tbuckley/cabot-search huggingface dataset:
应用人胰岛素过敏一例
Authors: 柳林
Journal: BMJ (2009)

患者男性,66岁.因烦渴、多饮1个月,嗜睡、呕吐1 d于2007年3月12日入院.查体:体温36.8℃,脉搏90次/min,呼吸20次/min,血压130/80 mm Hg(1 mm Hg=0.133kPa),体重指数21.5,精神萎靡,四肢湿冷,心肺腹部无明显异常,病理征阴性.实验室检查:血糖32.1 mmol/L,糖化血红蛋白(HbA1c)12.1%,尿酮体强阳性;二氧化碳结合力(CO2CP)5.3 mmol/L,肝功能无异常,肌酐124 μmol/L,谷氨酸脱羧酶抗体、胰岛细胞抗体阳性,诊断为1型糖尿病,酮症酸中毒.经纠正酸中毒、皮下注射诺和灵R、N控制血糖,空腹血糖为7～8 mmol/L,住院12 d出院,期间未出现任何皮肤改变.出院后一直应用诺和灵R、N注射。
A phase Ib/II, open-label study of tivozanib in combination with durvalumab in subjects with untreated advanced hepatocellular carcinoma.
Authors: Renuka V. Iyer, Daneng Li, Farshid Dayyani, Michael N. Needle, Thomas Adam Abrams
Journal: Journal of Clinical Oncology (2020)

e16599 Background: VEGFR TKIs and checkpoint inhibitors are current standards of care in HCC as single agents, however treatment options are limited, and significant unmet need remains. A recent ph3 study combining bevacizumab (VEGF-A Mab) with a PDL1 inhibitor have shown promising improvements in OS demonstrating that a combination of VEGF and PDL1 inhibition can improve patient outcomes over single agent treatment. Tivozanib (T, a potent and selective VEGFR 1, 2 &amp; 3 TKI) and durvlaumab (D, a PD-L1 antibody) have both demonstrated single agent activity in HCC and have been combined safely with other therapies to enhance patient outcomes in other tumor types. It is hypothesized that more complete inhibition of the VEGF pathway by tivozanib compared to bevacizumab combined with PDL1 inhibition may further enhance patient outcomes. The ph1 portion of this study combines T with D to establish the recommended phase 2 dose (RP2D) and provide preliminary safety and efficacy data. Methods: Major eligibility criteria are adults with documented advanced HCC, Child-Pugh Class A, ECOG 0 or 1, creatinine clearance &gt; 40 ml/min. Major exclusion criteria are co-infection with HBV and either HDV or HCV and significant organ dysfunction. Six patients with untreated advanced HCC will be treated with the combination of T 1 mg orally for 21 days followed by 7 days off treatment and D 1500 mg intravenously every 28 days. A DLT is generally defined as the occurrence of any Grade ≥3 immune or non-immune AE in Cycle 1 that is at least possibly related to the investigational regimen other than any grade of vitiligo or alopecia or Grade 3 controllable hypertension. If two or more patients have a DLT then the dose of tivozanib will be reduced to 1 mg every other day without interruption for the second cohort. In the Phase 2 portion of the study an additional 30 patients will be treated at the RP2D. The primary objective is to establish the RP2D and the safety and tolerability for this combination in patients with advanced HCC. Secondary objectives are to assess the objective response rate, progression free survival, and overall survival in this population. Patients will be treated until progression of disease, unacceptable side effects, or death. Outcome measures will be adverse events per CTCAE v.5 and cross-sectional imaging performed every 8 weeks. Results: Phase 1 safety and efficacy findings for this novel combination will be reported at the meeting. Conclusions: Phase 1 safety and efficacy findings for this novel combination will be reported at the meeting. Clinical trial information: NCT03970616 .
Electric acupuncture plus fire acupuncture improves facial nerve function and anxiety state in patients with obstinate facial palsy
Authors: Feiyu Chen, Xiaoping Liu, Donglin Chen, Jiamei Chu, Yehua Bao
Journal: BMJ (2019)

