tbuckley/cabot-search huggingface dataset:
Analysis of current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital
Authors: Quan-ying He, Chun-hua Wei
Journal: BMJ (2008)

Objective To investigate current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital. Methods Statistical reports of hospital work, notification forms of tuberculosis (TB) cases on the internet, registration book of laboratory sputum mgcobacteria examinations, statistical reports of X-ray examinations for outpatient department, referral forms for mycobacteria patients, medical records for hospitalized patients at the respiratory ward of the People's Hospital, Peking University during August 2005 to July 2006 were reviewed and analyzed. Results In outpatient pulmonary department, there were 45 055 visitors during the period of August 2005 to July 2006,and 4960 of them (11.0%) had their chest X-ray examined, 1 512 (3.4%) had sputum mycobacteria examined with smear-positive in 24 cases, 189 (0.4%) were referred to specialized TB dispensaries for further diagnosis and 183 with notification forms with a notification rate of 96.8%, and 30 (0.1%) were finally diagnosed as TB after hospitalization with an interval less than 14 days between onset of symptoms and diagnosis in 27 of the 30 (90.0%) and 26 were referred to a specialized TB dispensary (86.7%) for treatment. Conclusions On general, detection, diagnosis and referral of TB in People's Hospital of Peking University are in a good situation.However,more aUenfion should be paid to the following aspects：① quantity and quality of sputum myeobacteria examinations for outpatients should be improved further,②chest radiograph reading by radiologists and clinicians need to be improved,and ③consciousness of early detection for TB need to be enforced in physicians by bronchoscopy and pathological diagnosis,especially in those with complicated and difficultly diagnosed smear-negative TB.

Key words: 
Tuberculosis,pulmonary;  Referral and consultation;  Diagnosis
Effect of femoral nerve catheter location on postoperative pain relief after total knee arthroplasty
Authors: Yan Hu, Feng Zhu, Wei Zhang, Xi-qiang He, Shi-zhong Li
Journal: BMJ (2011)

We enrolled 60 patients with American Association of Anesthesiologists grade Ⅰ - Ⅱ undergoing unilateral total knee arthroplasty. All patients received combined epidural and spinal anesthesia,and a nerve stimulator was used to guide placement of a femoral nerve catheter. Patients were divided into three groups according to the catheter location on X-ray : psoas muscle group ( n = 18 ), iliacus muscle group (n = 19) and local group (n =23). Visual analog scale (VAS) pain scores were recorded at rest and with movement at 4, 24 and 48 h postoperatively and sensory blockade of the femoral, obturator and lateral femoral cutaneous nerves was recorded at 24 h. There were no significant differences in femoral nerve blockade among the three groups. Obturator nerve blockade was significantly better in the psoas muscle group than in the iliacus muscle and local groups, and was also better in the local group than in the iliacus muscle group. There was no significant difference in lateral femoral cutaneous nerve blockade between the psoas muscle and iliacus muscle groups, but there was better blockade in both these groups than in the local group. At 4 h postoperatively, VAS pain scores at rest were significantly lower in the psoas muscle group than in the iliacus muscle and local groups, but there were no significant differences in VAS pain scores with movement among the three groups. At 24 and 48 h postoperatively, VAS scores at rest and with movement were significantly lower in the psoas muscle group than in the iliacus muscle and local groups.

Key words: 
Anesthesia and analgesia;  Arthroplasty, replacement, knee
Starting dose selection and dose escalation for oncology small molecule first-in-patient trials: Learnings from a survey of approved drugs.
Authors: Rajendar K Mittapalli, Donghua Yin, Darrin M. Beaupre, Rameshraja Palaparthy
Journal: Journal of Clinical Oncology (2020)

