tbuckley/cabot-search huggingface dataset:
Evaluation of residency training program from general practitioners who completed the training in Zhongshan Hospital
Authors: Jian Wang, Shan-zhu Zhu
Journal: BMJ (2012)

Objective To evaluate the standardized general practice training program.Methods A questionnaire survey was conducted among general practitioners who completed the standardized residency training program in Zhongshan Hospital,Fudan University from January 2000 to June 2011.Results During this period 183 residents received general practice training,15 were excluded the survey due to loss of follow-up or other reasons,168 questionnaires were distributed and 165 valid questionnaires were returned with a recovery rate of 98％.The main findings:2/3 of surveyed GPs were sent by their affiliated institutions; 85％ evaluated the program as highly or  highly; 56％ thought that their expectations were completely or mostly fulfilled; 68％ thought that the program enhanced their clinical capability and theoretical levels; over half thought that the clinical rotation and strict teaching management were the advantages of the program; 84％ thought that they improved their skills,knowledge and ideas; 74％ thought that the training program was very good or fairly good; 48％ thought that the preceptors in communities were comparatively weak and some theoretical lessons were not relevant to the context of the community.The surveyed GPs required improving of practice components,shortening the total length of training and increasing the teaching contents on scientific research.Conclusion The surveyed general practitioners give credit to the GP residency training in Zhongshan Hospital and put forward some proposals for further improvement.

Key words: 
General practitioner; Questionnaires; Standardized training
Efficacy and safety of anticoagulant therapy with warfarin in hemodialysis patients with atrial fibrillation
Authors: Guangji Wang, Bin Kong, Yu Liu
Journal: BMJ (2019)

Objective
To evaluate the efficacy and safety of anticoagulant therapy with warfarin for hemodialysis patients with atrial fibrillation.


Methods
A cohort of 118 hemodialysis patients with atrial fibrillatio were enrolled. The patients were divided into two groups: in warfarin group (n=53) the standard medication of warfarin was given for at least 3 months by adjusting the INR between 2.0 and 3.0; while no anticoagulants were given after discharge in non-warfarin group (n=65). Patients were followed up regularly, the events of stoke, death and bleeding were documented and compared between two groups.


Results
There were no significant differences in age, sex, underlying disease, predictive score of stroke risk in patients with non-valvular atrial fibrillation (CHA2DS2-VASc), predictive score of bleeding risk in patients with non-valvular atrial fibrillation (HAS-BLED) and dialysis frequency between the two groups (P>0.05). There were no significant differences in events of ischemic stroke [11%(6/53) vs. 12%(8/65), χ2=0.027, P=0.87], bleedings [(9%(5/53) vs. 5%(3/65), P=0.46] and gastrointestinal bleeding events [6%(3/53) vs. 3% (2/65), P=0.66] between two groups. There were no significant differences in the death event [15%(10/53) vs. 22%(14/65), χ2=0.129, P=0.72] and cardiac death [9%(5/53) vs. 11%(7/65), χ2=0.057, P=0.81] between two groups.


Conclusion
This study suggests that warfarin may not prevent ischemic stroke in hemodialysis patients with chronic atrial fibrillation, further studies are needed to determine the risks and benefits of anticoagulation therapy in these patients.


Key words: 
Warfarin; Renal dialysis; Atrial fibrillation; Stroke; Hemorrhage; Death
Role of HLA-DP Expression in Graft-Versus-Host Disease After Unrelated Donor Transplantation
Authors: Effie W. Petersdorf, Mats Bengtsson, Dianne De Santis, Valerie Dubois, Katharina Fleischhauer, Ted Gooley, Mary Horowitz, J. Alejandro Madrigal, Mari Malkki, Caroline McKallor, Yasuo Morishima, Machteld Oudshoorn, Stephen R. Spellman, Jean Villard, Phil Stevenson, Mary Carrington
Journal: Journal of Clinical Oncology (2020)