One hundred and ten patients with obstinate facial palsy were randomly divided into study group and control group with 55 cases in each group. Both groups received electropuncture on face acupoints five times a week, the study group received additional acupuncture on Zhongzhen six acupoints, subsequently fire needles were used for Yangbai (GB 14), Quanliao (SI 18), Dicang (ST 4) and Jiachengjiang (Extra) acupoints twice a week. And the treatment courses lasted for four weeks. The House-Brackmann (HB) scale and Self-Rating Anxiety Scale (SAS) were used for evaluation of facial nerve function and anxiety status before and after treatment, respectively. One hundred and four cases completed the treatment in the two groups. Before treatment there were no significant differences in HB and SAS scores between study and control groups (Z=-0.271, P=0.79; Z=-1.689, P=0.09). After 4 weeks of treatment the HB and SAS scores in both group were significantly improved (Z=-5.652, Z=-5.038, all P<0.01; Z=-6.050, Z=-5.332, all P<0.01); however, there were significant differences in HB scale and SAS scores after treatment between two groups (Z=-2.066, Z=-2.884, all P<0.05). The electric acupuncture on face acupoints plus Zhongzhen six acupoints combined with fire acupuncture can effectively improve facial nerve function and anxiety state in patients with obstinate facial palsy.


Key words: 
Facial paralysis; Fire needle; Zhongzhen six acupoints; Electroacupuncture; Anxiety
Partial splenic embolization through endoscopic ultrasound-guided implantation of coil as a potential technique to treat portal hypertension
Authors: Qian Chen, Zhen Li, Yang Yang, Wei Yan, Bin Cheng, Yue Yuan, Zhen-gang Zhang
Journal: Endoscopy (2020)

Partial splenic embolization (PSE) through an interventional radiology procedure has been developed to manage two common complications of portal hypertension – variceal bleeding and hypersplenism [1] [2]. Here, we report the first case of endoscopic ultrasound (EUS)-guided PSE, which might offer an alternative technique for the prevention of recurrence of varceal bleeding and hypersplenism.
Female genital tract rhabdomyosarcoma in childhood and adolescence: A single center experience.
Authors: Inci Yaman Bajin, Tezer Kutluk, Ferah Yildiz, İbrahim Karnak, Berna Oğuz, Diclehan Orhan, Aysenur Elmali, Melis Gultekin, Burca Aydin, Bilgehan Yalcin, Nilgun Kurucu, Ali Varan, Canan Akyüz
Journal: Journal of Clinical Oncology (2020)

e22518 Background: Rhabdomyosarcoma is a rare tumor in children and adolescents, presenting 3% to 4% of all pediatric cancers. The female genital tract is considered as a favorable site of childhood RMS. The outcome has improved significantly during the last two decades, attributed to risk stratification and multimodality management of these challenging tumors. Here we present the clinical features and treatment results of girls with genital tract rhabdomyosarcoma to discuss. Methods: Fourteen girls with vaginal and uterine servical rhabdomyosarcoma younger than 18 years of age diagnosed and followed up between the years of 1995 and 2019 were included in this analysis. The clinical features and treatment results of patients were recorded from patient files and hospital information system retrospectively. Results: There were seven cases with vaginal and seven with uterin cervical carcinoma. All patients presented with polypoid masses protruding from the vagina. Median age of patients at diagnosis was 71 months (range 8-200 months). The IRS modified TNM staging was stage I for all the patients. All cases had embryonic type of RMS except one with alveolar type. All patients were treated with surgery and adjuvant chemotherapy, three received radiotherapy additionally. All achieved complete remission. Four patients experienced tumor relapse, 1 patient died with progressive disease. The median follow-up time was 75 months (7-271 months) for 13 patients who were alive with remission. Conclusions: Rhabdomyosarcoma is a rare sarcoma with a higher incidence in children and adolescents. With current treatment strategies, female genital tract rhabdomyosarcomas have a good prognosis. Favorable prognostic factors such as early stage at diagnosis and a favorable histology may contribute to the excellent observed survival. All parties who had involved on the care of these girls must be aware of the high survival with proper treatment to avoid treatment related morbidities and mortalities. Because of the rareness of the disease we wanted to share our experience.
Cardiac Scintigraphy With Technetium-99m-Labeled Bone-Seeking Tracers for Suspected Amyloidosis
Authors: Mazen Hanna, Frederick L. Ruberg, Mathew S. Maurer, Angela Dispenzieri, Sharmila Dorbala, Rodney H. Falk, James Hoffman, Wael Jaber, Prem Soman, Ronald M. Witteles, Martha Grogan
Journal: Journal of the American College of Cardiology (2020)
Utilization of liquid biopsy in a large community oncology practice.
Authors: Dipen Patel, Thuy Le, Harry Staszewski
Journal: Journal of Clinical Oncology (2020)