e15648 Background: The ideal starting dose (SD) for an oncology first-in-patient (FIP) trial should be low enough to be safe but not too far removed from therapeutically relevant doses. A low SD combined with small dose increments could lead to a lengthy dose escalation (DE) and could expose patients unnecessarily to sub-therapeutic dosing. Over the past decade, the SD selection for oncology FIP trials was predominantly based on ICH S9 Guidance. This work attempts to assess the performance of current approaches in SD selection and DE methods for small molecule oncology drugs (SMOD), with an aim to identify potential opportunities for more efficient FIP DE methods and to minimize patients receiving sub-therapeutic dosing. Methods: A systematic review of the FIP trials of USFDA approved SMODs from 2010 to early 2019 was performed. The data sources included the FDA “USPI”, relevant “Summary basis of approval” documents, and published articles. The review focused on FIP trial data including the SD, DE design, the number of cohorts to the maximum tolerated dose (MTD) or the recommended phase 2 dose (RP2D), and the number of subjects in each cohort. These data were analyzed to evaluate the efficiency and appropriateness of current approaches for FIP SD selection and DE. Results: Of 53 SMODs approved between 2010 and early 2019, ~ 65% were kinase inhibitors and ~74% were approved for solid tumor indications. All SMODs appeared to follow ICH S9 Guidance for SD selection and none of SMODs had more than doubling for dose increments in the escalation. The median MTD to SD ratio was 8 (1 to 125). A majority (57%) of the trials used a 3+3 design for DE and had a median of 4 cohorts (0 to 11) to reach MTD or RP2D from the SD. About 30% of the FIP trials had ≥ 6 DE to reach the MTD or RP2D, and in this subset, greater than 55% of the trial participants received subtherapeutic dosing. Conclusions: The ICH S9 Guidance-based SD and the DE methods for SMODs have generally performed well in most cases; the SD was well tolerated and the MTD or RP2D were achieved with reasonable efficiency. However, for a portion of SMODs the SD appeared to be too low or the DE was too conservative, suggesting opportunities for improvement to minimize the number of patients dosed at sub-therapeutic doses.
Accuracy of high resolution MRI in measurement of vascular stenosis ratio in atherosclerotic middle cerebral artery
Authors: Yongsheng Wang, Wenjie Zhang, Mingrui Yang, Zhijie Yin, Jing Wang, Xiaofei Zhong, Xingyue Jiang, Shanchang Shen
Journal: BMJ (2019)

Objective
To evaluate the accuracy of measurements of atherosclerotic middle cerebral artery (MCA) stenosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI).


Methods
Forty patients with symptomatic atherosclerotic stenosis of middle cerebral artery (MCA) confirmed by digital subtraction angiography (DSA) in the Affiliated Hospital of Binzhou Medical College from September 2017 to May 2018 were enrolled in the study. Patients were scanned by HR-MRI sequence (including T1WI, T2WI, PDWI). The MCA M1 stenosis rate on HR-MR images was assessed by warfarin-aspirin symptomatic intracranial artery disease (WASID) method and area measurement algorithm, respectively, and based on the stenosis rate the degree of stenosis (semi-quantitative measurement) was determined. The accuracy of the two measurement methods was evaluated with DSA results as the gold standard.


Results
The HR-MRI images showed the structure of the vessel wall clearly in 30 patients meeting the measurement requirements. The inner edge of the vessel was clearly distinguishable and smooth, showing eccentric stenosis. The stenosis rate of MCA measured by DSA, WASID method and area measurement algorithm were (82±17)%, (70±12)%, (81±16)%, respectively (P>0.05). The result of area measurement algorithm was better correlated with DSA (r=0.893); and the coincidence of the stenosis degree rate of two measurement method was 90%(27/30).


Conclusion
The area measurement algorithm based on the HS-MRI has high accuracy in measuring the degree of MCA stenosis,which is of high clinical application value.


