tbuckley/cabot-search huggingface dataset:
Pembrolizumab (Pem) in combination with stereotactic body radiotherapy (SBRT) for resectable liver oligometastatic MSS/MMR proficient colorectal cancer (CRC).
Authors: Dustin A. Deming, Philip Emmerich, Anita Ahmed Turk, Sam Joseph Lubner, Nataliya Volodymyrivna Uboha, Noelle K. LoConte, Daniel Mulkerin, David H. Kim, Kristina A. Matkowskyj, Sharon M. Weber, Daniel Abbott, Jens C. Eickhoff, Michael Frederick Bassetti
Journal: Journal of Clinical Oncology (2020)

4046 Background: SBRT is used to treat liver metastatic CRC, causing an increase in immunogenic antigen release and influx of responding immune cells. We hypothesize that radiation enhances the immunogenicity of MSS CRC and potentiates the effectiveness of PD-1 blockade. This phase Ib study examines the safety and efficacy of the sequential combination of SBRT and Pem in patients (pts) undergoing resection of their disease. Methods: Eligibility criteria include MSS CRC with resectable liver-confined metastatic disease. Prior surgery and systemic chemotherapy are allowed. Subjects receive sequential SBRT and cycle 1 of Pem prior to operative management and adjuvant Pem. The primary objectives are to determine the safety/tolerability of this regimen and the recurrence free survival (RFS) at 1 year following clearance of metastatic disease. Correlative studies examined tumor infiltrating CD8+ T lymphocytes (TILs) and the accumulation and proteolysis of versican (VCAN), an immunoregulatory tumor matrix proteoglycan. Proteolysis of VCAN results in the release of an immunostimulatory fragment, versikine. Cancers with low VCAN and high versikine (VCAN proteolysis predominant (VPP)) are hypothesized to respond better to immunotherapies. Results: 15 pts (median age 58.2 [range 38-69]) have been enrolled. All pts had prior FOLFOX. SBRT median dose was 50 Gy (40-60 Gy) to a single lesion targeted in all pts. No DLTs were observed. AEs included one case of biliary tract injury and biloma, not related to immunotherapy. No grade 3/4 immunotherapy-related AEs have occurred. 10 pts have completed a minimum follow-up of 1 year post resection. In the intention to treat analysis, the 1 year RFS was 70% (historic control 50%). 2 of 3 pts with BRAF V600E mutations have had early recurrences. 2 pts had VCAN high tumors and both recurred prior to 1 year. 4 pts had VPP cancers and all were recurrence free at 1 year. TILs in the radiated lesions were &gt; 2 times as abundant as in the pre-treatment (tx) tissue for 50% of pts. 3 of 4 pts who had non-radiated lesions available for analysis had TILs &gt; 2 times pre-tx in the non-radiated lesions indicating a potential abscopal effect. Conclusions: The combination of SBRT with Pem and surgical resection is well tolerated with no signal of increased immunotherapy-related toxicity and preliminary evidence of potential enhanced efficacy. Clinical trial information: NCT02837263 .
血标本放置时间对血糖检验结果的影响
Authors: 王晋, 吴夏枫, 朱璇
Journal: BMJ (2007)

对54例对象(包括低血糖组14例,正常血糖组与高血糖组各20例)的血标本在采集后放置不同时间进行血糖检测.结果 示随标本放置时间的延长,检测出血糖水平呈进行性下降,放置4 h后血糖检测水平平均每小时下降3.6%;放置不同时间(即刻、1、2和4 h)的血糖结果间差异有统计学意义(P＜0.05).提示血糖检验标本应在采集1 h内送检,以免影响其结果的准确性。
Provision of medical-care service and referral for children suffering from hand-foot-mouth diseases in rural areas
Authors: Wen-jun Wang, Jing Zhang, Chun-zhi Zhang, Jua-yan Zhou
Journal: BMJ (2010)

A survey with self-administered questionnaire conducted in 357 families with children suffering from with hand-foot-mouth disease showed that 74. 5 percent of patients' home was at a distance of less than one kilometer to medical-care institutions, and 41.7 % of patients went to village clinics or community health-care service stations as their first visit. Diagnosis could be established for 31. 5% of them in their first visit, and 78. 4% of them underwent referral taking public vehicles.

