tbuckley/cabot-search huggingface dataset:
Lung cancer screening knowledge in four internal medicine university programs.
Authors: Samuel Urrutia Argueta, Nishraj Basnet, Mollie Brittan, Owais Abdul-Kafi, Nasser H. Hanna
Journal: Journal of Clinical Oncology (2020)

11027 Background: Low density CT (LDCT) screening reduces lung cancer specific and all-cause mortality in high risk populations. However, it remains underutilized. Screening discussions often start in primary care clinics of which nearly 30% are occupied by residents. Recognizing gaps in knowledge in early medical training may translate into a higher utilization of LDCT screening. Methods: To evaluate knowledge about lung cancer screening in Internal Medicine (IM) residents at 4 academic programs we distributed a survey to assess population at risk, mortality benefits, comparison between LDCT, colonoscopy and mammogram, and a knowledge self assessment. Results: 166 out of 360 (46%) IM residents at the 4 institutions participated, including 42% PGY-1, 30% PGY-2, and 28% PGY-3. Residents attained an average of 2.9 correct responses out of 7 (43.1%), without any statistically significant difference among programs. PGY-1 residents performed better than PGY-2 and PGY-3 (p=0.022). 36% correctly identified the appropriate population for screening. 90% correctly indicated that LDCT screening results in a cancer specific mortality reduction. 59% correctly indicated that LDCT results in all-cause mortality reduction. 7.7% answered that women stand to benefit the most from screening. 66% correctly answered that LDCT underperforms colonoscopy regarding mortality reduction. 22% answered correctly that LDCT outperforms mammography in reducing mortality. 65% of residents perceived their knowledge to be average or lower. Conclusions: LDCT knowledge is deficient among the residents studied. PGY-1 residents performed significantly better than their upper level peers. There were no significant differences among institutions. [Table: see text]
Clinical thinking on diagnosis and treatment of patients with abdominal pain with gross hematuria in general practice
Authors: Chang Chen, Yue Jiang, Fuying Zhao, Xuejun Zeng
Journal: BMJ (2020)

社区全科门诊以腹痛为主诉就诊的患者很多，而伴肉眼血尿者不常见。文章通过展示社区全科医生对此患者的初诊、转诊、转回、长期随访的诊疗全过程，显示了全科医生通过问诊、查体和辅助检查等方面全面分析，遇到临床问题时运用全科医学的诊疗思路解决问题、开展连续性照顾，从而提高健康照顾的效果。
牵引钛钉在颌间固定中的临床应用
Authors: 刘洪泉, 王春胜, 张传彬
Journal: BMJ (2006)

在颌骨骨折治疗中,颌间结扎固定是治疗下颌骨骨折传统的治疗方法.为了尽快恢复咬合关系、进行必要的制动及限制开闭口运动,都要施行颌间固定.以往传统的颌间固定方法是不锈钢丝拴扎及带钩牙弓夹板牵引等方法[1].由于此类治疗方法存在口腔卫生条件差易造成牙龈及牙周组织炎症,操作不便,结扎钢丝头易扎伤口腔内黏膜等的弊端,因此寻求一种简便实用的颌间固定方法,是临床口腔科医生工作的目标.本研究自2002年12月始应用牵引钛钉对54例下颌骨骨折病人进行颌间固定治疗,效果较好,现报道如下。
A case report of adult autoimmune enteropathy and literature review
Authors: Lingmei Meng, Jianjun Liu, Shigang Ding, Hong Chang, Rongli Cui, Zhiqiang Song, Aiying Wang
Journal: BMJ (2015)

One case was selected from our hospital and another 31 cases from literature. Symptoms, endoscopic and pathological manifestations and autoimmune examinations of all cases were summarized and analyzed. Their major symptoms were prolonged diarrhea (100%) and malabsorption (100%). Specific small bowel histology indicated villous blunting and minimal intraepithelial lymphocytosis. And 15 of them had some other autoimmune diseases. And many positive autoimmune antibodies were detected, including anti-enterocyte antibodies (n=20), anti-intestinal goblet cell antibody (n=7) and anti-nuclear antibody (n=9). Most patients (27/32) responded to corticosteroids. Adult autoimmune enteropathy is a rare syndrome with intractable diarrhea and malabsorption. And it may be accompanied by other autoimmune diseases in some cases.


