tbuckley/cabot-search huggingface dataset:
Association between nonalcoholic fatty liver disease and serum magnesium level in patients with type 2 diabetes mellitus
Authors: Fuhong Zhang, Xianghai Zhou, Xin Wen, Sha Li, Le Han, Da Chen
Journal: BMJ (2018)

Objective
To investigate the association between nonalcoholic fatty liver disease (NAFLD) and serum magnesium level in patients with type 2 diabetic mellitus (T2DM).


Methods
Clinical data of 1 273 consecutive patients with T2DM admitted in hospital from June 2013 to June 2017 were retrospectively analyzed. According to the quartile of serum magnesium levels, patients were divided into 4 groups: Q1 group (≤ 0.79 mmol/L, n=376), Q2 group (0.80-0.84 mmol/L, n=296), Q3 group (0.85-0.89 mmol/L, n=287) , and Q4 group (≥0.90 mmol/L, n=314). Logistic regression was used to analyze the association between NAFLD and serum magnesium level.


Results
The average age of the study population was (56.4±13.8) years, males accounted for 52.7%(671/1 273), NAFLD patients accounted for 58.4%(743/1 273). The prevalence of NAFLD in Q4, Q3, Q2 and Q1 groups was 53.8%(169/314), 52.6%(151/287), 57.4%(170/296) and 67.3%(253/376), respectively (χ2=19.00, P=0.000). Logistic regression showed that compared with the Q4 group, OR(95%CI) for NAFLD in the Q1 group was 1.49 (1.03-2.16), Ptrend=0.011 after adjusting for age, sex, duration of diabetes, BMI, systolic blood pressure, alcohol consumption, TG, glycosylated hemoglobin and serum uric acid. After further adjusting for estimated glomerular filtration rate (eGFR), OR(95%CI) for NAFLD was 1.33 (0.92-1.94) and Ptrend=0.065 in the Q1 group compared with the Q4 group.


Conclusion
Reduction in serum magnesium is associated with an increased risk of NAFLD in T2DM patients, and eGFR may be a confounding factor.


Key words: 
Diabetes mellitus, type 2; Fatty liver; Magnesium, serum; Cross-sectional studies
Endoscopic ultrasound-guided colojejunal anastomosis: new treatment management for enteral occlusion
Authors: Mohamed Gasmi, Jean-Michel Gonzalez, Arthur Falque, Marc Barthet
Journal: Endoscopy (2020)

Digestive obstruction can be the final issue arising from digestive carcinoma with peritoneal carcinomatosis [1]. Endoscopic ultrasound (EUS)-guided gastrointestinal anastomosis has been developed to manage malignant gastric outlet obstruction with clinical results similar to that of surgical laparoscopy or endoscopic endoluminal stenting [2] [3] [4]. In some patients with advanced digestive adenocarcinoma, the development of peritoneal carcinomatosis can lead to local obstruction, sometimes located in the small bowel with upstream dilatation that can be treated neither endoscopically nor surgically [1]. Here we present an endoscopic technique that allows bypassing the distal bowel obstruction by performing an EUS-guided colojejunal anastomosis with a lumen-apposing metal stent (LAMS).
以循证医学方法指导临床教学
Authors: 蒋宏传
Journal: BMJ (2007)

传统医学教学是一种以知识为本位的教学,它把教学内容看成是固定的,确定无误的东西,要求学生死记硬背,以教师为主,强调教师的绝对权威.而在临床实践中,医师根据个人或上级医师传授的经验和技能指导医疗实践,以经验式、灌输式的教学活动为主。
The impact of comorbidities and adverse events on quality of life in patients with <i>EGFR</i>-mutated non-small-cell lung cancer (NSCLC) receiving epidermal growth factor receptor tyrosine kinase inhibitors therapy: A multicenter prospective study.
Authors: Jung Yueh Chen, Kuan-Yu Chen, Yu-Feng Wei, Sheng-Kai Liang, Tsu-Yi Chuang
Journal: Journal of Clinical Oncology (2020)

