tbuckley/cabot-search huggingface dataset:
Comparison of two modalities of minimally invasive surgery in treatment of acute biliary pancreatitis
Authors: Tan Wang, Yufeng Wang, Dehua Zhou
Journal: BMJ (2017)

Objective
To compare the therapeutic efficacy of laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC), and endoscopic retrograde cholangiopancretography (ERCP) plus endoscopic sphinetemtomy (EST) plus laparoscopic cholecystectomy (LC) in treatment of acute biliary pancreatitis.


Method
One hundred and six patients with acute biliary pancreatitis and biliary obstruction underwent minimally invasive surgery between January 2012 and February 2016 in our hospital, including 54 cases received LCBDE+ LC (LCBDE group) and 52 cases received ERCP+ EST+ LC (ERCP group). The operation time, intraoperative blood loss, length of hospital stay, medical expenses and postoperative complications were compared between two groups.


Results
The operating time in LCBDE group was longer than that in ERCP group [(110.2±11.2)min vs.(100.8±22.8)min, χ2 =-2.11, P 0.05], the rate of postoperative analgesic use [11.11%(6/54) vs. 13.46%(7/52), χ2=0.102, P>0.05] and the incidence of postoperative complications [9.26%(5/54) vs. 11.54%(6/52), χ2=0.080, P>0.05] between two groups.


Conclusion
laparoscopic common bile duct exploration plus laparoscopic cholecystectomy has advantages of shorter hospital stay and lower medical expenses in treatment of acute biliary pancreatitis combined with biliary infection.


Key words: 
Pancreatitis; Cholecystectomy, laparoscopic; Cholangiopancreatography, endoscopic retrograde; Obstruction of biliary tract
Combination of red and blue light therapy with acne film coating in treatment of moderate and severe acne.
Authors: Fanjun Meng, Yuxia Zhang
Journal: BMJ (2015)

Objective
To evaluate the efficacy of combined red and blue light therapy with acne film coating in treatment of moderate and severe acne.


Methods
Totally 547 patients with moderate or severe acne were enrolled in the study from March 2012 to July 2014. Using open control, according to the cycle of time sequence will patients were divided into three groups: 183 patients (study group) were received alternatively red and blue light therapy twice a week, and acre film coating was applied once a day; 182 patients in control group 1 received film coating alone and another 182 patients (control group 2) received light therapy alone. The treatment lasted for 6 weeks in all three groups. The numbers of skin lesions were recorded before and 2, 4, 6 w after treatment, and the curative effect was evaluated 10 w after treatment.


Results
The number of skin lesion were significantly reduced 6w after treatment in all three groups, that for study group was most markedly. For patients with moderate acne, the total effective rates in study group and in control groups 1 and 2 were 84.6% (110/130), 58.5% (76/130) and 51.9% (67/129), respectively (χ2=21.836, and 31.955, P<0.01). For patients with severe acne the total effective rates in study group and in control groups 1 and 2 were 84.9% (45/53), 57.7% (30/52) and 56.6% (30/53), respectively (χ2=9.525 and 10.258, P<0.01). There are 20 cases in observation group therapy for different degree of erythema, itching, burning, tingling, incidence of side effects was 10.9% (20/183), control group 1 and 2 were 7.1% (14/182), 12.1% (22/182), are tolerated.


Conclusion
The combination of red/blue light therapy with acne film coating is more effective than the application of single method alone for patients with moderate or severe acne.


Key words: 
Acne vulgaris; Color therapy; Propionibacterium; Administration, topical
Relationship between pancreatic beta-cell function and body mass index and age in patients with newly diagnosed type 2 diabetes
Authors: Li Zhang, Wen Peng, Yuan Yu, Lei Liu, Yu Duan
Journal: BMJ (2010)

