tbuckley/cabot-search huggingface dataset:
Early clinical features of severe cases with hand-foot-mouth disease
Authors: Zhen-wu Yan, Jian-hong Chen, Shu-hua Li, Hai-ying Gao, Wan-peng Wang, Xian-jie Yu
Journal: BMJ (2011)

The clinical features of 120 severe cases with hand-foot-mouth disease (HFMD) were retrospectively analyzed compared with those of the regular cases. Clinical data showed that the age of mostsevere cases ranged from 1-3 years. Sustained high fever ( 55% ) , hypertension ( 40% ) , fewer rash (73.3%) were important clinical features. Lethargy, somnolence or restlessness (70. 8% ), vomiting (30. 8% ) were early signs of central nervous system ( CNS) ; and the CNS involvement in severe cases was characterized by body trembling or muscle spasm (80% ). High white cell count(75. 8% ) and high blood glucose levels(32. 5% ) were important makers to diagnose the severe HFMD at early stage. There were significant differences in presentation of above features between severe cases and regular cases of HFMD ( P < 0. 01 or P < 0. 05 ) . Early treatment with mannitol, gamma globulin and glucocorticoids were effective, no death was reported and no side effects were found in this case series. 

Key words: 
Hand, foot and mouth disease;  Diagnosis
Characterization of KRAS mutations (mt) in non-small cell lung cancer (NSCLC).
Authors: Stephen V. Liu, Ari M. Vanderwalde, Hirva Mamdani, Luis E. Raez, Yasmine Baca, Joanne Xiu, Wolfgang Michael Korn, Misako Nagasaka, Sachin Gopalkrishna Pai, Mark A. Socinski, Jorge J. Nieva, Chul Kim, Antoinette J. Wozniak, Chukwuemeka Ikpeazu, Gilberto Lopes, Alexander I. Spira, Julia Judd, Edward S. Kim, Hossein Borghaei
Journal: Journal of Clinical Oncology (2020)

9544 Background: KRAS is the most commonly mutated oncogene in NSCLC and the development of direct KRAS inhibitors has renewed interest in this molecular subtype. However, there are several different KRAS mts, representing unique biology and different prognostic and therapeutic impact. A more comprehensive understanding of the genomic landscape relative to each KRAS mt subset will help guide therapeutic development. Methods: Molecular profiles of 17,113 NSCLC specimens were obtained using next-generation sequencing of 592 genes (Caris Life Sciences) and classified based on presence and types of KRAS mt. Incidence of KRAS mts was noted across the cohort and by histology. Co-occurring genomic alterations, tumor mutational burden (TMB) and PD-L1 IHC (22C3, TPS score) were analyzed by KRAS mt type. Results: Across the entire cohort, 4706 (27%) of samples harbored a KRAS mt (Table). The most common was G12C (40%), followed by G12V (19%) and G12D (15%). The prevalence of KRAS mt was 37.2% among adenocarcinoma and only 4.4% in squamous. High TMB, defined by &gt; 10 mts/Mb, varied across the different KRAS mt types, most common in G13X (68.3%) and least common in G12D (43.2%). PD-L1 expression also varied. G12C was the most likely to be PD-L1 positive, with 65.5% TPS &gt; 1%, and the most likely to be PD-L1 high, with 41.3% TPS &gt; 50%. STK11 was mutated in 8.6% of KRAS wild type NSCLC but more frequently noted in every KRAS subtype, with the highest rate in G13X (36.2%) and the lowest in G12D(14.2%). TP53 mts were more frequent in KRAS wild type NSCLC (73.6%), with the highest rate among KRAS mutants at 55.4% (G12other) and the lowest at 36.8% (Q61X). NF1 was noted to be mutated in 21.4% of KRAS G13X cases, while all other KRAS mts had a lower frequency of NF1 mts than KRAS wild type (11.5%). Conclusions: KRAS mts are relatively common in lung adenocarcinoma and KRAS G12C is the most common variant. The different KRAS mts have different co-occurring mutations and a different genomic landscape. KRAS G12C was associated with the highest rate of PD-L1 expression. The clinical relevance of these differences in the context of therapeutic intervention warrants investigation. [Table: see text]
Comparison of efficacy and safety with obinutuzumab plus chemotherapy versus rituximab plus chemotherapy in patients with previously untreated follicular lymphoma: Updated results from the phase III Gallium Study.
Authors: William Townsend, Christian Buske, Guillaume Cartron, David Cunningham, Martin J.S. Dyer, John G. Gribben, Zilu Zhang, Kaspar Rufibach, Tina Nielsen, Michael Herold, Wolfgang Hiddemann, Robert Marcus
Journal: Journal of Clinical Oncology (2020)