Key words: 
Hand, foot and mouth disease;  Rural health services
Correlates of health-care seeking behavior in patients with irritable bowel syndrome
Authors: Li-shou Xiong, Sui Peng, Wei Chen, Xiao-zhong Peng, Pin-jin Hu, Min-hu Chen
Journal: BMJ (2010)

Objective To explore correlates of health-care seeking behavior in patients with irritable bowel syndrome (IBS).Methods Four thousand permanent residents were recruited from eight urban communities and rural villages in Guangzhou and Huizhou, Guangdong province during 2009 by cluster stratified sampling for face-to-face questionnaire survey, including symptoms of bowel disease,behavior of seeking for health-care, demographic characteristics, coping style, life events and medical history.IBS was identified based on the Rome Ⅱ Criteria.Patient with IBS were divided into two groups,one seeking health-care at hospitals or clinics and the other non-seeking health-care.Univariate and multivariate logistic regression analysis was used to compare difference between the two groups and explore its related factors.Results A total of 237 IBS patients were identified based on the Rome Ⅱ Criteria, 53 of them (22.4% ) had sought health-care due to their symptoms.Results of multivariate logistic regression analysis showed that preference in seeking for health-care, abdominal pain lasting for more than one hour in each episode and extra-gastrointestinal symptoms were main factors related to their seeking for health-care,adjusted for age and gender, with odds ratios (ORs) of 1.81 (95% CI: 1.27 -2.58), 1.41 (95% CI:1.01 - 5.14 ) and 2.14 ( 95% CI: 1.06 - 4.33 ), respectively.Conclusions Extra-gastrointestinal symptoms and abdominal pain lasting for more than one hour in each episode correlate their health-care seeking behavior in patients with IBS, as well as their preferences in seeking for health-care.

Key words: 
Irritable bowel syndrome;  Data collection;  Health-care seeking behavior
甲状腺髓样癌21例
Authors: 周玉, 徐丽梅, 姚斌, 翁建平
Journal: BMJ (2005)

甲状腺髓样癌(medullary thyroid carcinoma, MTC)是一种少见的起源于甲状腺滤泡旁C细胞的恶性肿瘤.为提高对甲状腺髓样癌的认识,达到早期治疗.回顾分析1981年1月至2002年12月收治的21例MTC病例。
Survey on knowledge, attitude and behavior in patients with chronic kidney disease
Authors: Lianye Wu
Journal: BMJ (2019)

Objective
To investigate the knowledge, attitude, and behavior of patients with chronic kidney disease (CKD) in the community.


Methods
A questionnaire survey on knowledge, attitude and behavior through the mobile WeChat was conducted among 1 006 CKD patients in 57 villages of Jinze and Huaxin communities in Shanghai Qingpu district from June 2016 to May 2018, and the results were analyzed.


Results
The accuracy rate about CKD knowledge in 1 006 CKD patients was 69.98%. The participants who were very willing to accept referral, learning CKD knowledge, periodic follow-up, health education and lifestyle counseling accounted for 60.40%, those who were willing accounted for 32.59% and not willing for 7.01%. The survey of behavioral patterns showed that 29.17% often participated in actively learning disease knowledge, periodic follow-up and counseling, reasonable diet and regular exercise; 52.96% occasionally participated and 17.87% never participated. There were no significant differences in knowledge about CKD among patients of different sex, age and occupation(t=0.475,F=7.111,F=0.563;all P>0.05); while the CKD knowledge level was higher in patients with college or above educational levels (7.80±3.96) , or patients with a disease history over 5 years (7.64±2.84) , or patients with stage 5 CKD (8.25±1.16) .


Conclusion
The rate of knowledge, attitude and behavior in CKD patients is relatively low, especially in attitude and behavior. In order to control the disease progression and reduce the adverse impact of the disease, it is necessary to take effective measures to improve the attitude and behavior of CKD patients.