The main aim of this study was to evaluate the significance of HLA-DPB1 expression in acute graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT) from HLA-A, -B, -C, -DRB1, -DQB1-matched and -mismatched unrelated donors.
严重急性呼吸综合征激素治疗后跟骨缺血坏死六例
Authors: 刘霞, 屈辉, 程晓光
Journal: BMJ (2006)

严重急性呼吸综合征(SARS)激素治疗后康复患者192例进行双侧踝关节MR扫描,并于同一天拍摄双踝正、侧位片.结果表明,192例中有6例(9个跟骨)跟骨缺血坏死,双侧3例,单侧3例,跟骨缺血坏死发病率为4.1%.6例(9个跟骨)均发生在跟骨后半部分,且靠近中间髓腔部位;跟骨后部中央在TWI上可以看到环形线样低信号;并且均合并其他部位的多发骨坏死.提示当发生股骨头、膝关节、肱骨头等多发部位的缺血坏死时要特别注意跟骨,如果首先发现跟骨坏死,要特别注意其他部位是否有骨坏死。
住院医师规范化培训中的问题与思考
Authors: 凌玉
Journal: BMJ (2011)

实施住院医师规范化培训，是培养临床医学人才，提高临床医疗工作水平的重要措施之一，同时也是我国毕业后医学教育的重要组成部分。我国自1993年起陆续制定颁布了临床住院医师规范化培训有关办法及培训大纲，经过10多年的实践，各地在实施过程中取得了良好的效果，也积累了丰富的经验，但仍然存在一些问题。
Evaluations of nutritional status according to mini nutritional assessment in elder home-care patients
Authors: Bao-hua Qiu, Wei-min Ling, Guo-fang Cao, Chen-hui Xi
Journal: BMJ (2012)

Objective To assess the risk of malnutrition in elder home-care patients through mini nutritional assessment (MNA) and study the correlations between total MNA score and 18 individual questions in this patient group.Methods In May 2011,62 elder home-care patients from our center answered the MNA questionnaire.And the results were used to analyze the correlations between total MNA score and individual questions and the correlations among MNA classifications and body mass index(BMI),mid-arm muscle circumference (MAMC) and calf circunference (CC).Results According to MNA,18％ were malnourished ( 11/62 ),47％ at risk of malnutrition ( 29/62 ) and 35％ well-nourished ( 22/62 ) ; BMI,independence,mobility,neuropsychological problems,ingesting method,MAMC,CC and selfperceived nutritional status,self-perceived health status showed strong correlations with total MNA score (0.601,0.600,0.666,0.611,0.627,0.618,0.726,0.612,0.672,P ＜0.05).And weight loss within a month,number of daily meals and intake of drinks showed weak correlations with total MNA score (0.35,0.319,0.288,P ＜ 0.05 ).Positive correlations existed among MNA classifications and BMI,MAMC,CC (15.45,19.85,31.89,P＜0.05).Conclusions The elder home-care patients have a high risk for malnutrition.Half of 18 individual questions are strongly correlated with total MNA score in this patient group.

Key words: 
Nutrition assessment;  Home care services ;  Questionnaires;  Cross-sectional studies
Effects of in-hospital health education during pregnancy on breastfeeding
Authors: Yue Zhang, Hui-shan Wang
Journal: BMJ (2013)

The status of breastfeeding and in-hospital health education during pregnancy was surveyed in 32 maternity and children health care hospitals at provincial and municipal levels. A total of 1105 cases were assigned into hospital health education (A, n=872) and control (B, n=233) groups according to whether the women received the hospital health education of breastfeeding during pregnancy. Their differences in breastfeeding knowledge, attitudes and early feeding behavior were compared and analyzed by χ2 test and binary logistic regression. Mothers in the group A were at higher levels of breastfeeding knowledge and had a higher proportion of breastfeeding at Day 1 (82.3%). The rate of exclusive breastfeeding in-hospital was significantly higher in group A than that in group B (51.1% vs. 32.3%). After adjusting for in-hospital health education, health education during pregnancy had significant effects on breastfeeding in the first days for group A: breastfeeding in the first 24 hour (OR=2.076, 95%CI: 1.474-2.924) and exclusive in-hospital breastfeeding (OR=2.105, 95%CI: 1.529-2.898).