8023 Background: Immunochemotherapy is standard of care for patients (pts) with previously untreated advanced stage follicular lymphoma (FL). Four-year data from the Phase III GALLIUM study (NCT01332968) have previously demonstrated an improvement in the primary endpoint of investigator-assessed progression-free survival (PFS) for obinutuzumab (GA101, G) plus chemotherapy (G-chemo) versus rituximab plus chemotherapy (R-chemo) (Townsend et al. ASH 2018). Here, we report efficacy and safety results from an updated analysis. Methods: Eligibility criteria: ≥18 years; advanced stage, previously untreated grade 1–3a FL; requiring treatment according to Groupe d’Etude des Lymphomes Folliculaires criteria. Pts were randomized 1:1 to receive G 1000mg IV (day [D] 1, 8 and 15 of Cycle 1; D1 of each subsequent cycle) or R 375mg/m 2 IV (D1 of each cycle) with CHOP, CVP, or bendamustine for 6 or 8 cycles. Responders received maintenance therapy with the same monoclonal antibody every 2 months for 2 years. Results: 1202 pts (median age 59 years) were enrolled (n = 601 per treatment arm). Median duration of follow-up was 76.5 months. Pts receiving G- vs R-chemo demonstrated improved PFS (5-year PFS: hazard ratio [HR] 0.76; 95% CI: 0.62–0.92; p = 0.0043; 70.5% [95% CI: 66.4–74.1] vs 63.2% [95% CI: 59.0–67.1]). There was no notable difference in 5-year overall survival (OS), with few events in either arm (HR 0.87; 95% CI: 0.62–1.22; p = 0.41; G-chemo: 90.2% [95% CI: 87.5–92.4]; R-chemo: 89.4% [95% CI: 86.6–91.6]). Time-to-next-treatment (TTNT) was greater in the G- vs R-chemo arm (5-year TTNT rate: HR 0.72; 95% CI: 0.57–0.90; p = 0.0039; 79.7% [95% CI: 76.1–82.7] vs 72.9% [95% CI: 69.1–76.4]). Incidence of grade 3–5 adverse events was 79.3% in the G-chemo arm and 71.2% in the R-chemo arm, and consistent with those reported in the primary analysis (Marcus et al. N Engl J Med 2017). Conclusions: These data further demonstrate the clinically meaningful and durable benefit of treatment with G-chemo relative to R-chemo in previously untreated FL pts. Acknowledgement: GALLIUM was sponsored by F. Hoffmann-La Roche Ltd. Third-party medical writing assistance, under the direction of William Townsend, was provided by Louise Profit and Stephanie Lacey of Gardiner-Caldwell Communications, and was funded by F. Hoffmann-La Roche Ltd. Clinical trial information: NCT01332968 .
Single center retrospective study on cardiac safety of anti-HER2 agents and anthracyclines.
Authors: Odalys Estefania Lara Garcia, Ruby Maini, Priyanka Parajuli, Manjari Rani Regmi, Cameron Koester, Nitin Tandan, Asad Cheema, Zurain Niaz, Sabree Abedrabo, Hamsa Sahib, Noupama Mirihagalle, Abdisamad M. Ibrahim, Alexander Johnson, Bishal Bhandari, Kristin Delfino, Kathy Robinson, Meghna R. Desai, Abhishek Kulkarni
Journal: Journal of Clinical Oncology (2020)