Key words: 
Magnetic resonance imaging; Middle cerebral artery stenosis; Atherosclerosis
Efficacy and safety of RevoLix 2 micron continuous wave laser vaporesection in treatment for senile patients with benign prostatic hyperplasia
Authors: Jianlong Wang, Leilei Wang, Ming Liu, Pengjie Wu, Yaoguang Zhang, Ben Wan, Jianye Wang
Journal: BMJ (2017)

The clinical efficacy and safety of RevoLix 2 μm continuous wave laser vaporesection in treatment of senile patients with benign prostatic hyperplasia (BPH) were retrospective evaluated. In 291 senile patients with BPH, 213 received 2 μm continuous wave laser vaporesection (group A) and other 78 patients received transurethral resection of prostate (TURP, group B). Compared with group B the intraoperative blood loss was less, the bladder irrigation time, catheter time and hospitalization time were shorter in group A. The subjective or objective indexes were all significantly improved at 3 and 12 months after laser treatment. The improvements of international prostate symptom score (IPSS), IPSS-S, overactive bladder symptom score (OABSS) in patients of 70-79 were more marked than those of 80 or older. Patients with mild overactive bladder (OAB) had less improvement in IPSS and IPSS-S than those with moderate-severe OAB which suggest that the storage symptoms could be improved significantly by removing obstruction.


Key words: 
Lasers therapy; Prostatic hyperplasia; Transurethral resection of prostate
Sleep-disordered breathing in patients with neuromuscular disease
Authors: Huimin Li, Minglin Dong
Journal: BMJ (2018)

The cause of sleep-disordered breathing in patients with neuromuscular disease is due to a sharp decrease in lung volume during supine sleep and the disease-induced upper airway collapse or cardiopulmonary failure. Polysomnography is used for the diagnosis of sleep-disordered breathing. Noninvasive positive pressure ventilation is the standard management for sleep-disordered breathing.


Key words: 
Neuromuscular diseases; Sleep apnea syndromes; Noninvasive positive pressure ventilation; Polysomnography
Temporal trends in receipt of adjuvant chemotherapy for veterans with colorectal cancer.
Authors: Richard Lewis Martin, Gretchen C. Edwards, Lauren R. Samuels, Cathy Eng, Christianne L. Roumie
Journal: Journal of Clinical Oncology (2020)

e19171 Background: For patients with National Comprehensive Cancer Network (NCCN) high risk stage II or stage III colorectal cancer (CRC), adjuvant chemotherapy improves disease free (DFS) and overall survival (OS). Rates of use vary significantly across health care settings. Several demographic and healthcare factors are associated with decreased receipt of chemotherapy; however, few studies have assessed utilization patterns over time. We evaluated receipt of chemotherapy from 2000-2015 among patients treated at a Southeast Regional Veterans Health Administration (VHA) facility to determine local targets for quality improvement initiatives. Methods: We reviewed 1,107 electronic medical records of patients undergoing colorectal surgery from January 1, 2000 to December 31, 2015 at VHA Tennessee Valley Healthcare System. We included patients with NCCN eligible pathologic high risk stage II (T4/perf, R1, &lt; 12LN, LVI) or stage III CRC and excluded for age ≥80, age ≥75 hospitalized in the prior year with a major co-morbidity, and death or hospice within 30 days of surgery. The primary predictor was year of surgery, partitioned 2000-2005 (N = 60), 2006-2010 (N = 64), 2011-2015 (N = 56) to reflect changes in NCCN guidelines. The primary outcome was receipt of any chemotherapy. Results: Of 1,107 colorectal surgeries, we excluded 623 for non-cancers, 212 for stage I or low-risk stage II cancer, 47 for metastatic disease, and 45 for age, co-morbidity, death, and hospice, yielding a final cohort of 121 colon and 59 rectal cancers. Most patients were male (96%), white (79%), with median age 64 years [Interquartile Range 60, 70]. Overall, 117 of 180 (65%) received chemotherapy with a median time to treatment of 50.5 days [40,64]. Adjusting for known correlates, receipt of chemotherapy decreased over time; 2000-2005 (72%), 2006-2010 (69%), 2011-2015 (53%) p = 0.02. Regardless of CRC stage, more patients declined chemotherapy in 2011-2015 (27%) compared to 2000-2005 (6%) and 2006-2010 (8%) p &lt; 0.01. Conclusions: We identified decreased utilization of adjuvant chemotherapy in a non-elderly veteran cohort, which appeared to be due to patients declining chemotherapy regardless of cancer stage. Understanding patient and provider decisions around adjuvant chemotherapy and evaluating trends outside the VHA may offer important insights to implementing quality improvement measures.
Thymosin α_1 prevents acute exacerbation of chronic obstructive pulmonary disease in elderly patients
Authors: Zheng-tai Zhu, Hua Li, Jun-qiang ju, Xiao-wu Qian, Mao-rong Teng, Yue-fang Zhai
Journal: BMJ (2009)

