tbuckley/cabot-search huggingface dataset:
Longitudinal cumulative dose: A novel measure to assess multiple dimensions of chemotherapy adherence over time.
Authors: Michael Webster-Clark, Alexander P Keil, Hanna Kelly Sanoff, Til Sturmer, Daniel Westreich, Jennifer Leigh Lund
Journal: Journal of Clinical Oncology (2020)

3522 Background: Adjuvant chemotherapy regimens take months to complete. Despite this, trials and observational studies evaluate chemotherapy adherence via measures assessed at the end of treatment (e.g. number of patients missing any dose, relative dose intensity [RDI]). This approach misses information that impacts outcomes, like treatment delays. We propose longitudinal cumulative dose (LCD) as a way to integrate the impact of dose reductions, missed doses, and dose delays at each cycle over time. Methods: We obtained data from the 2,246 participants in the Multicenter International Study of Oxaliplatin/5FU-LV in the Adjuvant Treatment of Colon Cancer (MOSAIC). We evaluated proportions of patients stopping treatment early and reducing (based on protocol), missing, or delaying a dose in each arm for each chemo agent at each visit. We obtained LCD, the fraction of the final standard dose a participant reached by a given day, for each participant and each chemo agent. We compared LCD medians over time and at the end of a standard regimen (24 weeks) between treatment arms and by age and performance status. We assessed agreement between oxaliplatin LCD and RDI with Fleiss’ kappa (Table). Results: Participants randomized to FOLFOX were more likely than those randomized to 5FU to stop treatment, reduce doses, miss doses, or delay visits; these differences increased over time. Median LCD for oxaliplatin in the FOLFOX arm at 24 weeks was 77%. Graphs of median LCD for 5FU showed a clear difference between arms (FOLFOX arm median LCD: 81%; 5FU arm median LCD, 96%). While 5FU LCD decreased with age in the FOLFOX arm (median LCD in those age &lt;40: 85%; 40-64, 82%; 65-75, 76%), it was similar across ages in the 5FU arm (median LCD 94%, 96%, and 96%, respectively), with smaller performance status trends. RDI and LCD showed fair agreement (Fleiss’ kappa=0.34); 19% of those with RDI over 85% had LCD under 60%. Conclusions: Visualizing LCD highlighted the timing and scale of deviations from standard administration, with major differences in 5FU LCD across arms. Next steps include evaluating if LCD predicts clinical outcomes. [Table: see text]
Abstract P294: Greater Peripheral Vasoconstriction During Mental Stress Predicts Adverse Cardiovascular Outcomes
Authors: Jeong Hwan Kim, Muhammad Hammadah, Ibhar Al Mheid, Kobina Wilmot, Ronnie Ramadan, Bruno Lima, Ayman Alkhoder, Malik Obideen, Naser Abdelhadi, Irina Uphoff, Mohamad Mazen Ghafeer, Belal Kaseer, Fahad Choudary, Amit Shah, Paolo Raggi, Viola Vaccarino, Arshed Quyyumi
Journal: Circulation (2018)

Introduction: Peripheral arterial vasoconstriction during mental stress (MS) has been associated with mental stress-induced myocardial ischemia, which in turn has been linked with worse cardiovascular outcomes. It is unknown whether the magnitude of peripheral vasoconstriction with MS is predictive of long term outcomes. Hypothesis: We hypothesized that greater peripheral arterial vasoconstriction during MS would be associated with adverse events among patients with coronary artery disease (CAD). Methods: Four hundred sixty-three patients with stable CAD and normal left ventricular function, (age 63±9, 75% male, 27% Black, EF 60±8 %) underwent MS testing with a standardized public speaking stressor. Digital pulse wave amplitude was continuously measured at baseline and during MS using peripheral arterial tonometry (PAT), and the PAT ratio of pulse wave amplitude (during mental stress/ baseline) was calculated. Cox proportional hazard models were calculated to examine the association between the PAT ratio and outcomes. Results: Median PAT ratio during MS was 0.68, indicating 32% average constriction with MS compared to rest. Subjects with greater peripheral constriction [low (&lt;median) PAT ratio] were more likely to be male (80% vs. 70%, P=0.008) compared to those with PAT ratio ≥median, but their risk factor profiles were similar. During 2.8±0.5 year follow-up, 64 patients had adverse cardiac events including 7 cardiovascular deaths, 19 MI, and 54 revascularization events. After adjusting for age, sex, race, hypertension, diabetes, current smoking status, and prior MI, those with low PAT ratio had a greater risk of CV death/MI (HR[hazard ratio] 2.49, 95% CI [1.04-5.99]) and CV death/MI/revascularization (HR 1.77, 95% CI [1.03-3.04]) compared to those with high PAT ratio. Conclusion: Greater peripheral arterial vasoconstriction with MS is associated with a higher risk of adverse cardiovascular outcomes in patients with CAD.
Risk factors of nosocomial infection in intensive care unit
Authors: Li-ming Yang
Journal: BMJ (2011)