e12548 Background: Chemotherapy-induced cardiotoxicity has been associated with certain breast cancer therapy regimens, such as anthracyclines. With the development of newer therapies, just as the anti HER2 agents,another association with cardiotoxicity has been recognized in these drug groups. We report the cardiac safety of anti-HER2 agents and anthracyclines. Methods: A retrospective chart review was conducted of patients diagnosed with breast cancer between January 1st 2014 and December 31st 2017, treated with chemotherapy were identified from a large cancer center database. Heart failure, ACS, and other comorbidities were identified using billing codes. Primary outcome was cardiac event,defined by New York Heart Association class II, III or IV heart failure, ACS and heart failure hospitalization. Fisher's exact test was used to test associations between medication categories and cardiac events. Results: A total of 478 patients were included in our study.Our results indicated a significant association of anti HER2 agents with new heart failure with 12.24% (6/49) of patients, compared to 4.04% (12/297) in the control group (p = 0.0288). For the compound of all cardiac events, patients on the anti HER2 arm did not have a significant association, representing 12.50%(6/48) (p = 0.117).Regarding anthracyclines, results demonstrated a significant association of cardiac events, with an incidence of 17.46%(11/63) compared to 4.59%(14/305) in the control group (p = 0.001). We also found that specifically for new onset heart failure, the anthracycline group had a proportion of 13.64%(9/66), in comparison to the control group which had an incidence of 3.21%(9/280) (p = 0.0023). Conclusions: These findings are comparable to rates reported in studies evaluating cardiac safety of anthracyclines and anti-HER2 agents,calling attention to the importance of novel techniques and treatments for the management of chemotherapy-induced cardiotoxicity.
降结肠Dieulafoy病致失血性休克一例
Authors: 沈洪章, 朱家沂, 杨传春, 杨斌, 伏亦伟
Journal: BMJ (2011)

患者男，74岁，因2h内解鲜血便3次总量约300 g入院。无腹痛、呕血及发热等。患者于1周前住我院心内科行冠状动脉支架置入术，术后予拜阿司匹林和氯吡格雷等药物口服。体检：体温36.8℃，血压120/70 mm Hg(1 mm Hg=0.133 kPa)，贫血貌，心肺无异常，腹软，无压痛，未及包块，肝脾肋下未及，腹水征（一），肠鸣音活跃。 关键词：胃肠出血
Clinical features and treatment of type 1 diabetes mellitus in children
Authors: Xin-ran Cheng, Li Yan, Yan Wei, Xiao-ou Wang, Wei-lan He, Dong-mei Pu, Rong Xiang
Journal: BMJ (2011)

Objective To review the clinical characteristics and treatment of type 1 diabetes mellitus (T1DM) in children. Methods The clinical data of 103 children with T1DM admitted to our hospital from Februry 2002 to August 2010 were retrospectively analyzed. Thirty one cases with diabetic ketoacidosis (KDA) were treated with continuous insulin pump (group A) or basal-bolus insulin therapy (group B). The differences in blood glucose control time, the rate of hypoglycemic episodes, glucose fluctuation, fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hPBG), insulin dosage, the time of urine acetone bodies disappear and length of stay were compared in two groups. Results The age of 103 children with T1DM was from 38 d to 15. 33 y with an average of (8 ±3) y; most of them was 7 - 10 y (47, 45.6% ). Seventy eight children were first diagnosed accounting for 75.7%; boys accounted for 55.3% of total. Fifty one cases (49.5%) were diagnosed in winter and spring and 67 (65.2%) had infections, most of them were respiratory tract and gastrointestinal infections. Sixty two cases (60. 2% )presented as diabetic ketoacidosis at the first onset, including 4 cases (3.9%) with cerebral edema. Some patients were complicated by Hashimoto's thyroiditis, hyperthyroidism, SLE and other autoimmune diseases.Among 31 cases with ketoacidosis the FBG and PBG were decreased significantly after treatment, there were no significant differences between two groups (P ＞ 0. 05 ). Compared to group B the correction time of DKA and urine acetone bodies was shorter, and reached the targeted glucose levels more quickly, the frequency of blood fluctuation and the hypoglycemia was significantly lower, the length of stay was shorter, and the daily dose of insulin was lower in group A; the differences between two groups were statistically significant ( P ＜0. 05 or P ＜0. 01 ). Conclusions The clinical symptoms at first onset of T1 DM in children are not typical,and likely to be combined with DKA; infection may be one of the inducing factors for DKA. Continuous subcutaneous insulin infusion with pump can control the blood glucose more effectively and equably, and are convenient for use by children; so it is a better treatment option for type 1 diabetes mellitus in children.

