tbuckley/cabot-search huggingface dataset:
Concordance study of treatment guidance from an online patient assistance algorithm (OCPAP) and treatment recommendation of a multidisciplinary panel of oncologists in India.
Authors: Amit Kumar Jotwani, Rashie Jain, Rakesh Shankar Goud, Shashidhar Gururao, Thirtha Poovaiah, Rejil Rajan
Journal: Journal of Clinical Oncology (2020)

2049 Background: OCPAP (online cancer patient assistance pathway) is an algorithm-based online platform for patients to help them understand their treatment options. It is based on basic inputs like cancer type, stage, patient’s performance status and treatment received. It is developed by a team of oncologists from onco.com based on standard guidelines. Till date, more than 30,000 users from 18 countries have used OCPAP platform to get directional treatment recommendations. Onco.com also provides onco tumour board (OTB) services to help patients to get a detailed opinion from a multidisciplinary panel of oncologists. We presented initial data on development of OCPAP™ at the ASCO Breakthrough Summit 2019 ( OCPAP Breakthrough Abstract ). Here we present a concordance analysis of treatment recommendations from OCPAP platform against opinion of OTB panel. Methods: We analysed data from 448 eligible cases (those with 15 types of solid cancers) where an OTB opinion was provided and compared it with OCPAP treatment recommendation. We entered data from 448 anonymised OTB case records in to the OCPAP platform and recorded the output in terms of treatment recommendations. The study was blinded by its very design as we took data of cases from the time when the platform was non-existent. Results: We compared and analysed the recommendation provided by OCPAP in terms of surgery, chemotherapy, targeted therapy, radiation, clinical trials, palliative care or best supportive care against the opinion of OTB panel. Overall the concordance rate was found to be 93% for all cases and it was above 90% for all types of cancers included, except for brain tumors where it was 78% mainly due to variation in surgical operability and imaging findings influencing the treatment recommendation. The concordance rate was above 90% for all stages of disease and was highest for metastatic disease where it was 95%. The reasons for discordance were mostly related to availability of more detailed insights about the disease for OTB, like clinical details, performance status, imaging findings, molecular data and oligometastasis. Conclusions: The treatment direction recommended by OCPAP was found to be consistent with the one provided by OTB panel for most solid cancers. This indicates that OCPAP is an effective and simple online tool for patients to understand their treatment options, validate their ongoing treatment and be able to actively participate in their treatment decisions.
What Should I Know About Opioids and Living With Chronic Pain?
Authors: Sarah Leyde, Soraya Azari
Journal: JAMA Internal Medicine (2020)

What Should I Know About Opioids and Living With Chronic Pain?At one time, chronic pain (lasting longer than 3 months) was routinely treated with opioid pain medications (oxycodone, morphine, codeine, etc).But we now know that opioids are less effective and more risky than we thought, so many people are choosing other ways to treat chronic pain.What Are the Risks of Opioids?Even when taken as directed, opioids can cause side effects.These include tolerance (requiring more medication to have the same effect), dependence (developing unpleasant withdrawal symptoms if you stop taking opioids), increased sensitivity to pain, depression and fatigue, constipation, low sex hormone levels, itching, sweating, and overdose (slowed breathing, sedation, and possibly death).
One-year follow-up for patients with diabetic retinopathy in Shanghai communities
Authors: Fei Qin, Rong Shi, Lili Jia, Hua Jiang, Yi Feng, Shengbing Zhang, Daoping Song, Yuli Jiang, Wenjuan Gu, Yun Peng, Huiqin Cheng, Jieqiong Lou, Wen Long
Journal: BMJ (2019)

Objective
To investigate the outcomes of patients with diabetic retinopathy (DR) in Shanghai communities and the influencing factors.


Methods
From October 2015 to April 2016,533 type 2 diabetic patients with DR were selected by target sampling and cluster random sampling method from six community health service centers in Shanghai. Patients were followed up for 1 year. The demographic information,physical examination,laboratory tests and eye fundus exam results were documented and the DR was graded.The factors associated with the regression of DR were analyzed.