The clinical data of 195 patients in intensive care unit (ICU) were retrospectively analyzed. The total nosocomial infection rate was 15.5% in this group of patients; respiratory tract was the predominant site of infection (71.0%); the most common infection microorganism was Gram-negative bacteria (65. 1% ) ,the top two pathogens were Escherichia (32. 6% ) and Staphylococcus ( 11.6% ). The risk factors of nosocomial infection in ICU were female sex, high age, invasive mechanical ventilation, long hospitalization in ICU, multiple organ dysfunction syndrome (MODS), etc.

Key words: 
Cross infection;  Risk factors
右侧胸腔巨大黏液样软骨肉瘤一例
Authors: 林琳, 丛振杰
Journal: BMJ (2009)

患者女,51岁,12年前胸部外伤后剧烈疼痛,被当地医院诊断为胸腔积液,此后每年行X线胸透检查示胸腔积液无明显变化.2年前开始胸闷,未治疗.2个月前出现咳嗽、咳灰黄色黏痰,痰中带血,量不多,初为暗红色血块,后转为鲜红色血丝.X线胸透示胸腔积液增多.患者始终无发热、盗汗及乏力等症状.查体:右侧胸廓饱满,呼吸活动度减低,叩音实,呼吸音极低。
Acquisition of apical view of heart in echocardiography and image interpretation
Authors: Wenying Jin, Zhilong Wang
Journal: BMJ (2019)

心尖系列切面是显示心脏主要解剖结构的最重要标准切面之一。在心尖四腔心切面基础上，逆时针旋转探头可依次获得心尖两腔心切面和心尖三腔心切面。心尖系列切面较完整地显示了心脏的四个心腔，左、右心房室瓣，房室间隔等重要结构，并且亦可显示主动脉、肺动脉、肺静脉、冠状静脉窦等重要血管结构，是判定左、右心室功能、二尖瓣和三尖瓣病变、各种先天性心脏病等重要疾病的关键切面。
亚健康者肝郁需逍遥
Authors: 曾文颖, 张晋, 高燕平
Journal: BMJ (2011)

现在健康的概念已经不仅是身体没有疾病,同时要具备心理平衡以及足够的社会适应能力.世界卫生组织将机体无器质性病变,但是有一些功能改变的状态称为第三状态,我国称为亚健康状态.随着学习、工作及生活的压力增大,处在亚健康状态的人多起来,长此以往会影响到这类人群的生活质量,需要及时干预、调整。
The incidence of <i>NTRK</i> fusion in Chinese head and neck cancer and response to crizotinib treatment.
Authors: Lianke Liu, Yuange He, Jiali Xu, Rong Wang, Rongrong Chen, Xuefeng Xia
Journal: Journal of Clinical Oncology (2020)