Key words: 
Diabetes mellitus, type 1;  Insulin;  Therapy
Frailty index predicts poor outcome in COVID-19 patients
Authors: Giuseppe Bellelli, Paola Rebora, Maria Grazia Valsecchi, Paolo Bonfanti, Giuseppe Citerio
Journal: Intensive Care Medicine (2020)

Frailty is a condition of increased vulnerability to endogenous and exogenous stressors, resulting from the interaction of progressive age-related decline in physiologic systems with chronic diseases, leading to decreased functional reserve capacities [1].The effect of frailty on patient's clinical outcomes has been examined in several settings of care, including intensive care units (ICU) and acute hospital wards [1,2], showing to be a reliable predictor of clinical and health care related outcomes.Based on these and other evidences, some scientific societies (https ://www.nice.org.uk/guidance/ng159 /resou rces/criti cal-care-admis sion-algor ithm-pdf-87089 48893 ; https :// www.brc-rea.be/wp-content/uploa ds/2020/03/Ethic aldecis ion-makin g-in-emerg encie s_COVID 19_22032 020_ final .pdf ) are recommending to assess frailty in patients with coronavirus disease 19 (COVID-19) infection to guide their triage.However, not all international scientific associations have similar positions (https ://smw.ch/artic le/doi/smw.2020.20229; http://www.siaarti.it/SiteA ssets /News/COVID 19%20-%20doc ument i%20SIA ARTI/ SIAAR TI%20-%20Cov id19%20-%20Rac coman dazio ni%20di%20eti ca%20cli nica.pdf ).Therefore, we decided to evaluate the role of frailty assessment in patients with COVID-19.Here, we analyzed the data of a cohort of consecutive COVID-19 patients admitted to 8th floor of San Gerardo hospital between February 27th and April 7th, 2020.Inclusion criteria were age > 18 years, informed consent and hospitalization due to COVID-19 infection.There were no exclusion criteria.Frailty was assessed with the Frailty
恶性胃间质瘤二例
Authors: 王其军, 贾振丽, 刘红光, 马民, 张亮
Journal: BMJ (2010)

例1 患者男,73岁,于2004年10月26日因上腹部不适来我院就诊.患者自述腹痛、腹胀多日,时有黑便,否认遗传病史及类似家族史.触诊发现上腹部有质硬巨大团块、可活动.上腹部CT平扫示:胃底部大弯侧可见一约6.7 cm×8.2 cm巨大团块,突向胃腔外,边缘呈分叶状,边界清晰,肿块周边呈等密度,胃腔侧可见一小龛影,中问为略低密度.胃底周围脂肪间隙内可见2个短径分别为0.8 cm、1.5 cm的结节灶;增强后,肿块不均匀强化,周边强化明显,中心可见形态不规则无强化区.1周后行胃大部切除.手术探查患者腹腔,见胃底部一约6.0 cm×8.0 cm大小肿块,质硬,侵及浆膜层.组织病理学检查:镜下肿瘤细胞呈上皮样多边形,排列成漩涡状,核分裂＞5/50 HP.免疫组织化学检查示:CD117(+)、CD34(+)、肌动蛋白(±)、波形蛋白(+)、S-100(-).病理学诊断为胃肠道间质瘤。
Phase II study assessing tolerability, efficacy, and biomarkers for durvalumab (D) ± tremelimumab (T) and gemcitabine/cisplatin (GemCis) in chemo-naïve advanced biliary tract cancer (aBTC).
Authors: Do-Youn Oh, Kyung-Hun Lee, Dae-Won Lee, Tae Yong Kim, Ju-Hee Bang, Ah-Rong Nam, Young Lee, Qu Zhang, Marlon Rebelatto, Weimin Li, Jin Won Kim
Journal: Journal of Clinical Oncology (2020)