e21708 Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the standard first-line treatment for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, the impact of comorbidities and treatment-related adverse events (AE) on quality of life (QOL) in patients receiving EGFR-TKI therapy was seldom investigated in a prospective setting. Methods: We conducted a prospective observational study to evaluate the association of comorbidity, AEs, and QOL in patients with EGFR-mutated advanced NSCLC receiving EGFR-TKI as first-line therapy among four hospitals in Taiwan. The questionnaires for QOL and AEs were obtained at baseline, the 2nd, 4th, 12th, and 24th week. Comorbidities were evaluated at baseline by using Simplified Comorbidity Score (SCS). The QOL was assessed by using EORTC QLQ-C30, QLQ-LC-13, and dermatology life quality index (DLQI). Paronychia related to oncologic treatments (SPOT) scale was used for paronychia severity evaluation. Visual analogue score (VAS) was applied for pain and itching evaluation. AE was recorded by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The correlations between QOL and comorbidities as well as AEs were analyzed by generalized estimating equation. Results: A total of 110 patients were included. Comorbidities were not associated with QOL deterioration (p= 0.209). While assessed by QLQ-LC13, mucositis (p= 0.001), elevated aminotransferase levels (p= 0.046), and use of oral antibiotic for dermatitis (p= 0.009) were associated with QOL deterioration. There was no significant difference in QOL among patients receiving afatinib, erlotinib, or gefitinib therapy. Gefitinib and afatinib showed a trend of improved QOL assessed by QLQ-C30 and LC13, whereas erlotinib with a trend of deteriorated QOL by LC13 (effect size = 0.07). For dermatological toxicities, a trend of deterioration in QOL was observed by DLQI assessment in patients received erlotinib (effect size = 7.44) or afatinib (effect size = 0.71). SPOT scale was higher in patients taking afatinib (p= 0.002). VAS pain score was higher in those taking afatinib (p= 0.005) or erlotinib (p= 0.049). Conclusions: Comorbidities and the choice of EGFR-TKI have no impact on overall QOL in advanced NSCLC patients receiving EGFR-TKI therapy. Mucositis, impaired liver function, and dermatitis needed oral antibiotics use may lead to a QOL deterioration.
Updated entrectinib data in children and adolescents with recurrent or refractory solid tumors, including primary CNS tumors.
Authors: Ami Vijay Desai, Giles W. Robinson, Ellen M. Basu, Jennifer Foster, Karen Gauvain, Amit Sabnis, Suzanne Shusterman, Margaret E Macy, Luke Maese, Janet Yoon, Thomas Cash, Mohamed Abdelbaki, Kellie Nazemi, Brian D. Weiss, Saibah Chohan, Alison Cardenas, Katherine Hutchinson, Guillaume Bergthold, Amar J. Gajjar, Elizabeth Fox
Journal: Journal of Clinical Oncology (2020)

107 Background: The phase 1/2 STARTRK-NG trial (NCT02650401) is evaluating entrectinib, a CNS-penetrant oral inhibitor of TRK, ROS1 and ALK tyrosine kinases, in children and adolescents &lt; 21 years old with recurrent/refractory solid tumors, including primary CNS tumors. Methods: After determining the recommended dose as 550mg/m 2 /day in all-comers, expansion cohorts with gene-fusion-positive CNS/solid tumors ( NTRK1/2/3 and ROS1) are being enrolled. Results: As of 1 July 2019 (data cut-off), 34 patients (4.9 months to 20 years old; median age 7 years) have been evaluated for response to treatment with entrectinib. Responses were classified as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) using RANO for CNS tumors, RECISTv1.1 for solid tumors, or Curie score for neuroblastomas. Responses in fusion-positive patients were assessed by blinded independent central review (BICR), and occurred at doses ≥400mg/m 2 . Best responses in patients with fusion-positive CNS tumors (n = 8) were four CR ( ETV6-NTRK3, EML1-NTRK2, GOPC-ROS1, and TPR-NTRK1), two PR ( KANK1-NTRK2 and EEF1G-ROS1), and two PD ( EML4-ALK and PARP6-NTRK3). In patients with fusion-positive solid tumors (n = 6) best responses were three CR ( DCTN1-ALK, ETV6-NTRK3, and ETV6-NTRK3), and three PR ( TFG-ROS1, EML4-NTRK3, and KIF5B-ALK). Responses (Investigator-assessed) in patients with non-fusion tumors (n = 20) were one CR ( ALK F1174L mutation), four SD, ten PD, and five patients were unevaluable or had no data. The objective response rate (defined as the total number of CR and PR) in fusion-positive patients was 86% (12/14) versus 5% (1/20) in non-fusion patients. Similarly, PFS was 17.5 months (95% CI 7.4–NE) in fusion-positive patients versus 1.9 months (1.8–5.7; p = 0.0002) in non-fusion patients. Most commonly reported treatment-related adverse events included weight gain (n = 14 [5 Grade 3/4]), elevated creatinine (n = 13), anemia (n = 13), nausea (n = 11), increased ALT (n = 10 [1 Grade 3/4]), increased AST (n = 10 [1 Grade 3/4]), decreased neutrophils (n = 9 [6 Grade 3/4]), and bone fractures (n = 7, of which 4 were treatment related). Conclusions: In children and adolescents &lt; 21 years old, entrectinib has produced striking, rapid, and durable responses in solid tumors with target gene fusions, especially in high-grade CNS neoplasms. Clinical trial information: NCT02650401.
Radiographic paradoxical response in patients with metastatic castrate-resistant prostate cancer (mCRPC) undergoing treatment with second-generation hormone therapy (second-HT).
Authors: Jamal Alamiri, Mohamed E. Ahmed, Jack R. Andrews, Ayca Dundar, Giovanni Motterle, Jeffrey Karnes, Eugene D. Kwon, Alan Haruo Bryce, Ayse T. Kendi, Michael S. Bold
Journal: Journal of Clinical Oncology (2020)