Results
Total 478 patients, including 280 females (58.6%) and 198 males (41.4%),were followed up for 1 year. The mean age of patients was (64±7) years and the mean disease duration was (8.85±4.20) years. The original DR lesion was remitted in 35 patients with an improvement rate of 7.3%; while the original DR lesion was aggravated in 29 patients with a progression rate of 6.1%. Ordinal logistic regression analysis revealed that age (OR=0.197, 95%CI: 0.056-0.699), body mass index (BMI) (OR=0.383, 95%CI: 0.171-0.856), glycosylated hemoglobin (HbA1c) (OR=0.287, 95%CI: 0.102-0.803), triglycerides (TG) (OR=0.541, 95%CI: 0.295-0.991), urinary albumin to creatinine ratio (ACR)(OR=0.218,95%CI:0.066-0.720) were associated with DR in type 2 diabetic patients.


Conclusion
The regression of DR is closely related to age,BMI,glucose,serum lipids and renal function,so it is suggested that lowering BMI,controlling glucose and serum lipids and maintaining normal kidney function are necessary for preventing the progression and promoting the improvement of DR in diabetic patients.


Key words: 
Diabetes mellitus,type 2; Diabetic retinopathy; Follow-up studies; Regression; Risk factors
Advances of clinical research for primary Sj(o)gren's syndrome in children
Authors: 霍月红, 李军霞, 张莉芸, 许珂, 陈小云, 李小峰
Journal: BMJ (2008)

原发性干燥综合征(primary Sjogren's syndrome,pSS)是一种主要侵犯外分泌腺的系统性自身免疫性疾病.儿童pSS是指发生于年龄<16岁者的pSS,发病率低,临床表现与成人有所不同.现复习国内外相关文献,就儿童pSS的临床研究进行综述。
Phase II trial using haploidentical hematopoietic cell transplantation (HCT) followed by donor natural killer (NK) cell infusion and sirolimus maintenance for patients with high-risk solid tumors.
Authors: Monica S. Thakar, Meghen Browning, Parameswaran Hari, John A. Charlson, David A. Margolis, Brent Logan, Nathan Schloemer, Michael E. Kelly, Amy Newman, Bryon Johnson, Carolyn Anne Keever-Taylor, Subramaniam Malarkannan
Journal: Journal of Clinical Oncology (2020)

e23551 Background: Patients with relapsed solid tumors have dismal predicted OS &lt; 10-20% at 5 years with conventional salvage therapies. We hypothesized that a multi-faceted immunotherapy approach to optimize graft-versus-tumor (GVT) effects, in combination with a mammalian target of rapamycin (mTOR) inhibitor maintenance strategy, would enhance early disease-control rates (DCR), leading to improved progression-free survival (PFS) and OS for this high-risk population. Methods: Treatment consisted of HLA-haploidentical marrow (n = 12) or peripheral blood stem cell (n = 3) transplantation to optimize GVT effects, preceded by reduced-intensity conditioning (fludarabine, cyclophosphamide, and 3 Gy total body irradiation) to promote engraftment of these mismatched stem cells. Haplo-NK cells were given to boost this GVT effect. They were purified from non-mobilized donor mononuclear cells by CD3 depletion followed by CD56 selection using the Miltenyi CliniMACS system and were infused fresh on day +7 after HCT. Postgrafting immunosuppression included sirolimus maintenance, which continued until 6 months post-HCT. Results: Fifteen patients with relapsed Ewing sarcoma (EWS) (n = 9), rhabdomyosarcoma (n = 4), osteosarcoma (n = 1), and medulloblastoma (n = 1) having stable or undetectable gross disease were enrolled on this Phase II trial. Median age at HCT was 19 (4.5-37) years old and median performance status was 80%. Four patients underwent prior autologous transplants. Patients received a median NK dose of 6.5 (3.7-11.4) x 10 6 /kg. NK cell products had a median log T cell depletion of 5.94 (5.18-6.75), median NK recovery of 62% (48-71%), and median NK purity of 92% (74%-97%). All donor NK infusions were well-tolerated without cytokine release syndrome. All patients engrafted, and all had sustained full donor chimerism ( &gt; 95% CD3). Two patients developed grade II acute graft-versus-host disease (GVHD), and 2 patients developed chronic GVHD. No patients died from transplant-related causes. With a median follow-up of 1.3 years (range, 70 days – 5 years), 6-month DCR is 72%. 1- and 2-year OS for the entire cohort is estimated at 64% and 40%, respectively, while PFS is 29% and 22%, respectively. For patients with EWS,1- and 2- year -OS is estimated at 75% and 45%, and PFS is 38% and 25%, respectively. Conclusions: This dual immunotherapy approach followed by mTOR inhibition maintenance was well-tolerated, with better than expected OS for this high-risk set of diseases. Clinical trial information: NCT02100891 .
Real-world (RW) outcomes for advanced non-small cell lung cancer (aNSCLC) patients (pts) with <i>EGFR</i> exon 19 deletions (x19del) stratified by deletion size.
Authors: Sai-Hong Ignatius Ou, Russell Madison, Tamara Snow, Jeremy Snider, Margaret Elizabeth McCusker, Gaurav Singal, Brian Michael Alexander, Jeffrey Venstrom, Emily Castellanos, Alexa Betzig Schrock
Journal: Journal of Clinical Oncology (2020)