4520 Background: In aBTC, GemCis is the standard of care as 1 st -line treatment. Immunotherapies have shown early promising efficacy in some BTC patients (pts). We assessed D (anti-PD-L1) ± T (anti-CTLA-4) and GemCis in 1L BTC pts, including an extensive biomarker analysis (NCT03046862). Methods: Pts were first enrolled in the biomarker cohort (BMC) to receive 1 cycle of Gem 1000 mg/m 2 + Cis 25 mg/m 2 on D1 &amp; D8, followed by GemCis + D 1120 mg and T 75 mg, Q3W until disease progression (PD). Subsequent pts were allocated to GemCis + D (3 combo cohort [3C]) or GemCis + D+T (4 combo cohort [4C]) until PD. In all cohorts, tumor biopsies were obtained pre-treatment, after 1 cycle, and at PD. Blood samples for ctDNA were obtained every cycle. Results: 121 pts were enrolled. Median follow-up durations were 28.5 months (m; 95% CI, 26.5-30.5), 11.3 m (95% CI, 9.1-13.5), and 11.9m (95% CI, 8.4-15.4) in the BMC, 3C, and 4C arms, respectively. Efficacy data are shown (Table). The most common adverse events (AEs, any grade) were neutropenia (54.5%), nausea (59.5%), and pruritus (55.44%). The most common grade 3/4 AEs were neutropenia (50.4%), anemia (35.5%), and thrombocytopenia (16.5%). In the BMC cohort, frequent mutations were found in DNA damage repair, cell cycle regulation, and genome instability genes (eg, ATM, BRCA2, POLE, MSH2, CDKN2A). Distinct somatic variants were detected in responders vs non-responders. Baseline tissue TMB did not correlate with PFS or OS. Reductions in ctDNA variant allele frequency (VAF) were more prominent among responders during early D+T cycles. ctDNA VAF on C3, D1 was significantly correlated with ORR ( P&lt; 0.015). Pretreatment PD-L1 expression was not associated with efficacy, but PD-L1 expression after 1 st GemCis cycle trended with improved PFS. Conclusions: These are the first clinical data of D±T plus chemotherapy in chemo-naïve aBTC pts. The addition of immunotherapy to chemotherapy was tolerable and showed very promising efficacy. Biomarker analyses show early signs of markers associated with response. The combination of GemCis + D is being investigated in the Phase 3 TOPAZ-1 trial (NCT03875235). Clinical trial information: NCT03046862 . [Table: see text]
Survey on status and demands of advanced clinical training among community general practitioners in two districts of Shanghai
Authors: Xueying Ru, Limin Ren, Tianhao Wang, Qing Yu, Yuying Zheng, Zhigang Pan
Journal: BMJ (2018)

Objective
To survey the status and related demands of advanced clinical training among community general practitioners (GPs) in Shanghai.


Methods
A survey on the status and demands of advanced clinical training was conducted with a self-designed questionnaire among GPs in Minhang District and Jiading District of Shanghai from January to May 2016. The questionnaire included basic information, experience of advanced clinical training, satisfaction with training and training demands.


Results
Total 526 questionnaire were distributed and 478 valid questionnaires were returned with a response rate of 90.9%. Among the participants 202 (42.3%) had experience of advanced clinical study; the training units were mainly secondary hospitals in Shanghai (69.3%, 140/202); 67.2% (131/195) participants considered that the previous training did not fully meet the needs of the community. There was significant difference in the training demands among participants with different ages, professional titles, and working years (χ2=12.754, 7.912, 4.501, all P<0.01); those with younger age, higher education and shorter working years had higher training demands. Survey showed that 57.3% (274/478) of participants demanded further studies in the future; 58.3% (239/410) of them chose tertiary hospitals in Shanghai as training unit, 79.0%(321/406) chose internal medicine and geriatrics as training specialties, particularly in outpatient clinic (73.2%, 298/407); the length of study should be 3 months (32.8%, 132/402) or 6 months (27.6%, 111/402), and completed in segments (61.5%, 253/411). The purpose of training was mainly to upgrade clinical competence (94.2%, 258/272); busy working schedule (53.4%, 66/116) was the main reason for not intending the advanced clinical studies.


