tbuckley/cabot-search huggingface dataset:
Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart
Authors: Cinzia Perrino, Péter Ferdinandy, Hans E Bøtker, Bianca J J M Brundel, Peter Collins, Sean M Davidson, Hester M den Ruijter, Felix B Engel, Eva Gerdts, Henrique Girao, Mariann Gyöngyösi, Derek J Hausenloy, Sandrine Lecour, Rosalinda Madonna, Michael Marber, Elizabeth Murphy, Maurizio Pesce, Vera Regitz-Zagrosek, Joost P G Sluijter, Sabine Steffens, Can Gollmann-Tepeköylü, Linda W Van Laake, Sophie Van Linthout, Rainer Schulz, Kirsti Ytrehus
Journal: Cardiovascular Research (2020)

Abstract Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.
Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target?
Authors: R Anantharaman, Heatley M, C F M Weston, 赵振燕, 李崇剑, 吴永健
Journal: BMJ (2010)

急性冠脉综合征患者入院时经常伴随高血糖现象；这种现象是一个预后不良的标志。使血糖迅速正常化的干预措施不能恰当应用并且疗效也不确切。在此，我们对高血糖与预后之间的关系进行了综述，对高血糖不仅仅反映了糖尿病前期状态的看法提供依据，并且我们还讨论了高血糖可能对急性心肌梗死过程产生不利影响的机制。最后，我们寻求胰岛素强化治疗改善预后的依据。
e-Cigarette Hoodies and Backpacks Prompt FDA Warnings
Authors: Rebecca Voelker
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
年轻女性痛风一例
Authors: 郭茜, 薛小萍, 环文英, 何萍
Journal: BMJ (2005)

患者女,28岁,汉族.因反复关节肿痛3年、加重3周于1999年12月2日收入院.3年前患者无明显诱因出现左第一跖趾关节、左膝关节疼痛,伴红肿,无发热,诊断滑膜炎,服吲哚美辛(消炎痛)可缓解,间断用药1年.3周前跖趾关节红肿、疼痛加重,夜间痛醒。
Cyclooxygenase inhibitor use during checkpoint immunotherapy and effect on time to progression and overall survival for metastatic melanoma and non-small cell lung cancer patients.
Authors: Shang-Jui Wang, Karishma Khullar, Sinae Kim, Samuel H Crayton, Nikhil Yegya-Raman, Roman Groisberg, Ann W. Silk, John L Nosher, Jyoti Malhotra, Michael A. Gentile, Janice M. Mehnert, Salma K. Jabbour
Journal: Journal of Clinical Oncology (2020)

e22034 Background: Immune checkpoint inhibitors (ICIs) improve survival outcomes in metastatic melanoma and non-small cell lung cancer (NSCLC). Preclinical evidence suggests that overexpression of cyclooxygenase-2 (COX2) in tumors facilitates immune evasion through prostaglandin E2 production and that COX inhibition synergizes with ICIs to promote antitumor T-cell activation. This study investigates whether concurrent COX inhibitor (COXi) use during ICI treatment is associated with improved time-to-progression (TTP), objective response rate (ORR) and overall survival (OS) in metastatic melanoma and NSCLC patients. Methods: We retrospectively reviewed 90 metastatic melanoma and 37 metastatic NSCLC patients, treated only with ICI between 2011 and 2019. Differences in TTP and OS by COXi use were compared using Kaplan-Meier and Cox regression. Interaction between COXi use and neutrophil-lymphocyte ratio (NLR) was examined. Independent radiology review per RECIST v1.1 was performed. Results: For melanoma patients, median TTP was significantly prolonged in COXi users (245 v 100.5 days, p = .0002). On multivariate analysis (MVA), COXi use associated with increased TTP (HR 0.36, 95% CI: 0.2 – 0.66, p = 0.001) when adjusted for age, pretreatment NLR, and gender. For NSCLC patients, COXi use also associated with increased TTP on MVA (HR 0.45; 95% CI: 0.21 – 0.97; p = 0.042) adjusted for age. ORR at 6-months was significantly higher in patients who received concurrent COXi compared to those that did not in both melanoma (58.6% v 19.2%, p = 0.0005) and NSCLC (73.7% v 33.3%, p = 0.036) cohorts. COXi use was associated with improved OS in NSCLC patients on MVA (HR 0.3; 95% CI: 0.12 – 0.78; p = 0.013), but not in melanoma patients. In the melanoma cohort, high pretreatment NLR of &gt; 5 associated with decreased TTP on MVA (HR 3.21, 95% CI: 1.64 – 6.3; p = 0.0007). However, for melanoma patients with high NLR &gt; 5, COXi use significantly associated with increased TTP (HR 0.08, 95% CI: 0.03 – 0.25); but in melanoma patients with low NLR ≤5, there was no effect on TTP (HR 0.65, 95% CI: 0.32-1.32). Similar outcomes were found in an adjusted melanoma cohort after RECIST review. Conclusions: Our study suggests that use of COXi concurrent with ICI is significantly associated with longer TTP and improved ORR at 6-months in metastatic melanoma and NSCLC patients. NSCLC patients using COXi had prolonged OS. Furthermore, COXi use appears to reverse the negative prognostic effect of a high NLR by prolonging TTP in melanoma patients.
CT features of heterotopic pancreas in the stomach and duodenum
Authors: Hua Wang, Boyin Wang, Zhenhua Zhao, Xiaochao Liang, Minhua Li, Jianguo Wei
Journal: BMJ (2016)

