tbuckley/cabot-search huggingface dataset:
Efficacy and safety of hypofractionated preoperative radiotherapy in treatment of patient with primary locally advanced soft tissue sarcoma of limbs/trunk wall.
Authors: Hanna Kosela, Mateusz Spalek, Aneta Borkowska, Pawel Teterycz, Tadeusz Morysinski, Michal Wagrodzki, Tomasz Goryn, Marcin Zdzienicki, Piotr Rutkowski
Journal: Journal of Clinical Oncology (2020)

11555 Background: Soft tissue sarcomas (STS) are rare often malignant tumors. The primary treatment of most STS is radical resection with adjuvant radiotherapy. Our previous study showed that the use of preoperative hypofractionated radiotherapy is safe and efficient in the treatment of unselected group of patients with STS. Aim of this study was to assess the use of the treatment scheme in patients with primary STS treated in one institution. Methods: 311 patients (52% female) with primary locally advanced STS participated in this prospective trial conducted from 2010 till 2017. Median age was 55 years (range: 17-91). Median follow up is 57 months (95%CI 55-61). The most common subtypes were pleomorphic sarcoma, liposarcoma and synovial sarcoma. Median tumor size was 11cm. 258 patients (83%) had high grade tumors. The most common tumor localization were lower limbs (72%). 30% of patients received preoperative chemotherapy. For five consecutive days radiotherapy in 5 x 5Gy fraction was applied, with immediate (2-4 days) resection of the tumor. Results: In 260 patients (83.6%) clear surgical margins (R0) were obtained. 107 patients were dead at the time of the analysis.5-year overall survival is 63%. 156 (50%) had a recurrence of the disease. Local recurrence (LR) was found in 13.8% of the patients. Median time from surgery to LR was 14.7 months. In 56% of patients with LR another limb spearing radical surgery could be performed. Factors that had a significant adverse impact on LR were histological subtype (p = 0.017) and surgical margin status (p = 0.013). Factors that had a significant adverse impact on overall survival were tumor size (p &lt; 0.0001), grade (p = 0.0047) and surgical margin status (p = 0.013). 96 patients (30.8%) had any kind of treatment toxicity, factor having negative impact on the toxicity was lower limb location of the tumor (p = 0.0012). 20 patients (6.4%) required surgery for treatment of the complications. 14.6% patients had prolonged healing of the wound ( &gt; 1 month), 8.3% had wound dehiscence, 1.4% required prolonged punctures of the lymph fluid, 2.3% had severe fibrosis leading to contracture of limb, 11% patients prolonged edema of the operated limb. 0.9% of patients had a fracture of the treated limb. Conclusions: In this group, with a big percentage of patients with large, high grade STS use of hypofractionated preoperative radiotherapy was associated with similar local control when compared to published studies. The early toxicity is tolerable, with a small amount of late complications.
Prevalence and risk factors of chronic kidney disease in middle-aged and older adults in Shanghai Pudong New District
Authors: Yi Wang, Chen Yu, Xin-tian Zhang, Rui-qing Zhang, Feng Liu, Jun Wang, Ying-ying Zhang, Hai-dong Yan
Journal: BMJ (2012)

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in middle-aged and older adult population in Shanghai Pudong New District.Methods Two thousand residents aged 45 years and above were randomly selected for questionnaire survey and health check-up in Shanghai Pudong New District from July 2006 to October 2010.The laboratory examinations were also performed including the urine routine,urinary protein to creatinine ratio,serum creatinine,blood glucose and lipids.The glomerular filtration rate (eGFR) was estimated by simplified Chinese MDRD (modification of Diet in Renal Disease) equation.SPSS 13.0 statistical software was used for statistical analysis.Results Among 1905 residents who completed survey and examinations,the adjusted prevalence of albuminuria was 12.0％ (95％ CI:0.105-0.135) and of eGFR less than 60 ml · min-1 · 1.73 m-2 was 1.9％ (95 ％ CI: 0.172-0.213).The prevalence of CKD was 12.6％ (95 ％ CI: 0.112-0.142).Logistic regression analysis revealed that age (OR =1.043),hypertension (OR =2.272),diabetes mellitus (OR =1.233)and hyperuricemia (OR =1.003)were independently associated with CKD.Conclusions The prevalence of CKD in adult residents (≥45 years) from Shanghai Pudong New District is high.It is necessary to carry out early screening and to intervene risk factors of CKD in middle-aged and older residents.