Objective To investigate the prophylactic effect of thymosin α_1 on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in elderly patients.Methods One hundred and twenty COPD patients were randomized into two groups(n=60 for each).Patients in the treatment group received thymosin α_1 1.6 mg subcutaneously,2/week for 8 weeks;while patients in control group received normal saline instead.Serum CD3,CD4,CD8,IrA,IgG and IgM levers were measured,and the pulmonary function were examined before and 2.12 months after treatment.Results In treatment group the recurrence interval of AECOPD Was extended:the attack frequency and persistence time of AECOPD were significantly lower in cutuparison with those of the control group(P＜0.05).CD4 and CD4/CD8 levels were significanfly increased(P＜0.05)after treatment of thymosincd.Conclusion Thymosin α_1 Can protect acute exacerbation of chronic obstructive pulmonary disease in elderly patients.

Key words: 
Thymosin; Pulmonary disease,chronic obstructive; Lymphocyte subsets
Once weekly selinexor, carfilzomib, and dexamethasone (SKd) in patients with relapsed/refractory multiple myeloma (MM).
Authors: Cristina Gasparetto, Brea Lipe, Sascha Tuchman, Natalie Scott Callander, Suzanne Lentzsch, Muhamed Baljevic, Adriana C. Rossi, Nizar J. Bahlis, Darell White, Christine Chen, Heather J Sutherland, Rami Kotb, Richard LeBlanc, Michael Sebag, Christopher P Venner, William Bensinger, Heidi Sheehan, Yawen Ju, Kazuharu Kai, Gary J. Schiller
Journal: Journal of Clinical Oncology (2020)

8530 Background: Selinexor is a novel, first-in-class selective inhibitor of nuclear export (SINE), which blocks exportin 1 (XPO1), forcing the nuclear retention and activation of tumor suppressor proteins. Selinexor in combination with low dose dexamethasone (Sel-dex) was approved by the FDA, based on data from the STORM study wherein Sel-dex induced an overall response rate (ORR) of 26.2% in patients (pts) with refractory MM. We hypothesize that once weekly (QW) SKd may be an active well tolerated regimen and evaluated this combination in a dose escalation/expansion study. Methods: STOMP is a phase 1b/2 study evaluating various doses and enrolled pts with carfilzomib naive relapsed MM. Oral selinexor was dosed QW at 80 or 100 mg. Carfilzomib was dosed QW (on days 1, 8 and 15 of 28-day cycle) at 56 mg/m 2 or 70 mg/m 2 . Dexamethasone was dosed at 40 mg QW. The primary objectives of the study are to assess the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), as well as explore the efficacy and safety of SKd. Results: As of January 2020, 18 pts were enrolled. Median age was 71 years (range: 50-76). Median number of prior regimens was 4 (range: 1-8). All pts (n = 18) were previously treated with bortezomib and lenalidomide, and 50% and 56% pts were refractory to bortezomib and lenalidomide respectively. Nine (50%) pts received prior pomalidomide treatment and 8 (44%) pts were refractory. Eleven (61%) pts received prior daratumumab treatment and 9 (50%) were refractory. The MTD was selinexor 80 mg QW, carfilzomib 56 mg/m 2 QW and dexamethasone 40 mg QW. The ORR and CBR were 72% and 79% respectively with 4 complete responses, 7 very good partial responses, 2 partial responses, and 1 minimal response. Stable disease was observed in 3 pts. With a median follow-up period of 4.7 (1.8-16.3) months, median progression-free survival has not been reached. Common treatment-related adverse events (total, Grade ≥3) were thrombocytopenia (83.3%, 66.7%), nausea (66.7%, 0%), anemia (55.6%, 11.1%), fatigue (50%, 11.1%), anorexia (44%, 5.6%), weight loss (44%, 0%), and neutropenia (33.3%, 11.1%). Conclusions: Once weekly SKd demonstrated an encouraging ORR of 72% in pts with a median of 4 lines of prior therapy. The majority of responses are deep and predominantly CR and VGPR. The combination is well tolerated with no new safety signal, no Grade ≥3 nausea, vomiting, diarrhea, weight loss or anorexia. The side effects are a function of the dose and schedule and can be managed with dose modification and supportive care. Enrolment is ongoing and supports a phase 3 study of SKd. Clinical trial information: NCT02343042 .
Thinking of Risk in the Era of COVID-19
Authors: Howard Bauchner, Phil Fontanarosa
Journal: JAMA (2020)