Objective To investigate relationship between insulin sensitivity and beta-cell function with body mass index (BMI) and age in patients with newly diagnosed type 2 diabetes mellitus (T2DM).Methods Totally, 304 patients with T2DM newly-diagnosed at admission to the first hospital affiliated to Nanjing Medical University, Jiangsu province, during 2006 to 2007 were recruited in the study. The patients were divided into three groups based on WHO criteria of obesity in Asia Pacific Region in 2003, 68 cases with normal weight ( 18. 5≤ BMI ＜ 23.0), 69 in overweight (23.0 ≤ BMI ＜ 25.0), and 167 in obesity (BMI≥25.0). Fasting serum glucose, glycesylated hemoglobin Alc (HbAlc) and lipids were measured for all the subjects, as well as oral glucose tolerance test (OGTr), C-peptide releasing tests and determination of serum insulin performed. Homeostasis model assessment of insulin resistance index (HOMA-IR), insulinogenic index (AI30/AG30) and modified beta-cell function index (MBCI) werecalculated to evaluate their insulin sensitivity and beta-cell function of the islets. All these parameters werecompared between the three groups and subgroups. Results HOMA-IR and MBCI were significantly higherin T2DM patients with obesity than those in the groups with normal weight and over-weight ( P < 0. 05 ).AI30/AG30 in obesity group was significantly higher than that in the group with normal weight (P <0. 05).Multiple linear regression analysis showed that BMI independently correlated with HOMA-IR ( P < O. 05 ).Sub-group analysis showed that △I30/△G30 and MBCI were significantly higher in those aged 60 years and over with obesity than those in the groups aged less than 60 years ( P ＜ 0. 05 ). Conclusions Non-obese patients with newly diagnosed T2DM have more severe impaired insulin secretion than that in obese ones,and their insulin resistance increases with BMI. Age has no significant correlation with pancreatic beta-cell function or insulin sensitivity.

Key words: 
Diabetes mellitns,type 2; Body mass index; Insulin resistance; Pancreatic β cell function; Age factors
Immunoscore as a parameter predicting time to recurrence and disease-free survival in T4N0 stage II colon cancer patients.
Authors: Jerome Galon, Fabienne Hermitte, Bernhard Mlecnik, Alessandro Lugli, Carlo Bruno Bifulco, Iris D. Nagtegaal, Arndt Hartmann, Florence Marliot, Marc Van Den Eynde, Michael H. A. Roehrl, Pamela S Ohashi, Eva Zavadova, Toshihiko Torigoe, Prabhudas S. Patel, Yili Wang, Yutaka Kawakami, Francesco Marincola, Paolo Antonio Ascierto, Bernard A. Fox, Franck Pages
Journal: Journal of Clinical Oncology (2020)

4105 Background: Risk assessment is particularly important to decide when to propose an adjuvant treatment for Stage II Colon Cancer (CC) patients. However, the current tumor risk features are imperfect and additional risk factors are needed to guide treatment decisions. The consensus Immunoscore is an alternative and powerful approach that could be used in the T4N0 Stage II colon cancer population. Immunoscore is an in vitro diagnostic test that predicts the risk of relapse in patients with CC by measuring the host immune response at the tumor site. Methods: From the international Immunoscore consortium study (n = 2681) (Pagès et al. The Lancet 2018), a subgroup analysis was performed on T4N0 Stage II colon cancer patients (n = 208). Results: In stage II T4N0, Int+Hi Immunoscore represented 65.4% of the population and low-Immunoscore only 34.6%. T4N0 patients with Int+Hi Immunoscore presented a significantly prolonged survival for TTR compared to low Immunoscore patients (5 years recurrence rate Int+Hi: 84.6% (78.3-91.5), Lo: 46.3% (35.1-61); unadjusted HR [Int+Hi vs Lo] = 0.21; (95% CI 0.11-0.4); P&lt; 0.0001), representing a restricted mean survival time (RMST) difference of 80.9 months (95% CI 51.1-110.6) ( P&lt; 0.0001). The DFS was significantly different between Int+Hi and Low Immunoscore (5 years recurrence rate Int+Hi: 70.5% (95% CI 62.7-79.1), Lo: 38.5% (95% CI 28.2-52.5); unadjusted HR [Int+Hi vs Lo] = 0.31; (95% CI 0.19-0.49); P&lt; 0.0001). Using restricted mean survival time (RMST) a significant ( P&lt; 0.0001) difference of 60.4 months (95% CI 32.6-88.1) was observed between the 2 groups Importantly, Cox multivariate analysis in Stage II T4N0 colon cancer patients, revealed that Immunoscore was the only remaining significant parameter (HR [Int+Hi vs Lo] = 0.15; (95% CI 0.05-0.46); P= 0.0009). In contrast, all other parameters, gender, sidedness, mucinous, grade, T-stage, VELIPI, MSI were not significant in multivariate analysis. Finally, Immunoscore showed the highest relative contribution to predict relapse (76.2% chi2 relative contribution), stronger than all the other parameters, MSI (16.1%), Grade (5%), sidedness (2%), gender (2%), VELIPI (1%). Conclusions: Immunoscore is the most powerful parameter to predict the risk in T4N0 population, and could be a good tool for adjuvant treatment decision in Stage II patients.
Phase II study of pembrolizumab in docetaxel-pretreated patients with metastatic castration-resistant prostate cancer (mCRPC): Updated follow-up of cohorts (C) one to three from KEYNOTE-199.
Authors: Jeffrey C. Goh, Jose Maria M. Piulats Rodriguez, Marine Gross-Goupil, Ulka N. Vaishampayan, Ronald De Wit, Tuomo Alanko, Satoshi Fukasawa, Kenichi Tabata, Susan Feyerabend, Raanan Berger, Haiyan Wu, Jeri Kim, Charles Schloss, Johann S. De Bono, Emmanuel S. Antonarakis
Journal: Journal of Clinical Oncology (2020)

