Adjusted-Life Year (QALY) was used as a threshold to determine the most cost-effective treatment. Results: The base case 15-years cancer-specific survival was 93.5% (95% confidence interval [CI] 91.5-94.9] on a WW program, compared to 95.9% [95%CI 93.6-97.7] after RRR. WW was dominant relative to RRR with cost savings of $48,566.58 (95%CI $47,635.77 - $49,497.39 ) and incremental QALY of 7.47 (95%CI 1.46 – 7.48). WW was also dominant relative to LRR, with cost savings of $48,764.49 (95%CI $47,768.49 - $49,760.48 ) and incremental QALY of 7.44 (95%CI 7,43 – 7.45). WW remained dominant in sensitivity analysis unless the rate of SR fell to 73.0%). Conclusions: This study provides data of cost-effectiveness differences between SR, RRR, WW approaches in LARC after cCR, showing a benefit for WW.
Risk assessment of thromboembolism and bleeding in patients with non-valvular atrial fibrillation
Authors: Yifang Guo
Journal: BMJ (2016)

对于非瓣膜性心房颤动患者，应采用CHADS2评分系统对其进行卒中危险分层。CHADS2评分≥2分者应长期接受维生素K拮抗剂等抗凝药物治疗。与此同时，在开始抗凝治疗之前还需对患者进行出血风险评估，HAS－BLED评分法是临床常用的评估系统。HAS－BLED评分≥3分者视为出血高危患者，在接受抗凝治疗过程中应加强监测。
Clinicopathological predictors of bone metastases in prostate cancer patients.
Authors: Ingreed Portilla, Joseph Pinto, Claudio J. Flores, Jhajaira M Araujo, Johanna A Villalobos, Alfredo Aguilar
Journal: Journal of Clinical Oncology (2020)

e17520 Background: To determine if there is association between the clinical-pathological characteristics and the development of bone metastases in patients with prostate cancer treated in Oncosalud during the period 2016-2018. Methods: An observational, analytical, cross-sectional and retrospective study was conducted in 386 men diagnosed with prostate cancer in a Private Clinic in Peru. We presented descriptive and analytic analysis to identify variables associated with bone metastases; in addition, odds ratios were estimated. Results: In reference to the PSA groups, those patients with PSA values higher than 20 ng / ml presented a risk 9.69 times higher to develop bone metastases (95% CI: 5.08-18.45). In regard to Gleason groups, those with a 9-10 score presented a risk of bone metastasis 2.67 times higher than patients with lower Gleason score (95% CI: 1.31-5.45). In regard to the clinical stage, those patients with a T3 stage had a 6.77 higher risk than those with lower clinical stages (95% CI: 3.79-12.09). Conclusions: Clinical-pathological characteristics associated with bone metastasis were identified in patients with prostate cancer, including age, Gleason scale, PSA value and clinical T stage.
Covid-19: Women’s health campaigners sue FDA over access to medical abortion pills
Authors: Janice Hopkins Tanne
Journal: BMJ (2020)

A group of prominent women’s health organisations are suing the Food and Drug Administration (FDA) for preventing telemedicine prescribing of mifepristone, one of the drugs used in early abortions and miscarriages. It is the only prescription drug with such a restriction.

The plaintiffs argue that the prohibition on telemedicine prescribing and mail delivery of mifepristone puts both the patient and the provider at risk of exposure to covid-19 during the current pandemic. Public health authorities have urged people to stay home as much as possible and the Centers for Disease Control and Prevention advised people to fill prescriptions by mail.

Those behind the action are the American Civil Liberties Union (ACLU), the American College of Obstetricians and Gynecologists, the Council of University Chairs of …