Key words: 
Diagnosis; Treatment; Adult autoimmune enteropathy
Atrial myxoma: a clinical and pathologic analysis
Authors: Jun Rui, Shu-dong Yang, Zhi-yi Zhou
Journal: BMJ (2010)

Fifteen cases with atrial myxoma in our hospital from May 2001 to Dec 2008 were retrospectively analyzed.Patients presented with a variety of symptoms mimicking mitral valve disease,including palpitation, shortness of breath and activity intolerance.Pulmonary and systemic embolizations occurred in three patients and sudden syncope in one.Radiograph and echocardiography can help to reveal atrial myxoma.Definite diagnosis was made based on histological examinations.In 6 months - 6 years'follow-up one case recurred.Surgical treatment should be prompted once diagnosis established.Tumor pedicle must be completely removed to prevent recurrence.

Key words: 
Myxoma;  Heart atrial
Defining diagnostic criteria for ductal prostate cancer on prostatic MRI.
Authors: Weranja Kalana Bodhisiri Ranasinghe, Patricia Troncoso, Andrea Kokorovic, Mohamed A Elsheshtawi, Miao Zhang, Ana Aparicio, Brian Francis Chapin, Tharakeswara Bathala
Journal: Journal of Clinical Oncology (2020)

e17532 Background: Ductal prostate adenocarcinoma (DAC) is an aggressive histologic variant of prostate cancer (PCa) which often be missed due to their low PSA secretion. Further, a large proportion of DACs have extra-prostatic extension and nodal disease at presentation warranting accurate diagnosis and treatment planning. However studies have yet to differentiate DACs from high grade acinar PCas (PAC) on MRI. Therefore we aimed to develop MRI criteria to identify DACs and assess its diagnostic accuracy. Methods: Patients with histologically proven DAC who had MRIs prior to RP were identified from January 2011 to November 2018. Histology-based MRI diagnostic criteria were developed using RP specimens from nine patients with a pure dominant DAC focus and corresponding MRIs. Sixty-eight DAC patients were compared to a matched cohort of 70 patients with Gleason Score 8 or 9 PAC using the pre-defined MRI criteria. Chi-Squared, T tests, Mann Whitney U tests and sensitivity analyses were performed. Results: The following features of DAC were defined on MRI after correlation with histology: 1) intermediate T2 signal 2)well-circumscribed 3) lobulated tumor and 4) a dark peripheral rim. Majority of DACs were lobulated (79.4% vs 5.7%), with a dark peripheral rim on T2 weighted imaging (55.9% vs 4.3%) and had ≥3 MRI features compared to PAC (73.6% vs 7.2%) (all p &lt; 0.001). Moreover, a higher proportion of pure DACs were lobulated (100% vs 5.7%), had a dark peripheral rim (94.7% vs 4.3%) and ≥3 MRI features (100% vs 7.2%) compared to PAC (all P &lt; 0.001). There were no differences in median T2 contrast enhancement, ADC values or ADC ratios between the groups. Using our criteria MRI demonstrated sensitivity of 73.5%, specificity of 92.9 %, PPV of 90.9%, and NPV of 78.3% in diagnosing DACs if ≥3 features were present. In the diagnosis of pure DACs, MRI demonstrated sensitivity of 100%, specificity of 92.9%, PPV of 95.2%, and NPV of 100%. The area under the curve (AUC) for the diagnosis of all DACs was 0.81 and 0.98 for pure DACs. Conclusions: The presence of ≥3 features (well-circumscribed, lobulations and a dark peripheral rim and intermediate signal on the T2 phase) on prostatic MRI can help differentiate DAC from PAC. While this is the largest cohort of DACs to be analyzed, further studies are needed to validate these findings.
慢性阻塞性肺疾病相关肺动脉高压诊疗策略进展
Authors: 薛鸿, 解卫平, 王虹
Journal: BMJ (2012)

慢性阻塞性肺疾病(COPD)患者出现肺动脉高压时,在临床上并无特异症状,较难诊断.右心导管检查仍是目前诊断肺动脉高压的金标准,超声心动图作为无创检查应用广泛,但误诊率相当高.目前,尚缺乏治疗COPD相关肺动脉高压的理想手段,长期氧疗是惟一证明能减轻肺动脉高压的方法.不建议使用传统的血管扩张剂如钙离子拮抗剂,用新型血管扩张剂治疗COPD相关肺动脉高压尚缺乏大规模研究,对小规模研究结果争议较大。
Clinical progress of compression therapy in treatment of venous leg ulcers
Authors: Can Lu, Kejia Kan, Haozhe Qi, Shuofei Yang, Jiaquan Chen, Hui Xie
Journal: BMJ (2017)