e18532 Background: Previous studies have been reported that the frequency of NTRK ( NTRK1 NTRK2 NTRK3) fusion varies from up to 1% in solid or hematological cancers but more common in rare tumor types, such as mammary-analog secretory carcinoma of the salivary gland (more than 90%), thyroid cancer (up to 25%) and gastrointestinal stromal tumour (up to 25%). The specific TRK inhibitor Larotrectinib and multiple TRK inhibitor Entrectinib have been approved by FDA for advanced solid tumors. Here we report the incidence of NTRK alteration in Chinsese Head and Neck cancer and a patient harboring ETV6- NTRK3 fusion acquired durable clinical response to multiple TRK inhibitor Crizotinib. Methods: We retrospectively analyzed the genetic aberrations in 127 patients of Chinese Head and neck cancer. All the patients were detected by hybridization capture-based NGS 1021-gene panel (including NTRK1 NTRK2 NTRK3) sequencing with tumor tissue and peripheral blood control samples. A parotid cancer patient with lung metastasis harboring ETV6-NTRK3 fusion underwent Crizotinib treatment after disease progressed with chemotherapy. Results: A parotid cancer patient with lung metastasis harboring ETV6-NTRK3 fusion was diagnosed on Mar. 2016. Five months after first-line chemotherapy, the disease progressed. Crizotinib was administered from Aug. 2017 to Sep. 2019 with regular CT examination. The latest CT on Sep. 2019 showed mixed response, some of the lesions shrunk but one of them enlarged. Then the patient received third line chemotherapy. In brief, the patient reached a progression-free survival (PFS) of 2 years. Then we reviewed 127 cases of Head and Neck cancer in our database, the most common histology type was HNSCC (87.4%), the incidence of NTRK genetic aberrations was 7.9% (10/127) including NTRK fusion (n = 4, 3.1%) and NTRK mutation (n = 6, 4.7%). The most common fusion was ETV6-NTRK3 (n = 3, 2.4%). Conclusions: In conclusion, we reported the incidence of NTRK genetic aberrations in Chinese Head and Neck cancer and an ETV6-NTRK3 fusion patient reached long-term response (2 years) with Crizotinib, indicating alternative therapy insights to Head and Neck Cancer patients.
Annals Graphic Medicine - Dr. Mom: PPE
Authors: Grace E. Farris
Journal: Annals of Internal Medicine (2020)

Web Exclusives2 June 2020Annals Graphic Medicine - Dr. Mom: PPEFREEGrace E. Farris, MDGrace E. Farris, MDMount Sinai School of Medicine, New York, New York (G.E.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G20-0042 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Mount Sinai School of Medicine, New York, New York (G.E.F.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G18-0042.Author/Illustrator Information: Grace E. Farris, MD, is an assistant professor of medicine at Icahn School of Medicine at Mount Sinai and chief of hospital medicine at Mount Sinai West hospital in New York, New York. You can view her work at her website: www.farrisgrace.com.About Dr. Mom: In Dr. Mom, physician and cartoonist Grace Farris examines work–life balance while mothering and doctoring. Dr. Mom appears monthly in Annals Graphic Medicine at Annals.org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 2 June 2020Volume 172, Issue 11Page: W134-W135KeywordsConflicts of interestDisclosureHospital medicineHospitalistsPersonal protective equipment ePublished: 2 June 2020 Issue Published: 2 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A phase II study of efficacy and safety of RC48-ADC in patients with locally advanced or metastatic HER2-overexpressing gastric or gastroesophageal junction cancers.
Authors: Zhi Peng, Tianshu Liu, Jia Wei, Airong Wang, Yifu He, Liuzhong Yang, Xizhi Zhang, Nan-Feng Fan, Suxia Luo, Jifang Gong, Zhen Li, Kangsheng Gu, Jin Wei LU, Jianming Xu, Qingxia Fan, Rui-hua Xu, Liangming Zhang, Jianmin Fang, Yi Ba, Lin Shen
Journal: Journal of Clinical Oncology (2020)