9591 Background: EGFR x19dels are well-established targetable drivers in NSCLC. Historically x19dels have been treated as a single group, but it’s unclear whether responses vary for distinct subtypes. We compared demographic, clinical and genomic characteristics as well as outcomes to EGFR tyrosine kinase inhibitors (TKIs) for aNSCLC pts with x19dels of varying lengths using a RW Clinico-Genomic Database (CGDB). Methods: Eligible pts had a diagnosis of aNSCLC, received care within the Flatiron Health network between 1/2011-9/2019, and had comprehensive genomic profiling (CGP) by Foundation Medicine. Clinical characteristics, treatment history and RW progression were obtained via technology-enabled abstraction as previously described (Singal G, JAMA 2019). x19del length was evaluated for association with overall survival (OS) and RW progression-free survival (rwPFS) with Kaplan-Meier analysis and unadjusted/adjusted (practice type, gender, age at TKI start, EGFR TKI type, race) hazard ratios (HR/aHR) from Cox proportional hazards models adjusted for survival bias. Results: Among 6,577 aNSCLC pts, EGFR x19dels were detected in 336 cases (5%). E746_A750del was the most frequent (214; 64%) and generally 5 amino acid (aa) deletions (x19del-5) were the most common (241; 72%). Other deletions (x19del-other) of 6 (61; 18%), 3 (20; 6%), 4 (11; 3%) or 8 aa (3; 1%) were also observed. Among pts treated with 1st-line EGFR TKI monotherapy after CGP, the x19del-5 (n = 70) cohort was more frequently female compared to x19del-other (n = 27) (90% vs 59%, p = 0.001). No statistically significant differences in the frequency of co-occurring alterations were observed, specifically for genes associated with response to EGFR TKI response such as CTNNB1 (14% vs 19%) and PIK3CA (10% vs 15%). 1st line EGFR TKIs used were similar for x19del-5 vs x19del-other (43% vs 41% osimertinib, 30% vs 37% erlotinib, 24% vs 22% afatinib, 3% vs 0% gefitinib). x19del-5 pts had similar median rwPFS (10.6 vs 10.6 months, HR: 0.73 [0.41-1.28], aHR:0.78 [0.38-1.59]) and median OS (29.2 vs 24.9 months, HR: 0.64 [0.32- 1.29], aHR: 0.75 [0.32-1.75]) compared to x19del-other. Conclusions: In a RW CGDB of 336 aNSCLC pts with EGFR x19dels, 5 aa x19dels were most common (71%) and 29% of cases had 3, 4, 6 or 8 aa x19dels . For pts included in the treatment cohort, no significant differences in rwPFS or OS were observed. These results suggest that x19del length does not significantly impact clinical outcomes to 1st-line EGFR TKIs.
Intestinal microbiome diversity and clinical outcomes with multiple myeloma: A systematic review.
Authors: Aqsa Ashraf, Shaha Nabeel, Zahoor Ahmed, Arafat Ali Farooqui, Saif ur Rehman, syeda Sabeeka Batool, Zunairah Shah, Muhammad Salman Faisal, Muhammad Saad Farooqi, Aisha Akhtar, Faiz Anwer
Journal: Journal of Clinical Oncology (2020)