CT findings of 10 patients with tumor-like heterotopic pancreas in the stomach and duodenum, proven by surgery and pathology between 2007 and 2015, were reviewed retrospectively. The location, size, shape and contrast-enhancement pattern were analyzed. All 10 cases were of single lesion, 7 cases were located in the stomach (3 in gastric antrum, 3 in lesser curvature, 1 in large curvature of gastric body); 3 cases were located in the duodenum (2 in duodenal bulb, 1 in duodenal papilla). The size of lesions was between 6.2 mm×12.3 mm to 24.7 mm×16.2 mm with a mean of 16.8 mm×10.6 mm. Nine lesions were of ovoid or round in shape, 1 was of irregular shape. All cases underwent CT dual phase enhancement scanning. In the venous phase, 9 cases showed bright enhancement, which was composed chiefly of pancreatic acini in pathological examination; 1 cases of cystic shape showed no enhancement, which was composed chiefly of pancreas ducts and large amount of hyperplastic smooth muscle shown on pathology. The contrast-enhancement patterns of 7 cases were similar to those of normal pancreas; those of remaining 2 cases were in disorder. Tumor-like heterotopic pancreas in the stomach and duodenum has certain CT characteristics, which are of diagnostic value.


Key words: 
Stomach; Duodenum; Tomography, spiral computed; Ectopic pancreas
Early detection for pancreatic cancer in individuals at elevated-risk, using endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) of the abdomen: Feasibility and preliminary outcomes.
Authors: Joshua P. Raff, Charles Noyer, Nicole Boxer, Sara Sadan, Dan Costin, Sasan Roayaie, Mark Gordon, Meghan Kaumaya, Una Hopkins, Marisa Cortese, Melissa Rowan Rice, Sanjay Goel
Journal: Journal of Clinical Oncology (2020)

e16798 Background: There are no accepted guidelines for testing individuals at elevated risk for developing pancreatic duct adenocarcinoma (PC). We initiated a prospective screening and surveillance program for individuals at elevated risk for PC. Methods: Eligibility for the Pancreatic Cancer Early Detection Protocol (PCEDP) was based on germ line status and/or family history of PC, provided that the imparted risk was either five times that of the general population or 7.5% lifetime risk for developing PC. Testing was continued alternating between Endoscopic Ultrasound (EUS) and Magnetic Resonance Imaging (MRI) of the abdomen. Objectives were was to analyze the number, type, and location of pancreatic conditions found and their associations with genetic or family history; and to evaluate the outcomes and/or complications that may have resulted from our testing. Results: From April 2014 through October 2019 we received 238 queries, out of which 75 individuals (31%) enrolled in the PCEDP. Eligibility was based upon individual’s germ line only (45%), family history only (32%), and both (23%). Germ line mutations were observed in 34 (BRCA2), 9 (BRCA1), 4 (ATM), 3 (PALB2), and 3 (CDKN2A) individuals. Median age at consent was 57, 60% were female,and88%, 4%, 3%, and 1% self-identified as Caucasian, African American, Hispanic, and Asian, respectively. 133 EUS procedures and 83 MRIs have been performed. No serious adverse events occurred. Standard Insurance approved and paid for the vast majority of tests. Four individuals withdrew (5%) and three (4%) were lost to follow up. Ten individuals (13%) were found to have abnormal findings in the pancreas and therefore met an endpoint of the study, including seven anechoic cysts and three suspected intraductal papillary mucinous neoplasms (IPMN). All individuals with endpoints were recommended to continue surveillance with EUS. Eight of the ten endpoints were found on baseline EUS, one one from baseline MRI, and one was found on the 3rd EUS. One of the individuals with a 2.5cm IPMN seen on baseline EUS underwent a subsequent distal pancreatectomy, with pathology revealing high grade dysplasia. Conclusions: Screening and surveillance for PC using EUS alternating with MRI was feasible and well tolerated in our population of individuals with an elevated risk. Baseline EUS was successful in detecting 10/75 = 13% of enrollees with some abnormal pancreatic finding, including one requiring intervention with a high grade pre-malignant IPMN.
Finding an optimal treatment regimen for endemic Burkitt's lymphoma in a limited resource setting: A historical comparison of an INCTR-03-06 protocol for children treated at a tertiary pediatric oncology unit in Tanzania.
Authors: Shakilu Jumanne Kayungo
Journal: Journal of Clinical Oncology (2020)