e19150 Background: Analysis of tumor cell free DNA, or liquid biopsy, is emerging as a useful adjunct to tissue biopsies in advanced solid tumors. These tests may reduce the need for repeating invasive biopsies, and may be performed serially with minimal risk to patients.The purpose of our study is to document how liquid biopsies are being used in a large, diverse community based practice in Long Island, NY and how often the results lead to changes in treatment. The aim is to derive guidelines within the practice for appropriate use of liquid biopsies going forward. Methods: The practice electronic medical record (EMR) was retrospectively examined for the first 100 patients with solid tumors who had a specimen sent to a commercial laboratory for a liquid biopsy. The EMR was also reviewed to establish the treatment regimens each patient was receiving prior to the liquid biopsy, as well as any changes to the regimen based on liquid biopsy results. Results: This analysis was based on 100 patients: 11 out of 100 patients (11%) were excluded due to loss of follow up and 89 out of 100 (89%) patients were included, 59% female and 41% male. 11 out of 100 patients (11%) were not found to have any tumor alterations on liquid biopsy. The most prevalent cancers were lung (40.4%), ovarian (17.0%), breast (6.4%), colon (5.3%) and prostate (5.3%). Treatment was changed 43% of the time after liquid biopsy results were obtained and there was no change in 57% of the time see Table. This change was irrespective of type of cancer, gender, or types of current regimen. Conclusions: Liquid biopsy has proven to be a useful adjunct to molecular testing of tumor tissue in a large community oncology practice, but ongoing examination of our results should better define its optimal use. [Table: see text]
Prognostic impact of hepatic involvement on spontaneous tumor lysis syndrome in solid tumors.
Authors: Dhiran Verghese, Phyo Thazin Myint, Faisal S. Ali, Nivedita Sundararajan, Zimu Gong, Kelley Elizabeth Kozma
Journal: Journal of Clinical Oncology (2020)

