tbuckley/cabot-search huggingface dataset:
Compliance of secondary prevention in patients with coronary artery disease post coronary revascularization
Authors: Wen-lin Ren, Li-hui Zhou, Feng-ying Zhang, Kou-rong Zhao, Yan-hui Wang, Li Li, Gui-hua Li, Lin Pi, Ming-ming Zhang, Da-yi Hu
Journal: BMJ (2012)

Objective To investigate the compliance status of secondary prevention in patients with coronary artery disease (CAD) following revascularization.Methods A total of 512 patients with CAD who received procedures for coronary revascularization were enrolled in the study from January 2009 to October 2010,including 472 cases of percutaneous coronary intervention stenting,25 cases of coronary artery bypass grafting and 15 cases of stenting plus bypass.The demographic information,prophylactic drug therapies, lifestyle changes and modifiable risk factors were surveyed with questionnaires,anthroposomatological measurements and laboratory tests in patients 3 months after coronary revascularization.Results The proportion of patients on statins,aspirin,β-blockers,angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) and influenza vaccination were 81.4％ (417/512),93.9％ ( 481/512 ),82.0％ ( 420/512 ),76.2％ ( 390/512 ) and 3.7％ ( 19/512 ) respectively.Based on the criteria recommended by the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update, the percentages of achieving therapeutic targets of modifiable risk factor management were as follows:glycosylated hemoglobin (90.2％,462/512 ),total cholesterol ( 68.6％,351/512 ),triglycerides ( 58.8％,301/512 ),high-density lipoprotein cholesterol ( 91.6％,469/512 ),low-density lipoprotein cholesterol ( 44.5 ％,228/512 ),systolic pressure ( 75.2 ％,385/512 ) and diastolic pressure (90.4％,463/512 ) respectively.And the proportions of improved lifestyle were as follows:smoking cessation/non-smoking 81.4％ (417/512),diet control 78.5％ ( 402/512 ),achieving weight targets 61.7％ (316/512)and regular exercise 58.2％ (298/512).Conclusions There is a relatively high percentage of standardized antiplatelet therapy and continuous statins medication in patients with coronary artery disease following revascularization. However,many significant modifiable risk factors have not been controlled optimally and lifestyle of patients needs further improvement. There is still a considerable scope for further improvement of secondary prevention in this group of patients.

Key words: 
Perartaneous coronary intervention; Coronary artery bypass; Secondary prevention; Data collection
A signalling cascade of IL-33 to IL-13 regulates metaplasia in the mouse stomach
Authors: Petersen Christine P, Meyer Anne R, De Salvo Carlo, Choi Eunyoung, Schlegel Cameron, Petersen Alec, Engevik Amy C, Prasad Nripesh, Levy Shawn E, Peebles R Stokes, Pizarro Theresa T, Goldenring James R, 李佳宁, 吴东
Journal: BMJ (2018)

目的
选择性活化巨噬细胞（Alternatively activated macrophages，M2）与胃部解痉多肽表达性化生（spasmolytic polypeptide-expressing metaplasia，SPEM）过程相关。然而，诱导SPEM的确切机制及关键介质尚不明确。


研究设计
为确定这一过程中的关键基因，分离胃部SPEM小鼠（DMP-777处理）及高级胃部SPEM小鼠（L635处理）胃体的巨噬细胞进行RNA测序。评估白介素-33、白介素-33受体（ST2）及白介素-13基因敲除小鼠，经L635处理急性壁细胞缺失后对上皮细胞化生过程的影响。


结果
胃部上皮化生相关性巨噬细胞中可鉴定出M2极化亚群。高级胃部SPEM小鼠巨噬细胞中白介素-33的表达显著上调。L635可在野生型小鼠胃组织中诱导上皮化生，但在白介素-33及白介素-33受体敲除鼠中未观察到这一现象。尽管在诱导上皮化生过程中不需白介素-5及白介素-9，白介素-13基因敲除小鼠无法在L635诱导下发生上皮化生。对白介素-33受体基因敲除小鼠应用白介素-13，可重新诱导急性壁细胞缺失后的上皮化生。