Key words: 
Chronic kidney disease; Knowledge; Attitudes; Behaviors; Combination of medical and medical care
Risk factors of pulmonary hypertension and analysis of survival in hemodialysis patients
Authors: Ziliang Wang, Jianyong Liu, Mingbo Wang, Yan Xu
Journal: BMJ (2017)

One hundred and forty-two patients on maintenance hemodialysis were enrolled in the study.According to the guideline of American Society of Echocardiography 97 patients (68.3%) were classified as pulmonary artery hypertension [PAH, pulmonary artery systolic pressure (PASP)>35 mmHg(1 mmHg=0.133 kPa)] and 45 patients (31.7%) as non-PAH (PASP ≤ 35 mmHg). High sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were measured by automatic analyzer and enzyme linked immunosorbent assay (ELISA), respectively.There were significant differences in CRP and TNF-α levels between PAH and non-PAH patients (P 45 mmHg was higher than that in patients with PASP ≤45 mmHg (log-rank test: χ2=6.58, P=0.010), the risk was 2.82-fold (HR=2.82, 95%CI: 1.38-5.77, P=0.004).


Key words: 
Hypertension, pulmonary; Renal dialysis; Survival
Determination of serum levels of visfatin and high-sensitivity C-reactive protein in patients with polycystic ovary syndrome
Authors: Yan-li Zhao, Xiu-zhen Guo
Journal: BMJ (2009)

Objective To explore serum levels of visfatin and high-sensitivity C-reactive protein (Hs-CRP) in patients with polycystic ovary syndrome (PCOS), as well as their clinical significance. Methods Ninety patients with PCOS and 30 ovulating healthy women with body mass index (BMI) less than 25 as controls were recruited. PCOS patients were divided to two groups, 48 in obese group with BMI≥ 25 and 42 in non-obese group with BMI<25. Serum level of visfatin was measured by enzyme-linked immunosorbent assay (ELISA) and that of Hs-CRP was assayed by immunoturbidimetry in all participants. Oral glucose tolerance test (OGTT) and insulin sensitivity were assessed in PCOS patients only. Results ①Obese and non-obese patients with PCOS beth presented markedly higher serum levels of visfatin and Hs-CRP than those in controls (t=11.35, 8.46, 10.43 and 8.25, respectively, P<0.05), and levels of visfatin and Hs-CRP were higher in obese group than those in non-obese group (t=7.74 and 6.38, respectively, P< 0.05 ). ②Univariate analysis revealed that serum levels of visfatin and Hs-CRP positively correlated with BMI and homeostasis model assessment insulin resistance, respectively (P<0.05) and serum level of visfatin positively correlated with that of Hs-CRP (P<0.05). Conclusions Chronic inflammation possibly exists in patients with PCOS, which may cause their serum visfatin and Hs-CRP levels increased.

Key words: 
Polycystic ovary syndrome(PCOS);  Cytokines;  C-reative protein;  Inflammation
英夫利昔单抗治疗银屑病关节炎四例分析
Authors: 张娜, 魏蔚, 巩路
Journal: BMJ (2011)

银屑病关节炎(psoriastic arthritis,PsA)是主要发生于银屑病患者的慢性关节炎,大约有2％人群受累,患者可出现关节肿痛,部分患者可有骶髂关节炎和(或)脊柱炎,晚期可致残.患者通常生活质量下降,死亡率增高,寿命缩短[1].传统治疗对PsA的疗效多不满意,直到生物制剂的出现使PsA的治疗大为改观[ 2].英夫利昔单抗(inflixmab,IFX)是嵌合性抗肿瘤坏死因子-α (TNF-α)单克隆抗体,其中75％为人源性,25％为鼠源性.2004年欧盟批准IFX与甲氨蝶呤( methotrexate,MTX)联合治疗传统改善病情抗风湿药(disease-modifying antirheumatic drugs,DMARDs)治疗失败的活动期和进展期PsA.2005年美国食品药品管理局批准IFX单药治疗PsA.现将我科IFX治疗的4例PsA患者报道如下. 关键词：银屑病;关节炎性
心血管病常见用药误区(一)
Authors: 顼志敏
Journal: BMJ (2008)