e19098 Background: Tumor lysis syndrome (TLS) is a life-threatening oncological emergency. Spontaneous TLS (STLS) in solid tumors occurring prior to initiation of therapy is a rarely reported entity and has poor outcomes. Little is known about the prognostic factors influencing STLS in solid tumors. Methods: A systematic search of Medline, PubMed, and Embase was conducted to identify reports of patients ≥18 years diagnosed with STLS in solid tumors. Individual case reports and case series were summarized, and descriptive statistics were employed to report clinical outcomes. Fischer exact t test was used for statistical analysis. Results: 63 patients from 61 case reports and one patient from our institution resulted in a total of 64 patients. 53.1% were males with a median age of 56.1 years. The most common solid tumors were of pulmonary origin. 85.9% patients had stage 4 malignancy, 75.0% had hepatic involvement. The most common presenting symptom was abdominal discomfort. The mean serum potassium, phosphorus, uric acid, calcium, lactate dehydrogenase, and creatinine upon presentation were 6.1 mmol/l, 7.5 mg/dl, 16.4 mg/dl, 7.5 mg/dl, 4421.2 IU/L and 3.7 mg/dl, respectively. In addition to intravenous hydration, allopurinol and rasburicase were administered in 48.4% and 42.2% patients. Urinary alkalization and sodium bicarbonate administration were reported in 6.3% and 15.6% patients. 43.8% patients required hemodialysis and 39 patients died (mortality of 60.9%). Patients who underwent hemodialysis had a similar mortality of 60.4%. We assessed liver involvement (primary hepatocellular carcinoma and hepatic metastasis) as a potential prognostic factor. Compared to patients without liver involvement, patients with liver involvement had a higher unadjusted all-cause mortality (70.83% vs 25%; OR 7.29 [95% CI 1.71 - 30.98]; p = 0.006). Conclusions: Hepatic involvement is a potential prognostic factor for STLS in solid tumors and is associated with a grave prognosis. Future large prospective studies are needed to probe into the role of early hemodialysis and to identify other prognostic factors of STLS in solid tumors.
降脂灵片对高胆固醇血症患者抗氧化能力的影响
Authors: 秦彦文, 杜兰萍, 李晋生, 安海梅, 何继强, 潘晓冬, 王绿娅, 王伟
Journal: BMJ (2006)

观察降脂灵片对高胆固醇血症患者血清一氧化氮、丙二醛及总抗氧化能力的影响,以探讨降脂灵片的抗氧化作用.将60例高胆固醇血症患者随机分为降脂灵组和对照组,服药前及服药4周后检测血清血脂及一氧化氮、丙二醛、总抗氧化能力含量.结果示降脂灵组血清总胆固醇显著下降[(6.3±0.7) mmol/L比(5.8±0.8) mmol/L, P<0.05];一氧化氮含量显著上升[(12.7±2.5) μmol/L比(20.7±3.5) μmol/L,P<0.01],总抗氧化能力含量显著上升[(12±6)单位/ml比(23±7)单位/ml,P<0.01],丙二醛显著下降[(6.6±5.7)nmol/L比(2.7±2.6)nmol/L,P<0.01].提示降脂灵片在降低血清胆固醇的同时能够增强高胆固醇血症患者机体抗氧化能力。
Activity of cabazitaxel in patients with metastatic or inoperable locally advanced dedifferentiated liposarcoma: European Organization for Research and Treatment of Cancer (EORTC) Phase II trial 1202.
Authors: Roberta Sanfilippo, Richard L Hayward, Jammbe Musoro, Charlotte Benson, Michael Gordon Leahy, Antonella Brunello, Jean-Yves Blay, Neeltje Steeghs, Ingrid M.E. Desar, Nasim Ali, Alice Hervieu, Khin Thway, Sandrine Marreaud, Saskia Litiere, Hans Gelderblom
Journal: Journal of Clinical Oncology (2020)