e17584 Background: Pembrolizumab monotherapy has shown antitumor activity and acceptable safety in patients with mCRPC previously treated with a next-generation hormone agent (NHA) and docetaxel. Presented herein are updated results from KEYNOTE-199 (NCT02787005), a multicohort phase 2 study, in patients with RECIST-measurable PD-L1 + disease (C1), RECIST-measurable, PD-L1 − disease (C2), and bone-predominant disease, irrespective of PD-L1 (C3). Methods: Patients who previously received ≥1 NHA and 1 or 2 chemotherapies, including docetaxel, received pembrolizumab 200 mg Q3W for 35 cycles or until progression/toxicity. The primary end point was ORR per RECIST v1.1 by blinded independent central review (BICR). Key secondary end points were DCR, PSA response rate (≥50% decrease from baseline), time to PSA progression, rPFS, OS, DOR, and safety. rPFS and OS were evaluated using the Kaplan-Meier method. Results: Of 258 treated patients (C1, 133; C2, 67; C3, 58), 6 completed therapy (C1, 4; C3, 2) and 252 discontinued (C1, 129; C2, 67; C3, 56), primarily due to progression (C1, 106; C2, 61; C3, 45). Median (range) time from enrollment to data cutoff was 31.3 mo (26.7-34.7) in C1, 30.6 mo (28.0-34.1) in C2, and 32.6 mo (27.4-34.4) in C3. Efficacy results are displayed in the table. ORR (95% CI) for patients with measurable disease was 6% (2.6-11.5) in C1 and 3% (0.4-10.4) in C2. Of 10 responders, 6 had a DOR ≥18 mo. Median time to PSA progression was 4 mo across cohorts. Any grade treatment-related AEs (TRAEs) occurred in 57-60% of patients across C1-3. Grade ≥3 TRAEs occurred in 16% of patients in C1, 15% in C2, and 17% in C3; 1 patient in each cohort died of a TRAE (C1, sepsis; C2, unknown; C3, immune-related pneumonitis). Conclusions: Pembrolizumab monotherapy was well tolerated and showed durable, antitumor activity and disease control with survival up to 24 mo in 3 cohorts of docetaxel and NHA-pretreated patients with RECIST-measurable or bone-predominant mCRPC. Clinical trial information: NCT02787005 . [Table: see text]
A phase Ib/II study of the polo-like kinase 1 (PLK1) inhibitor, onvansertib, in combination with FOLFIRI and bevacizumab for second-line treatment of patients with KRAS-mutated metastatic colorectal Cancer (mCRC).
Authors: Daniel H. Ahn, Maya Ridinger, Mark Erlander, Tanios S. Bekaii-Saab, Heinz-Josef Lenz
Journal: Journal of Clinical Oncology (2021)

TPS155 Background: Chemotherapy in combination with targeted agents are standard-of-care options for patients for mCRC with response rates &gt; 50% in first line. In the second line setting, efficacy of chemotherapy and targeted agents are much lower with response rates of 5% for FOLFIRI (5-fluorouracil, leucovorin, irinotecan) + bevacizumab (anti-VEGF). New treatment options are urgently needed in particular for the 50 % of patients harboring a KRAS mutation. PLK1 is a serine/threonine kinase, master regulator of the mitotic checkpoint and cell division. PLK1 is overexpressed in CRC and its overexpression is associated with poor prognostic. A genome wide RNAi screen identified PLK1 as a synthetic lethal target in KRAS mutant CRC cells, inducing cell cycle arrest and apoptosis upon inhibition. Onvansertib is an oral, highly selective PLK1 inhibitor that demonstrates single agent and synergistic activity with irinotecan and 5-FU in preclinical CRC models. Additionally, KRAS mutated versus wild-type cells showed higher sensitivity to onvansertib. PLK1 inhibition is a potential target in KRAS-mutated mCRC, and the combination of onvansertib + FOLFIRI + bevacizumab may provide a new second-line treatment option. Methods: The primary objective of this single-arm Phase 1b/2 study is to assess the safety and preliminary efficacy of onvansertib in combination with FOLFIRI and bevacizumab in the second line setting for KRAS-mutated mCRC patients. For the Phase 1b segment, a standard 3 + 3 dose-escalation design is used to determine the maximum tolerated dose or recommended phase 2 dose (RP2D) of onvansertib. As of September 15 th 2020, the first two dose levels have been cleared for safety and the third is enrolling. Efficacy will be determined by objective response rate (ORR) according to RECIST v1.1 (primary endpoint), progression-free survival and reduction in KRAS allelic burden in liquid biopsies (secondary endpoints). Biomarker analyses include genomic profiling of circulating tumor DNA genomic to evaluate altered pathways that correlate with patient clinical response. Based on a one-sided one sample log-rank test with 10% Type I error, there will be at least 90% power to detect an improvement in ORR from 5% to 20% with 32 patients. Clinical trial information: NCT03829410.
海洛因依赖者住院戒毒时年龄结构调查
Authors: 谢守敦, 谢先飞, 陈昌莲
Journal: BMJ (2005)

