tbuckley/cabot-search huggingface dataset:
Pain in cancer: The patient experience in Spain.
Authors: Jesus Garcia-Foncillas, Antonio Anton, Fernando Caballero, Margarita Feyjoo, Alfonso Gomez De Liano Lista, Vicente Guillem, Diana Monge, Carlos Camps
Journal: Journal of Clinical Oncology (2020)

e19021 Background: For patients, pain management can be a therapeutic objective that is just as important as oncological treatment. The aim was to analyze the illness experience of a group of oncological patients with pain associated to cancer and episodes of breakthrough cancer pain (BTcP), as well as their opinions on the care received. Methods: This study is an initiative of the ECO Foundation (Oncology Excellence and Quality Foundation), undertaken with the methodological support of Francisco de Vitoria University. Descriptive, transversal, multicenter and ecological study. 47 oncologists participated. Each of them invited 6 patients that met the participation selection criteria (one patient every day for 6 consultation days). An anonymous patient questionnaire was used, produced by the Scientific Committee, so they could provide their personal opinions and scores on their oncological pain (categorical variables). The doctor was in charge of transcribing the aggregated data compiled by means of an online survey. Statistical package: version 21.0 IBM SPSS-Windows. Results: The 47 oncologists collected information from 275 patients whose average age was 62.4. 46.5% were women. Clinical profile of the patient: The most frequent location of the primary tumor was the lung (28%), followed by breast (15.3%) and the intestine/colon (13.1%). Almost half of the patients (46.2%) suffered from maximum intensity pain of 8 points or higher (on a scale of 0 to 10) within the last 24 hours. Despite this, 8 out of 10 patients reported that they are satisfied or very satisfied with their pain treatment. 43% of patients were worried about the possibility of addiction or side-effects as a result of the treatment. However, 95% expressed satisfaction with the information offered by their doctor regarding analgesic treatment. More than half of patients gave the impact of their pain on their general activity, mood, everyday work and enjoyment of life a score of ≥7 out of 10 (10 = completely impacted). Conclusions: Although the patient satisfaction level regarding the doctors’ pain management was high, there seems to be room for improvement in terms of pain control and the impact of pain on each patient’s life.
急性头痛的现场快速判断和初步诊断
Authors: 冯庚
Journal: BMJ (2004)

头痛(headache)指位于眉弓以上至枕部范围内的各种疼痛,它既可以是一种独立的疾病,也可以是某些疾病的症状或并发症,有头痛症状的患者占神经内科门诊总数的70%～90%.急性头痛是指突然发病,其疼痛以小时为单位加重的情况.虽然头痛的发病率较高,且不同疾病患者的预后也不尽相同,但头痛的紧急程度和即刻危险性在院前急救中却不在前列,少数属于Ⅲ级,大多低于Ⅲ级.尽管有些急性头痛患者的预后较差,但大多数人在发病后短时间(≤30 min)不大可能有生命危险,因此对以头痛为主诉患者的现场急救主要是迅速区分一般性头痛和有预后危险的头痛.有预后危险的头痛是指急性脑血管病导致的头痛,也称为卒中相关性头痛(stroke-associated headache),这类头痛是在所有的头痛疾患中发展最快、对患者威胁最大的疾病.院前急救的目的就是要迅速识别这种头痛,进而及时将患者送医院。
Hematologic parameters in patients with <scp>COVID</scp>‐19 infection: a reply
Authors: Bingwen Eugene Fan
Journal: American Journal of Hematology (2020)