11556 Background: The optimal treatment for patients with advanced dedifferentiated (DD) liposarcoma (LPS) remains uncertain. Single agents which are most effective include doxorubicin and ifosfamide but, as with soft tissue sarcomas (STS) in general, objective response rates (ORR) and progression free survival (PFS) are very modest. Cabazitaxel exerts its effect through inhibition of microtubular disassembly and has been shown to be relatively safe, effective and well-tolerated. EORTC 1202 assessed whether cabazitaxel demonstrated sufficient antitumor activity in patients with metastatic or inoperable locally advanced DD LPS to justify further investigation in a phase III setting. Methods: This was an international multi-center, open label single arm phase II trial. Eligible patients with metastatic or inoperable locally advanced DD LPS were treated with cabazitaxel 25mg/m² IV infusion over 1 hour every 21 days. Primary endpoint was PFS rate at 12 weeks assessed by local investigator per RECIST 1.1. Based on a Simon two-stage design, at least 4 out of 17 (Stage 1) and 11 out of 37 (Stage 2) eligible and evaluable patients who are progression-free at 12 weeks were needed. Results: Forty patients were registered by 10 institutions in 4 countries between March 2015 and March 2019, with 2 patients being ineligible. Among the 38 eligible patients who started treatment, 3 (7.5 %) were still on treatment at the time of analysis. The number of cycles ranged from 1 to 30, with a median of 5; 26 patients (65%) received at least 4 cycles of cabazitaxel. Among the first 17 (Stage 1) and 37 (Stage 2), 11 and 20 patients were progression-free at 12 weeks respectively, satisfying the study decision rules. The PFS rate at 12 weeks for all 38 eligible patients was 52.6% (conditional 1-sided 95 % CI 38.3 – 100). Two patients (5.3%) achieved a confirmed partial response (PR) and 23 stable disease (SD) (60.5%). Disease control (PR+SD) was achieved in 25 patients (65.8%). Median PFS was 7.4 months (95%CI 2.8-10.3). The most common cabazitaxel -related grade &gt;3 adverse events in all 40 registered patients were neutropenia (60%), febrile neutropenia (25%), fatigue (12.5%), and anemia (10%). There were no cabazitaxel-related deaths. Conclusions: EORTC 1202 met its primary endpoint, with 20/37 pts (54%) being progression-free at 12 weeks. Results of this trial confirm activity of cabazitaxel in patients with metastatic or inoperable locally advanced DD LPS and warrant further exploration of the drug. Clinical trial information: NCT01913652 .
Clinical performance of a comprehensive novel liquid biopsy test for identifying non-small cell lung cancer (NSCLC) patients for treatment with osimertinib.
Authors: Jhanelle Elaine Gray, Ji-Youn Han, Aino Telaranta-Keerie, Xiangning Huang, Alexander Kohlmann, Rachel Hodge, Yuri Rukazenkov, Juliann Chmielecki, Carin R. Espenschied, Yi-Long Wu, Suresh S. Ramalingam, J Carl Barrett, Justin Iver Odegaard
Journal: Journal of Clinical Oncology (2020)

9553 Background: Genotyping is required to identify cancer patients (pts) eligible for targeted therapy; however, many do not receive biomarker testing, in part due to limitations associated with tissue-only genotyping practices and the growing list of biomarkers recommended to be tested. Liquid biopsy overcomes many of these limitations but is not yet fully adopted. We report here the clinical performance of a comprehensive liquid biopsy test based on next generation sequencing (NGS) of circulating tumor DNA (ctDNA) for the identification of NSCLC patients with EGFR exon 19 deletions (ex19del) or L858R mutations ( EGFRm) or EGFR T790M, eligible for treatment with osimertinib. Methods: 441 (79%) of 556 pts randomized in FLAURA (NCT02296125; first-line osimertinib vs comparator EGFR TKI in EGFRm NSCLC) and 300 (72%) of 419 pts from AURA3 (NCT012151981; osimertinib vs chemotherapy in NSCLC pts with T790M at progression on EGFR TKI) were retrospectively tested with Guardant360 (G360), a 74-gene ctDNA NGS assay assessing single nucleotide variants, insertion-deletions, amplifications, and fusions in genes relevant to targeted therapy selection as well as microsatellite instability. Progression-free survival (PFS) of pts with EGFRm or T790M detected by G360 was compared to pts detected by the cobas EGFR Mutation Test (cobas) using tissue or plasma with an unadjusted cox model. Results: Treatment with osimertinib was associated with a significant PFS benefit relative to control therapy in NSCLC pts with EGFRm (FLAURA) and T790M (AURA3) detected using G360 (Table). Observed clinical benefit for pts with EGFRm or T790M detected by G360 was similar to that for pts with EGFRm or T790M identified by cobas using tissue or plasma specimens. Conclusions: This analysis demonstrates that G360 accurately identifies pts for osimertinib therapy while simultaneously providing comprehensive genotyping for other therapeutic molecular targets. The application of NGS liquid biopsy has the potential to increase rates of pts genotyped and access to precision medicine. [Table: see text]
The comparison of X-ray, CT and MRI imaging in diagnosis of limb bone contusion
Authors: Ni-ni Xu, Zhi-ping Wang, Hai Zhou
Journal: BMJ (2009)