结论
壁细胞缺失后上皮化生及巨噬细胞极化过程通过白介素-33及白介素-13的细胞信号网络协调进行，将损伤应答过程中固有黏膜机制及M2浸润联系起来。
The Easy Elective—A Surprising Revelation in Medical School
Authors: Charisse Villareal
Journal: JAMA Internal Medicine (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 Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Internal Medicine journal
The incidence, risk factors and outcomes of chemotherapy related acute kidney injury in China.
Authors: Lu Li, Sheng Nie, Chen Ren, Yanqin Li, Dehua Wu
Journal: Journal of Clinical Oncology (2020)

e24161 Background: Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. However, comprehensive data on the epidemiology and outcomes of chemotherapy related acute kidney Injury in China is lacking. Methods: We conducted a nationwide cohort study of hospitalized patients from 25 general and children’s hospitals in China during 2013-2015. Patient-level data were obtained from the electronic hospitalization information system, prescription database and laboratory databases of all cancer patients who received chemotherapy and had at least two serum creatinine tests within any 7-day window during the hospitalization. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in patients with various type of cancer and chemotherapeutic agents was examined. The outcomes of AKI, including in-hospital mortality, death after discharge, kidney recovery, and length of stay, were also assessed. Results: A total of 23,232 cancer patients, including 3,120 children ( &lt; 18 years old), 16,310 adult (19-65 years old) and 3,802 elderly patients ( &gt; 65 years old), were analyzed. Platinum compounds and pyrimidine analogues were the most common used chemotherapy agents for cancer patients. The overall incidence of AKI was 4.9%. Patients with urinary system malignancy (12.3%), hematological malignancy (10.2%) and nerve motor system malignancy (4.1%) have the highest incidence of HA-AKI. The top three types of chemotherapy drugs with the highest incidence of AKI were Purine analogues (30.1%), folic acid analogues (15.3%) and combinations of antineoplastic agents (14.1%). The nephrotoxicity of chemotherapy drugs was different among age groups. AKI is associated with a higher risk of in-hospital mortality and death after discharge. Conclusions: The risk of AKI in cancer patients varied in different age group, type of cancer and chemotherapeutic agents.
Correlation of obstructive sleep apnea with diabetes needs more attention by general practitioners
Authors: 张晓林
Journal: BMJ (2010)

社区卫生服务机构的医疗工作重点是治疗常见病和管理慢性病,但至今很多常见病还没有引起社区医生的广泛关注和重视.如阻塞性睡眠呼吸暂停综合征(OSAS). 长期以来,民间都认为睡觉打呼噜是一个人睡眠好的标志.其实并非这样!研究表明,每4个中、重度打鼾的人里面就会有一人是OSAS.OSAS在临床上的主要表现就是睡眠时打鼾并伴有呼吸暂停和呼吸表浅。
Radiation and cardiotoxicity: A retrospective analysis of a midwest population.
Authors: Nitin Tandan, Cameron Koester, Priyanka Parajuli, Odalys Estefania Lara Garcia, Manjari Rani Regmi, Asad Cheema, Ruby Maini, Sabree Abedrabo, Hamsa Sahib, Noupama Mirihagalle, Zurain Niaz, Bishal Bhandari, Alexander Johnson, Abdisamad M. Ibrahim, Kristin Delfino, Kathy Robinson, Meghna R. Desai, Abhishek Kulkarni
Journal: Journal of Clinical Oncology (2020)

e12616 Background: The most common female malignancy diagnosed in the US is breast cancer. Early breast cancer therapy is often treated with radiation therapy; one of the unfortunate side effects of radiotherapy in the past has been cardiotoxicity, especially coronary artery disease. Recent usage of dose reduction techniques have helped reduce these effects. Here, we present our analysis of breast cancer patients that received radiation therapy and the likelihood of cardiotoxicity. Methods: An IRB-approved retrospective study was performed utilizing ICD codes to analyze patients diagnosed with biopsy-confirmed breast cancer between January 1, 2014 and December 31, 2017. 478 of 1618 de-identified patients qualified for this study. Statistical analysis was performed with SAS v9.4. Descriptive statistics were computed for all study variables. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Comparisons between categorical variables were compared with the Chi-Square test (or Fisher’s Exact) where appropriate. Survival curves were estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival were assessed with Cox proportional hazards regression analyses. All significance is assumed at the p &lt; 0.05 level. Results: Of the 478 eligible patients, heart failure (HF), HF hospitalizations, acute coronary syndrome and overall cardiac events were compared among breast cancer patients. Patients who received radiation experienced HF 6.02% compared to 4.61% without radiation (p = 0.574). HF hospitalization was recorded as 2.27% in radiotherapy compared to 1.23% in non-radiotherapy patients (p = 0.686). Patients who radiation experienced ACS 2.27% of the time as compared to 1.21% in patients who were not treated with radiation. Of note, 9.25% receiving radiation experienced cardiac events compared to 4.24% in patients without radiation (p = 0.068). While results were not statistically significant, the trend of elevated cardiac events in breast cancer patients receiving radiation is noteworthy. Conclusions: Per our study, although statistically insignificant, radiation therapy may result in higher incidence of cardiac events in breast cancer patients. Further large-scale, prospective studies should be performed to confirm the aforementioned trends with respect to survival outcomes in urban and rural populations.
Renal Function Parameters and Serum Sodium Enhance Prediction of Wait‐List Outcomes in Pediatric Liver Transplantation
Authors: Leanne Thalji, Nassir M. Thalji, Julie K. Heimbach, Samar H. Ibrahim, Patrick S. Kamath, Andrew Hanson, Phillip J. Schulte, Dawit T. Haile, Daryl J. Kor
Journal: Hepatology (2020)