e20542 Background: Human gastrointestinal microbiome (GM) plays a role in food digestion, drug metabolism and protection against infections. We systematically reviewed the outcomes for multiple myeloma (MM) patients (pts) and its changes in GM diversity (GMD) with regimen-related toxicities. Methods: After a systematic search of PubMed, Embase, Web of Science, Cochrane, and Clinicaltrials.gov (until 01/12/2020), 9 out of 135 studies met our inclusion criteria. Results: GM changes were studied in 1343 pts. 1070 pts received Autologous (Auto) and 119 pts received Allogeneic (Allo) hematopoietic cell transplantation (HCT). 1. Impact of Induction without HCT: Higher levels of Eubacterium hallii and Faecalibacterium prausnitzii in 16 (MM) minimal residual disease (MRD) –ive pts and lower levels in 18 (MM) MRD +ive pts were noted (Pianko 2019). 2. Impact of HCT and microbiome: 1142 pts (MM = 1011) were studied; day+15 samples showed reduction of Bacteroidetes in Auto-HCT compared with Allo-HCT pts. Pts with graft versus host disease (GVHD) harbored more Firmicutes, Proteobacteria and less Bacteroidetes than pts without GVHD (Chiusolo 2015). Day+30 fecal samples (FS) revealed increase in Proteobacteria, Clostridium difficile and decrease in Firmicutes, Fusarium in FS while oral samples (OrS) showed increase in Firmicutes and decrease in Proteobacteria and Glomerella. Increased gastrointestinal adverse effects (AEs) (40%) correlated with decreased GMD especially in pts with ulcerative oral mucositis (OM) (Alexa 2019, El-Jurdi 2019, Apewokin 2015). At 3 years, Allo-HCT pts with highest GMD manifested least treatment-related mortality (TRM) (9%) and vice versa (Taur 2014). 3. Impact of Post-HCT Lactobacillus Probiotics (LBP) or Antibiotics: Improvement in AEs with LBP was statistically insignificant (Gorshein 2017, Giammarco 2016). Pts showed better clinical outcomes with ciprofloxacin and metronidazole (Cp-M) (n = 68) than Ciprofloxacin (n = 66) alone; i.e. overall survival (49% vs 42%), increased number of FS without anaerobic bacteria (53% vs 23%), GVHD (25% vs 50%), OM (82% vs 92%) (Beelen 1999). Conclusions: Treatment for MM alters microbiome diversity. Increased diversity was associated with fewer gastrointestinal AEs. Improvement in AEs with LBP was statistically insignificant. Post-HCT use of Cp-M showed better overall survival.
急性一氧化碳中毒的诊断与治疗
Authors: 李艳萍
Journal: BMJ (2005)

一氧化碳(carbon monoxide,CO)俗称煤气,是最常见的窒息性气体.其无色、无臭、无刺激性,密度0.967,比空气稍轻;微溶于水,易溶于氨水;易燃易爆,与空气混合的爆炸极限为12.5%～74.2%.急性一氧化碳中毒(ACMP)是最常见的急性职业中毒,也是常见的生活性中毒之一,北方冬季尤为常见。
Epilepsy and Other Chronic Convulsive Diseases; Their Causes, Symptoms and Treatment.
Journal: JAMA (1901)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Therapeutic strategies of chronic constipation in special patients
Authors: Ya Jiang
Journal: BMJ (2018)

Chronic constipation is one of the common gastroenterological conditions, which impairs physical and mental health of patients, compromises quality of life and increases medical cost. Constipation is usually managed by changing life styles, using enemas, laxatives, probiotics or antidepressants, performing bio-feedback or behavioral therapy. However, some patients are not satisfied with treatment. It is important to give individualized therapy to special patients with chronic constipation in order to enhance the therapeutic efficacy and to improve the quality of life.