We thank Dr Sahu and Dr Siddiqui for adding further input on the effect of COVID 19 infection on the blood system, in their correspondence to our letter to the American Journal of Hematology.1 We did not specifically look at coagulation abnormalities in our correspondence to AJH, but we have noted these have been already addressed by other publications, notably Tang et al2 and Han et al3 in their papers on COVID-19 associated coagulopathy. Our initial impression at the time of our correspondence was that apart from D-dimer, the coagulation parameters such as PT, PTT and fibrinogen in non-ICU patients were less significant in identifying patients needing ICU care. While an elevated D-dimer may also reflect underlying inflammation, immobility or liver disease, patients with COVID-19 infection with markedly raised D-dimers are significantly at risk of mortality,2 and a raised level also implies increased thrombin generation. We note that anticoagulation therapy mainly with low molecular weight heparin appears to be associated with a better prognosis in severe COVID-19 infection with markedly elevated D-dimer in a further publication by Tang et al.4 As such, the International Society for Thrombosis and Haemostasis (ISTH) interim guidance on recognition and management of coagulopathy in COVID-195 has the recommendation that prophylactic dose low molecular weight heparin should be considered in all patients, who require hospital admission for COVID-19 infection in the absence of any contraindications. As mentioned in our correspondence, our primary focus was on hematologic parameters and we did not cover the scope of any specific data on thrombosis and bleeding. We have however, further published in a separate letter to the American Journal of Hematology about the usage of blood and blood products,6 which may answer partially the concerns of risk of bleeding in our population of patients. None of our patients we studied with COVID-19 infection had hematologic malignancies at the point of submitting our letter, but we do recognize that these immunosuppressed patients are particularly vulnerable and may likely experience greater morbidity and mortality when having a COVID-19 infection.
The proportion of out-patients in Department of Ophthalmology of Kunming Children's Hospital
Authors: Li-hong Li
Journal: BMJ (2009)

From Jan 2003 to Dec 2007 total 110 239 out-patients visited the Department of Ophthalmology of Kunming Children's Hospital, among them 62.21% were non-Kunming residents.In all patients there were 61 613 boys and 48 626 girls with an average age of 7.4 years, and 66.48% was under age of 7.For the diagnostic category 13.82% was normal, ametropia accounted for 41.73%, inflammation of eyelid and conjunctiva 27.20%, congenital obstruction of lacrimal passage 7.56%, strabismus and amblyopia 4.01%, trichiasis 0.88%, ptosis 0.35%, disease of cornea 0.27%, cataract 0.14%, congenital glaucoma 0.05%, trauma 0.67% and 3.32% were others.The number of patients had a seasonal variation and 42.98% patient visits occured in winter and summer vacation.

Key words: 
Child health services;  Ophthalmology
A case of Graves hyperthyroidism with hypercalcemia and thymus enlargement
Authors: Xu Wendong, Shi Min, Zhang Ridong, Wang Xingzhou, Hu Zhangjun, Gao Pengxia, Zhang Hong
Journal: BMJ (2019)

报道1例格雷夫斯（Graves）病甲状腺功能亢进症伴高钙血症、胸腺增大患者的临床资料。患者男性、21岁，因恶心、呕吐入院。检测促甲状腺激素受体抗体、甲状腺功能、血钙水平升高，颈部超声检查示双甲状腺弥漫性增大、MRI检查示甲状腺两叶对称性增大，胸部CT示胸腺肿大。抗甲状腺治疗3个月甲状腺功能及血钙水平正常，治疗6个月后胸腺大小正常。
Myositis in primary Sj(o)gren's syndrome
Authors: Hua Ye, Shi Chen, Zhan-guo Li
Journal: BMJ (2009)

This study was to identify the clinical features of myositis complicated with primary Sj(o)gren's syndrome (pSS). A total of 202 patients with pSS were investigated. Myositis was diagnosed according to the clinical findings, muscle enzyme levels, electromyographic results, and muscle biopsy, and compared with 15 polymyositis (PM) patients. Myositis was identified in 4 of 202 pSS patients (2.0%). They developed myositis 5 to 20 years after the onset of SS. Two patients showed no myalgia and muscular weakness. Creative kinase (CK) was increased from 480 to 2702 IU/L. Anti-Jo-1 antibody was negative. All patients responded well to prednisone and had a median serum CK decrease by 48.9%. No patients had myositis recurrence. Compared with the PM group, the percentage of myalgia, peak of CK, descending rate of CK, and positive rate of anti-Jo-1 antibody were all significantly different. Myositis with Sj(o)gren's syndrome is not common, show relatively moderate symptoms, and respond well to prednisone.