Venous leg ulcers (VLU) are open skin lesions of the lower extremities that occur in an area affected by venous hypertension. Due to the long healing time, high prevalence and recurrent rate, VLU always comes with a heavy economic burden that affects the quality of life of the patients. Currently, compression therapy is the main approach for treatment of VLU. However, which is the most effective device for compression therapy is still controversial. This article reviews the cutting-edge advances of the clinical compression therapy for VLU, which would provide a reference for clinicians to set an optimal strategy for VLU treatment.


Key words: 
Varicose ulcer, lower extremity; Compression bandages
Clinical features and neuroimaging analysis of hemichorea and non-ketotic hyperglycemia
Authors: Min Wang, Xiaoling Wang, Huaiqiang Hu
Journal: BMJ (2014)

Three cases of nonketotic hyperglycemia plus hemichorea were treated from 2011 to 2012. And the clinical data, radiological diagnosis and treatment were retrospectively analyzed. Three patients were all elderly diabetics with an onset level of glucose> 20 mmol/L and negative urine ketone. Dance symptoms involved unilateral extremity and/or face. Cranial computed tomography showed high-density lesions in contralateral putamen and caudate nucleus head. And magnetic resonance imaging detected T1WI high signal, T2WI slightly low or equal signals. The diagnosis was based on clinical features and imaging manifestations. The primary treatment was lowering blood sugar plus uses of haloperidol, chlorpromazine and other drugs when necessary. Three cases were all cured.


Key words: 
Hyperglycemia, nonketotic; Chorea; Diagnostic imaging
Distribution of intra-/extracranial large-artery disturbance of patients with ischemic stroke or transient ischemic attack
Authors: Yan-wen Fang
Journal: BMJ (2013)

Objective
To explore the distribution characteristics of intra/extracranial large-artery disturbance in patients with ischemic stroke (IS)/transient ischemic attack (TIA).


Methods
The medical history information of 169 IS/TIA patients was recorded. The results of laboratory examination, electrocardiogram, echocardiography, abdominal ultrasound and chest radiography were analyzed. At the same time, the intra/extra-cranial large arteries were examined to analyze the degree, distribution and pattern of their disturbance.


Results
Among them, there were intra/extra-cranial large-arterial stenosis (n=112, 66.3%) and small-arterial disturbance (n=57, 33.7%). Multiple vascular disturbance pattern was more common in patients with intra/extra-cranial large-arterial stenosis (n=71, 63.4%). The incidence of intracranial large-arterial stenosis was significantly higher than that of extracranial large-arterial stenosis (53.8% vs. 35.5%, P<0.05). And middle cerebral artery was the most commonly affected artery, 36 of those were culprit vessels accounting for 73.5%(36/49).


Conclusions
The IS/TIA patients have a high incidence of intra/extra-cranial large-arterial stenosis. Multiple vascular disturbance is a more common pattern. The incidence of intracranial large-arterial stenosis is greater than that of extracranial and middle cerebral artery is the most common affected artery.


Key words: 
Cerebrovascular accident; Arteriostenosis; Intracranial arteriosclerosis
Development and validation of a risk prediction model for poor performance status and severe symptoms among cancer patients.
Authors: Hsien Seow, Peter Tanuseputro, Lisa Catherine Barbera, Craig Earle, Dawn Guthrie, Sarina Isenberg, Rosalyn A. Juergens, Melissa C. Brouwers, Jeffrey Myers, Rinku Sutradhar
Journal: Journal of Clinical Oncology (2020)