Society remains in the grip of the worldwide coronavirus disease 2019 (COVID-19) pandemic.As each town, city, and country attempts to restore some aspect of normal life, they are confronted with 2 nearly identical questions:What is the individual risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and ultimately COVID-19?What is the risk for the population that renewed activities will fuel a surge of new cases of disease and potentially overwhelm the health care system?Neither of these questions can be answered with precision, and yet they have come to dominate everyday conversation.Some data are helpful to understand the risk.Overall, since March 1, 2020, the overall cumulative hospitalization rate for COVID-19 in the US was estimated at 67.9 per 100 000 or about 0.068%. 1 In addition, the major risk factors for mortality related to COVID-19 are now welldefined-age and underlying comorbid conditions. 2-4About 50 million individuals in the US are older than 65 years of age. 5 Based on various data sources, 6-9 about 75% of the more than 100 000 COVID-related deaths in the US to date have occurred among these older individuals; thus the risk of death in this population is about 1.50 per 1000 or 0.15%.One-third to half of the deaths in some US states have involved residents in nursing homes or other long-term care centers. 10Approximately 1.5 million individuals live in these facilities in the US, 11,12 and if approximately one-third of the 100 000 deaths in the US have occurred among individuals from these facilities, the risk of death in this population is about 22 per 1000 or 2.2%.In contrast, the rate of SARS-CoV-2 infection among children thus far appears to be relatively low, and when children do become infected, they are less likely to develop serious COVID-19 illness; however, a new entity, multisystem inflammatory syndrome in children, 13 has been identified and is of concern to parents and clinicians, and others, including teachers.Yet even with this new entity, it is unclear if the risk of infection or severe disease is 1 in 1000, 1 in 10 000, or 1 in 100 000.Despite these differences in risk, a general approach has emerged involving the mandatory wearing of masks and physical distancing when indoors, with greater flexibility when outside.However, it is not possible to accurately define the risk of becoming infected while walking or jogging outside or going to the beach.The precise benefit of wearing masks and physical distancing in preventing disease is unknown, although it is quite clear that these are effective behaviors, with virtually no individual consequences.
心包血管肉瘤一例
Authors: 陈晓春, 张志坚, 葛智平, 高子芬
Journal: BMJ (2005)

患者女,28岁,因阵发性心悸、气短半个月,胸骨后锐痛1周,于2001年5月18日入院.体格检查:血压110/70mm Hg(14.7/9.3 kPa),呼吸平稳,无紫绀,全身浅表淋巴结未触及肿大,双肺呼吸音清,心界扩大,心率88次/min,律齐,未闻及杂音和心包摩擦音,无奇脉.心电图示:窦性心律,标准肢体导联低电压。
Thinking of training for general practitioners and its preliminary practice
Authors: Yun-jie Liu, Yan-hong Wang
Journal: BMJ (2010)

For the issues existed in training of general practitioners, with characteristics of community health-care service centers (CHS) and large-scale urban hospitals, a training model of exchange physicians between hospitals and CHSs was formulated. After three-month practice, a general practitioner-specialist technical cooperation group was established. The new model not only promoted construction of a two-way referral system, but also created environmental condition for training community physicians.

