tbuckley/cabot-search huggingface dataset:
Covid-19 and ethnicity: it’s too early to point to healthcare provider attitudes as a cause of poorer outcomes
Authors: Anthony D Dimarco
Journal: BMJ (2020)

<h3>Background</h3> Corticosteroids are used to treat a variety of medical conditions including acute asthma and croup where they are often given in short-courses. Epidemiological studies in Saudi Arabia show an increasing prevalence of respiratory diseases such as asthma in the past three decades.1 This study aimed to evaluate the tolerability and palatability of oral prednisolone and dexamethasone in children in Saudi Arabia. Both drugs are available in different formulations from different pharmaceutical companies. <h3>Methods</h3> Prospective observational and interview study. The palatability of the oral corticosteroids was evaluated by asking children and their parent9s opinions of the taste and acceptability of the medication soon after drug administration. Children were asked to point at the appropriate face on a 10-cm visual analogue scale depicting five degrees of pleasure: 1 ‘dislike very much, 2 ‘dislike a little’, 3 ‘not sure’, 4 ‘like a little’ and 5 ‘like very much’.2 The tolerability of the drugs, in particular nausea, vomiting and abdominal pain was also evaluated by direct questioning of the parent/patients after each drug administration, and at the end of the course. Data was collected over three months, February to April 2015. Patients aged 2–18 years with any condition being treated with oral prednisolone or dexamethasone in hospital were approached to participate. <h3>Results</h3> 122 patients (89 with asthma and 33 with croup) age range 2–11 years (mean=4.3) were recruited. 52 patients were given prednisolone base tablets, 37 patients were given prednisolone sodium phosphate syrup and 33 patients dexamethasone oral solution. The palatability score was lowest for the prednisolone base tablet (Mean rating=1.12), (prednisolone sodium phosphate group, Mean=1.62, 95% CI −0.75, −0.26; P=0.000001) (dexamethasone group, Mean=1.97, 95% CI −1.11, −0.6; P=0.000001). Dexamethasone was rated the most palatable (prednisolone sodium phosphate, 95% CI 0.08, 0.62; P=0.012). Nausea and vomiting occurred only in patients given prednisolone base tablets (24 and five patients respectively). Both were statistically more frequent when compared with the prednisolone sodium phosphate group (only four patients had nausea) (95% CI 0.19, 0.52; P=0.000001 and 95% CI 0.1, 0.18; P=0.024 respectively). In the dexamethasone group only two patients had nausea. Abdominal pain was reported in 13 patients given prednisolone sodium phosphate syrup compared to eight patients in the prednisolone tablet group (95% CI 0.02, 0.38; P=0.032). In the dexamethasone group eight patients had abdominal pain. <h3>Conclusions</h3> Dexamethasone was the most palatable preparation though it did cause abdominal pain in nearly one quarter of patients. Prednisolone base tablets were rated the least palatable preparation and were also the least well tolerated.
Quantitative immunochemical fecal occult blood test in health check-up population
Authors: Li Zhao, Siyi Yuan, Xiuchi Li, Gaiqing Ruan, Xiaoling Hao, Fulun Long, Tengda Xu
Journal: BMJ (2020)

Objective
To assess the application of quantitative immunochemical fecal occult blood test (qFIT) in screening of gastrointestinal diseases for health check-up population.


Methods
Total 19 633 health check-up subjects, who received qFIT in AiKang Guobin Physical Examination Center from January 2018 to June 2019 qFIT, were enroll in the study. The positive rate of subjects who received qFIT were analyzed. Gastrointestinal endoscopy were used to diagnose gastrointestinal lesions. The application of qFIT in screening gastrointestinal diseases, especially colorectal cancer and precancerous lesions was evaluated.