e22507 Background: Adoption of intensive chemotherapy for endemic Burkitt lymphoma (eBL) in low income settings such as the French LMB-protocol with survival rates over 90% is limited by unavailability of quality supportive care for treatment related toxicity. Late stage at diagnosis and comorbidities such as HIV, Malnutrition and other socioeconomic challenges complicate this quagmire. Review the nonclinical trial setting performance of a three-drug regimen previously reported by the INCTR-03-06 study among children treated for eBL from 2012 to 2017 at a National Hospital in Dar es Salaam Tanzania. Methods: Medical record review of children treated for eBL to document demographic, clinical, chemotherapy regimen and outcome was conducted followed by phone call structured interviews for current survival status. Overall survival (OS) and Event Free Survival (EFS) were determined by Kaplan-Meier method and survival differences compared using the Log-rank test. Cox regression analysis was used to relate variables with mortality. Data analysis was done by SPSS version 20 and p-value of &lt; 0.05 considered statistically significant. Results: Out of the 123 children enrolled, male to female ratio was 1.6:1, median age 7 years (IQR 4 -10). Abdominal disease was the commonest presentation, 39% (48/123) and 25.2% (31/123) jaw mass. On phone call interviews 39.84% (49/123) of the children were in remission, 33.33%(41/123) died while 26.83% (33/123) were lost to follow up. Complete tumor response was achieved in 55.9% (62/111) of children treated on 1 st line chemotherapy. Overall Survival rates (OS) at 12 and 18 months were 63.4% and 54% respectively while Event-Free Survival (EFS) were 38.8% and 36.4% respectively. HIV infected children (aHR 5.12 95% CI 1.39- 19.0; log-rank P&lt; 0.01). and those with advanced disease at diagnosis( aHR2.34 95% CI 1.09-5.05 P &lt; 0.03) were at high risk of death. Conclusions: Contrary to prior understanding of eBL as a predominantly jaw disease, abdominal site is increasingly reported likely due to widespread use of sensitive imaging modalities. In line with other studies in low- and middle-income countries, few children with eBL achieve complete remission using low intensity chemotherapy regimens calling for more studies for safe and feasible regimens to be used as efforts to improve supportive care continue. HIV infected children with eBL and those with advanced disease at diagnosis should be considered at high risk of mortality.
TeamSTEPPS course and its application in medical team training
Authors: Xiuying Mao, Shanzhu Zhu, Zhijie Yu, Yuezhong Tang, Donghao Xu, Hua Yang
Journal: BMJ (2017)

TeamSTEPPS(Team Strategies & Tools to Enhance Performance & Patient Safety)is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals. It integrates teamwork skills with clinical practice to improve team performance in healthcare services and improve the quality of care effectively. The article introduces the TeamSTEPPS course and its clinical application.


