tbuckley/cabot-search huggingface dataset:
Unmet supportive care needs and health behaviors in Hispanic/Latino cancer survivors with cardiometabolic comorbidities.
Authors: Patricia Moreno, Amelie G. Ramirez, Frank J. Penedo
Journal: Journal of Clinical Oncology (2020)

e24038 Background: Cardiometabolic illness is a leading cause of death among cancer survivors previously treated for early-stage breast, prostate, and colorectal cancer. Despite the fact that Hispanics/Latinos in the U.S. are at a significantly elevated risk for poor cardiometabolic health, there is a paucity of research examining cardiometabolic comorbidities in Hispanic/Latino cancer survivors. The aim of this study was to examine unmet supportive care needs and health behaviors in Hispanic/Latino cancer survivors with and without comorbid peripheral vascular disease and diabetes. Methods: Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer (N = 288) were assessed using the Charlson Comorbidity Index, Supportive Care Needs Survey, and ACS Lifestyle Behavior Scale within 15 months of treatment completion in an NCI-funded project. Logistic regression analyses were conducted adjusting for sociodemographic and medical covariates. Results: Most survivors had a high school education or less (65.6%) and a household income less than $50,000 (68.4%) and were foreign-born (59.4%) and either monolingual Spanish-speaking (54.2%) or English-Spanish bilingual (26.0%). One-quarter (24.7%) were diagnosed with comorbid diabetes and one-fifth (20.8%) were diagnosed with comorbid peripheral vascular disease. Survivors with peripheral vascular disease were more likely to have unmet health system and information needs (OR 2.29, p = .011) and unmet sexuality needs (OR 2.07, p = .020) and marginally more likely to have unmet psychological care needs (OR 1.71, p = .099) than those without peripheral vascular disease. Survivors with diabetes were more likely to have unmet sexuality needs (OR 2.06, p = .015) than those without diabetes. Survivors reported increasing some positive health behaviors following their diagnosis of cancer, including regular health check-ups (61.5%) and consumption of healthy foods like fruits and vegetables (61.8%). However, attempts to lose weight (45.1%), exercise (40.6%), and avoid alcohol (26.0%) and cigarettes (17.0%) were less common. Health behaviors did not vary between survivors with and without peripheral vascular disease and diabetes (p &gt; .05). Conclusions: Comorbid peripheral vascular disease and diabetes are highly prevalent among Hispanic/Latino cancer survivors and are associated with greater unmet supportive care needs. Targeted efforts are needed to increase exercise and weight loss as well as reduce smoking and alcohol consumption in Hispanic/Latino cancer survivors.
Platelet-rich plasma versus corticoid in the treatment of chronic lateral elbow epicondylitis
Authors: Guo-you Zou, Wei-tao Jia, Min-qian Zheng, Ru-li Zhu, Hong-bing Liu, Wen-sheng Zhang
Journal: BMJ (2013)

A total of 52 patients with chronic lateral epicondylitis were randomly assigned into platelet-rich plasma (PRP) (n=28) or corticosteroid (n=24) group. The visual analog pain scale (VAS) and Mayo elbow score had no significant difference between two groups within 1 week post-treatment. However, VAS and Mayo elbow score improved more significantly in PRP group versus corticosteroid group at Month 1 and 6 post-treatment (P<0.05). The PRP trigger point injection treatment of elbow lateral epicondylitis achieved clinical outcomes and it was superior to glucocorticoid treatment.


Key words: 
Lateral elbow epicondylitis; Platelet-rich plasma
Reasonable application of benzodiazepine drugs in insomnia management
Authors: Xiaoming Zhang, Juan Li
Journal: BMJ (2016)