Key words: 
Nephrosis;  Prevalence;  Risk factor
Sun′s tip-flexible ureterorenoscopy combined with holmium laser lithotripsy in treatment of renal and upper ureteral calculi
Authors: Lei Wang, Song Ma, Xianyun Zhang, Qian Li
Journal: BMJ (2017)

Objective
To evaluate the efficacy and safety of Sun′s tip-flexible ureterorenoscopy (tf-URS) combined with holmium laser lithotripsy in treatment of renal and upper ureteral calculi.


Methods
Clinical data of 48 patients (29 males and 19 females) with renal and upper ureteral calculi treated by tf-URS with holmium laser lithotripsy in our hospital from November 2015 to May 2016 were retrospectively analyzed. Among 48 patients there were 29 males and 19 females with a mean age of (37.8±12.5) years (21-67), including 31 cases of upper ureteral calculi and 17 cases of renal calculi with a mean stone size of (1.4±0.6) cm (0.8-2.1). The tf-URS was advanced through the ureter under visual direction with rigid mode . When the endoscope reached the ueteropelvic junction, the inner flexible part was extended out to explore the pelvicaliceal stones and then the holmium laser lithotripsy was performed. The therapeutic results were evaluated by KUB 2 days after operation and color ultrasonography or CT 4 weeks after operation.


Results
The success rate of insertion of tf-URS was 94% (45/48). The calculi were detected in 45 cases, and laser lithotripsy succeeded in 43 cases (96%). The rate of total stone clearance was 87% (39/45). The procedure was transformed to laparoscopic or percutaneous nephrolithotomy (PCNL) in 3 patients with ureterostenosis or ureteral distortion. No serious complications occurred.


Conclusion
The tf-URS with holmium laser in the treatment of renal and upper ureteral calculi is safe, reliable and effective.


Key words: 
Ureteroscopy; Ureteral calculi; Lithotripsy, laser; Laser, holmium
Clinical value of kinase Aurora-A serum level determination in patients with breast cancer qualified for neoadjuvant chemotherapy: Pilot study.
Authors: Beata Kotowicz, Pawel Winter, Małgorzata Fuksiewicz, Agnieszka I. Jagiello-Gruszfeld, Katarzyna Pogoda, Zbigniew Nowecki, Maria Kowalska
Journal: Journal of Clinical Oncology (2020)