Results
Total 718 (3.66%) subjects were positive for qFIT, among whom 103 (42.3%) underwent gastrointestinal endoscopic examinations. Finally, 33 (42.3%) cases of colon adenoma, 9 (11.5%) cases of peptic ulcer, and 4 (3.1%) cases of colorectal cancer were detected; and other conditions including gastroenteritis and hemorrhoids were were also diagnosed. There were 87 cases whose qFIT were negative performed colon endoscopy, 5 (5.7%) cases of colon adenoma, no colorectal cancer were detected. The mean value of qFIT for colon cancer was higher than that for polyps (3 569±1 085)μg/L vs. (823±106) μg/L, P=0.01]. The detection rate of colon polyps in qFIT positive subjects was higher than that in qFIT negative subjects [32%(33/103) vs.5.7% (5/87)], and the detective rate of colon cancer in qFIT positive subjects was higher than that in qFIT negative subjects [3.9%(4/103) vs.0(0/87)].


Conclusion
Quantitative immunochemical fecal occult blood test can improve the detection rate of colorectal cancer and precancerous lesions in screening of gastrointestinal diseases.


Key words: 
Occult blood; Feces; Colonic neoplasms; Healthy examination
双眼眶贯通伤一例
Authors: 李传虎, 郑顺生, 董源涛, 孟海云, 王明全
Journal: BMJ (2004)

患者男,35岁,因左眼球被钢筋刺伤1 h就诊.查体:左眼无光感,眼压Tn-3,角膜缘3点处不规则伤口,眼内容物脱出.诊断为:左眼球破裂伤,急诊行眼内容物摘除术.术中见鼻侧巩膜不规则裂伤.次日患者自述右眼失明,查体:右眼轻度上睑下垂,眼压Tn,眼球固定,轻度突出,眼睑、角膜知觉减退,瞳孔散大,直径5 mm,对光反射消失.眼底:视盘水肿,网膜颜色略淡.CT示左眶内侧壁骨折,蝶窦见骨折线,右视神经管形态不规整,见骨折征象.诊断:右视神经管骨折,右视神经损伤.给予大剂量糖皮质激素、抗生素、脱水剂、血管扩张剂等药物,治疗2 d无效,转院行视神经管开放减压术.2个月后随访,右眼无光感,视神经萎缩。
Biomarker screening for the early detection of prostate cancer using an exosomal-enrichment RNA liquid biopsy test.
Authors: Douglas Roberts, Emily Mitsock, Olubode Ogunlusi, Seth Yu, Johan Skog
Journal: Journal of Clinical Oncology (2020)

e15553 Background: Prostate cancer is one of the most common cancers in men, with approximately 10% of all new cancer cases and ~5% of all cancer deaths in 2019. The standard test for prostate cancer is the Prostate Serum Antigen (PSA) test. The PSA test suffers from low specificity (20-40%) in patients including ‘grey zone’ levels (4-10 ng/mL); moreover, the PSA test fails to identify patients with high-risk cancers. Previously we developed ExoDx Prostate Intelliscore (EPI), a urine-based exosome prostate cancer test optimized to rule out the need for a biopsy (risk stratification for high-grade prostate cancer). This study utilized a next generation exosome-based test that specifically enriches a subtype of prostate cancer exosomes from urine. Early detection of prostate cancer via a non-invasive method is desirable and the identification of patients with high-risk cancer is critical. Here we describe the development of a prostate-specific urinary exosome test for the identification of patients with prostate cancer. Methods: We have developed a prostate-specific enrichment method to isolate exosomes of prostate origin from urine samples. Using an affinity-based method against surface marker proteins found on prostate cells, we were able to selectively enrich for exosomes shed by the prostate gland with demonstrated specificity. Subsequent analysis of exosomal nucleic acids enables a promising panel of gene expression biomarkers capable of distinguishing patients with prostate cancer from healthy individuals. Results: RNA from prostate cancer enriched exosomes was compared to total exosomes from urine. Enrichment of prostate cancer specific exosomes significantly enhanced the RNA signature compared to total urine exosomes. Conclusions: Prostate cancer tests have recently been developed for RNA signatures in urine. Exosomes provide a source of nucleic acids as they are actively shed continuously from living cells as part of their normal life cycle. The urine exosomes can be used for total RNA transcriptome analysis and are therefore a very rich source of biomarkers for prostate cancer that can be tailored to different clinical indications. An affinity-based enrichment for tissue-specific exosomes allow for better resolution of the gene expression profile from the tissue of interest and reduces the RNA targets from non-relevant processes of the bladder and kidneys. The gene signature identified in this ongoing study could potentially provide a non-invasive molecular means for the early diagnosis of prostate cancer.
Results of a randomized, open-label, multicenter trial to assess the safety, dose, and schedule ofRRx-001(001) in reducing incidence, severity and duration of severe oral mucositis (SOM) inpatients receiving concomitant chemoradiation (CRT) for advanced head and neck cancer (HNC).
Authors: Marcelo Raul Bonomi, David Sher, Dukagjin Blakaj, Rafi Kabarriti, Kyle Colvett, Bryan Oronsky, Stephen T. Sonis, James A. Bianco
Journal: Journal of Clinical Oncology (2020)