Background and Aims Reliance on exception points to prioritize children for liver transplantation (LT) stems from concerns that the Pediatric End‐Stage Liver Disease (PELD) score underestimates mortality. Renal dysfunction and serum sodium disturbances are negative prognosticators in adult LT candidates and various pediatric populations, but are not accounted for in PELD. We retrospectively evaluated the effect of these parameters in predicting 90‐day wait‐list death/deterioration among pediatric patients (&lt;12 years) listed for isolated LT in the United States between February 2002 and June 2018. Approach and Results Among 4,765 patients, 2,303 (49.3%) were transplanted, and 231 (4.8%) died or deteriorated beyond transplantability within 90 days of listing. Estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.09 per 5‐unit decrease, 95% confidence interval [CI] 1.06‐1.10) and dialysis (HR 7.24, 95% CI 3.57‐14.66) were univariate predictors of 90‐day death/deterioration ( P &lt; 0.001). The long‐term benefit of LT persisted in patients with renal dysfunction, with LT as a time‐dependent covariate conferring a 2.4‐fold and 17‐fold improvement in late survival among those with mild and moderate‐to‐severe dysfunction, respectively. Adjusting for PELD, sodium was a significant nonlinear predictor of outcome, with 90‐day death/deterioration risk increased at both extremes of sodium (HR 1.20 per 1‐unit decrease below 137 mmol/L, 95% CI 1.16‐1.23; HR per 1‐unit increase above 137 mmol/L 1.13, 95% CI 1.10‐1.17, P &lt; 0.001). A multivariable model incorporating PELD, eGFR, dialysis, and sodium demonstrated improved performance and superior calibration in predicting wait‐list outcomes relative to the PELD score. Conclusions Listing eGFR, dialysis, and serum sodium are potent, independent predictors of 90‐day death/deterioration in pediatric LT candidates, capturing risk not accounted for by PELD. Incorporation of these variables into organ allocation systems may highlight patient subsets with previously underappreciated risk, augment ability of PELD to prioritize patients for transplantation, and ultimately mitigate reliance on nonstandard exceptions.
高血压的社区筛查
Authors: 张晓林
Journal: BMJ (2009)

我国慢性病死亡人数占总死亡人数的比例呈持续上升趋势,用于治疗慢性非传染性疾病的费用占疾病治疗总费用的比例高达60%,远远高于43.2%的世界平均水平.世界卫生组织指出,医疗卫生费用的恶性膨胀已经成为全球性医疗危机.美国健康管理20多年的实践表明,90%的个人和企业通过健康管理后,医疗费用将降到原来的10%;而没有进行健康管理的10%个人和企业,医疗费用会比原来上升90%。
Real-world evidence highlights sizeable gap in adopting early palliative care referral in patients with advanced cancers.
Authors: Suzanne Cole, Sarah Storie, Sonya Owens, LaShanta Gipson, Michael Hardy, Ashley Turk, Ishwaria Mohan Subbiah
Journal: Journal of Clinical Oncology (2020)