Key words: 
Breast feeding; Health education
手术治疗髋关节置换术后假体松动17例
Authors: 阎庆明, 孔令英, 王建辉, 白音
Journal: BMJ (2005)

对17例(18髋)人工髋关节置换术后髋关节疼痛、假体松动的患者行髋关节翻修术.平均随访3.6年,14例疼痛消失,3例疼痛基本消失;均术后功能恢复满意.术中发现假体周围有不同程度的纤维肉芽界膜组织,与关节假体松动有关.彻底清创及建立良好骨基质是髋关节翻修成功的关键。
Neoadjuvant treatment with chemotherapy or chemoradiation in stage III non-small cell lung cancer: Analysis of the National Cancer Database.
Authors: Sindhu Janarthanam Malapati, Sunny R K Singh, Rohit Kumar, Tarik H. Hadid
Journal: Journal of Clinical Oncology (2020)

7046 Background: Use of neoadjuvant chemotherapy (Neo-chemo) improves survival in locally advanced NSCLC. However, data regarding the benefit of adding radiation (Neo-CRT) is limited. Meta-analyses suggest that the use of Neo-CRT could lead to significant tumor downstaging but with increase in therapy-related mortality. Methods: Patients with resected stage III NSCLC were identified from the NCDB between 2010 and 2015. Patients were divided into two groups based on the type of neoadjuvant therapy received (Neo-chemo vs. Neo-CRT). Surgical and survival outcomes were compared. Kaplan-Meier method and log-rank test were used for survival analysis. Results: Of the 136,942 patients with stage III NSCLC, 15,804 patients had definitive surgery. Mean age was higher for those who received Neo-chemo (63.8 vs. 61.8 years, p&lt;0.0001). Median overall survival (OS) for Neo-CRT was 49.8 months and for Neo-chemo was 53.6 months. After adjusting for treatment facility, age, gender, race, comorbidity index, insurance status, T and N stage, there was a 12% reduction in mortality with use of Neo-chemo compared to Neo-CRT (p=0.03, 95% confidence interval 0.78-0.98). 3 years OS for Neo-CRT and Neo-chemo was 51.1 and 54.3%, respectively. The 30-day operative mortality rate was slightly higher in the Neo-chemo group (4.6 vs. 3.2%, p=0.004) but 90-day mortality rates were similar (7.41% vs. 6.83%, p=0.37). Length of hospital stay for primary tumor resection was shorter for the Neo-chemo group (5 vs. 6 days, p&lt;0.0001); however, there was no significant difference in 30-day readmission rates between the two groups (91.53% vs. 94.01%, p=0.09). Conclusions: In this study, neoadjuvant chemotherapy resulted in 12% lower mortality compared to neoadjuvant chemoradiation despite the notable increase in the rate of complete pathologic tumor and nodal response achieved with the addition of neoadjuvant radiation. There was no difference in R0 resection rates, postoperative mortality or readmissions between the two groups. [Table: see text]
Preclinical and clinical studies of a class I/IV HDAC inhibitor, mocetinostat, in melanoma.
Authors: Jeffrey S. Weber, Andressa S Laino, Melinda Vassallo, Anna Pavlick, Saundra Malatyali, Swathi Krishnarajapet, Gabriel DeLeon, Isan Chen, Max Hallin, David Woods
Journal: Journal of Clinical Oncology (2020)