逐一查阅武汉市药物依赖治疗中心2001年5月至2003年5月1 000例海洛因依赖者住院戒毒时的病历,对戒毒时年龄、性别构成等进行归类分析.结果表明,样本男女比例为3.26∶ 1,戒毒时男女平均年龄分别为(33±5)、(29±5)岁(P＜0.01);构成比最高年龄组为30～39岁(71.9%),其中以30岁最多(16.2%).男性在各年龄组中的构成比随年龄的增高而上升,女性则随年龄增高而下降,差异有统计学意义(P＜0.01)。
预防戒烟者复吸
Authors: 肖丹, 王辰
Journal: BMJ (2009)

烟草依赖是一种慢性疾病,研究表明,10个戒烟者中会有9人复吸.关于最终能否真正戒烟,1999年Smith提出,如果患者年龄45岁以上、无抑郁症、低度尼古丁依赖、不酗酒、因患吸烟相关性疾病住过院、支持方为非吸烟者,则成功戒烟的几率会比较高。
Epidemiology, treatment, and outcomes in locally advanced spindle cell lung cancer.
Authors: Michelle Sterpi, Shivani Handa, Kathan Mehta, Anup Kasi
Journal: Journal of Clinical Oncology (2020)

e21048 Background: Spindle cell lung cancer (SpCC) is a rare type of NSCLC which portends a poor prognosis. Due to the rarity of diagnosis, there is a dearth of information about the epidemiology and overall survival for these patients. Methods: We performed a retrospective analysis using the SEER database from 1975-2016 to study the demographics, treatment modalities and outcomes for patients with locally advanced SpCC. Data regarding age, sex, race, pathological grade, staging, treatment, overall and disease specific survival was extracted. Hazards ratios were calculated to identify any difference in mortality between patients who received surgery alone versus those who received adjuvant chemotherapy or radiation. Results: A total of 936 cases of SpCC were identified, out of which 367 (39%) patients had locally advanced disease. 84% cases were diagnosed after the age of 60, with peak incidence occurring in the 70-74 age group. 87% were Caucasians, and 56% were males. 68% of the tumors were poorly differentiated. In terms of the treatment modalities for locally advanced SpCC, surgical resection was performed only in 58.5% cases. 27% patients received systemic chemotherapy, out of which 50% was in the adjuvant setting after surgery. 32 % patients received radiation therapy, only 38.5% of which was in the adjuvant setting. No statistically significant difference in mortality was seen in patients who received surgery alone vs adjuvant RT vs adjuvant chemotherapy. However, pts who did not receive surgery had a higher odds of mortality (OR = 4.2, p value 0.0001). Similarly, pts who only received chemotherapy alone had a higher odds of mortality vs those who received chemotherapy along with surgery (OR = 3.4, p-0.045), Overall survival was 25% for patients with localized disease, 9.5% for regional and only 2.6% for distant metastatic disease. For locally advanced SpCC, the observed cumulative 1-year survival was 54.8 % and declined to 29.2% after 5 years. Conclusions: Majority of the spindle cell carcinoma cases are poorly differentiated and present at an advanced stage at the time of diagnosis. For locally advanced SpCC, surgical resection can improve survival. Randomized trials are needed to test efficacy of adjuvant therapies.
Assessing impact of inpatient rotations on resident interest in hematology-oncology.
Authors: Bilal Farooqi, Lynne Meyer, Julia Lee Close, Jennifer Michelle Duff
Journal: Journal of Clinical Oncology (2020)