e24147 Background: Early referral to palliative care (PC) for patients w/ adv cancer is supported by compelling evidence from large RCTs demonstrating a lower symptom burden, higher QOL, and increased OS. However, these studies reflect pts who have self-selected to accept a PC referral and attend a PC visit. WHO/NCCN/ASCO guidelines support early integration of PC. We sought to characterize the referral patterns in our heme/onc practice to identify and mitigate the barriers to early PC adoption in the community setting. We began a concerted effort to discuss early PC referral w/ pts recently diagnosed w/ adv cancer at the time systemic therapy was initiated. Methods: To ensure real-world applicability of this study, we identified a large satellite clinic of a major academic center w/ access to PC on the main campus (located 20 miles from the satellite clinic). We retrospectively reviewed new pts age 18y+ w/ adv cancer, characterized PC referrals and outcomes. Using qualitative methodology, we identified pt-reported barriers to accepting PC care. Results: 407 new pts were seen; 168 w/ benign heme, 145 w/ early cancers, 94 w/ adv cancers. Of the 94 pts w/ adv cancers, 25 pts had one-time 2 nd opinion visits, and 16 pts were not candidates for, or did not desire cancer treatment and directly enrolled on hospice. Our analysis cohort consisted of 53 pts w/ adv cancer pursuing life prolonging therapy. At initiation of treatment, 57 % (n=30) were not offered a PC referral, 22% (n=12) received a PC referral and attended the appt, however 21% (n=11) received a PC referral but did not attend the appt. A qualitative analysis of the 11 patients referred to early PC who did not attend the appt revealed; 5 patients scheduled an appt but did not attend (3-unknown reason, 2-hospitalized during appt, 1-lack of transportation), 2 pts were unreachable, and 4 pts were contacted but declined to schedule stating: “I feel pressured” “I want to hear what other treatment options I have” “I want to be treated first and then see if I need it” "I am overwhelmed with too many new doctors and visits". Conclusions: Despite the benefit of early PC referral in pts w/ adv cancer, we identified a considerable gap in its adoption in our community practice despite access to proximate PC clinic. Further studies are under design to address institutional and pt-related factors to improve real-world adoption of this critical service.
Genomic and epigenomic profiles to distinguish pulmonary enteric adenocarcinoma from lung metastatic colorectal cancer.
Authors: Jie Wang, Ying Zuo, Hua Bai, Jianchun Duan, Zhijie Wang, Weihua Li, Jianming Ying, Jie-Fei Han, Yanhua Tian, Yedan Chen, Yang Shao
Journal: Journal of Clinical Oncology (2020)

e13528 Background: As an extremely rare variant of lung adenocarcinoma, the diagnosis of pulmonary enteric adenocarcinoma (PEAC) remains challenging in the clinic due to shared morphological and immunohistochemical features with lung metastatic colorectal cancer (mCRC). Current differentiation of PEAC and mCRC mainly relies on clinical history and pathological examination while which still remain risks of misdiagnosis. Due to their distinct treatment regimens, effective molecular markers are essential for accurate diagnosis. However, comprehensive molecular features of PEAC is still poorly understood. Methods: We performed whole-exome sequencing and targeted bisulfite sequencing of 23 PEAC and 20 mCRC and matched normal tissue to improve molecular characterization. For DNA methylation profiling, differentially methylated regions (DMR) were analyzed by comparing PEAC with normal lung tissue and with mCRC. We also trained machine learning methods to distinguish PEAC from mCRC and validated the classifier in an independent cohort with 10 PEAC and 10 mCRC. Results: Mutations of KRAS, APC, and EGFR, alterations of chromosome arms 13q, 14q and 18p were found to be the major differential genetic alterations between PEAC and mCRC (P &lt; 0.05), yet not enough to aid clinical diagnosis. For epigenomic profile, we identified 524 DMRs (false discovery rate ≤0.05) which were further reduced to 30 DMRs according to importance rank by the random forest algorithm. Based on these DMR features, we developed a diagnostic classifier that correctly classified 95.1% of patients in this discovery cohort. We further validated this predictive model in the validation cohort, with a prediction accuracy of 90.0%. We demonstrated its clinical application in two cases with difficulties to diagnosis by traditional methods. Conclusions: We have illustrated the unique genetic and methylation profiles of PEAC and mCRC. Our approach for disease classification may have a substantial impact on diagnostic precision and therapeutic decision for PEAC.
Prioritizing targeted therapies in an evidence-based manner, integrating biological context and functional precision medicine.
Authors: Simina Boca, Krithika Bhuvaneshwar, Virneliz Fernandez-Vega, Jayaram Kancherla, Shruti Rao, Subha Madhavan, Rebecca Riggins, Robert A. Beckman, Hector Corrada Bravo, Louis Scampavia, Timothy Spicer
Journal: Journal of Clinical Oncology (2020)