10052 Background: Mocetinostat is a class I/IV HDAC inhibitor with HDAC1/2/3/11 activity. Preclinical murine data suggest that HDAC inhibition has immune activity and may augment the clinical benefit of checkpoint inhibition. Several trials are assessing the effects of adding HDAC inhibition to PD-1 blockade. Methods: Patients with therapy-naive metastatic melanoma were treated in a pilot phase Ib trial with nivolumab at 3 mg/kg/ipilimumab at 1 mg/kg every three weeks four times and a starting dose of mocetinostat at 70 mg orally three times a week in a 12-week induction cycle followed by 12-week maintenance cycles of nivolumab 240 mg every 2 weeks and mocetinostat at the same dose and schedule as induction. Endpoints were toxicity, definition of a recommended phase 2 dose and preliminary assessment of response as well as correlative marker determination. Peripheral blood mononuclear blood cells from patients were tested in vitro at varying concentrations of mocetinostat, and its impact on T, regulatory T and myeloid-derived suppressor cell phenotypes were assessed by flow cytometry, as well as cytokine production by Luminex. Results: In the mocetinostat, nivolumab and ipilimumab phase I trial, 10 patients were treated, including 5 males and 5 females with a median age of 59. There were 2 complete and 5 partial responses confirmed; 6 of 7 are maintained at a median of 16 months of follow up. Three patients had progressive disease. Seven patients had grade 3-4 immune related adverse events; in 3 they were multiple. No patients died. In vitro, mocetinostat at doses from 125 to 500 nM increased relative percentage of CD4/CD8 central memory T cells, and decreased IL-6 levels while increasing interferon-gamma production (p = 0.005). Percentages of regulatory T and monocytic myeloid-derived suppressor cells were decreased by mocetinostat (p = 0.005), which also down-modulated regulatory T cell function by reducing FOXP3, HELIOS and GARP (p = 0.001). Conclusions: In vitro, mocetinostat promoted accumulation of central memory CD8 and CD4 T cells from melanoma patients, and decreased percentages and suppressive activity of T regulatory cells and myeloid-derived suppressor cells. In a pilot clinical trial, mocetinostat combined with nivolumab and ipilimumab in treatment-naïve metastatic melanoma patients exhibited a response rate of 70% with long duration of response but all ten patients treated had at least one grade 3 or 4 immune-related toxicity. De-escalation of the mocetinostat dose to 50 mg three times a week was felt to be indicated due to the toxicity of the triple regimen. Clinical trial information: NCT03565406.
Asymptomatic Green-Gray Nodules on the Chest
Authors: Morgan A. Amigo, Benjamin H. Kaffenberger, Catherine G. Chung
Journal: JAMA Dermatology (2020)

A man in his 60s with a history of allogenic hematopoietic stem cell transplant for acute myelogenous leukemia presents with asymptomatic green-gray nodules and plaques on the chest. What is your diagnosis?
Stereotactic body radiotherapy and systemic dose chemotherapy for locally advanced lung cancer, single-arm phase II study.
Authors: Greg Kubicek, Polina Khrizman, Christian Michael Squillante, Qianyi Xu, Wissam Abouzgheib, Ziad Boujaoude, Ashish Bharat Patel, Alexandre Hageboutros
Journal: Journal of Clinical Oncology (2020)