12097 Background: Existing cancer predictive tools focus on survival, but few incorporate patient-reported outcomes to predict quality-of-life domains, such as symptoms and performance status. The objective was to develop and validate a predictive cancer model (called PROVIEW) for poor performance status and severe symptoms over time. Methods: We used a retrospective, population-based, cohort study of patients, with a cancer diagnosis, in Ontario, Canada between 2008-2015. We randomly selected 60% of patients for model derivation and 40% for validation. Using the derivation cohort, we developed multivariable logistic regression models with baseline characteristics, using a backward stepwise variable selection process. The primary outcome was odds of having poor performance status six months from index date, as measured by a score &lt; = 30 out of 100 on the Palliative Performance Scale. The index date for each model was diagnosis (Year 0), which was then re-calculated at each of 4 annual survivor marks after diagnosis (up to Year 4). Secondary outcomes included having severe pain, dyspnea, well-being, or depression, as measured by a score of &gt; = 7 out of 10 on the Edmonton Symptom Assessment System. Covariates included demographics, clinical information, current symptoms and performance status, and healthcare utilization. Model performance was assessed by AUC statistics and calibration plots. Results: Our population-based cohort identified 125,479 cancer patients for the performance status model in Year 0. The median diagnosis age was 64 years, 57% were female, and the most common cancers were breast (24%), lung (13%), and prostate (9%). 32% had Stage 3 or 4 disease. In Year 0 after backwards selection, the odds of having a poor performance status in 6 months was increased by more than 10% when the patient had: COPD, dementia, diabetes; radiation treatment; a hospital admission in the prior 3 months; high pain or depression; a current performance status &lt; = 30; any issues with appetite; or received end-of-life homecare. Generally, these variables were also associated with a &gt; 10% increased odds in other years and for the secondary outcomes. The average AUC across all 25 models is 0.7676 which indicates high model discrimination. Conclusions: The PROVIEW model accurately predicts risk of having a poor performance status or severe symptoms over time among cancer patients. It has the potential to be a useful online tool for patients to integrate earlier supportive and palliative care.
Non-user physician perspectives about an oncology clinical decision-support system: A qualitative study.
Authors: Hermano Alexandre Lima Rocha, Srinivas Emani, Carlos Andre Moura Arruda, Rubina Rizvi, Pamela Garabedian, Camila Machado de Aquino, Winnie Felix, Rezzan Hekmat, Megan Sands-Lincoln, Pedro Meneleu, Gretchen Purcell Jackson, David Westfall Bates, Sergio Ferreira Juaçaba
Journal: Journal of Clinical Oncology (2020)

e14061 Background: Advances in artificial intelligence (AI) continue to expand capabilities within the healthcare domain, particularly in the discipline of oncology. Watson For Oncology (WfO) is an AI-enabled clinical decision support system that presents potential therapeutic options for cancer-treating physicians. The objectives of this study were to identify non-user physicians’ expectations, perceived challenges and benefits of WfO use in Brazil. Methods: The study took place at Instituto do Câncer do Ceará (ICC), a Brazilian oncology hospital that implemented WfO in December 2017, but not all physicians adopted the tool. Physicians who had not used WfO (n = 5) were recruited through purposive sampling identified with the assistance of local research personnel. Semi-structured interviews were conducted in Portuguese and later de-identified and transcribed into English. A thematic analysis of interview data based on grounded theory by two members of the research team with extensive experience in qualitative data analysis was conducted. Results: Non-user physicians had positive perceptions about WfO, along with several concerns and uncertainties. They expected that WfO would be easy to learn, useful, and helpful. Physicians perceived that WfO would provide a more standardized approach to treatment than care without it. They also believed that WfO would play a supportive and not a substitute role in care especially for complex cases in which the physicians had more in-depth knowledge of a patient and already had an established patient-provider relationship. Physicians did expect WfO use to negatively impact productivity, specifically through longer office times per patient because of the need to enter data and review recommendations. Physicians questioned whether the use of WfO would negatively impact their autonomy and role in providing care. Finally, physicians also questioned whether the treatment suggested by WfO would fit the social context of a low-middle income country such as Brazil with limited technological and economic resources. Conclusions: The implementation of US-developed AI technologies, such as WfO, should be further explored in different social and economic contexts. Physician concerns about productivity and autonomy need to be assessed and addressed in AI implementation; one strategy is to leverage previous lessons learned from electronic health record (EHR) implementations. This study is a critical step in understanding potential user perspectives in adopting a new AI tool in different social contexts.
Endocrine therapy adherence of premenopausal Mexican breast cancer patients.
Authors: Cynthia Villarreal-Garza, Fernanda Mesa-Chavez, Ana Sofia Ferrigno, Cynthia De la Garza-Ramos, Karen Villanueva-Tamez, Alan Fonseca, Jose Yair Campos-Salgado, Claudia Pineda, Marisol García-García, David Omar Rodriguez, Marlid Cruz-Ramos, Paula Cabrera-Galeana
Journal: Journal of Clinical Oncology (2020)