e14065 Background: It is becoming increasingly common for cancer patients to undergo molecular profiling of their tumors in order to see whether there are any actionable DNA, gene expression, or protein expression signatures. For example, individuals with ER+ or HER2+ breast cancer or KRAS wild type (non-mutated) colorectal cancer are prescribed specific targeted therapies. When an individual’s molecular alterations do not match any currently-approved recommendations for their tumor type, their clinician may consider prescribing a therapy approved in a different tumor type. Unfortunately, tumors often eventually become resistant to the therapies they are exposed to, leading to a narrowing of options after each therapy line. Methods: We previously developed CDGnet, an evidence-based approach and web-based tool for prioritizing targeted therapies based on tumor molecular profiles based on known pathways which provide biological context. CDGnet considers approved therapies with biomarkers among the alterations for the individual’s tumor type and other tumor types as the first and second evidence level categories respectively. These are followed by therapies that target or have as biomarkers genes or proteins downstream of altered oncogenes, considering curated pathways for the individual’s tumor type and other tumor types as the third and fourth evidence level categories respectively. We are currently expanding CDGnet in order to include data from high-throughput screening (HTS) experiments of NCI oncologic drugs performed on patient-derived organoids. The concept of “functional precision medicine” consists of using functional drug efficacy determination directly on individual patients, in this case by considering drugs with low half maximal effective concentrations (EC50) which are tested on tissues derived from the actual patients. Results: We will present extensions to CDGnet that allow users to upload both the molecular profiles and the HTS data to see whether any drugs are predicted by both approaches or whether specific combinations appear promising for further testing. Preliminary results on a set of glioblastoma samples will be presented. Conclusions: We hope that extending CDGnet to also include HTS data will eventually allow a truly multi-factorial personalized oncology approach, whereby both molecular alterations at the DNA, RNA, and protein levels and patient-derived organoids will be considered in deciding on treatment plans for individuals.
Network meta-analysis fordiagnostic tests
Authors: O'Sullivan Jack W, 于树青, 高乐, 孙凤
Journal: BMJ (2019)

当在证据体中相匹配的干预措施之间缺乏直接比较的头对头随机对照试验时，网状meta分析（network meta-analysis, NMA）能够借助间接比较进行多种干预措施之间的比较。类似地，诊断性试验的NMA是一种新的证据合并方法，能够在不同的诊断阈值下进行不同诊断试验间的准确性比较。
Castleman disease spectrum.
Authors: Johnson Khor, Sheila K. Pierson, Victoria Powers, Mark-Avery Tamakloe, Alexander Gorzewski, Katherine Floess, Jasira Ziglar, Eric Haljasmaa, Yue Ren, Corey Casper, Mary Jo Lechowicz, Thomas S. Uldrick, Amy Chadburn, Gordan Srkalovic, Megan S. Lim, Hongzhe Li, Elaine S. Jaffe, Frits Van Rhee, David C. Fajgenbaum
Journal: Journal of Clinical Oncology (2020)

8548 Background: Castleman disease (CD) describes a group of lymphoproliferative disorders that share characteristic histopathology. Unicentric CD (UCD) and idiopathic multicentric CD (iMCD) are differentiated by the number of enlarged lymph node (LN) regions: UCD involves 1 region and iMCD involves &gt; 1 region. UCD typically has mild or no symptoms whereas iMCD requires abnormal labs and symptoms for diagnosis and can progress to life-threatening multi-organ failure. Review of an international natural history registry of CD revealed patients across a broad spectrum with regards to number of enlarged LN regions and disease severity. We hypothesize that there is a positive correlation between disease activity and the number of enlarged LNs and that the spectrum of CD is more complex than a binary UCD-iMCD dichotomy. Methods: Herein, enrolled UCD and iMCD patients whose diagnosis was confirmed by an expert-panel were selected for analysis (N = 81). A standardized disease activity score (scale 0-1) was computed for each patient using available diagnostic values of C-reactive protein, hemoglobin, and albumin (CHA score). Results: We looked at the association between number of enlarged LNs and CHA and found a significant positive correlation (R = 0.65, p &lt; 0.0001). Given this, we divided the cohort into groups of mild, moderate, and extensive lymphadenopathy according to the number of regions of enlarged LNs at the time of diagnosis: group 1 (1 enlarged LN region); group 2 (2-4 enlarged LN regions); and group 3 (≥5 enlarged LN regions). We identified 20 patients in group 1, 19 in group 2, and 42 in group 3 with no statistical differences in sex, race, or age at diagnosis. Histopathological subtype differed significantly among groups. Group 1 was 89% hyaline vascular (HV)/ hypervascular (HpV) and 11% mixed (Mx); group 2 was 74% HV/HpV, 21% Mx, and 5% plasmacytic (Pl); and group 3 was 64% HV/HpV, 32% Mx, and 5% Pl. We then looked at CHA score in these groups and found that group 3 patients have a significantly greater CHA score (median [IQR]: 0.46 [0.49]) than both group 2 (0.08 [0.14]) and group 1 (0.0 [0.10]) (adjusted p &lt; 0.001 for both) while there was no difference between groups 1 and 2. Conclusions: These results suggest that disease severity is positively associated with the number of enlarged LNs. The different proportions of histopathological subtypes between the three groups could indicate different pathologic mechanisms are involved. Further work is needed to determine if patients with a few enlarged LNs exhibit disease more closely to UCD or iMCD and to understand long-term outcomes for these patients.