顼志敏:第一部分仅讨论两个最主要的问题.首先举两个例子. 第1个例子:假病给了真药 55岁女性,闭经2年.感觉阵发性胸闷痛,伴有失眠和心慌,出现在劳累后和生气时.这时问诊一定要问发生在劳累的当时还是劳累后,还要引导病人说出胸痛持续时间?部位在前胸?侧胸还是后背?
Systematic approach to management on prenatal care in floating population: effectiveness and proposal for improvement
Authors: Xiao-hua Zhang, Li-ping Xiao
Journal: BMJ (2010)

Objective To investigate the effectiveness of system approach to management on prenatal health care in floating population. Methods The prenatal care was managed through establishing Contact  on the health of pregnant women in Shanghai for 505 lying-in women from the floating population of Minhang District. The condition of antenatal health care, the outcome of gestation and related factors were investigated and the results were compared to those reported in literatures. Results After system approach to management, the rate of having 1 - 3 antenatal examinations accounted for 32.1% ( 162/505 ), that of 4 - 8 examinations accounted for 43.0% ( 217/505 ), that ≥ 9 examinations accounted for 15.6% (79/505), which were higher than that reported by Zhuang Chanjuan (P = 0.001 ). Among 458 responders 185 (40.4% ) thought the cost for prenatal examination was high or too high. Among 293 responders, 211 (72.0%) did  establish the contact  due to not knowing the handbook or not clear about the process. The frequency of antenatal examination was associated with education levels of the lying-in women ( P =0.000) , whether their husbands being native Shanghainese or  ( P =0.002)and establishing contact handbood ( P = 0.002). Conclusions System approach to management promotes the utilization of antenatal health care for floating population, establishing contact  is a workable method to promote the utilization.

Key words: 
prenatal care;  Health service adiministration;  Residential mobility
SOPHIA analysis by chemotherapy (Ctx) choice: A phase III (P3) study of margetuximab (M) + Ctx versus trastuzumab (T) + Ctx in patients (pts) with pretreated HER2+ metastatic (met) breast cancer (MBC).
Authors: Santiago Escrivá, Seock-Ah Im, Fatima Cardoso, Javier Cortes, Giuseppe Curigliano, William John Gradishar, Mark D. Pegram, Gail Lynn Shaw Wright, Christelle Levy, Michelino De Laurentiis, Jean-Marc Ferrero, Shakeela Wazeen Bahadur, Sung-Bae Kim, Katarína Petráková, David A. Riseberg, Denise A. Yardley, Sutton Edlich, Sam Hong, Edwin P. Rock, Hope S. Rugo
Journal: Journal of Clinical Oncology (2020)

1040 Background: Despite advances, pretreated HER2+ MBC remains incurable with ongoing need for new therapies. Investigational M has similar HER2 binding and antiproliferative effects as T. Relative to T, M Fc engineering increases binding affinity for both variants of activating Fc receptor (FcR) CD16A and decreases affinity for inhibitory FcR CD32B, coordinately activating innate and adaptive immunity. In a Phase 3 (P3) trial, M prolonged PFS over T (Table). Second interim OS results from Sept 2019 also favor M (hazard ratio [HR], 0.89; 95% CI 0.69–1.13; nominal P=0.326). Methods: SOPHIA (NCT02492711), an open-label P3 trial, enrolled pts with HER2+ MBC after pertuzumab and 1–3 lines of prior treatment (Tx) for MBC. Randomization was 1:1 to M (15 mg/kg IV q3w + Ctx) or T (6 [8 for loading dose] mg/kg IV q3w + Ctx), stratified by met sites (≤2, &gt;2), lines of Tx for met disease (≤2, &gt;2), and Ctx choice, including capecitabine (Cap), eribulin (Eri), gemcitabine (Gem), or vinorelbine (Vin). Primary endpoints were central blinded PFS and OS, assessed sequentially using the stratified log-rank test. Results: Investigator chemotherapy choices and results by chemotherapy are shown in the table. Subjects receiving Eri and Gem had the lowest PFS hazards ratios (HRs), favoring M over T, although no statistical significance of individual chemotherapy subgroups was seen. There was variable toxicity among Ctx subgroups, and fewer subjects receiving Cap had Ctx related Grade 3 or higher (&gt;=Gr 3) AEs. In this unblinded study, more subjects on M than T in all subgroups discontinued Ctx while continuing study antibody. Conclusions: In combination with chemotherapy in pretreated HER2+ MBC, M improved PFS over T. Safety was manageable in all Ctx subgroups. Differences among HRs for chemotherapy subgroups may be driven by selection bias and/or sensitivity differences. Clinical trial information: NCT02492711 . [Table: see text]
Mental health service status in Chengdu Communities
Authors: Hui Li, Hua Ren
Journal: BMJ (2015)