Key words: 
Sj(o)gren's syndrome; Myositis
Multigene profiling to identify clinically relevant actionable mutations in head and neck cancers: An Indian study.
Authors: Sateesh S. Kunigal, Shalini Thakur, Yogesh Shivkumar, Sheela M L, Krishna CR, Urvashi Bahadur, Ravi Nayar, Kodaganur S. Gopinath, Mithua Ghosh, Basavalinga Sadasivaiah Ajaikumar, Vishal Uchila Shishir Rao
Journal: Journal of Clinical Oncology (2020)

e18529 Background: Head and Neck squamous cell carcinoma (HNSCC) represents approximately 5-10% of malignancies worldwide. Despite the advances in treatment modalities there lies a disparity in response, owing to the underlying molecular and genetic make up. In the era of precision medicine, it is important to profile each disease and customise treatment to improve the outcomes by identifying predictive or prognostic indicators at the molecular and genetic level. Methods: 100 patients with HNSCC, diagnosed at our centre from April 2015-17 were profiled by targeted deep sequencing for hotspot mutations in 48 cancer-related genes using Illumina’s TSCAP panel and MiSeq technology. The average coverage across 220 hot spots was greater than 1000X. Data was processed using Strand Avadis NGS. Mutations identified in the tumor were assessed for ‘actionability’ i.e. response to therapy and impact on prognosis. The clinical data for these patients was collected retrospectively and analysed for treatment outcomes with standard therapy. The association of mutations with habits, stage at presentation, poor treatment outcomes and prognosis was also analysed. Results: Somatic variants were detected in 63.1% of cases. Genetic aberrations were identified in major RAS/RAF signalling pathway in 10 % of cases out of which HRAS activating mutations were the most common (n=4). HRAS was co-mutated with PI3KCA (n=3) and PTEN deletions (n=2). Based on the result, Cetuximab was discontinued in 2 patients with metastatic HNSCC. Other targetable mutations included ATM (n=1), STK11 (n=1), RB1 (n=1) and BRAF (n=1). Disruptive and non-disruptive mutations in TP53 alone were found in 43.8% of H&amp;N cancers, varying widely among different histology with variable treatment outcome. Interestingly all metastatic/recurrent patients, with very short progression free survival of 9-12 months (PFS) post Cisplatinum based chemotherapy, were found to have mutated TP53. TP53 was also found to be co- mutated with ATM gene (n=1), an important prognostic marker, indicating poor response to chemotherapy and radiotherapy. The patients with recurrence and poorer prognosis (n =5) showed point mutations in codon regions 173 -273. Conclusions: Indian patients with HNSCC display a wide mutational landscape with specific actionable targets. Although traditional treatment modalities remain the standard of care, specific mutations may be utilised to customise treatment, prognosticate and predict outcomes.
Efficacy of daratumumab in the treatment of multiple myeloma with high-risk cytogenetics: Meta-analysis of randomized phase III trials.
Authors: Smith Giri, Alyssa Grimshaw, Susan Bal, Kelly Nicole Godby, Prakash Kharel, Benjamin Djulbegovic, Saad Zafar Usmani, Thierry Facon, Philippe Moreau, Meletios A. Dimopoulos, Maria-Victoria Mateos, Luciano J. Costa
Journal: Journal of Clinical Oncology (2020)