12081 Background: SOM occurs in 70% of patients receiving CRT for HNC with consequent pain, treatment interruptions and increased costs of care. Supraphysiologic levels of oxidative stress are key SOM initiators. 001 activates nuclear factor erythroid related factor 2 (Nrf2) increasing expression of multiple antioxidant genes including superoxide dismutase glutathione peroxidase and glutathione S-transferase. This trial examined the effect of dose and schedule on safety and efficacy of 001. Primary efficacy endpoint was duration of SOM (WHO criteria assessed); secondary endpoints included time to onset, incidence grade 4 through 60Gy and 70Gy. Methods: Locally advanced HNC treated with definitive or postoperative CRT (cisplatin + RT) received one of 3 001 schedules: (ARM1) 2 doses/wk for 2 weeks (prior to) CRT. ARMS 2, 3: prior to + 2 doses or 6 doses with CRT respectively or standard of care (SOC). Results: 53 patients randomized, 45 evaluable. Benefit trends for endpoints were consistent across all 3 001 arms with greatest effect size in pre-treatment only, ARM1. Compared to SOC, 001 reduced duration of SOM by 45% (40 vs 22 days). Through 60Gy and 70Gy a reduction of 95% and 79% in duration SOM was also observed (17 vs 1 day, and 23 vs 5 days) respectively. No patients in ARM1 developed grade 4, (0% vs SOC 30%). Side effects were comparable to SOC. Conclusions: In this small, open label trial, 001 demonstrated a favorable risk-benefit profile supported by reductions in overall SOM duration including through 60Gy and 70Gy with no grade ARM1 was most effective suggesting short periods of Nrf2 activation before CRT oxidative stress generation may increase the threshold and buffering capacity of upregulated antioxidants. Larger, blinded trials, confirming the observed dose, schedule and treatment effects are warranted. Clinical trial information: NCT03515538 .
Involvement of pharmacists and dietitians in contract service of family doctor
Authors: Ling Tian, Qing Lin, Yan Wang, Jing Zhang, Aili Ma
Journal: BMJ (2017)

Community health service centers provide basic medical and public health service for the residents in community with the contract service mode.In the last five years our center started the construction of primary care team.The family physicians, nurses and public health workers formed the basis of health care team, and pharmacists and nutritionists actively joined the team work.The pharmacists provided health education of rational medication, participated in the ward-rounds of home beds and comprehensive management of chronic disease patients, and also conducted counseling clinic of drug use.The clinical nutritionists provided special nutrition guidance for patients, delivered nutrition education and conducted nutrition clinic.The involvement of pharmacists and nutritionist in contract service has greatly ungraded the primary care team, improved the quality of comprehensive care and provided better service for the people in the community.


Key words: 
Disease Management; Community Health Services; Contract Service of Family Doctor
Pectoralis muscle wasting during chemotherapy.
Authors: Jason Wiederin, Christina Gu, Patricia Jewett, Anne Hudson Blaes
Journal: Journal of Clinical Oncology (2020)