A questionnaire survey was conducted among 319 mental health workers from 319 grass-roots health institutions of 21 districts (cities, counties) in Chengdu in March 2013. The items of survey included general information of participants, subjective perceptions and status of community mental health services. Total 252 effective questionnaires were received, the average age of participants was (33.12±9.39) years (19-61); 59.5% had clinical medicine and 16.3% had public health background; most of them had educational levels of three-year college or below (84.9%); the average duration of working experience was 18 months; 86.5% was part-time; most of participants (87.4%) thought that the mental health service was a hard job and only 25.3% expressed satisfaction with the work. Only 16.3% of community health service centers had rehabilitation facilities for mental illness patients. Public health education was carried out for average (2.21±1.62) times/year, the education for mental patients and family members was (1.62±1.83) times/year. Between areas with sufficient detection rate of mental illness and those with insufficient detection rate, there was significant difference in training frequency of mental workers (P=0.012), there were no significant differences in having formal employment of mental workers (P=0.064), professional guidance, co-working with police officers, co-working with Disabled Persons' Federation, and the duration of working experience (all P>0.05). The results suggest that the capacity of mental health service in community levels is relatively weak in Chengdu, and the personnel training, public education and rehabilitation work of mental health need to be strengthened.

Key words: 
Community mental health service; Data collection
睡眠呼吸暂停与心律失常
Authors: 韩芳
Journal: BMJ (2010)

正常人在睡眠状态下可发生多种心律失常,包括窦性心动过缓、窦性停搏、Ⅰ度及Ⅱ度Ⅰ型窦房传导阻滞,以快动跟睡眠期(REM)多发.其中持续时间在2 s以上的窦性停搏发生率为4%～10%,<40次/min的窦缓占24%,Ⅰ度房室传导阻滞占8%～12%,Ⅱ度Ⅰ型房室传导阻滞6%～11%。
Survival associated with mutations in SWI/SNF chromatin remodeling complex genes.
Authors: Michael J. Hassett, Angela Tramontano, Zilu Zhang, Kenneth L. Kehl, Deborah Schrag
Journal: Journal of Clinical Oncology (2020)