8540 Background: The addition of Daratumumab (D) to backbone multiple myeloma (MM) regimens leads to improved response rates and progression free survival (PFS). Whether improved outcomes are also seen among patients with high-risk cytogenetics (HRC) remains unclear, particularly in first-line (FL) setting. Methods: We conducted a systematic search of bibliographic databases, clinical trials registries and meeting libraries from inception to December 2019, for phase III randomized trials that compared backbone MM regimens vs. same regimen plus D either in FL or relapsed/refractory (R/R) setting and reported outcomes by cytogenetic risk (HRC vs standard risk cytogenetics, SRC). We defined HRC as presence of t(4;14), t(14;16) or del(17p). The primary endpoint was PFS. We pooled relative log-hazard ratios using DerSimonian-Laird random-effects model. We assessed heterogeneity using Cochran’s Q and the I 2 statistic. Results: Of 3,070 studies screened, 6 phase III trials were included. This included 3 trials in FL setting (Alcyone, Maia and Cassiopeia, 2,528 patients, 358 HRC) and 3 trials in R/R setting (Castor, Pollux and Candor, 1,533 patients, 222 HRC). The addition of D to FL backbone regimens among patients with HRC led to improved PFS (pooled HR 0.67; 95% CI 0.47-0.95, p = 0.02) with little heterogeneity (Cochran’s Q p = 0.77, I 2 = 0), similar to R/R setting (pooled HR 0.45; 95% CI 0.30-0.67, p &lt; 0.01, Cochran’s Q = 0.63, p &lt; 0.01, I 2 = 0). Similar results were seen in SRC MM patients in FL setting (pooled HR 0.45; 95% CI 0.37-0.54, p &lt; 0.01, Cochran’s Q p = 0.49, I 2 = 0) and R/R setting (pooled HR 0.38; 95% CI 0.25-0.56; p &lt; 0.01, Cochran’s Q p = 0.04, I 2 = 70%). Conclusions: Incorporating D to backbone regimens led to improved PFS among patients with HRC MM in both FL and R/R setting. Lack of substantial heterogeneity suggests benefit of D regardless of backbone regimen. D based regimens are appropriate choices in FL and R/R setting for both SRC and HRC patients. Longer follow up with mature overall survival data is needed to validate these findings. [Table: see text]
Diagnostic value of interferon-gamma release assay T-SPOT for childhood tuberculosis
Authors: Qiufeng Sun, Yongdong Yan, Zhengrong Chen, Yuqing Wang, Li Huang, Canhong Zhu, Meijuan Wang
Journal: BMJ (2014)

To evaluate the diagnostic value of interferon-gamma release assay T-SPOT for childhood tuberculosis. A total of 45 children suspected of tuberculosis at Affiliated Children Hospital, Soochow University were enrolled from July 2011 to June 2012. T-SPOT test was performed and its results were compared with those of PPD test, tuberculosis antibody test, acid-fast bacilli stain and tuberculosis polymerase chain reaction. The sensitivity and specificity of T-SPOT were 92% and 95% respectively. And the values were higher than PPD test (76%, 75%, P<0.01). The overall concordance rate between two tests was 18/19. Positive and negative predictive values of T-SPOT were 96% and 90% respectively. Thus T-SPOT test is rapid, sensitive and specific for diagnosing tuberculosis. It can be applied for an early diagnosis of tuberculosis in children.


Key words: 
Tuberculosis; Child
Efficacy assessment of early enteral nutrition intervention in patients with alimentary tract carcinoma after surgery
Authors: 杨勤兵, 周伟
Journal: BMJ (2007)

目的 探讨消化道恶性肿瘤术后早期肠内营养与肠外营养在术后并发症以及医学经济学方面的差异.方法 对2003年9月至2005年12月我院普通外科住院的164名消化道恶性肿瘤患者术后进行营养支持干预,其中84例(EN组)采用术后早期肠内营养(24～48 h内),80例(TPN组)采用肠外营养治疗,分别比较两组患者术后7～10 d的营养指标变化、肛门排气、胃排空恢复时间、术后住院日和总住院费、并发症发生率.结果 EN组术后第7天血清前白蛋白(309±49)mg/L,高于TPN组的(277±46)mg/L(P＜0.05).EN组肛门排气时间、胃排空恢复时间、平均术后住院时间分别为(54±17)h、(7.1±2.8)h和(18±6)d,均显著低于TPN组的(75±15)h(P＜0.05)、(13.1±6.7)h(P＜0.01)和(21±4)d(P＜0.05).EN组的营养支持并发症发生率和总住院费分别是19.0%和16 376.60元,显著低于TPN组37.5%和23 748.50元(P＜0.01).结论 消化道恶性肿瘤患者术后给予早期肠内营养比单纯肠外营养安全可靠、简便,更符合正常生理状态,对胃肠功能恢复有利,且相关并发症少,费用更低廉。
Prognostic importance of primary tumor resection and synchronous metastasis on overall survival in metastatic colorectal cancer: Data from the FIRE-3 (AIO KRK-0306) study.
Authors: Jobst C. von Einem, Sebastian Stintzing, Ludwig Fischer von Weikersthal, Thomas Decker, Alexander Kiani, Ursula Vehling-Kaiser, Salah-Eddin Al-Batran, Tobias Heintges, Christian A. Lerchenmuller, Christoph Kahl, Gernot Seipelt, Martina Stauch, Werner Scheithauer, Joerg Hielscher, Michael Scholz, Dominik Paul Modest, Andreas Jung, Thomas Kirchner, Volker Heinemann
Journal: Journal of Clinical Oncology (2020)