Key words: 
Training; General Practice
Prevalence of metabolic syndrome among overweight and obese children and adolescents in Guangzhou
Authors: Lie-hua Liu, Yan-bing Li
Journal: BMJ (2009)

Objective To know prevalence of metabolic syndrome (MS) and metabolic abnormalities (MA) in overweight and obese children and adolescents in Guangzhou, China. Methods Totally, 439 children and adolescents aged six to 18 years were enrolled, including 129 obese, 115 overweight and 195 normal control ones. Their body height, body weight, waist circumference, hip circumference and blood pressure were measured, as well as their fasting blood glucose (FBG), lipid profiles and oral glucose tolerance test (OGTF). Results ①Prevalence of MS in overweight and obese children and adolescents was 20.9 % (27/129) and 10.4 % (12/115), respectively, 17.9 % (35/195) and 1.6% (4/244) in those with insulin resistance and non-insulin resistance, respectively. Prevalence of MS, each component of MA and cluster of each components of MA all increased in linear trend with their body mass index (BMI) or insulin resistance increasing. ② BMI correlated with all metabolic indicators and could independently predict risk of MS. Conclusions Prevalence of MS among overweight and obese children and adolescents in Guangzhou was considerably high, and BMI can be used as a suitable index for their obesity assessment in MS diagnosis.

Key words: 
Metabolic syndrome X;  Child;  Adolescent;  Over weight
肾综合征出血热致严重心肌损伤一例
Authors: 李秋英, 胡宝峰, 孔祥芬, 郭小菊, 魏金花, 周国利
Journal: BMJ (2007)

患者男,60岁,农民.因无尿伴喘息气促8 d、手足发凉2 d,于2004年11月12日入院.患者8 d前无明显诱因出现精神萎靡、食欲不振、无尿、腹胀、喘息气促、心悸,无明显胸闷、胸痛,无头晕及晕厥,无发热恶寒.之后出现恶心呕吐,呕吐物为少量涎液,无咖啡样物.2 d前,患者出现手足发凉、青紫。
Abstract 15147: Echocardiographic Predictors of Persistent Left Ventricular Systolic Dysfunction in Peripartum Cardiomyopathy
Authors: Evin Yucel, Christos G Mihos, Nandita S Scott, Judy Mangion, Doreen DeFaria Yeh
Journal: Circulation (2016)

Background: Peripartum cardiomyopathy (PPCM) is often associated with persistent left ventricular systolic dysfunction. We sought to determine the echocardiographic predictors of lack of left ventr...
Assessing real-world outcomes in metastatic colorectal cancer with KRAS<sup>G12C</sup> mutation.
Authors: Hui-Li Wong, Wanyuan Cui, Matthew Loft, Margaret Lee, Rachel Wong, Jeremy David Shapiro, Jeanne Tie, Belinda Lee, Prasad Cooray, Allan Solomon Zimet, Peter Gibbs, Benjamin J. Solomon, Jayesh Desai
Journal: Journal of Clinical Oncology (2020)

e16072 Background: The KRAS G12C mutation is present in 3% of colorectal cancer and is of particular interest given the recent development of specific targeting drugs. Previous data suggest KRAS (all) mutations may impact prognosis. Here we assess the clinical features and outcomes of real world patients with KRAS G12C mutant metastatic colorectal cancer (mCRC) to explore any clinicopathologic associations and prognostic impact. Methods: Patients diagnosed with mCRC between January 2011 and December 2018 were included in this prospective mCRC registry. Patients with BRAF mutations, unknown or unspecified KRAS variants were excluded. Clinicopathologic features, treatment and overall survival (OS) were compared for RAS wildtype (RAS WT ) and KRAS G12C mutant patients, and between KRAS G12C and other (RAS other ) mutations. Results: Of 1308 patients analysed, 674 (52%) were RAS mut , of whom 56 (8.3%) were KRAS G12C . More patients with KRAS G12C were female compared to RAS other and RAS WT (Table). No differences were observed in primary tumor location, number of metastatic sites and distribution of metastases. The proportion of patients undergoing metastasectomy was similar between KRAS G12C and RAS other , and KRAS G12C and RAS WT . There was no difference in the proportion of patients receiving systemic therapy. RAS WT patients received more lines of therapy. Median OS was similar between KRAS G12C , RAS other , and RAS WT : 31.7 vs 29.2 vs 31.8 months respectively (P = 0.545). Conclusions: KRAS G12C mutations were observed in 4.3% of mCRC patients and in 8.3% of RAS mutant cases. Patients with KRAS G12C have comparable clinical features to RAS WT or RAS other mCRC. Treatment and survival were also similar between groups. KRAS G12C does not appear to be prognostic, but may be an important predictive biomarker as promising targeted therapies continue to be developed. [Table: see text]
Correlation between white matter lesions and cognitive dysfunction in type 2 diabetic patients
Authors: Jun Li, Keke Miao, Chongxian Wang, Dongming Zhang, Chenguang Tian, Suhe Zhang, Qingjü Li
Journal: BMJ (2018)