失眠症是睡眠与觉醒障碍的一种，严重影响患者生命质量。镇静催眠药物是目前治疗失眠的主要方法。苯二氮类药物是目前临床应用最广泛的镇静催眠药物，其不合理使用可造成药物依赖、过度镇静、认知损害、停药反应等问题。通过介绍苯二氮类药物的药理学特征、临床应用中的注意事项以及常见误区，促进该类药物的合理使用。
Analysis of occurrence regularity and risk factors of deep venous thrombosis in patients with distal fractures of the knee during perioperative period
Authors: Shuhao Li, Jianping Sun, Chen Wang, Shuangwei Qu, Lisong Heng, Dongxu Feng, Pengfei Wang, Na Yang, Ding Tian, Jun Zhang, Yangjun Zhu, Kun Zhang
Journal: International Journal of Surgery (2019)
Increased pathological complete response rate with neoadjuvant denosumab in locally advanced giant cell tumor.
Authors: Gabriela Monte Tenorio Taveira, Felipe Da Silva Marinho, Antonio Marcelo Gonçalves de Souza, Wagner cabral Gomes Carneiro
Journal: Journal of Clinical Oncology (2020)

11528 Background: Giant cell bone tumor corresponds to 5% of bone tumors, has an osteolytic pattern and mainly affects long bone epiphyses in young adults. Despite being considered benign, it can metastasize and is treated as a locally destructive tumor, since it causes pain, limited joint movement and impaired function, with a risk of pathological fractures. The use of denosumab for surgical downstaging and reduction of recurrence is being studied, but the standard of treatment is still surgical. Methods: 15-year experience in monitoring 40 patients at the Cancer Hospital of Pernambuco-BR, who used neoadjuvant denosumab. They received Denosumab 120mg on D1, D8 and D15 as attack phase and subsequent maintenance with 120mg monthly. Results: The 40 patients made an average of 10 doses of neoadjuvant denosumab. Mostly located in the femur (41%) and tibia (23%), but with rare disorders in talus or orbit. Metastasis occurred in 6%, with site in lung and bones. Most were women (62%) around 21-40 years old, with Capanacci III classification at 72%. In this group, 28 had locally advanced disease and 12 had unresectable or metastatic disease. After using neoadjuvant denosumab, 75% have already had a biopsy, of which 63% (19/30) had a complete pathological response in biopsy. Of the patients with no post-denosumab neoplasia, 26% (5/19) had recurrence after medication and surgical procedure. Neoadjuvant treatment with denosumab, a monoclonal antibody that binds to RANKL, has been shown to benefit from histological response and surgical downstaging. We found 63% of complete pathological response in the 30 patients who underwent biopsy after medication, with bone sclerosis and hypocellular fibrous tissue as the main finding. Of these, 26% had disease recurrence after surgery. These data follow the international standard of disease recurrence rate, which is around 30%. Conclusions: We hope that the use of neoadjuvant desonumab will be more widespread and that it will be able to perform surgical downstaging, allowing less invasive and morbid procedures. Thus achieving greater joint preservation at the expense of a disease recurrence rate similar or less than standard surgical treatment.
Tobacco control: responsibility of physician
Authors: 姜垣, 赵国栋
Journal: BMJ (2009)

目前,全球吸烟者达到11亿,每年死于吸烟的人数大约540万[1].按照这种趋势,到2030年全球烟草导致的年死亡人数将达到1000～1500万[1];到21世纪末,烟草将夺去10亿人的生命,而且其中有3/4以上会集中在中低收入国家[2]。
The development and clinical status of traditional chinese medicine on insomnia
Authors: 王麟鹤
Journal: BMJ (2008)

中医对于失眠的基本认识是根据失眠症的临床表现,归属到中医学的失眠、不寐、嗜睡、多梦、奸眠、梦惊、梦游、梦语等病证的范畴.本病证是以经常难以入睡为特征的一种症候,根据中医学的临床经验,失眠症的证情不一,有初卧难以入寐者;有寐而易醒,醒后不能再眠者;有时寐时醒,睡眠不稳或乱梦纷纭者;甚则还有通宵不寐者.在治疗上要根据不同的病症特点辩证分型治疗.
Risk factors of acute pancreatitis after endoscopic retrograde cholangiopancreatography
Authors: Wenhua Chen, Jun Lin, Hongling Wang, Jianping Wang, Sheng Yang, Tengteng Hu
Journal: BMJ (2019)

Objective
To investigate the risk factors of acute pancreatitis after endoscopic retrograde chloangiopancreatography (ERCP).