e12627 Background: Aurora A (AURKA) is serine/threonine kinase that plays a regulatory role in mitosis and multiple signaling pathways. Overexpression of AURKA has been found in many solid tumors including breast cancer. It also has been found to be a prognostic marker indicating resistance to taxane treatment and poor prognosis in ER positive breast cancer. The aim of this study is to assess clinical value of Aurora-A serum level determination in patients with breast cancer qualified for neoadjuvant chemotherapy. Methods: 60 patients with confirmed breast cancer before treatment were qualified for the study, aged 31-77 (median 52 years), including 30 premnopausal and 30 pomenopausal. The control group consisted of 30 healthy women aged 20-80 (median 53 years). Clinical and pathological features were determined in a selected group of patients with breast cancer who subsequently underwent preoperative chemotherapy, i.e. tumor size (T), lymph node status (N), presence of distant metastases (M), estrogen receptor status (ER) and progesterone (PgR), HER2 receptors and Ki 67 proliferative index. The blood serum of the examined patients and healthy women was determined by the enzyme-linked ELISA method in doublets of the AURKA biomarker concentration. Mann-Whitney test and ROC curve analysis were used for statistical calculations. Results: No significant differences were found between the concentrations of AURKA in breast cancer patients and in the control group. In both analyzed groups there were no significant differences in biomarker levels depending on the menopausal status. When assessing the relationship between AURKA concentrations and clinical-pathological features, significant differences were found depending on the state of the lymph nodes (N0 vs N1 + N2) (p = 0.006). There was no correlation between the concentrations of the tested biomarker and the tumor size (T), the state of receptors and the Ki67 index. In patients with a lack of receptors (triple negative vs others), higher levels of Aurora A (p = 0.06) in the blood serum were observed at the level of the statistical trend. Conclusions: The preliminary results obtained indicate the potential usefulness of determining the concentration of the new biomarker Aurora A in the blood serum of patients with breast cancer. The research is continuing.
Clinical characteristics and lung CT imaging features in heart failure patients with normal or reduced left ventricular ejection fraction
Authors: Shaohua Lin, Guangyuan Guo, Kai Dong, Xinling Zhao, Fuping Sun, Cunkun Chu
Journal: BMJ (2014)

The clinical features and lung CT findings of 174 heart failure patients, including 85 cases with normal left ventricular ejection fraction (LVEF) and 89 cases with reduced LVEF were reviewed. Patients with normal LVEF had a higher proportion of hypertension, diabetes and obesity than patients with normal LVEF; and cough and dyspnea were more common. The lung CT findings in patients with normal LVEF were frequently presented as interstitial lung edema, increased pulmonary texture, subpleural line, Kerley lines and diffuse ground-glass opacity. Patients with reduced LVEF had a higher proportion of coronary heart disease and clinical manifestations of acute left heart failure, and central alveolar edema presented in lung CT images. Results suggest that heart failure patients with normal LVEF usually have longer clinical history and occult symptoms, and have a different lung CT imaging features from those in heart failure patients with reduced LVEF.


Key words: 
Heart failure; Ventricular ejection fraction
Regionalization of Pancreatectomy for Pancreatic Cancer
Authors: Joshua N. Herb, Karyn Stitzenberg
Journal: JAMA Surgery (2020)

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 Surgery HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Surgery journal
Perivascular Fat Attenuation Index Stratifies Cardiac Risk Associated With High-Risk Plaques in the CRISP-CT Study
Authors: Evangelos K. Oikonomou, Milind Y. Desai, Mohamed Marwan, Christos P. Kotanidis, Alexios S. Antonopoulos, David Schottlander, Keith M. Channon, Stefan Neubauer, Stephan Achenbach, Charalambos Antoniades
Journal: Journal of the American College of Cardiology (2020)
Using real-world data to investigate time-dependent blood count response to PD-1 and PD-L1 inhibitors and its impact on survival in advanced non-small cell lung cancers.
Authors: Kristin Ayers, Zongzhi Liu, Meng Ma, Kyeryoung Lee, Scott Newman, Li Li, Xiang Zhou, Tommy Mullaney, Arielle Redfern, Whitney Jappe, Michelle Zimmerman, Tony Prentice, William Oh, Eric Schadt, Dan Li, Rong Chen
Journal: Journal of Clinical Oncology (2020)