5577 Background: Prostate specific antigen (PSA) has well-recognized limitations as a marker for treatment response and disease progression. A post hoc analysis of the PREVAIL trial reported 24.5% of chemotherapy naïve mCRPC patients on enzalutamide had radiographic progression on conventional imaging with non-rising PSA. In this study, we sought to retrospectively compare PSA levels with C-11 choline positron emission tomography/ computed tomography (PET/CT) images in patients with m-CRPC on 2 nd -HT with prior use of chemotherapy. Methods: We identified 123 patients with mCRPC on 2 nd -HT following prior use of docetaxel chemotherapy (Abiraterone, n = 106; Enzalutamide, n = 17). Patients underwent serial PSA testing and C-11 choline PET/ CTs every 3–6 months. Disease progression was defined by the increase in blood pool corrected maximum standardized uptake value (SUVmax) of the index lesion on C-11 choline PET/CT scan. Suspicious lesions were confirmed by biopsy and/or conventional imaging. Results: Approximately 43% (n = 53) of patients had radiographic disease progression while on 2 nd -HT. At time of radiographic progression, 60.4% of patients showed a parallel rise in PSA (Group-A), while 39.6% showed a paradoxical response; defined as radiographic progression with stable or down-trending PSA (Group-B). Median PSA at time of progression was 3.1 ng/ml for Group-A, and 1.3 ng/ml for Group-B (p-value = 0.0176). Median SUVmax was the same (4.9 Group-A, 4.6 Group-B; p-value = 0.6072). Bone-predominance progression was more significant in Group-B (90%) versus Group-A (65%) (p-value = 0.0309). The median time for radiographic progression was 9.5 months versus 3.9 months for Group-A and Group-B, respectively (Log-Rank = 0.0063). Conclusions: Metabolic imaging is a useful tool that should complement PSA in the evaluation of treatment response and disease progression in mCRPC patients on 2 nd -HT, especially considering the paradoxical response observed in our data.
3,3'-Diindolylmethane (DIM): A nutritional intervention and its impact on breast density in healthy BRCA carriers compared to non-treated carriers—A prospective clinical trial.
Authors: Rinat Yerushalmi, Sharon Bargil, Yaara Ber, Rachel Ozalvo, Sivan Sela, Yael Rapson, Adi Pomerantz, Dalia Tsoref, Eran Sharon, Opher Caspi, Ahuva Grubstein, David Margel
Journal: Journal of Clinical Oncology (2020)

1556 Background: Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol (I3C) found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast-cancer risk. Methods: Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mgx1/d for one year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention were scored by two independent expert radiologists using the Breast Imaging and Reporting Data System (BI-RADS). Each woman in the cohort was matched by age (within 3 years) and menopausal status to a woman attending the clinic who was not participating in the study and who underwent breast MRI in parallel year. Results: A decrease in the average score for FGT amount from 2.8±0.8 at onset to 2.65±0.842.8 after one year (p = 0.031), with no significant change in BPE (p = 0.429). A group of DIM-untreated age- and menopausal-status-matched clinic patients did not show a significant change in FGT amount (p = 0.33) or BPE (p = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/L (p = 0.01), and mean testosterone level, from 0.42 to 0.31 pmol/L (p = 0.007). Side effects were grade 1. Conclusions: One year’s supplementation with DIM 100 mgX1/d in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings. Clinical trial information: NCT02197000.
Challenges for endoscopic antireflux procedures
Authors: Stephen E. Attwood
Journal: Endoscopy (2020)