Methods
Clinical date of 1 041 patients who underwent therapeutic ERCP from January 2016 to August 2017 in department of gastroenterology, Zhongnan Hospital of Wuhan University, were retrospectively studied. Among them post-ERCP pancreatitis developed in 53 patients (PEP group) and the remaining 988 patients were assigned in the non-PEP group. The clinical characteristics, procedures of ERCP, gastrointestinal symptoms and laboratory findings after ERCP were compared between two groups. The SPSS software (version 22.0) was applied to analyze the risk factors of PEP.


Results
The overall incidence rate of PEP was 5.09% (53/1 041). There were statistic difference in the number of white cells [8.56 (5.43, 12.23) ×109/L vs. 7.12 (5.58, 9.20) ×109/L, Z=-2.122] and the ratio of neutrophils [0.82±0.11 vs. 0.76±0.12, t=-3.612] after ERCP operation; the incidence of endoscopic sphincterotomy (EST) [60.37%(32/53) vs. 43.72% (432/988) , χ2=5.646] and endoscopic papillary balloon dilation (EPBD)[50.94% (27/53) vs. 33.00% (326/988) , χ2=7.230] during operation, and periampullary diverticula [35.85% (19/53) vs. 52.98% (523/988) , χ2=4.619] (all P<0.05). Logistic analysis indicated that the ratio of neutrophils was independent risk factor of PEP (OR=1.058, 95%CI: 1.019-1.098, P=0.003) .


Conclusion
The number of white cells, the ratio of neutrophils after ERCP and endoscopic sphincterotomy, endoscopic papillary balloon dilation and periampullary diverticula are associated with PEP, while the ratio of neutrophils is the independent risk factor of PEP.


Key words: 
Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Risk factors
SAVOIR: A phase III study of savolitinib versus sunitinib in pts with MET-driven papillary renal cell carcinoma (PRCC).
Authors: Toni K. Choueiri, Daniel Yick Chin Heng, Jae-Lyun Lee, Mathilde Cancel, Remy B Verheijen, Anders Mellemgaard, Lone Ottesen, Melanie M. Frigault, Anne L'Hernault, Zsolt Szijgyarto, Sabina Signoretti, Laurence Albiges
Journal: Journal of Clinical Oncology (2020)

5002 Background: PRCC is the most common type of non-clear cell RCC, accounting for 10–15% of renal malignancies. As a subset of PRCC cases are MET-driven, MET inhibition may be an appropriate targeted treatment approach. In a single-arm Phase II study, savolitinib (AZD6094, HMPL‐504, volitinib), a highly selective MET-tyrosine kinase inhibitor, demonstrated antitumor activity in pts with MET-driven PRCC (Choueiri et al. JCO 2017). The Phase III SAVOIR study (NCT03091192) further assessed savolitinib vs standard of care sunitinib in pts with MET-driven PRCC. Methods: In this open-label (sponsor blinded), randomized study, pts with centrally confirmed MET-driven ( MET and/or HGF amplification, chromosome 7 gain and/or MET kinase domain mutations), metastatic PRCC were randomized to savolitinib 600 mg once daily (QD), or sunitinib 50 mg QD 4 weeks on / 2 weeks off. Primary objective was progression-free survival (PFS; RECIST 1.1 by blinded independent central review). Secondary objectives included overall survival (OS), objective response rate (ORR), and safety and tolerability. Results: After external data on predicted PFS with sunitinib in pts with MET-driven disease became available, study enrollment was closed. At data cutoff (Aug 2019), only 60 of the planned 180 pts were randomized (savolitinib n = 33; sunitinib n = 27). Most had chromosome 7 gain (savolitinib 91%; sunitinib 96%) and no prior therapy (savolitinib 85%; sunitinib 93%). PFS, OS, and ORR were numerically improved with savolitinib vs sunitinib (Table). CTCAE grade ≥3 adverse events (AEs) were reported in 42% and 81% of pts; dose modifications were related to AEs in 30% and 74% of pts with savolitinib and sunitinib respectively. After discontinuation, 36% of all savolitinib and 19% of all sunitinib pts received subsequent anticancer therapy. Conclusions: Although pt numbers and follow-up were limited, savolitinib demonstrated encouraging efficacy and an improved safety profile vs sunitinib, with fewer grade ≥3 AEs and fewer dose modifications required. Sunitinib performance was poorer than expected based on external retrospective data. Further investigation of savolitinib as a treatment option for MET-driven PRCC is warranted. Clinical trial information: NCT03091192 . [Table: see text]
Changes on functional capacity after impact of oncological digestive surgery: Reality in Chilean patients at Clinical Oncology Institute Arturo López Pérez Foundation.
Authors: Veronica Hurtado, Felipe Brito, David Carrera, Marcela Penjean
Journal: Journal of Clinical Oncology (2020)