e21514 Background: Although some advanced non-small cell lung cancer (aNSCLC) patients respond favorably to immune checkpoint inhibitors, a larger portion either do not respond or experience negative side effects. At present, there is no consensus on how to best predict response to immunotherapy (IO) agents. Complete blood count (CBC) data have shown correlation with both progression and survival for patients treated with IO. However, previous studies have been relatively small, or did not focus on aNSCLC. Given CBCs are measured routinely for every patient throughout their course of therapy, we used real-world data (RWD) to assess the biomarker potential of CBCs in predicting response at the start and through the course of therapy. Methods: We performed a retrospective cohort study of 11,138 lung cancer patients treated at hospitals in the Mount Sinai Health System of whom 249 aNSCLC and were treated with anti-PD1/PD-L1 therapy. We extracted and harmonized medical record data using an automated abstraction engine and evaluated the impact of changes in CBCs, including eosinophils, lymphocytes, monocytes, neutrophils, red blood cells and platelets after treatment initiation. Time to treatment discontinuation (TTD) and overall survival (OS) were our clinical endpoints. Results: Abnormal baseline levels of monocytes, neutrophils, and red bloods cells were associated with OS; counts taken between 2-8 weeks were modestly to significantly associated with poorer OS, with hazard ratios ranging from 1.7-4.7. Most strikingly, neutrophil levels above 7 (HR = 4.3, p = 3.2*10 −10 , 95% CI = 2.7-6.7) and a neutrophil-to-lymphocyte ratio &gt; 5 (HR = 3.4, p = 8.0*10 −8 , 95% CI = 2.2-5.4) were associated with poorer OS. For those with normal neutrophil levels at baseline, progressing to high levels at 2-8 weeks resulted in a hazard for OS of 5.0 (p = 4.4*10 −8 , 95% CI = 2.8-9.0). Those with progression are more likely to have high neutrophil levels at baseline, or an increase in neutrophil levels from normal to high levels between baseline and 2-8 weeks or 8-14 weeks. Our results remained consistent even after controlling for factors that may affect neutrophil levels including concurrent chemotherapy, administration of neutropenia medications, or concurrent infections. Repeating the analysis with TTD as the primary endpoint showed similar but less significant trends. Conclusions: RWD showed changes in blood cell counts after anti-PD1/PD-L1 therapy were associated with OS in aNSCLC and show promise as a predictive biomarker.
Nivolumab (NIVO) + ipilimumab (IPI) + 2 cycles of platinum-doublet chemotherapy (chemo) vs 4 cycles chemo as first-line (1L) treatment (tx) for stage IV/recurrent non-small cell lung cancer (NSCLC): CheckMate 9LA.
Authors: Martin Reck, Tudor-Eliade Ciuleanu, Manuel Cobo Dols, Michael Schenker, Bogdan Zurawski, Juliana Menezes, Eduardo Richardet, Jaafar Bennouna, Enriqueta Felip, Oscar Juan-Vidal, Aurella Alexandru, Hiroshi Sakai, Arnaud Scherpereel, Shun Lu, Thomas John, David Paul Carbone, Stephanie Meadows-Shropshire, Jinchun Yan, Luis G. Paz-Ares
Journal: Journal of Clinical Oncology (2020)