4560 Background: RC48-ADC is an antibody-drug conjugate (ADC) drug comprised of a novel humanized anti-HER2 IgG1, a linker, and a microtubule inhibitor, MMAE. The MoA included inhibition of HER2 signal pathway and cytotoxicity of MMAE. RC48-ADC has demonstrated promising anti-tumor activity in pre-clinical and early clinical studies. The current study is designed to evaluate the efficacy and safety of RC48-ADC in heavily treated patients with HER2-overexpressing (IHC 2+ or 3+) gastric or gastro-esophageal junction cancers. Methods: This is an open-label, multicenter, single-arm, phase II study. Eligibility criteria include: histologically confirmed gastric or gastro-esophageal junction cancers, HER2-overexpression (IHC 2+ or 3+), ECOG PS 0-1, post-to ≥2 prior systemic treatment. The patients received RC48-ADC, 2.5 mg/kg, q2w until disease progression, unacceptable toxicity, withdrawal, or study termination. The primary endpoint was ORR. PFS, OS, and safety were also evaluated. Results: Patient enrollment started in July 2017, and completed in November 2019. By the data cut-off date on 17-Dec-2019, 127 patients were enrolled. The median age was 58 years. At baseline, 59 patients (46.5%) had received ≥ 3 lines prior treatment. For the overall 127 patients, the investigator-assessed confirmed ORR was 18.1% (95% CI: 11.8%, 25.9%). Sub-group ORR was 19.4% and 16.9% for the patients post to 2 lines and ≥ 3 lines, respectively. For the 111 patients who were monitored for ≥ 2 cycles of efficacy assessments (i.e. 12 weeks), the ORR was 20.7% (95% CI: 13.6%, 29.5%). For the 127 patients, the mPFS was 3.8 months (95% CI: 2.7, 4.0, 89 events [70.1%]) and the mOS was 7.6 months (95% CI: 6.6, 9.2, 52 events [40.9%]). The most commonly reported treatment-related AEs were leukopenia (52.0%), alopecia (51.2%), neutropenia (48.0%), and fatigue (42.5%). Conclusions: RC48-ADC demonstrated a clinically meaningful response and survival benefit in the heavily treated patients with HER2-overexpressing gastric or gastro-esophageal junction cancers. The safety profile was in line with the previously reported data of RC48-ADC. RC48-ADC showed positive benefit/risk ratio for the target population. Clinical trial information: NCT03556345 .
Laparoscopic breast-conserving surgery combined with radiofrequency ablation to treat the early-stage breast cancer
Authors: Huiming Zhang, Hairui Wu, Zihan Wang, Changsheng Teng, Zhicheng Ge, Zhu Yuan, Yinguang Gao, Guoxuan Gao, Jinfu Wang, Xiang Qu
Journal: International Journal of Surgery (2017)
腹痛误诊36例分析
Authors: 杨崇美, 朱强, 李延青, 刘吉勇, 朱菊人
Journal: BMJ (2004)

分析近10年来以腹痛为首发表现的36例患者的误诊情况,提出对腹痛进行鉴别诊断时,除考虑局部病变外,还应考虑全身性疾病和放射性神经痛.临床医师应扩大知识面,不要仅满足于消化系统疾病或急腹症的诊断。
Window-of-opportunity trial of nivolumab with or without the IDO inhibitor BMS-986205 in patients with resectable squamous cell carcinoma of the head and neck (SCCHN).
Authors: Adam Luginbuhl, Jennifer Maria Johnson, Larry Harshyne, Madalina Tuluc, Stacey Gargano, Benjamin Leiby, Joseph M. Curry, David M. Cognetti, Rita Susan Axelrod, Priyanka Bhateja, Matthew O. Old, Ulrich Rodeck, Athanassios Argiris
Journal: Journal of Clinical Oncology (2020)

TPS6595 Background: Indoleamine 2,3-dioxygenase (IDO1) catabolizes tryptophan to kynurenine and is highly expressed in multiple malignancies including SCCHN. Elevated IDO1 activity may contribute to an immunosuppressive tumor microenvironment and compromise therapeutic responses to immune checkpoint therapy. We designed a window-of-opportunity trial to test whether the IDO inhibitor BMS-986305 improves treatment responses and T cell function in SCCHN patients treated with nivolumab. Methods: Patients with previously untreated, resectable, pathologically confirmed SCCHN are eligible. Primaries of the oral cavity, oropharynx, larynx, hypopharynx, or nasal cavity/paranasal sinuses must be AJCC 8 th edition stage II or higher (M0). Stage I oropharyngeal cancers with lymphadenopathy are also eligible. Patients are randomized 3:1 to receive either A) nivolumab 480 mg IV x 1 plus BMS-986205 100 mg PO daily starting a week prior to nivolumab and continuing for 4 more weeks (total of 5 weeks) or B) nivolumab 480 mg IV alone for 4 weeks. At the 5 th week of treatment patients are assessed for response with physical exam and repeat CT scans for tumor volumes: if there is greater than 10% reduction in volume of either primary tumor or lymph node metastases, patients will be considered responders and receive another cycle of their originally assigned treatment, i.e. nivolumab 480 mg IV for a second dose +/- BMS-986205 100 mg PO daily for an additional 4 weeks followed by surgery in week 9. If tumor volume is stable or progression is noted in either the primary site or lymph nodes, patients are considered non-responders followed by definitive surgery in week 5 (i.e. after only one cycle of treatment). The primary endpoint of this study is the response rate after cycle 1 (using the criteria defined above). The projected sample size is 48 patients (36 in arm A and 12 in arm B). Secondary endpoints include safety, pathologic treatment effect and metabolic and molecular correlates of treatment in the tumor microenvironment. Clinical trial information: NCT03854032 .
The diagnosis and treatment for palindromic rheumatism
Authors: 梁东风, 黄烽
Journal: BMJ (2005)