e16714 Background: Currently Chile does not have a database of functional capacity (FC) in cancer patients. Our purpose is to assess the impact of oncological digestive surgery in FC in Chilean patients at the Clinical Oncology Institute Foundation Arturo López Pérez (FALP) through the 6 minutes walking test (6MWT), which allows objectifying the FC based within the meters walked for 6 minutes by the patient. Methods: It’s a retrospective study of data analysis. The 6MWT was assessed on the day of admission to FALP and discharge. The FC was measured by the distance walked in 6 minutes. Inclusion criteria were male and female candidates for elective oncological digestive surgery from December 2018 - January 2020 and eligible for the 6MWD. We compared the result of the 6MWD baseline admission against an expected reference value according to age, weight and height, and were classified according to whether they were above or below the reference level; their change was also evaluated after surgery, estimated as a percentage of change. Digestive interventions were classified according to site. A P &lt; 0.05 was considered significant. Results: 108 patients were included; the mean age was 57.8 years and the average body mass index (BMI) 26.6. Upon admission 40.7% (N = 44) were above the reference value and 59.3% (N = 64) below it. Regarding the length of hospital stay, we observed an average 8.97 days (Men = 9.96; women = 7.96; P = 0.008). At discharge in 6MWD an average decrease of 149.6 meters (admission = 502.2 mts; Discharge = 352.6 mts.) is seen. At admission, men with age &lt; 40 years (P = 0.031) and subjects with BMI &lt; 30 (P = 0.039) walked a greater distance. There are no significant differences by surgery classification. Regarding the percentage loss of FC, women are more affected (P &lt; 0.001). Conclusions: Based on the results obtained in the 6MWT, we can conclude that the surgery has an impact on patient’s FC. Note that over 50% of patients had a lower value than the base reference. Therefore, we believe it is important to make a multidisciplinary approach at the time of cancer diagnosis to evaluate and optimize the FC baseline before surgery. Clear examples of this approach are the prehabilitation programs. More studies are required in Chilean patients for more conclusive data.
Association between serious immune-related adverse events and survival in patients with advanced HCC treated by nivolumab: A single-center experience.
Authors: Antonia Digklia, Antonella Diciolla, Arnaud Hocquelet
Journal: Journal of Clinical Oncology (2020)