e21081 Background: The outcomes for locally advanced non-small cell lung cancer (NSCLC) are overall poor. This is a single arm phase 2 study (Clinical trials.gov NCT02568033) evaluating the role of stereotactic body radiosurgery (SBRT) along with full dose systemic chemotherapy in the treatment of unresectable stage 2 and stage 3 NSCLC. Methods: patients were treated with SBRT to all sites of gross disease. Dosing consisted of 60 Gy in 3 fractions for peripheral lung tumors, 50 Gy in 5 fractions for central lung tumors, and 40-50 Gy in 5 fractions for hilar and mediastinal lymph nodes. Chemotherapy was histology dependent and consisted of 4 cycles, there was a 7 days break between chemotherapy and SBRT. Quality of life was measured using FACT-L. Results: Twenty two patients were enrolled and analyzed. 17 (77 %) were stage III and 19 (86%) had lymph node involvement. Median follow-up for all patients was 23.1 months. Median overall survival is 27.2 months. Overall survival at one year was 82% and overall survival at two years was 53%. Two year regional failure rate 19%. Two year distant failure rate 47.2%. Quality of life scores at one year were available for 12 patients and were unchanged compared to baseline. Acute toxicity grade 3 or greater was seen in 6 patients and late toxicity grade 3 or higher was seen in 2 patients. Conclusions: A combination of SBRT and full dose chemotherapy appears to be a safe and effective treatment for locally advanced NSCLC and warrants further investigation. Clinical trial information: NCT02568033 .
Temporal trends in inpatient outcomes and resource utilization in patients with tumor lysis syndrome (TLS) with solid and hematologic cancers: A nationwide analysis.
Authors: Krishna Rekha Moturi, Prasanth Lingamaneni, Binav Baral, Ishaan Vohra, Shristi Upadhyay Banskota, Shweta Gupta
Journal: Journal of Clinical Oncology (2020)

e19102 Background: Tumor lysis syndrome (TLS) is a well-recognized complication in cancer patients with high tumor burden receiving chemotherapy and is associated with increased morbidity and mortality. Our study specifically looks at longitudinal trends in outcomes and healthcare utilization in TLS patients over time. Methods: Adult patients with TLS admitted between 2012-2017 were identified from the Nationwide Inpatient Sample database. Statistical tests for trends of outcomes (including mortality and Acute Kidney Injury (AKI)) and resource utilization across six years were performed. Multivariable logistic regression was used to evaluate risk factors for mortality in TLS. Results: A total of 57,760 patients met inclusion criteria, with 15.2% having Solid Tumors (ST) and rest hematological cancers (HC). Patients with ST were predominantly older (mean age 60.7 vs 56.4 years, p &lt; 0.0001) and female (44.6% vs 35.2%, p &lt; 0.0001). ST patients had higher mortality (32.3% vs 19.1, p &lt; 0.0001) and AKI (68.6% vs 59.3%, p &lt; 0.0001); but shorter hospitals stay (10.5 vs 15.8 days, p &lt; 0.0001) and lower hospital charges ($34k vs $59k, p &lt; 0.0001). Multivariable analysis showed increased inpatient mortality with ST compared to HC (OR 1.54, 95% CI 1.35-1.76, p &lt; 0.001). Although mortality in ST non-significantly decreased from 36.2% to 28.9% over time, it remained constant in HC. Rate of AKI increased significantly in both cohorts. There were no significant temporal changes in hospital charges in either group, although those with HC were noted to have a decrease in length of stay, from 16.8 to 15.6 days (p = 0.02) over time. Trends of outcomes and resource utilization in TLS. Conclusions: TLS in ST has worse prognosis than HC, although mortality has improved over years. However, inpatient mortality remains largely unchanged in HC. Despite therapeutic advances, [Table: see text]
Prevalence and association of <i>ARID1A</i> with driver alterations and immune checkpoint inhibitor (ICPi) biomarkers in cell-free circulating tumor DNA (ctDNA) from 27,000 non-small cell lung cancer (NSCLC) patients.
Authors: David R. Gandara, Caroline Weipert, Jennifer Saam, Jonathan W. Riess, Heinz-Josef Lenz, Razelle Kurzrock
Journal: Journal of Clinical Oncology (2020)