4070 Background: The FIRE-3 study (AIO KRK-0306) was designed as a randomized multicenter trial to compare the efficacy of FOLFIRI plus cetuximab (cet) to FOLFIRI plus bevacizumab (bev) as first-line treatment in KRAS WT mCRC patients. FOLFIRI plus cet as first-line treatment of KRAS WT mCRC patients resulted in comparable overall response rates (ORR) and progression free survival (PFS) when compared to FOLFIRI plus bev. Overall survival (OS) was significantly longer in the FOLFIRI plus cet arm. Methods: In the present analysis of the FIRE-3 trial we explored the impact of primary tumor resection on outcome in relation to anti-EGFR vs. anti-VEGF treatment. Furthermore, we investigated the prognostic value of synchronous versus metachronous metastases. Results: In patients with synchronous disease no significant difference in OS was detected when comparing resected (n=339) vs. non-resected (n=97) patients (p-value: 0.29, HR: 1.17, 95%-CI: 0.88 – 1.55). In the cetuximab arm, resection (n=167) showed no significant benefit in OS when compared to non-resection (n=52) (p-value: 0.51, HR: 1.15, 95%-CI: 0.77 – 1.71). Treated with bevacizumab, similar results were present, when comparing resection (n=172) vs. non-resection (n=45); (p-value: 0.29, HR: 1.25, 95%-CI: 0.83 – 1.9). A strong trend was seen when comparing OS in treatment arms cet. (n=219) vs. bev. (n=217)) for patients with synchronous disease; (p-value: 0.05, HR: 1,26, 95%-CI: 1.0 - 1.59). 436/592 pts suffered from synchronous, 153/592 from metachronous disease (in 3/592 pts the information was not given). Median OS in pts with synchronous disease was 24.5 months and 29.5 in pts with metachronous disease (p-value: 0.02, HR: 0.76, 95%-CI: 0.6 - 0.96). In pts treated in the cetuximab arm metachronous disease (n=77) was associated with a trend towards longer OS when compared to synchronous disease (n= 219) (p-value: 0.13, HR: 0.76, 95%-CI: 0.54 – 1.1). The same effect was present in the bevacizumab arm (p-value: 0.05, HR: 0.73, 95%-CI 0.53 – 1.0) when comparing pts with synchronous disease (n=217) vs. pts. with metachronous disease (n=76). Conclusions: In the FIRE-3 study, metachronous disease was associated with superior OS compared to synchronous disease. This finding was accentuated in the bevacizumab arm. The role of resection of the primary tumor had no impact on survival. Clinical trial information: NCT00433927 .
成功来之不易也不难
Authors: 冯莉霞, 施桂英
Journal: BMJ (2009)

一位36岁女患者,主因关节肿痛4个月于2008年5月28日到我院风湿科门诊就诊.既往体健,自今年1月以来相继出现手和足关节肿痛,无诱因,持续至今,影响行走,无晨僵.病前无腰背痈、发热、皮疹、咽痛、尿频尿痛、眼炎及腹泻.否认类似疾病家族史.曾在外院就诊,诊断未定,未接受治疗。
Effect of UV-curable and injectable dendrimer matrix on tumor pharmacokinetics and survival in a hepatocellular carcinoma mouse model using interstitial photodynamic therapy.
Authors: Sauli Vuoti, Kumar Narasimha, Kai Reinikainen
Journal: Journal of Clinical Oncology (2020)