e16661 Background: Nivolumab received accelerated approval by the FDA in 2017 for the treatment of advanced hepatocellular carcinomas (HCC). This study is aimed at evaluating the relationship between serious irAEs leading to treatment pause and survival of patients treated with nivolumab in our center. Methods: we performed a retrospective analysis of the patients treated at our center. The Kaplan Meir method was used to evaluate overall survival(OS). Log-rank test was conducted to compare groups in terms of OS. Adverse events were assessed using NCI CTCAE version 4.03 criteria. Results: Twenty patients with advanced HCC received nivolumab as palliative therapy between 2017-2019. 12/20 received nivolumab as first line treatment, 7/20 as second line. 6/20 patients stopped nivolumab due to serious irAEs including pancreatitis, kidney dysfunction and colitis leading to definitively stop of the therapy. The majority of patients received nivolumab in second line (5/6). The 1 year OS was 44% at the non-serious irAEs group and 84% in the serious irAEs group (p value = 0.0166). Median overall survival for the entire cohort was 11.4 months. The median OS was 8.11 months in patients without serious irAEs and 18.2 months in the group with toxicity. Conclusions: the occurrence of serious irAEs was associated with longer OS at our single center review. These results are in line with reports in other diseases such as lung cancer and melanoma. These retrospective data warrant further evaluation.
Lenvatinib plus pembrolizumab combination therapy in patients with radioiodine-refractory (RAIR), progressive differentiated thyroid cancer (DTC): Results of a multicenter phase II international thyroid oncology group trial.
Authors: Bryan Haugen, Jena French, Francis P. Worden, Bhavana Konda, Eric Jeffrey Sherman, Ramona Dadu, Andrew G. Gianoukakis, Eric G. Wolfe, Nathan R. Foster, Daniel W. Bowles, Lori J. Wirth
Journal: Journal of Clinical Oncology (2020)

6512 Background: Lenvatinib is an approved therapy for patients with RAIR DTC. While the overall response rate (ORR) is high, few patients achieve a complete response (CR) and most patients eventually have progressive disease (PD). Combination lenvatinib and pembrolizumab is being explored in many different cancers, and this combination has been approved for advanced endometrial carcinoma. Methods: Patients with RAIR DTC with Response Evaluation Criteria in Solid Tumor (RECIST v1.1) measurable PD (&lt;14 months (mo) prior to registration) were enrolled in this single-arm multicenter phase II study. Patients were excluded if they had received previous VEGFR-directed multikinase therapy. The lenvatinib starting dose was 20 mg/day orally and pembrolizumab was 200mg IV every 3 weeks. The primary endpoint was CR. ORR, progression-free survival (PFS) and safety graded by Common Terminology Criteria for Adverse Events v4.0 were secondary endpoints. Results: Thirty patients were enrolled. The median age was 62.5 years, and 53% of the patients were women. Seventy percent of patients had grade 3 adverse events (AEs) and 10 percent had grade 4 AEs. There were no treatment-related deaths. The most common &gt; grade 3 AEs were hypertension (47%), weight loss (13%), maculopapular rash (13%), leukopenia (7%), diarrhea (7%) and oral mucositis (7%). Twenty-one patients (70%) required lenvatinib dose reduction. Of 29 evaluable patients, 18 (62%) had a partial response (PR) and 10 (35%) had stable disease (SD). The clinical benefit rate (ORR +SD) was 97%. Median time to tumor nadir was 7.4 mo (1.6-17.8 mo). Median PFS was not yet reached. The PFS at 12 months was 74%. Median time on therapy was 9.9 mo (3.2-18.9 mo). Fourteen patients are continuing therapy (7.6-18.9 mo). Six of these patients (43%) have not yet reached tumor size nadir. Three patients (10%) had &gt; 80% target tumor shrinkage. Conclusions: Lenvatinib plus pembrolizumab is reasonably tolerated in patients with RAIR DTC. To date, there have been no documented complete responses. Combination lenvatinib plus pembrolizumab therapy has a high ORR in patients with RAIR DTC. Continuation of this study will help determine the depth and length of the responses. Clinical trial information: NCT02973997 .
Immune-checkpoint inhibitors among privately insured cancer patients: Utilization pattern and out-of-pocket cost.
Authors: Hui Zhao, Ying Xu, Sharon H. Giordano, Ya-Chen T. Shih
Journal: Journal of Clinical Oncology (2020)