e24069 Background: Chemotherapy is often followed by muscle mass loss which has been associated with frailty. We explored factors associated with change in pectoralis muscle mass after chemotherapy. We hypothesized greater muscle loss with time would be associated with poorer overall survival. Methods: We identified individuals with breast cancer (N = 221), sarcoma (N = 115), and lymphoma (N = 216) who received chemotherapy at the University of Minnesota MHealth Fairview and had CT scans before and after chemotherapy. Right pectoralis muscle area was measured using CORESLICER and indexed to body surface (right pectoralis muscle area [cm 2 ] / body surface [m 2 ]). We calculated quartiles of the indexed pectoralis measure. We restricted our analyses to participants who received a follow-up CT within two years after starting chemotherapy. In a multivariate linear regression, we explored associations of sex, age, BMI, ever-smoking, time since start of chemotherapy, indexed baseline muscle area, stage, type of diagnosis, and cumulative anthracycline dose with relative (%) change in muscle area. In a Cox regression we tested the association of relative muscle change with overall mortality. We used cubic splines to test for nonlinear effects. Results: Of 477 participants (66% female; mean age 61.3 (10.1) years), 366 received anthracyclines, 61 Trastuzumab, and 60 both. The average loss in right pectoral muscle area was -10% for women and -12% for men. We detected nonlinear effects of indexed baseline muscle area, P = 0.03. In a model using quartiles of indexed baseline muscle area, significant predictors of muscle loss included sex (women vs. men, -9.0%, 95% confidence interval (CI) -14.2- -3.7%, P = 0.0008), larger indexed baseline muscle area (quartiles 2, 3, 4 compared with quartile 1, change range -7 - -24%, 95% CI range, -2 - -30%, P-range &lt; 0.0001 – 0.006), smoking (ever vs. never, -4.1%, 95% CI -7.6 - -0.7%, P = 0.02), and diagnosis (sarcoma vs breast cancer, -5.7%, 95% CI -11.1 - -0.3%, P = 0.04). There was no significant association between muscle change and overall survival (median follow-up time 4.1). Conclusions: Being female, larger baseline muscle mass (per m 2 body surface), ever-smoking, and a sarcoma diagnosis were associated with greater relative muscle loss after chemotherapy. More data is needed to understand the course of sarcopenia in terms of recovery and survivorship. [Table: see text]
Prognostic nutrition index for evaluation of surgical risk and prognosis in elderly patients with gastric cancer
Authors: Gang Zhao, Xianglong Cao, Qi An, Tao Yu, Hua Yang, Hongda Pan, Jian Cui
Journal: BMJ (2018)

Objective
To assess the application of preoperative prognostic nutritional index (PNI) in evaluation the surgical risk and long-term prognosis for elderly patients with gastric cancer.


Methods
The clinical data of 205 patients aged ≥75 years with gastric cancer undergoing radical resection from January 2004 to December 2016 were analyzed retrospectively. The PNI value was calculated by serum albumin (g/L) + 5×lymphocyte count (×109/L). The receiver operating characteristic (ROC) curve and Youden′s index was used to determine the value of PNI in surgical risk and prognosis of patients. Patients were divided into low PNI group and high PNI group based on the cut-off value, the clinicopathological characteristics, postoperative complications and long-term survival were compared between two groups.


Results
The average PNI value of 205 patients was 47.3±5.5. When 44.9 was set as the cut-off value with the maximal Youden′s index, the sensitivity and specificity of PNI were 0.86 and 0.47, respectively. There were statistically significant differences between the two groups of patients in age(t=-2.16, P=0.032), BMI (t=4.88, P=0.000), Charlson comorbidity score(χ2=7.77, P=0.005), gastric resection range(χ2=8.63, P=0.003), postoperative complications (χ2=9.46, P=0.002). The incidence of complications in the high PNI group was 24.8% (33/133), which was lower than that in the low PNI group (45.8%, 33/72; χ2=9.46, P=0.002). Multivariate logistic analysis showed that age (P=0.032), Charlson coplications scal (CCS)(P=0.042)and PNI<44.9(P=0.027)were independent risk factors for postoperative complications; PNI<44.9(P=0.001), gastrectomy(P=0.011), lymph node dissection(P=0.000), tumor differentiation (P=0.001)and TNM stage (P=0.000)were independent prognostic factors for elderly patients with gastric cancer.


Conclusions
Prognostic nutritional index is a valuable clinical marker in evaluation of surgical risk and prognosis for elderly patients with gastric cancer.