1944年,Hench和Rosenberg[1]首次提出了复发性风湿症(palindromic rheumatism)的概念,他们描述了34例患者表现出的一系列相似的症状:复发性急性关节炎、关节周围炎或关节旁炎,可持续几小时、甚至几天,发作后不遗留关节功能障碍等。
Clinical benefits of a nutrition-focused quality improvement intervention at a safety-net hospital gastrointestinal oncology clinic.
Authors: Nicholas Levonyak, Mary P Hodges, Nicole Broome, Verca Mhoon, Muhammad Shaalan Beg, Radhika Kainthla, Amy Little Jones, Aravind Sanjeevaiah, Syed Mohammad Ali Kazmi
Journal: Journal of Clinical Oncology (2020)

e19163 Background: Patients with GI cancer have high rates of malnutrition related poor outcomes. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), a safety net hospital, the number of GI cancer patients with a documented nutrition assessment by a registered dietitian was 5-7%. The aim of QI project was to increase the rate of documented nutrition assessment by a registered dietitian to 25%. Methods: Three PDSA cycles were conducted after identifying barriers to nutritional interventions. A registered dietitian was assigned to the GI oncology clinic during the 1st PDSA cycle, an adapted Malnutrition Screening Tool (MST) was implemented through the institute electronic medical record during 2nd PDSA cycle, and clinical staff was trained during 3rd PDSA cycle. Patient weight, ECOG performance status, and serum albumin were recorded at initial visit and 3-month follow up from May-July 2019. Paired t Test was performed. Results: Through PDSA cycles, the percentage of GI oncology patients with documented nutrition assessment increased from 5.9% to 21.8% by July 2019 and has sustained over subsequent 6-month period. From May-July 2019, there were 132 new patients seen by the registered dietitian, with 63/132 patients (47.7%) with GI cancer. Between the initial dietitian visit and 3-month follow up, significant average difference in weight -1.14 kg (CI: -2.17, - 0.19; p 0.02) was observed among all patients. However, there was no significant difference observed in average difference in weight in GI cancer patients -0.78 kg (CI: -2.4, +0.9; p = 0.34). Improvement and stability in ECOG performance status was observed in 87.5% of GI cancer patients and there was a non-significant improvement in average difference in serum albumin. Conclusions: Through a nutrition focused QI program on GI cancer patients at high risk of malnutrition, the rate of documented nutrition assessment was doubled. The GI cancer patients maintained weight, ECOG performance status, and serum albumin over 3-months.
Randomized comparisons of bevacizumab (B) and irinotecan (I), added to temozolomide (T), in children with relapsed or refractory high-risk neuroblastoma (RR-HRNB): First survival results of the ITCC-SIOPEN BEACON-Neuroblastoma phase II trial.
Authors: Keith Wheatley, Grace Holt, Cormac Owens, Jennifer Laidler, Dominique Valteau-Couanet, Marion Gambart, Victoria Castel, Natasha van Eijkelenburg, Aurora Castellano, Karsten Nysom, Nicolas U. Gerber, Genevieve Laureys, Ruth Lydia Ladenstein, Guy Makin, Sucheta Vaidya, Estelle Thebaud, Pamela Kearns, Andrew DJ Pearson, Lucas Moreno
Journal: Journal of Clinical Oncology (2020)