e19252 Background: Immune-checkpoint inhibitors (ICI) is a form of immunotherapy that “releases the brakes” on the immune cells to restore antitumor immunity and promote tumor cell death to treat cancer. In March 2011, the United States Food and Drug Administration (FDA) approved ipilimumab, the 1 st ICI, to treat advanced-stage melanoma. Since December 2014, FDA successively approved another six ICIs: nivolumab, pembrolizumab, avelumab, durvalumab, cemiplimab, and atezolizumab. Beside melanoma, the treatment indications for these agents have been expanded to renal cell carcinoma, microsatellite instability (MSI)-high malignancies, small-cell lung cancer, non-small-cell lung cancer, and cutaneous squamous cell carcinoma. No study had examined the patterns and out-of-pocket (OOP) costs of ICI among cancer patients (pts) with private insurance. Methods: We used the IBM MarketScan Commercial Claims and Encounters database to document the uptake of ICI from 2011 to 2017. Using the Healthcare Common Procedure Coding System (HCPCS) codes, and national Drug code, we identified ICI claims among pts 18 to 64 years old. OOP cost for ICI was computed as sum of coinsurance, copayment, and deductible. To determine whether financial burden was higher for pts with high-deductible (HD) plans, we dichotomized pts’ insurance plan as HD vs. non-HD. Summary statistics was used to describe the patterns of ICI use. We used Wilcoxon Rank Sum test to compare the OOP by HD status. Results: The study cohort included 7,855 pts with 62,636 ICI claims of ipilimumab, nivolumab, pembrolizumab, avelumab, durvalumab, and atezolizumab between 2011 and 2017. The median age was 57 years and about 56.9% pts were male. Approximately 90% of pts used ICI as monotherapy, and the median number of claims per patient was 4. The most commonly used ICI was nivolumab (55.4%), accounting for about 90% of claims after 2014, followed by lpilimumab (24.6%), pembrolizumab (18.5%). Among the ICI pts, 17.2% enrolled in HD plans and 82.8% had non-HD plans. The median OOP for both HD and non-HD groups was $0, whereas the 3 rd quartile of OOP was significantly higher for pts in HD plans ($556 vs. $26, P &lt; 0.01). In addition, approximately 18.7% of pts (17.3% of pts in non-HD and 25.6% in HD plans) paid over $500 OOP per patient for ICI. Conclusions: The use of ICI was dramatically increased as more ICI agents were approved since 2015. Although more than 50% of pts had $0 OOP, possibly due to the out-of-pocket max provision in private insurance, pts with HD plans are especially susceptible to high financial burden of ICIs.
Aerobic exercise improves cardiopulmonary function of elderly patients with heart failure and preserved ejection fraction
Authors: Shao-hua Lin, Ling Jiang, Ai-jun Kong, Yan-song Ju
Journal: BMJ (2011)

A total of 89 elderly patients with heart failure and preserved ejection fraction were randomly divided into 2 groups:patients in control group received conventional medication,those in exercise group receive conventional medication plus aerobic exercise training,which was lasted for 6 weeks.The changes in VO2max,maximum heart rate (HRmax),VO2max/HRmax,exercise time,6-minute walk and quality of life (QOL) were evaluated after 16 weeks.The VO2max,HRmax,VO2max/HRmax,exercise time,6-minute walk and QOL had increased significantly in exercise group,compared with the control group.The results indicate that aerobic exercise can improve cardiopulmonary function of elderly patients with heart failure and preserved ejection fraction.

Key words: 
Heart failure,congestive; Exercise
Clinical characteristics of COVID-19 and active tuberculosis co-infection in an Italian reference hospital
Authors: Claudia Stochino, Simone Villa, Patrizia Zucchi, Pierpaolo Parravicini, Andrea Gori, Mario Carlo Raviglione
Journal: European Respiratory Journal (2020)

<b>The COVID-19 infection rate was high in patients with active tuberculosis. Major clinical complications were seen only in two patients, thus requiring <i>ex novo</i> oxygen supply, one of whom with advanced tuberculosis died. Nasal swab viral clearance was rapid.</b>https://bit.ly/3cdvdZJ
阿托伐他汀钙致老年脑血管病患者横纹肌溶解症一例
Authors: 滕瑛珏, 黄朝阳
Journal: BMJ (2010)

患者,女,75岁,主因突发短暂性意识丧失、恶心呕吐2 h于2009年9月17日入院.2 h前患者无明显诱因突发双眼发黑,意识丧失,持续数分钟后意识转清,伴恶心呕吐,家人急送至医院,查颅脑CT示脑梗死。