Cranial magnetic resonance imaging (MRI) examinations were performed in 419 patients with type 2 diabetes mellitus (T2DM) from June to December 2016. The brain white matter lesions were defined by white matter hyperintensity (WMH) in MRI, which was detected in 380 cases (WMH group) and not detected in 39 cases (non-WMH group). The Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function. The study showed that there were significant differences in the duration of diabetes, the proportion of hypertension, total cholesterol (TC) and MoCA scores between the two groups (all P<0.05). The age, duration of diabetes, hypertension and glyclated hemoglobin (HbA1c) were significantly correlated with white matter lesions(OR=1.157, 1.116, 5.184, 1.128; P<0.05); and the white matter lesions, age, and body mass index (BMI) were significantly correlated with cognitive dysfunction in diabetic patients (OR=2.137, 1.175, 1.247; P<0.05) . The study result indicates that control of white matter lesions may prevent and improve cognitive dysfunction in T2DM patients.


Key words: 
Diabetes mellitus, type 2; Cognitive dysfunction; Leukoencephalopathy
Safety of acalabrutinib (Acala) monotherapy in hematologic malignancies: Pooled analysis from clinical trials.
Authors: Richard R. Furman, John C. Byrd, Roger G. Owen, Susan Mary O'Brien, Jennifer R. Brown, Peter Hillmen, Deborah Marie Stephens, Priti Patel, Liat Schwartz-Sagi, Marshall Baek, Beth Christian, Martin J.S. Dyer, Matthew J. Streetly, Clare Chui Ling Sun, Simon Rule, Michael Wang, Paolo Ghia, Wojciech Jurczak, John M. Pagel, Jeff P. Sharman
Journal: Journal of Clinical Oncology (2020)

8064 Background: Acala is a next-generation, highly selective, covalent Bruton tyrosine kinase inhibitor approved in the US for patients (pts) with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and previously treated mantle cell lymphoma (MCL). We evaluated the safety profile of acala monotherapy (monotx) in multiple B cell malignancies. Methods: Data from pts with activated B-cell diffuse large B-cell lymphoma, CLL, follicular lymphoma, MCL, multiple myeloma, prolymphocytic leukemia, Richter syndrome, SLL, or Waldenström macroglobulinemia treated with ≥1 dose of acala monotx in 9 studies were pooled. Acala was administered at 100 mg BID in most pts (100–400 mg total dose daily). Adverse events (AE) were assessed. Results: A total of 1040 pts were included (median age: 67 y [range: 32–90]; ECOG status ≤1: 93%; median exposure duration: 24.6 mo [range: 0–58.5]). A total of 360 (34%) pts discontinued acala, most commonly due to progressive disease (PD; 17%). AEs led to acala discontinuation in 97 (9%) pts; those in &gt; 2 pts were pneumonia (n = 5) and thrombocytopenia (n = 4). Incidence of AEs, including the most common (any grade and grade ≥3), are shown in the Table. Events of clinical interest (ECIs) included atrial fibrillation (afib) of any grade in 46 (4%) pts and grade ≥3 in 13 (1%) pts; major hemorrhage (any grade) in 37 (4%) pts; grade ≥3 infection in 183 (18%) pts; hypertension (any grade) in 79 (8%) pts and grade ≥3 in 36 (4%) pts; and second primary malignancies (SPM) excluding non-melanoma skin cancer (NMSC; any grade) in 68 (7%) pts. Median (range) time to first onset in days for each ECI (any grade) was: afib, 522 (8–1280); major hemorrhage, 293 (4–1327); infections, 92 (1–1317); hypertension, 157 (2–1345); SPM excluding NMSC, 339 (7–1499). Death was reported in 139 (13%) pts, most commonly due to PD (6%) and AEs (5%). Conclusions: Acala monotx has a favorable tolerability profile with increased exposure across multiple mature B cell malignancies. Additional analyses will further explore the longitudinal characteristics of AEs. [Table: see text]