9501 Background: NIVO + IPI was shown to improve overall survival (OS) and durability of response vs chemo in 1L advanced NSCLC in CheckMate 227 Part 1, regardless of PD-L1 expression. We hypothesized that a limited course of chemo combined with NIVO + IPI could provide rapid disease control while building on the durable OS benefit seen with dual PD-1 and CTLA-4 inhibition. CheckMate 9LA (NCT03215706) is a phase 3 randomized study evaluating NIVO + IPI + 2 cycles chemo vs chemo in 1L stage IV/recurrent NSCLC. Methods: Adults with tx-naive, histologically confirmed stage IV/recurrent NSCLC, ECOG performance status 0–1, and no known sensitizing EGFR/ALK alterations were randomized 1:1 to NIVO 360 mg Q3W + IPI 1 mg/kg Q6W + chemo (2 cycles) (n = 361) or chemo (4 cycles) alone (n = 358), stratified by PD-L1 (&lt; 1% vs ≥ 1%), sex, and histology (squamous vs non-squamous). Chemo was based on histology. Pts with non-squamous NSCLC in the chemo-only arm could receive optional pemetrexed maintenance. Pts were treated with immunotherapy until disease progression, unacceptable toxicity, or for 2 y. The primary endpoint was OS; the interim analysis using Lan–DeMets alpha spending function with O’Brien–Fleming boundary was planned at ~80% information fraction (ie, after observing ~322 total events). Secondary endpoints included progression-free survival (PFS) and objective response rate (ORR) by blinded independent central review, and efficacy by PD-L1 subgroups. Exploratory endpoints included safety/tolerability. Results: Baseline characteristics were balanced across arms. At a preplanned interim analysis (minimum follow-up 8.1 mo), OS was significantly prolonged with NIVO + IPI + chemo vs chemo (HR 0.69, 96.71% CI: 0.55–0.87; P = 0.0006); statistically significant improvements in PFS and ORR were seen. With longer follow-up (minimum 12.7 mo), NIVO + IPI + chemo vs chemo continued to provide longer OS; median 15.6 vs 10.9 mo (HR 0.66, 95% CI: 0.55–0.80); 1-y OS rates were 63 vs 47%. Clinical benefit was consistent across all efficacy measures in key subgroups including by PD-L1 and histology. Grade 3–4 tx-related adverse events were reported in 47 vs 38% of pts in the NIVO + IPI + chemo vs chemo arms, respectively. Conclusions: CheckMate 9LA met its primary endpoint: a statistically significant improvement in OS was observed with NIVO + NSCLC-optimized IPI + a limited course of chemo vs chemo (4 cycles) in 1L advanced NSCLC. No new safety signals were reported. Clinical trial information: NCT03215706 .
Treatment and prognosis of moyamoya disease
Authors: Jiang Xiaobin, Fang Yuming, Jiang Xiufeng
Journal: BMJ (2016)

Moyamoya disease is a rare intracranial angiopathy resulting in symptoms and prognosis similar with the stroke, if not diagnosed and treated early. The article reviews the characteristics, pathogenesis, treatment and prognosis of Moyamoya disease. Clinicians should be aware of this disease in routine work, so that the patients with Moyamoya disease can be early diagnosed and treated to avoid disability or death.


Key words: 
Moyamoya disease; Diagnostic imaging
脑卒中先兆的识别与处置
Authors: 龚涛
Journal: BMJ (2009)

脑血管病为血管源性病变导致脑部疾病的总称.其中突然起病,因血液循环障碍导致神经功能缺损,症状、体征持续时间超过24 h的脑血管病称为脑卒中,是脑血管病最常见类型,又分为出血性和缺血性2种亚型。
冠心病的诊断和治疗——由病例看原则
Authors: 顼志敏
Journal: BMJ (2006)

例1患者女,53岁,阵发性胸痛2年.胸痛在劳累后及生气时诱发,每次持续几秒钟到40 min左右,部位在左前胸但不固定,且伴左肩胛区丝丝拉拉或针刺样疼痛,有时按摩或叹气后减轻.平时心电图(ECG)示多导联T波倒置或低平,胸导联ST段上斜型下移0.05 mV,但近2年的多次ECG检查无动态改变.平板运动试验阴性.否认高血压、糖尿病、颈椎病及吸烟史;有冠心病家族史;已闭经1年。
Envafolimab (KN035) in advanced tumors with mismatch-repair deficiency.
Authors: Lin Shen, Jian Li, Yanhong Deng, Weijie Zhang, Aiping Zhou, Weijian Guo, Jianwei Yang, Ying Yuan, Liangjun Zhu, Shukui Qin, Silong Xiang, Haolan Lu, John Gong, Ting Xu, David Liu
Journal: Journal of Clinical Oncology (2020)