e15598 Background: Intratumoral drug delivery in cancer treatment has shown to increase drug accumulation in tumors and decrease adverse effects of systemic therapies. The active agent is typically required to stay in contact with the tumor and thus attachment directly into the tumor or to the surrounding tissue is warranted. In addition, a long-acting release of the active drug is vital. Dendrimers are nano-sized, radially symmetric molecules with homogeneous and monodisperse structures, which can used to encapsulate drug molecules for controlled release with the aid of external stimuli at physiological pH. Methods: We prepared a dendrimeric drug delivery matrix based on a PEG-core. The model drug (5-fluorouracil or doxorubicin) was covalently bonded to the core. The release of the drug was observed up to 29 days in vitro. The outer shell of the matrix was partially modified to obtain a fast UV-curing and subsequent attachment to the tumor tissue utilizing interstitial photodynamic therapy. We compared the pharmacokinetics, tissue distribution and antitumor efficacy of conventional systemic therapy and the intratumoral therapy in xenograft-bearing mice. In addition, we monitored blood parameters and body weight of the animals for adverse effects. Results: The dendrimer matrix caused significantly greater inhibition of human hepatocellular carcinoma xenograft tumor growth when compared with systemic therapy, without increasing toxicity. The matrix enabled a significant increase in drug accumulation in tumors, and markedly extended the survival of mice compared with systemic treatments. A larger decrease in blood parameters as well as spleen weight was observed in the systemic therapy group especially when using 5-fluorouracil. Conclusions: Our study shows that the intratumoral treatment strategy based on a novel UV-curable dendrimer hydrogel matrix enhances antitumor activity by improving pharmacokinetics and drug accumulation and increases efficacy in comparison to conventional systemic therapy. These results highlight the potential use of dendrimer hydrogels in the treatment of hepatocellular carcinoma.
ATR inhibitor AZD6738 enhances the antitumor activity of radiotherapy and immune checkpoint inhibitors by potentiating the tumor immune microenvironment in hepatocellular carcinoma
Authors: Hailong Sheng, Yan Huang, Yazhi Xiao, Zhenru Zhu, Mengying Shen, Peitao Zhou, Zeqin Guo, Jian Wang, Hui Wang, Wencong Dai, Wanjun Zhang, Jingyuan Sun, Chuanhui Cao
Journal: Journal for ImmunoTherapy of Cancer (2020)

Background Radioimmunotherapy has a promising antitumor effect in hepatocellular carcinoma (HCC), depending on the regulatory effect of radiotherapy on tumor immune microenvironment. Ionizing radiation (IR)-induced DNA damage repair (DDR) pathway activation leads to the inhibition of immune microenvironment, thus impairing the antitumor effect of radioimmunotherapy. However, it is unclear whether inhibition of the DDR pathway can enhance the effect of radioimmunotherapy. In this study, we aim to explore the role of DDR inhibitor AZD6738 on the combination of radiotherapy and immune checkpoint inhibitors (ICIs) in HCC. Methods C57BL/6 mouse subcutaneous tumor model was used to evaluate the ability of different treatment regimens in tumor growth control and tumor recurrence inhibition. Effects of each treatment regimen on the alterations of immunophenotypes including the quantification, activation, proliferating ability, exhaustion marker expression, and memory status were assessed by flow cytometry. Results AZD6738 further increased radiotherapy-stimulated CD8 + T cell infiltration and activation and reverted the immunosuppressive effect of radiation on the number of Tregs in mice xenografts. Moreover, compared with radioimmunotherapy (radiotherapy plus anti-PD-L1 (Programmed death ligand 1)), the addition of AZD6738 boosted the infiltration, increased cell proliferation, enhanced interferon (IFN)-γ production ability of TIL (tumor-infiltrating lymphocyte) CD8 + T cells, and caused a decreasing trend in the number of TIL Tregs and exhausted T cells in mice xenografts. Thus, the tumor immune microenvironment was significantly improved. Meanwhile, triple therapy (AZD6738 plus radiotherapy plus anti-PD-L1) also induced a better immunophenotype than radioimmunotherapy in mice spleens. As a consequence, triple therapy displayed greater benefit in antitumor efficacy and mice survival than radioimmunotherapy. Mechanism study revealed that the synergistic antitumor effect of AZD6738 with radioimmunotherapy relied on the activation of cyclic GMP–AMP synthase /stimulator of interferon genes (cGAS/STING) signaling pathway. Furthermore, triple therapy led to stronger immunologic memory and lasting antitumor immunity than radioimmunotherapy, thus preventing tumor recurrence in mouse models. Conclusions Our findings indicate that AZD6738 might be a potential synergistic treatment for radioimmunotherapy to control the proliferation of HCC cells, prolong survival, and prevent tumor recurrence in patients with HCC by improving the immune microenvironment.