Key words: 
Stomach neoplasms; Nutrition assessment; Prognosis
腔口结核五例误诊分析
Authors: 秦泗森, 张凤英, 张秀传
Journal: BMJ (2005)

腔口结核亦称皮肤、黏膜溃疡性结核病,发生于皮肤、黏膜腔口部位,最常见于口腔及肛门.此病在临床上很少见,极易误诊为其他疾病而首诊于综合医院,最后经病理证实和(或)脓液中找到结核杆菌而转至结核病防治机构接受规范抗结核治疗.我所1996年8月至2003年6月共收治腔口结核患者5例,现分析如下。
Unraveling tumor–immune heterogeneity in advanced ovarian cancer uncovers immunogenic effect of chemotherapy
Authors: Alejandro Jiménez-Sánchez, Paulina Cybulska, Katherine LaVigne Mager, Simon Koplev, Oliver Cast, Dominique-Laurent Couturier, Danish Memon, Pier Selenica, Ines Nikolovski, Yousef Mazaheri, Yonina Bykov, Felipe C. Geyer, Geoff Macintyre, Lena Morrill Gavarró, Ruben M. Drews, Michael B. Gill, Anastasios D. Papanastasiou, Ramon E. Sosa, Robert A. Soslow, Tyler Walther, Ronglai Shen, Dennis S. Chi, Kay J. Park, Travis Hollmann, Jorge S. Reis-Filho, Florian Markowetz, Pedro Beltrao, Hebert Alberto Vargas, Dmitriy Zamarin, James D. Brenton, Alexandra Snyder, Britta Weigelt, Evis Sala, Martin L. Miller
Journal: Nature Genetics (2020)
Phase I/II open label nonrandomized safety and efficacy study of the viral vectored ChAdOx1-MVA 5T4 immunotherapy in combination with PD-1 checkpoint blockade in intermediate-risk localized or locally advanced prostate cancer and advanced metastatic prostate cancer.
Authors: Mark Tuthill, Federica Cappuccini, Richard John Bryant, Ian Poulton, Emily Pollock, Lucy Carter, Clare Verrill, Armin Meier, Günter Schmidt, James WF Catto, Tom Evans, Silke Gillessen, Andrew Protheroe, Freddie Hamdy, Adrian V.S. Hill, Irina Redchenko
Journal: Journal of Clinical Oncology (2020)

TPS3170 Background: Antigen-specific immunotherapy (Sipuleucel-T) is licenced for the treatment for castrate resistant prostate cancer, but has modest clinical efficacy and is complex to administer to patients. New therapeutic antigen-specific approaches are required to generate and sustain therapeutic immune responses against tumour specific antigens in men with early and advanced prostate cancer. We have previously reported immunogenicity and efficacy data of a novel viral vectored vaccines-based immunotherapy based on two replication-deficient viruses, chimpanzee adenovirus (ChAdOx1) and MVA, targeting an oncofetal self-antigen 5T4, administered as a single agent and in combination with anti-PD-1 in mouse tumour models. We tested this immunotherapy alone in a first-in-human trial, VANCE (NCT02390063), in intermediate risk prostate cancer patients. Based on encouraging safety and exceptional T cell immunogenicity of the VANCE study, the phase I/II trial, ADVANCE (NCT03815942) is being undertaken to test the immunotherapy safety and efficacy in combination with PD-1 blockade in intermediate risk disease and metastatic prostate cancer. Methods: Study design: ADVANCE, an open label non-randomised phase I/II study, will recruit 12 patients with intermediate-risk prostate cancer patients (Gleason score ≤ 7, local tumour stage ≤T3c, PSA≤ 20 ng/ml) scheduled to undergo radical prostatectomy (Cohort 1) and 24 mCRPC patients with disease progression on anti-androgen therapy with either enzalutamide or abiraterone (Cohort 2). Cohort 1 will receive one cycle of ChAdOx1-MVA 5T4 immunotherapy and a single nivolumab infusion. Cohort 2 will receive 2 cycles of ChAdOx1-MVA 5T4 vaccination and three nivolumab infusions. Primary endpoint: Cohort 1 - PSA change from baseline to surgery, Cohort 2 – composite response rate measured as either ≥50% reduction of circulating tumour DNA or ≥50% serum PSA decrease from baseline at 24-week assessment and the maximal response rate. Secondary and exploratory endpoints include 5T4-specific immune response in the periphery, progression-free and overall survival and reduction of circulating tumour cells. 23 of planned 24 patients have been enrolled in Cohort 2. Enrolment to the Cohort 1 is ongoing. The data analysis is expected to be completed by Q4 2020 for Cohort 2. Clinical trial information: NCT03815942 .
Efficacy and safety of fruquintinib in the treatment of poor patients with metastatic gastrointestinal cancer.
Authors: Yanzhi Cui, Da Jiang, Xue Zhang, Fang Huang, Shaoshuang Fan, Long Wang, Ran Hou
Journal: Journal of Clinical Oncology (2020)