The 1-year outcome of improvement in reflux symptoms after ultrasound-guided transoral incisional fundoplication (TIF) with the Medigus ultrasonic surgical endostapler (MUSE) reported in this issue by Testoni et al. [1] is an important contribution to the literature in the developing field of alternative methods of anatomical and functional repair for the lower esophageal sphincter (LES) in gastroesophageal reflux disease (GERD). In order to be a valid improvement on current therapeutic options, TIF with MUSE needs to compare favorably with laparoscopic Nissen fundoplication, and with other new technologies, such as magnetic sphincter augmentation (LINX) or endoscopic microwave therapy (Stretta).
新生儿无眼畸形一例
Authors: 李丽红
Journal: BMJ (2011)

患儿男性,孕1产1,孕42+6周,因“宫内窘迫、脐绕颈2周”于外院剖腹产出生,出生体重2900 g,Apgar评分l min 8分,5 min 8分(扣分原因不详).出生6小时20分因产院体检后考虑患儿胎脂多、乳晕结节小、足纹浅,疑是“早产儿”,即由120转送我院,经初步检查为适宜胎龄儿,简易胎龄评估为39周,收住新生儿科,并完善相关检查.人院当晚反复出j现面色青紫、氧饱和度下降,心率、呼吸增快,呼吸困难.心前区可见心尖搏动,心音亢进,可闻及Ⅲ级收缩期吹风样杂音,双肺呼吸音粗.白细胞33×109/L,分类中性粒细胞0 817,高敏C反应蛋白5.6 mg/L;床旁X线胸片提示右侧肺炎、气胸、膈疝、肺隔离症;头颅B超未见异常. 关键词：无眼畸形
Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood
Authors: Ylva B. Almquist, Yerko Rojas, Bo Vinnerljung, Lars Brännström
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited. <h3>Objective</h3> To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood. <h3>Design, Setting, and Participants</h3> This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016. <h3>Exposures</h3> Childhood experiences of OHC based on information from the Social Register (age 0-19 years). <h3>Main Outcomes and Measures</h3> Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years). <h3>Results</h3> In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions. <h3>Conclusions and Relevance</h3> The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.
被忽视了的主要病情
Authors: 曾昭耆
Journal: BMJ (2007)

患者男,62岁,因发热20余天,于1975年8月21日入院.患者于1961年(当时48岁)曾患中毒性痢疾于外院住院治疗,昏迷2 d,其后常有肝区痛,肝大曾达右肋缘下4横指(约6 cm);十二指肠引流液见脓细胞满视野,经该院内科治疗7个月未见好转.原拟做胆囊切除术,但肝穿刺发现广泛性肝细胞坏死而未手术.其后出现过三四次高热,伴腹胀及肝区痛.曾由几位著名专家诊治,仍无效.20多天来,反复发热,肝区痛如刀割.数次来门、急诊就医,用过多种抗生素,效果不明显.因病因不明,故收入我院诊治。
Clinical analysis of 23 cases of histiocytic necrotizing lymphadenitis presented as fever of unknown origin
Authors: Wei Wang, Xiaochun Shi
Journal: BMJ (2016)

We retrospectively analyzed 23 cases of histiocytic necrotizing lymphadenitis (HNL) admitted to our hospital as fever of unknown origin (FUO). Fever, lymphadenopathy and skin rash were the most common clinical manifestation. The major laboratory features included cytopenia, abnormal liver enzyme and elevated inflammatory markers. Three of the 23 cases were finally diagnosed as infectious disease, 5 as autoimmune disease, while the left 15 remained as HNL during the follow-up. Four of the 15 HNL patients resolved spontaneously, while the other 11 relieved by steroid use. Two patients relapsed during the follow-up. HNL was one of the rare causes of FUO. Since it would be accompanied with infectious, autoimmune or malignant diseases, long follow-up is necessary.