Key words: 
Constipation; Pregnancy; Diabetes mellitus; Parkinson disease; Depression; Anxiety
Addition of carboplatin to chemotherapy regimens for metastatic castrate-resistant prostate cancer in post-second generation hormone therapy setting: Does it improve treatment response and survival outcomes?
Authors: Jamal Alamiri, Mohamed E. Ahmed, Jack R. Andrews, Manaf Alom, Giovanni Motterle, Julianna Higa, Jeffrey Karnes, Eugene D. Kwon, Alan Haruo Bryce
Journal: Journal of Clinical Oncology (2020)

e17540 Background: The clinical course in metastatic castrate-resistant prostate cancer (mCRPC) can be complicated when patients have disease progression after treatment with 2 nd generation hormone therapy (2 nd -HT), such as enzalutamide or abiraterone. Currently, limited data exist regarding the optimal choice of chemotherapy for mCRPC after failing 2 nd -HT. We sought to evaluate three common chemotherapy regimens in this setting. Methods: We retrospectively identified 150 patients with mCRPC with disease progression on enzalutamide or abiraterone. 92 patients were chemo-naïve, while 58 patients had previously received docetaxel chemotherapy prior to 2 nd -HT. After failing 2 nd -HT, 90 patients received docetaxel-alone (group A), 33 patients received carboplatin plus docetaxel (group B), while 27 patients received cabazitaxel-alone (Group C). Favorable response was defined by ≥50% reduction in PSA level from baseline after a complete course of chemotherapy. Survival outcome was assessed for 30-month overall survival. Results: Mean (SD) age was 71.2 (8.28), 69.5(8.38) and 67.2 (8.36) for group (A), (B) and (C), respectively. Mean (SD) pre-chemotherapy PSA was 63.8 (138.18), 58.5 (118.15) and 53.7 (88.15) for group (A), (B) and (C), respectively. Mean (SD) Gleason score was 7.9 (1.1), 8.4 (0.88) and 8.1 (1.06) for group (A), (B) and (C), respectively. Patients in group (B) were 2.6 times more likely to have a favorable response compared to group (A) (OR = 2.625, 95%CI: 1.15 - 5.99) and almost 3 times compared to patients in group (C) (OR = 2.975, 95%CI: 1.04 – 8.54) (p-value = 0.0442). We report a Hazard Ratio (HR) of 3.1 (95% CI 1.31-7.35; p = 0.0037) between patients in group (A) versus group (B), and a HR of 4.18 (95% CI 1.58-11.06; p = 0.0037) between patients in group (C) versus group (B). Thirty-month overall survival was 70.7%, 38.9%, and 30.3% for group (B), (A), and (C) respectively (p-value = 0.008). Conclusions: Our data demonstrate improved response and cancer-specific survival in patients with treatment-refractory mCRPC on docetaxel plus carboplatin compared to docetaxel or cabazitaxel alone. Selection bias is inherent in any retrospective study; however, our finding suggests that clinicians may consider docetaxel plus carboplatin in mCRPC patients who fail 2 nd -HT. Further prospective studies are warranted.
椎间盘镜下组织冷融汽化刀治疗臀肌挛缩症八例
Authors: 万里, 廖中东, 汪冬生
Journal: BMJ (2005)