The imaging of X-ray, CT and MRI of 25 cases of limb bone contusion were analyzed retrospectively. Twenty five cases of limb bone confusion were diagnosed by MRI imaging, including 18 cases(72% ) in knee joint,4 cases(16%) in anklebone,2 cases(8%) in wrist and 1 case(4%) in elbow joint. But only 3 cases (12%)presented partial positive results in CT imaging and there was no bone contusion diagnosed. No abnormal manifestation in X-ray imaging for all 25 cases. The results suggest that MRI examination is valuable for diagnose of limb bone contusion.

Key words: 
Bone;  Contusions
The landscape of <i>POLE</i> variants in colorectal and endometrial tumors: Correlation with microsatellite instability (MSI) and tumor mutation burden (TMB).
Authors: Sanjeevani Arora, Joanne Xiu, Davendra Sohal, Emil Lou, Richard M. Goldberg, Benjamin A. Weinberg, Axel Grothey, W. Michael Korn, Mohd Khushman, Anthony Frank Shields, John Marshall, Michael J. Hall
Journal: Journal of Clinical Oncology (2020)

e13538 Background: Polymerase epsilon (POLE) is a major replicative DNA polymerase. Somatic POLE pathogenic variants (PV) are prevalent in endometrial cancer (EC) and in germline predispose to colorectal cancer (CRC), EC, and possibly other cancers (CA). PVs in the exonuclease domain (ExoD) [amino acid (AA) 268-471] lead to CAs with exceptionally high TMB. PV and uncertain variants (VUS) outside ExoD are sometimes concurrent with an ExoD PV and/or MSI. We hypothesized that the presence of non-ExoD variants may further increase POLE-associated mutation rate and tumor mutational burden. Methods: We retrospectively examined 1870 CRC and 4481 EC genomic profiles conducted by Caris Life Sciences (6/2016-6/2019). All patients had a 592-targeted gene somatic panel. Profiles with a POLE variant (PV or VUS) were analyzed. Median TMB (TMB, in mutations/megabase) was dichotomized to low/intermed ( &lt; 17) vs high (&gt;17). Tumors were grouped by: single ExoD PV, ExoD PV plus another variant (PV or VUS), or no ExoD PV. Known CRC/EC ExoD PV drivers were identified (Campbell et al, Cell 2017): D275G, P286R, S297F/Y, F367C/L/V, V411L, L424F, P436R/S/Y, M444K/L, A456P, S459F/Y, S461L/P, A465V. Kruskal-Wallis and chi-square tests were used. Results: Overall 4.5% CRC (80/1870) and 6.5% EC (303/4481) samples had POLE variants (Table). High TMB was seen in 56.3% CRC and 53.3% EC. In both CRC/ECs, TMB was higher in tumors with an ExoD PV and a 2 nd variant compared to those with a solitary ExoD PV or no ExoD PV (both p &lt; 0.001). MSI was more prevalent in CRC and EC with high TMB but no ExoD PV vs those with either high TMB and an ExoD PV, or low/intermed TMB and no ExoD PV (both p &lt; 0.001). In both CRC/ECs, several ExoD PV associated with very high TMB when non-ExoD regions of POLE contained recurrent variant clusters: AA 1906 (TMB 225); AA 1826-7 (TMB 243); AA 1380-2 (TMB 229). Conclusions: In CRC/ECs, POLE ExoD PV and MSI appear to drive TMB in distinct and largely non-overlapping ways. Non-ExoD POLE variants may synergize with ExoD PVs to further increase mutation rates. [Table: see text]