3643 Background: The SWI/SNF (SWitch/Sucrose NonFermentable) chromatin remodeling complex (CRC) - a combinatorial assembly of products from multiple genes - alters histone/DNA interactions and thereby impacts transcription, DNA replication/repair, and cell division. Studies suggest that over 20% of human cancers contain mutations in at least one SWI/SNF gene, implying that it is the most highly mutated CRC in human cancer. To address existing knowledge gaps, we sought to evaluate the association between SWI/SNF mutations and overall survival (OS). Methods: We identified adult cancer patients who consented to have OncoPanel testing (Dana-Farber/Brigham &amp; Women’s Hospital’s next generation sequencing platform) from June 2013-August 2019. These data were merged with institutional electronic health records and National Death Index vital status. We determined mutation frequency and co-occurrence for the nine SWI/SNF genes included in OncoPanel (ARID1A, ARID1B, ARID2, BCL11B, PBRM1, SMARCA4, SMARCB1, SMARCE1, and SS18). We assessed the association between mutation and OS (from time of OncoPanel testing) for cancers with at least 500 analyzed and 20 mutated cases, controlling for age and TP53 status. Exploratory analyses were conducted using cBioPortal and SAS (no multiple comparison adjustment). Results: Among 25,434 samples from 24,648 patients, a mutation in at least one evaluated SWI/SNF gene was identified in 26% of cases (ARID1A 10.5%, ARID1B 7.2%, SMARCA4 5.5%, PBRM1 4.9%, ARID2 4.8%, BCL11B 3.5%, SMARCE1 1.1%, SMARCB1 1.0%, and SS18 0.7%). The most frequently mutated cancers included small bowel (52%), endometrial (49%), ampullary (48%) and bladder (45%). Co-occurrence was common (30 of 36 potential gene-pairs), with the largest associations (odds ratio; all P &lt; .05) seen for SMARCB1:BCL11B (4.19), ARID1B:BCL11B (3.87), ARID2:BCL11B (3.85), and SMARCA4:BCL11B (3.78). Associations between having a mutation and OS were seen for the following cancers/genes (odds ratio; all P &lt; .05): ARID1A (colorectal 0.72, pancreatic 1.46), ARID1B (melanoma 0.32), SMARCA4 (esophagogastric 1.48, non-small cell lung 1.89, ovarian 0.43), SMARCB1 (non-small cell lung 2.04), and SS18 (soft tissue sarcoma 2.06). Conclusions: Mutations in SWI/SNF genes are widespread, with mutation rates varying by cancer type. Co-occurrence was common, especially with BCL11B. Associations with OS were both favorable and unfavorable, with variability seen by gene and cancer type. Future research should explore the mechanisms by which mutations in SWI/SNF genes influence treatment response/OS.
Effect of high-dose chemotherapy with autologous stem cell rescue (HDC-aSCR) on outcome in ovarian small-cell carcinoma, hypercalcemic type (SCCOHT): Prospective series from the French Rare Gynecologic Malignant Tumors Network (TMRG).
Authors: Felix Blanc, Claudia Lefeuvre, Anne Floquet, Dan Chaltiel, Isabelle Laure Ray-Coquard, Emeline Meriaux, Dominique Berton, Diana Bello, Cecile Guillemet, Pierre-Francois Dupre, Emilie Faller, Jérôme Alexandre, Anne-Claire Hardy-Bessard, Olivier Collard, Michel Fabbro, Magali Provansal, Elsa Kalbacher, Catherine Genestie, Patricia Pautier
Journal: Journal of Clinical Oncology (2020)

6023 Background: Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare and rapidly lethal disease affecting young women with over half dying within 2 years of diagnosis. We previously reported improved outcomes with cytoreductive surgery followed by HDC-aSCR in a prospective study, but these encouraging results needed to be confirmed in an independent and larger cohort. Methods: Between 2008 and 2019, out of 44 patients (pts) diagnosed with centrally confirmed SCCOHT in 16 referent centers of the TMRG network, 38 were treated prospectively according to the French recommendations of the network with complete surgery (primary or after neoadjuvant chemotherapy), 4 to 6 cycles of PAVEP chemotherapy (cisplatin, doxorubicin, vepeside, and cyclophosphamide), and for pts with complete response (CR), HDC-aSCR, followed by pelvic radiotherapy. The 6 patients who could not receive PAVEP (unfit or diagnostic delay) relapsed and died rapidly. The primary endpoint was the event-free survival (EFS) in the intention-to-treat cohort. Results: Median age at diagnosis was 33 years (14-76). 13 pts presented with FIGO stage I, 17 stage III and 6 stage IV, 2 unknown. Median follow-up was 55.5 months. 34 patients achieved CR with CT + surgery and 30 received HDC-aSCR (40%, 47% and 10% with stages I, III and IV diseases respectively) and 21 received also pelvic radiotherapy. Median overall and event-free survival was 36.4 and 15.9 months respectively, and 2-years event-free survival rate was 40% (CI95% 25-56). Median OS was respectively not reached, 18 and 9.6 months for FIGO I, III and IV patients. Among the pts (N = 14) who did not receive HDC-aSCR (rapid progression during or after PAVEP), the 2-yr EFS was 0% compared to 50.5% for the 30 patients receiving HDC. In multivariate analysis, HDC was significantly correlated with better outcomes (p &lt; 0.001). For the 21 patients receiving also pelvic radiotherapy, 57% (12/21) are free of recurrence at 4 years. Grades 3/4 adverse events were frequent (78%) but, in most cases, manageable, although one toxic death (3%) occurred during HDC (fungal septic shock). Conclusions: Treatment of SCCOHT, with intensive multimodal therapy, is associated with a 40% 2-yr event-free survival. However, this protocol is associated with significant toxicity and should be restricted to good performance status patient and expert centers.