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.
Trousseau syndrome with multiple acute cerebral infarction as initial presentation: a clinical analysis of 12 cases
Authors: Liru Guo, Yanqing Li, Lantao Wang, Yaqiong Jia, Yazhu Zhou
Journal: BMJ (2019)

Clinical data of 12 cases of Trousseau syndrome with cerebral infarction as initial presentation admitted in the neurology department of the Fourth Affiliated Hospital of Hebei Medical University from December 2011 to December 2017 were retrospectively analyzed. Of the 12 patients, 4 cases had risk factors for cerebral infarction and 8 ones had no risk factors. There were 2 patients with 1 lesion and 10 patients with two or more lesions in brain imaging. The infarction lesions of 9 patients were located in 2 or more arterial blood supply areas. Ten patients showed an elevated plasma D-dimer level, 5 had elevated fibrinogen level, 7 showed increased blood platelet count and 8 had increased homocysteine level. Ten cases were confirmed by pathology, 2 cases by clinic and imaging diagnosis. The study suggests that multiple lesions with several cerebral arteries involved, high plasma D-dimer and fibrinogen levels may be the clinical characteristics of Trousseau syndrome with initial presentation as acute ischemic stroke and lacking of risk factors. The hypercoagulation state may be the important pathogenesis of this disorder.


Key words: 
Neoplasms; Cerebral infarction; Signs and symptoms
Initially unresectable hepatocellular carcinoma treated by combination therapy of tyrosine kinase inhibitor and anti-PD-1 antibody followed by resection.
Authors: Hui-Chuan Sun, Xiao-Dong Zhu, Cheng Huang, Ying-Hao Shen, Yuan Ji, Ning-Ling Ge, Chang-Jun Tan, Jian Zhou, Jia Fan
Journal: Journal of Clinical Oncology (2020)

e16690 Background: Combination of tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody showed a high tumor response for advanced hepatocellular carcinoma (HCC). We are aiming to study the effect of combination therapy followed by resection in pts with initially unresectable HCC. Methods: 60 consecutive pts with unresectable or advanced HCC were treated with combination therapy as first-line treatment, including 2 in BCLC-A (China Liver Cancer stage [CNLC]-Ib), and 13 in BCLC-B (CNLC-IIa and IIb), 26 in BCLC-C (vascular invasion, CNLC-IIIa) and 19 in BCLC-C (extrahepatic metastasis, CNLC-IIIb). Tumor response and resectability were evaluated by imaging every 2 months (± 1 week). The criteria of resectability included: (1) R0 resection can be achieved; (2) remnant liver volume ≥ 40%; (3) Child-Pugh score is 5; (4) no contra-indications for hepatectomy. Results: Conversion to resectable HCC was identified in 11 (18.3%) pts after combination therapy. Of them, 2 pts are still under treatment for immune-related adverse events, and 9 underwent hepatectomy as of January 2020. Of the 9 pts, the initial tumor was unresectable because of macro-vascular invasion (n = 6, 1 Vp3, 3 Vp4, 1 hepatic vein, 1 inferior vena cava), extrahepatic metastasis (n = 1, right adrenal gland), tumor nodules ≥ 4 (n = 1) and recurrent HCC within 2 months after first resection (n = 1). The TKIs used were lenvatinib (n = 6) and apatinib (n = 3); anti-PD-1 antibodies used were pembrolizumab (n = 4), sintilimab (n = 3), camrelizumab (n = 1) and nivolumab (n = 1). The median interval between start of combination therapy and resection was 99 days (range, 73–251). The median post-operative hospital stay was 14 days (range, 11–68). The prevalence of post-hepatectomy liver dysfunction (the criteria by ISGLS) is 5 (55.6%) pts, and the post-operative complications (by Clavien–Dindo classification) occurred in 4 (44.4%) pts, including grade I in 1, grade IIIa in 2, and grade V in 1 (died from immune-related adverse events). Tumor response (RECIST v1.1) evaluated before surgery were PR (n = 5), SD (n = 3), and PD (n = 1). Pathological CR (pCR) was found in 5 (55.6%) cases. After a median follow up of 72 days (range, 11–184), tumor recurrence were diagnosed in 1 patient, and mortality without tumor recurrence in 1 patient, the other 7 cases remained tumor-free. Conclusions: This is to date the largest cohort of pts underwent R0 resection after combination therapy for initially un-resectable HCC. The combination of a TKI and anti-PD-1 antibody is feasible as a conversion therapy.