Key words: 
Histiocytic necrotizing lymphadenitis; Fever of unknown origin; Pathological conditions, signs and symptoms
Perception of residents towards general practitioners and their services in Shijiazhuang
Authors: Xiao Zhi, Feng Li, Zhenyin He, Rongying Wang, Weijie Wang
Journal: BMJ (2016)

Objective
To survey the perception of community residents towards the general practitioners and their services in Shijiazhuang.


Methods
Questionnaire survey on the perception of community residents toward general practitioners was conducted among 540 residents in Shijiazhuang with different gender, age, education levels by random sampling.


Results
The number of valid questionnaires returned was 509. Among the residents investigated, only 5.1% (26/509) knew general practitioners, 32.6% (166/509) knew a little about general practitioners, and 13.0% (66/509) residents had never heard of general practitioners. The internet was the main approach to understand general practitioners for the residents ≤45 yr (46.9%, 89/190), and the television report was the main approach to understand general practitioners for the residents above 45 yr (21.4%, 28/131). The proportion of requirement for general practitioners was highest in the residents aged 31-45 yr (75.6%, 133/176), and lowest in the residents aged ≤30 yr (59.4%, 120/202); there was significant difference between different age groups (P=0.013). There was no significant difference in the requirement for general practitioners between residents of different occupations and education levels (P>0.05). 78.0% (398/509) residents showed their willingness to accept the home service provided by general practitioners, and only 9.6% (49/509) were not willing to accept home service. 51.7% (263/509) residents showed that they were willing to consider the community health center as the first choice, 8.1% (41/509) residents were not willing. 40.3% (205/509) residents would make their decision till the general practice system shows its effectiveness. 41.5% (211/509) residents thought that it was reasonable if the service was offered on a yearly subscription basis, 14.1% (72/509) residents thought that it was unreasonable, and 44.4% (226/509) residents showed a wait-and-see attitude.


Conclusion
The perceptive level of residents towards general practitioners is not high, but the requirement for services is higher, and most residents show their willingness to accept the home services and considering the community health center as the first choice, but high proportion of residents shows a wait-and-see attitude toward the yearly subscription, and thus it is necessary to raise the perception of community residents towards the general practice in Shijiazhuang.


Key words: 
Questionnaires; Community health services; General practitioners
Opportunities and challenges in cervical cancer screening program in Kazakhstan: Results after imPACT review.
Authors: Dilyara Kaidarova, Raikhan Bolatbekova, Alma Zhylkaidarova, Tolkyn Sadykova, Yerlan Kukubassov, Askar Aidarov, Alima Satanova
Journal: Journal of Clinical Oncology (2020)

e18020 Background: Cervical cancer is the second most common cancer in women worldwide, where the majority of registered patients are in developing countries. Screening programs in developed countries have reduced morbidity and mortality from cervical cancer by more than 2 times. Cervical cancer (CC) is the most common gynecological cancer in Kazakhstan (KZ). Standardized incidence rate of CC was 18.2 per 100,000, while the mortality rate was 6.2 per 100,000, in 2019. The National Cervical Screening program in KZ uses cytology (Pap test) from 2008. Screening program funded by the State budget. In 2016, Experts of imPACT Mission analyzed the CC screening and made recommendations for improvement. Since 2018 target age of CC screening expanded to 30-70 years and shortened the interval to 4 years, strengthened the control of patients with pre-cancerous pathology. Until 2018, people came to a fixed age; today we start CC screening within the target age at any age at the time of the first visit. The purpose of this study is to analyze cytological screening results in KZ after imPACT recommendations. Methods: Coverage, the number of screened women, the level of pre-cancer detection and cervical cancer during screening have been obtained from specific reports (form № 025, № 08) for 2008-2019. Results: The total number of screened women was in 6.775.975. There is a decrease in the number of screened women by 32% from 2008 to 2017. Since improvement of CC screening we increased coverage from 49.9% in 2017 (abs. number 409.124) to 89% in 2019 (abs. number 954.322). According to the results of screening, 2603 cases of CC were registered in 12 years. Analysis of screening results showed a marked increase in the detection of CC with an increasing by 67%. The persentage of registered cases of ASH+HSIL increased from 0.136% to 0.673%. Conclusions: there has been an increase in the coverage by screening of the target population since the screening update. During the study period, there has been an improvement in the detection of precancerous pathology and cancer in the early stage. Despite the positive results of screening, sufficient coverage by screening, certain successes in detecting the initial stage of CC, mortality rate from CC remain high, which makes it necessary to improve the screening of CC in KZ through the introduction of HPV-screening.