e16028 Background: To explore the efficacy and safety of fruquintinib in the treatment of poor PS patients with Metastatic colorectal cancer. Methods: The data of patients who were treated with fruquintinib in oncology department of our hospital from December 2018 to Janurary 2020 were analyzed retrospectively. Fruquintinib 5mg/ days, 3 weeks of withdrawal for 1 week, 4 weeks as a course of treatment, until the disease progression, death or voluntary cessation of treatment. When side effects occurred, the corresponding anti-symptomatic treatment can be given, if the drug side effects still intolerable, the drug was reduced to 4mg/ days or stop treatment. The adverse drug reactions were evaluated by CTCAE 4.0. The curative effects were evaluated by RECIST Version 1.1. All patients were followed up once every 28 days until the disease progression, death or voluntary cessation of treatment. Results: A total of 9 patients were included, including 2 patients with right metastatic colon cancer, 3 patients with advanced rectal cancer, the incidence of fruquintinib side effects was 100%, which occurred in the first 2 months of treatmentand was common in grade 1 and 2. The common symptoms were hypertension (100%),hand and foot skin reaction (50%), proteinuria (12.5%), dysphonia (31.4%), etc.Incidence of severe side effects was 12.5%, hypertension. Conclusions: The adverse reactions of fruquintinib often occurred within 2 months of treatment, most of which were grade 1 or 2; the patients can benefit from fruquintinib in physical state and organ function.
Nicotine dependence among rural-to-urban migrant workers in Shanghai
Authors: Yao Liu, Zhigang Pan, Tianying Wang, Tianhao Wang, Yao Shen, Jian Gong, Wei Dai, Jin Zhou, Hua Yang
Journal: BMJ (2014)

Objective
To explore the nicotine dependence levels and the influencing factors of dependence among rural-to-urban migrant workers in Shanghai so as to provide scientific rationales for an effective implementation of tobacco control.


Methods
Multi-stage randomized sampling was used to select a total of 5 856 rural-to-urban migrant workers from 7 districts in Shanghai. Fagerstrom Test for Nicotine Dependence (FTND) and logistic regression model were used to analyze the association between nicotine dependence and relevant risk factors.


Results
The current smoking prevalence was 23.7%. The average FTND score for current smokers, high dependence and low dependence were 3.38±2.49, 7.00±1.07 and 2.23±1.71 respectively. The high and low dependence rates were 21.7% and 78.3%. The results of logistic regression showed that education, duration of smoking and length of migration were associated with nicotine dependence. Lower level of education was more prone to high nicotine dependence. Those with a lower education had a higher risk of nicotine dependence (junior high school: OR=1.742, primary school or lower: OR=1.994 vs. senior high school or higher). High nicotine dependence increased with the duration of smoking (smoking 6-10 years: OR=3.007, 11-15 years: OR=4.076, 16-20 years: OR=5.451, 20 years or more: OR=5.726 vs. 5 years or less). Length of migration over 3 years was less likely to have a high nicotine dependence (3-5 years: OR=0.602, more than 5 years: OR=0.407 vs. < 1 year).


Conclusion
The rate of high nicotine dependence is high among rural-to-urban migrant workers in Shanghai. Level of education, duration of smoking and length of migration are significant influencing factors of nicotine dependence.


Key words: 
Tobacco use disorder; Smoking; Questionnaires