10501 Background: BEACON is a randomized phase 2 trial assessing whether inhibiting angiogenesis with bevacizumab adds to the activity of chemotherapy and evaluating chemotherapy regimens for children with RR-HRNB. Methods: Patients with RR-HRNB were eligible. There were randomizations (rand), in a 3x2 factorial design, to: T, IT or topotecan (To)-T, +/- B. Toxicity and response were reported in 2019 (ASCO, ESMO). Survival outcomes – progression-free (PFS) and overall (OS) – for the I and B rands are reported here (To rand is still open). The B rand used a relaxed alpha (1-sided p=0.2) for PFS as its phase 2 success criterion; the I rand was Bayesian. Cox model hazard ratios (HR) &lt;1.0 indicate benefit for I or B. Heterogeneity tests (HT) assessed interactions between B and I. Analysis was intention-to-treat. Results: From 2013-19, 160 patients were randomized to B v. no B, including 121 to I v. no I, with: median age 5.8 years; 113 and 47 measurable and evaluable disease; 67 and 93 refractory and relapsed disease; 35 had MYCN amplification. Median follow-up was 15.4 months. PFS and OS are shown in the table. In the main comparisons (I v. no I, B v. no B), I improved PFS and OS (98% probability that true HR&lt;1.0 for both) and B just met its success criterion (PFS: 1p=0.20; OS: 1p=0.19). However, there was some, but not conclusive, evidence of a positive interaction between B and I for both PFS (HT: p=0.06) and OS (HT: p=0.12). If real, this would suggest that adding either I (IT) or B (BT) to T does not improve outcome, but adding both (BIT) does. Twice as many patients had serious adverse events with BIT (57%) than with T (26%) or IT (27%), with BT at 40%. Conclusions: The BEACON results show that single agent T is suboptimal. Statistical uncertainty about an interaction between I and B means two further interpretations are possible: 1) IT and possibly BT are better than T; 2) IT and BT are not better than T, but I and B together (BIT) are better. Hence, a definitive conclusion on the best combination(s) to take forward is not currently possible and further randomized evaluation is needed. Clinical trial information: ISRCTN40708286. [Table: see text]
Change and significance of serum levels of CRH, NOS and 5-HT in acute carbon monoxide poisoning patients with delayed encephalopathy
Authors: Wei-lin Li
Journal: BMJ (2013)

To explore the change and significance of serum levels of corticotropin releasing hormone (CRH), nitric oxide synthase (NOS) and 5-hydroxytryptamine (5-HT) in the pathogenesis of acute carbon monoxide poisoning delayed encephalopathy (DEACMP). The groups of DEACMP (n=42), acute carbon monoxide poisoning (ACOP) (n=40) and normal control (n=40) were selected. The peripheral blood levels of CRH, NOS and 5-HT were measured for acute and convalescent phases of three groups. Information-memory-concentration test (IMCT), activities of daily living (ADL) and Hasegawa′s dementia scale (HDS) were used to evaluate the intelligent state of acute and convalescent phases. When DEACMP and ACOP groups in acute phase were compared with normal control group, the serum levels of CRH and NOS significantly increased while the serum level of 5-HT decreased markedly (P<0.05). And statistically significant difference existed between DEACMP and ACOP groups (P<0.05). After treatment, the serum levels of CRH and NOS significantly decreased while the serum level of 5-HT increased markedly in DEACMP and ACOP groups in convalescent phase (P<0.05). The IMCT and HDS scores of acute phase DEACMP group were significantly lower than those of ACOP group while ADL was significantly higher (P<0.05). After treatment, the scores of IMCT and HDS increased and ADL decreased in DEACMP group in convalescence (P<0.05). CRH was correlated positively with NOS (P<0.05) and negatively with 5-HT (P<0.05). Hypothalamic-pituitary-adrenal cortical axis, NO-NOS system and the presence of 5-HT may be related with the pathogenesis of DEACMP.


Key words: 
Carbon monoxide poisoning; Hypoxia, brain