9523 Background: Recent data suggest that the tumor suppressor gene ARID1A is associated with high anti-tumor immunity and may have value as a predictive biomarker for response to ICPi therapy in NSCLC. We examined ARID1A alterations detected in ctDNA from a large cohort of advanced NSCLC patients using a commercially available liquid biopsy assay and explored associations of ARID1A with lung cancer driver alterations and other putative ICPi mutational biomarkers. Methods: Consecutive samples from stage IIIB/IV NSCLC patients tested from March 2016 - August 2019 using a 73- to 74-gene targeted next-generation sequencing ctDNA assay (Guardant360) were queried. Testing included analysis of single nucleotide variants, insertions/deletions, fusions, and amplifications ( KEAP1 not tested). Mutation frequencies were compared using Fisher’s exact test, with variants of uncertain significance and synonymous variants excluded. Results: Of 27,776 NSCLC patients with &gt;1 ctDNA alteration detected, 1,094 (3.9%) had &gt;1 functional ARID1A (f ARID1A) mutation. f ARID1A mutations were significantly more common in patients with squamous histology compared to adenocarcinoma (5.1% vs 3.8%, p = 0.0007). There were significantly fewer EGFR exon 19 deletion mutations (4.9% vs 11.1%; p &lt; 0.0001) and EGFR L858R mutations (4.0% vs 7.0%; p &lt; 0.0001), and significantly more BRAF V600E alterations (2.2% vs 1.4%; p = 0.0338) in patients with f ARID1A. There was no significant difference in the frequency of ALK and ROS1 fusions, nor STK11 mutations between patients with and without f ARID1A (8.0% vs 6.8%; p = 0.126). Activating KRAS mutations were significantly more frequent in patients with f ARID1A (31.1% vs 19.4%; p &lt; 0.0001), including KRAS G12C (10.9% vs 7.0%; p &lt; 0.0001). Conclusions: These data provide a mutational landscape for f ARID1A mutations in NSCLC. f ARID1A was associated with significant differences in the frequency of multiple lung cancer driver alterations, of particular interest in the EGFR-mutated cohort, where ICPi efficacy is low. The frequency of STK11 mutations, a possible negative predictor of ICPi efficacy, was not significantly different. KRAS mutations were significantly more frequent in patients with f ARID1A, notable given recent data reporting that KRAS mutations, particularly KRAS G12C, may be a positive predictor of ICPi response in NSCLC. Determination of ICPi efficacy in patients with f ARID1A is in-process.
Clinicopathological characteristics and survival outcome in oral cavity cancer with masticator space involvement (T4b): A retrospective single-institutional experience.
Authors: Abdulla K P, Nebu Abraham Geotge, Hajara M C, Raj Mohan
Journal: Journal of Clinical Oncology (2020)

e18517 Background: Oral cavity cancer with the masticator space involvement is considered as very advanced localised disease and staged as T4b in AJCC 8th edition, along with the involvement carotid artery,base of skull or prevertebral fascia. NCCN treatment guidelines consider this as inoperable disease and advocate non surgical options or palliative treatment. This study intends to compare the different treatment modalities in T4b oral cavity cancer and their impact on survival. Methods: This is a retrospective study of 150 patients with T4b oral cavity ca, from 2013to 2015 and follow up data till 31 st July 2019 were collected. All patients had biopsy proven SCC and CT evidence of masticator space involvement. Results: Total of 150 patients were included. 102 patients had received curative treatment and 48 patients had received palliative treatment. 30% in the curative group and 42% in the palliative group were supra notch disease. In the curative group 84% were treated with surgery and adjuvant treatment and remaining had received RT with or without chemotherapy. 90% patients in the surgically treated group had attained margin negative resection. 4 year OS in the curatively treated group was 58.9% and in the palliative group was 12%. 2 year OS was 69% and 31% respectively, (p=0.001). The survival of supra notch disease was not different from infra notch disease neither in the curative group (61% v/s 57%, p=0.452) nor in the palliative group (10% v/s 14%, p=0.13). The surgically treated patients in the curative arm had significant survival advantage over the patients who had received only RT with or without chemotherapy, (63.5% v/s 34%, p=0.001). Conclusions: Curatively treated oral cavity cancer with masticator space involvement has survival outcome comparable to the published survival data of those without masticator space involvement. Clinicopathological spectrum of supra notch disease is not different from infra notch disease, and their prognosis is similar to infr anotch disease, if margin negative resection is attained. Radical intent treatment, preferably surgery should be offered to all patients with masticator space involvement, if negative margin is anticipated from preoperative imaging.