臀肌挛缩症(gluteal muscle contracture,GMC)是临床较常见疾病,我院自2003年6月至2004年6月应用椎间盘镜系统及组织冷融汽化刀治疗GMC患者8例,疗效满意,现报告如下。
Landscape of targetable alterations discovered by next generation sequencing demonstrates the role a community hospital can play in precision-guided oncology: Experience from Lenox Hill Hospital.
Authors: Morana Vojnic, Jordan Steinberg, Igor Odintsov, Yonah Ziemba, Lindsay K Hill, Oana Vele, Keith R. Brunckhorst, Adnan Hasanovic
Journal: Journal of Clinical Oncology (2020)

e19279 Background: Next generation sequencing (NGS) has become standard of care in aiding diagnosis and treatment of advanced solid cancers, and in conducting clinical trials at large centers. It is imperative that this is expanded to other hospitals that care for the majority of cancer patients. We analyzed NGS reports from our hospital to assess the number of patients who can benefit from approved or investigational targeted therapies. Methods: We analyzed NGS data for 511 solid tumor samples sequenced between January 1, 2018 and December 31, 2019. NGS was performed by GenPath Dx (77%), Caris Life Sciences (16%) or Foundation Medicine (7%). Results: The majority of samples represented advanced stage malignancies and 21% were stage I or II. They originated from the following primaries: 195 lung (37%), 150 gastrointestinal (29%), 64 primary brain (12%), 20 gynecological (4%), 14 skin (3%), 13 head and neck (3%) and 11 sarcomas (1%). 72 samples had mutations in EGFR (14%), 170 in TP53 (33%), 124 in KRAS (24%), 28 in BRAF (6%), and 3 in RET (0.6%). 34/107 (32%) early stage samples harbored an actionable mutation (20 EGFR mutations, 1 MET exon 14 skipping, 4 KRAS G12C, 7 BRAF V600E, 1 FGFR3 amplification and 1 CD74/NRG1 fusion). In contrast, only 58/317 (18%) advanced stage samples had a targetable mutation (p-value = 0.02, χ² test). 76% of EGFR-mutated samples were lung adenocarcinomas, and 19% were primary brain tumors; 54% of these are targetable by FDA-approved EGFR inhibitors. KRAS mutations were found in gastrointestinal (54%), lung (37%) and pancreatic (5%) malignancies. 17 patients had a KRAS G12C mutation and, therefore, could benefit from one of the KRAS G12C inhibitors in early clinical trials. Four samples harbored crizotinib-sensitive mutations (2 MET amplifications and 2 MET exon 14 skipping mutations). Regarding gene fusions, one glioblastoma sample had a PTPRZ-MET fusion and one lung adenocarcinoma sample harbored a CD74-NRG1 fusion. Conclusions: We identified 92/511 samples (18%) with clinically actionable mutations; distributed in 32% early stage and 18% advanced stage disease, indicating that actionable mutations are present at an increased frequency in early stage solid malignancies in our data set and trials to investigate targeted therapy in such settings should be considered. Furthermore, we show that a community-based hospital can be a site for future clinical trials of small molecule inhibitors and bring precision-guided medicine to additional patients.
Endovascular stroke treatment during the COVID-19 pandemic
Authors: Johanna M. Ospel, Mayank Goyal
Journal: Nature Reviews Neurology (2020)

The COVID-19 pandemic has added an additional layer of complexity to endovascular treatment (EVT) for acute ischaemic stroke. Drawing on recently published guidelines, this article provides a conceptual framework for EVT in the COVID-19 era, outlining key principles for ensuring safe and timely EVT while minimizing the risk of infectious exposure for health-care workers and patients.
食管源性胸痛30例分析
Authors: 马进玉, 齐颖, 邸岩, 宋秀华, 吴边
Journal: BMJ (2009)

胸痛是临床常见的症状,分为心源性和非心源性.非心源性胸痛主要包括食管源性、骨骼肌肉病变、肺源性、胃一胆道疾病、精神因素等.近一半非心源性胸痛为食管源性,诊断正确与否对治疗起着决定性作用.现对我院确诊的30例食管源性胸痛进行分析,以提高对非心源性胸痛诊断和鉴别诊断的认识。
The Invisible University Is COVID-19 Positive
Authors: Daniel S. Park
Journal: Trends in Genetics (2020)

Within the ivory tower of academia, the coronavirus disease 2019 (COVID-19) pandemic stands to disproportionately impact the invisible workforce of postdoctoral researchers (postdocs). Faced with university closures, hiring freezes, and a general lack of support and benefits, an entire generation of postdocs and their knowledge and skills may be lost to academia without intervention.