3021 Background: KN035 is a novel fusion protein of humanized anti-PD-L1 single domain antibody and human IgG1 Fc formulated for subcutaneous injection. This open-label phase II study evaluated the safety and antitumor activity of KN035 in patients with advanced microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) cancer. Methods: The study included patients aged ≥18 years with previously treated MSI-H/dMMR colorectal cancer (CRC) or other advanced solid tumors. MSI-H/dMMR status was assessed centrally for CRC and gastric cancer (GC) and locally for other tumors. KN035 was administered at 150 mg once weekly until progression, unacceptable toxicity, or withdrawal. Tumor assessments were every 8 weeks. The primary endpoint was the objective response rate per RECIST v1.1 by independent radiology review. The primary efficacy population (PEP) included patients with CRC who failed fluoropyrimidine (F), oxaliplatin (O), and irinotecan (I) plus those with advanced GC who had failed at least one prior systemic treatment. This was a planned interim analysis performed after the first 50 patients in the PEP had at least two on-study tumor assessments (PEP i ). Results: As of December 17, 2019, 103 patients with MSI-H/dMMR advanced cancers were enrolled at 25 centers in China. The PEP i included 39 patients with CRC and 11 with GC, with a median follow-up of 7.5 months. The overall population included 65 patients with CRC (24 had prior therapy with F and O or I), 18 with GC, and 20 with other tumors, with a median follow-up of 6.7 months. The confirmed objective response rate was 30% (95% CI: 17.9%, 44.6%) in the PEP i , 54.2% (95% CI: 32.8%, 74.4%) in the CRC patients who had prior therapy with F and O or I, and 34.0% (95% CI: 24.9%, 44.0%) in the overall population. Of patients who had an objective response at the interim analysis, 80% of those in the PEPi, 84.6% of CRC patients who had prior therapy with F and O or I, and 85.7% of those in the overall population were still responding at the time of data cutoff. Median progression-free survival was 6.6 months in both the PEP i and the overall population. Median overall survival was not reached in either population. Fourteen (13.6%) patients had grade 3–4 treatment-related adverse events. No grade 5 treatment-related adverse events, pneumonitis, or colitis were reported. Local injection-site reactions, all grade 1 or 2, were reported in nine patients. Conclusions: Envafolimab demonstrated durable anti-tumor activity with a manageable safety profile in patients with previously treated advanced MSI-H/dMMR cancer. Clinical trial information: NCT03667170 .
Dendritic cell vaccine as an alternative to opioid analgesia in patients with advanced cervical cancer.
Authors: Anna P. Menshenina, Oleg I. Kit, Elena M. Frantsiyants, Tatiana I. Moiseenko, Ekaterina V. Verenikina, Sergey V. Tumanyan, Elena A. Dzhenkova, Tatiana G. Chalabova, Olga G. Selezneva, Anna A. Cherkasova
Journal: Journal of Clinical Oncology (2020)

e18022 Background: Locally advanced and progressive cervical cancer is always accompanied by the pain syndrome. The common analgesics include non-steroidal anti-inflammatory drugs and opioids. The purpose of the study was to assess allogeneic dendritic cell vaccine (DCV) as an alternative analgesic in patients with advanced cervical cancer. Methods: The pain syndrome dynamics was assessed in 20 patients with advanced T3-4N1M0-1 cervical cancer receiving subcutaneous paravertebral injections of allogeneic DCV in a total alternating dose of 5-10 million cells every 2 weeks. Patients received DCV for one year, with a total of 24 vaccine therapy sessions and a total dosage of 180 million dendritic cells. The pain intensity was assessed on a verbal rating scale: 0 – no pain; 1 – mild pain; 2 – moderate pain; 3 – severe pain; 4 – extremely intense pain. Results: Prior to the therapy, 15 patients (75%) had severe pain; 2 (10%) - moderate pain; 3 (15%) - extremely intense pain. After 4-6 DCV injections, the pain intensity decreased, patients refused opioid analgesics. After 10-12 DCV sessions, 19 (95%) (p &lt; 0.05) women had no pain at all, patients denied additional pain relief with non-opioid analgesics. Unrelieved pain was registered only in one cervical cancer patient. Conclusions: DCV injections in patients with advanced cervical cancer provide pain relief thereby improving their quality of life.