11031 Background: Working as a hematologist-oncologist is rewarding yet challenging. As cancer cases increase, there is a growing need to recruit more oncologists. It has been hypothesized that earlier exposure to oncology may improve resident interest in the field. This is often achieved by rotations on inpatient oncology wards, which represents only a small subset of the clinical work typical in hematology-oncology. We looked to assess whether early exposure to an inpatient oncology rotation impacts pursuit of this career path. Methods: Categorical interns in Internal Medicine at the University of Florida during year 2017-2018 were surveyed anonymously before and after their inpatient oncology rotation. Confidential identifiers were used to pair surveys. Similar surveys were used in the cardiology and gastroenterology rotations to allow for comparison. The survey included descriptor words to choose when describing the field. These words were categorized as either positive or negative. Results: Thirty-three interns were surveyed. Seventeen surveys were able to be paired (52% response rate) in oncology. Cardiology had 15 paired survey responses and gastroenterology had 13 paired responses. Using a 4-point Likert scale, interest in hematology-oncology decreased overall from 3.12 to 2.82 (p = 0.059) while interest in pursuing a fellowship remained the same. Stress levels were increased slightly from 2.30 to 2.05 (p = 0.564). Cardiology also saw a decrease in interest in the field from 3.53 to 2.93 (p = 0.007) but also an increase in pursuing fellowship from 2.20 to 2.60 (p = 0.014) and decreased stress from 3.13 to 2.67 (p = 0.020). Gastroenterology saw a decrease in interest in the field as well from 3.46 to 2.92 (p = 0.020). Interest in pursuing a fellowship and stress levels were not significantly different for gastroenterology. Field descriptors including “challenging,” “scared,” and “excited” decreased the most while “confident,” “inspired,” and “motivated” increased the most when describing hematology-oncology. Conclusions: While interest in this field was negatively impacted, stress levels associated with the field decreased. Furthermore, field descriptors were generally more positive and optimistic in the post-rotation setting. Though not statistically significant, these findings suggest that interns see oncology as less stressful and feel more capable after inpatient exposure during intern year. As much of hematology-oncology practice is outpatient, increasing intern exposure in this area may further improve perception and recruitment to the field.
Hospice Carve-In—Aligning Benefits With Patient and Family Needs
Authors: William H. Shrank, Kristin Russell, Ezekiel J. Emanuel
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
A new prognostic model for high-grade appendiceal mucinous neoplasms with peritoneal carcinomatosis.
Authors: Jason A Mouabbi, Sindhu Janarthanam Malapati, Ahmed Abdalla, Adam Biedny, David Hayward, Susan Szpunar, Tarik H. Hadid, Richard N Berri, Zyad Kafri
Journal: Journal of Clinical Oncology (2020)

e16718 Background: Peritoneal carcinomatosis of appendiceal origin (PCAO) is a rare malignancy accounting for less than 1% of all cancers. High-grade appendiceal mucinous neoplasms (HAMN) have a poor prognosis and are often treated with cytoreductive surgery (CRS), with hyperthermic intraperitoneal chemotherapy (HIPEC) followed by adjuvant systemic chemotherapy (ASC). Peritoneal cancer index (PCI) and completeness of cytoreduction score (CCR) are useful prognostic tools in patients with PCAO undergoing CRS/HIPEC. However, neither PCI nor CCR take response to ASC into account. Therefore, we propose an enhanced prognostic scoring system (tumor response index, TRI) that incorporates response to ASC as assessed at the completion of treatment. Methods: We retrospectively reviewed the charts of patients with PCAO who received care at the Van Elslander Cancer Center between January 2011 until December 2018. All patients with HAMN who underwent CRS/HIPEC followed by ASC were included. TRI was assessed by comparing the patients' performance status, tumor markers and imaging at the completion of ASC to those prior to the initiation of ASC. A competing risk model, Kaplan-Meier analysis and multivariate Cox regression analysis were used to estimate correlations between TRI and clinical outcomes (PFS and OS). TRI was also compared to PCI and CCR using the Akaike’s Information Criteria (AIC). Results: A total of 84 charts were reviewed. Patients were divided into groups based on their TRI score. The median age was 57 years with 55% females and 85% Caucasians. Approximately 20% of patients had signet-ring features. The most common ASC regimen used was a combination of 5-fluorouracil, oxaliplatin (FOLFOX) and bevacizumab (65%). The table depicts the median PFS and OS of each TRI group. Lower TRI was associated with significantly better PFS and OS. For all outcomes, AIC was substantially reduced by adding TRI to PCI and CCR, suggesting that TRI is a better predictor of PFS and OS. Conclusions: This study proposes TRI as an effective prognostic tool in patients with PCAO and HAMN after CRS/HIPEC/ASC. [Table: see text]