Conclusions
The community general practitioners in Shanghai have high demands for advanced clinical training. The training should meet the needs of clinical practice in community and the mode of study should be more flexible.


Key words: 
Community; General practitioner; Clinical training
Effects of comprehensive rehabilitation on stable chronic obstructive pulmonary disease patients in rural communities
Authors: De-qi Zou, Xue-shun Zhang, Yan-li Xu, Wei-hua Sun, Yu Wang, Hai Gao
Journal: BMJ (2013)

Objective
To explore the effects of comprehensive rehabilitation on patients with stable chronic obstructive pulmonary disease (COPD) in rural communities.


Methods
Between June 2010 and June 2012, 212 stable COPD patients were randomly divided into management group (n=107) and control group (n=105). All patients received conventional treatment. In addition, 107 stable COPD patients relying on new rural cooperative medical service station in management group underwent community comprehensive rehabilitation including training in respiratory function, exercise training, nutrition intervention and psychological care. Effect of lung function, symptoms (times of acute attack & hospitalization) and quality-of-life (QOL) rated by SF-36 questionnaire between two groups were recorded at Month 6.


Results
The score changes of QOL had significant inter-group differences between 2 groups for PCS (scores for physical component summary) and MCS (scores for mental component summary) (11.4±8.2 vs.1.6±1.2, 5.5±3.5 vs.2.2±0.9, all P<0.01). In the scores for physical component summary, the score change of physical function, physiological function, body pain and general health were significantly different between two groups (6.7±4.3 vs.1.2±0.8, 10.9±6.3 vs.1.9±1.5, 6.4±4.7 vs. 3.6±2.7, 3.2±2.7 vs.1.6±1.1, P<0.01). In the scores for mental component summary, the score change of vitality, emotional function, social function and mental health were significantly different between two groups (4.9±3.2 vs.1.9±1.4, 2.7±2.1 vs.1.6±1.1, 11.6±9.2 vs.3.6±2.3, 6.7±4.3 vs.1.4±0.9, P<0.01). The times of acute attack and hospitalization were obviously lower than those of the control group. No significant inter-group difference existed in lung function.


Conclusion
Comprehensive rehabilitation may improve the QOL in stable COPD patients in rural communities and reduce their times of acute attack.


Key words: 
Pulmonary disease, chronic obstructive; Intervention studies; Treatment outcome
"三联法"抗幽门螺杆菌感染治疗97例分析
Authors: 朱萍, 刘卫东, 马峻岭, 赵洪军, 赵建军, 张联
Journal: BMJ (2005)

幽门螺杆菌(Hp,Helicobacter pylori )感染与慢性胃炎、胃溃疡以及胃癌的发生密切相关,IARC已将Hp感染列为胃癌的I类致癌因子.临朐县是我国北方胃癌高发区,当地居民Hp感染率高,其可能是造成胃黏膜异型增生和癌变的主要危险因素.为检验三联疗法的疗效,我们对一组有代表性的人群进行抗Hp感染治疗,结果如下。
Research progress of adriamycin in targeted therapy for liver carcinoma
Authors: Yanxia Gong, Qingyu Zhang, Yanping Tang
Journal: BMJ (2016)

Targeted cancer therapy is one of the modalities to increase efficiency and decrease adverse effects of chemotherapy, and the selection of drug vector system is of importance for targeted therapy. An ideal adriamycin targeted vector system should have maximal efficacy and minimal adverse effects in inhibiting cancer cells through different mechanisms. This article reviews the recent progress in adriamycin targeted therapy, including the modes of adriamycin administration, the selection of drug vectors, as well as other chemotherapeutic drugs in targeted therapy of liver carcinoma.


Key words: 
Liver neoplasms; Adriamycin; Cancer-targeted therapy