Key words: 
Education, continuing;  Professional competence
Late toxicities and recurrences in patients with clinical stage I nonseminomatous germ cell tumor after one cycle of adjuvant BEP versus primary retroperitoneal lymph node dissection: A 13-years follow-up analysis of a phase III trial cohort.
Authors: Andreas Hiester, Anna Fingerhut, Guenter Niegisch, Roswitha Siener, Susanne Krege, Hans U. Schmelz, Klaus-Peter Dieckmann, Axel Heidenreich, Peter Kwasny, Maik Pechoel, Jan Lehmann, Sabine Kliesch, Kai Uwe Koehrmann, Rolf Fimmers, Volker Volker Loy, Christian Wittekind, Michael Hartmann, Peter Albers
Journal: Journal of Clinical Oncology (2020)

5512 Background: One cycle of adjuvant BEP has shown superiority in recurrence free survival over RPLND in patients (pts) with clinical stage (CS) I nonseminomatous germ cell tumor of the testis (NSGCT) (JCO 2008). We report recurrences and late toxicities of this randomized trial after 13 yrs of follow-up (FU). Methods: Questionnaires of 382 unselected pts with CS I NSGCT treated within a phase III trial comparing recurrence rate after 1 cycle of adjuvant BEP (arm A) vs. RPLND (arm B) were evaluated regarding recurrences and late toxicity. Overall (OS) and progression free survival (PFS) was calculated by Kaplan-Meier and arms were compared using logrank test. Categorial data were analyzed by chi-square test (PRISM v8). Results: In each arm 191 pts were analyzed as intention-to-treat with a median FU of 13.75 yrs (0-22.9 yrs); 3/191 pts (1.6 %) in arm A and 16/191 pts (8.4 %) in arm B had a recurrence. 20-yrs PFS in arm A / B was 97 % (CI 96-99 %) / 92 % (CI 90-95 %), ( p = .0049). 20-yrs OS in arm A / B was 90 % (CI 86-94 %) / 88 % (CI 86-94 %), ( p = .83). 23/382 (6 %) pts have died, 22/23 not related to testis cancer, 1/23 died of a recurrence in arm B. 8/191 pts (4.2 %) in arm A and 4/191 pts (2.1 %) in arm B showed metachronous secondary testis cancer ( p = .26). 5/191 pts (2.6 %) in arm A and 4/191 pts (2.1 %) in arm B developed other malignancies. 170/382 questionnaires were evaluable (arm A: 95; arm B: 75). 45 pts were lost to FU. There were no significant differences comparing both treatment arms regarding potentially treatment-related late toxicities. However, excluding pre-existing complaints, ototoxicity (9/95 (9 %) vs. 4/75 (5 %) pts, p = .31) was reported more frequently in arm A. Excluding pre-existing neurological conditions, peripheral neuropathy of all grades was more frequently reported in arm A (15/95 pts; 16 % vs. 9/75 pts; 12 % pts; p = .48). Retrograde ejaculation occurred more frequently after RPLND (9/95 pts; 9% vs. 18/75 pts; 24 %, p = .01). Conclusions: After more than 13 yrs of FU, recurrences in non-risk factor selected pts with CS I NSGCT remain to be significantly more frequent with RPLND. No excess mortality due to secondary malignancies was observed. Late toxicities did not differ between 1 cycle of BEP and RPLND. Only retrograde ejaculation was observed significantly more frequent after RPLND. With long-term observation, 1 cycle of BEP has not only a high efficacy to prevent recurrence but also seems to be tolerated without clinically relevant long-term toxicity.