tbuckley/cabot-search huggingface dataset:
Association of Skin Psoriasis and Somatic Comorbidity With the Development of Psychiatric Illness in a Nationwide Swedish Study
Authors: Kirk Geale, Martin Henriksson, Jussi Jokinen, Marcus Schmitt-Egenolf
Journal: JAMA Dermatology (2020)

<h3>Importance</h3> Psoriasis is a complex systemic disease with skin involvement, somatic comorbidity, and psychiatric illness (PI). Although this view of psoriasis is widely accepted, potential synergies within this triad of symptoms have not been adequately investigated. <h3>Objectives</h3> To investigate the independent association of skin psoriasis and somatic comorbidity with the development of PI and to assess whether skin psoriasis and somatic comorbidity act synergistically to produce a risk of PI that is greater than the additive associations. <h3>Design, Setting, and Participants</h3> Participants were enrolled between January 2005 and December 2010, in this retrospective matched case-control study using secondary (ie, administrative), population-based registry data from Swedish patients in routine clinical care. The dates of analysis were March 2017 to December 2019. Participants were patients with skin psoriasis and control participants without psoriasis matched on age, sex, and municipality, who were all free of preexisting PI. <h3>Exposures</h3> Presence of skin psoriasis and somatic comorbidity (captured through the Charlson Comorbidity Index and the Elixhauser Comorbidity Index). <h3>Main Outcomes and Measures</h3> Risk of PI onset (composite of depression, anxiety, and suicidality) is shown using Kaplan-Meier curves stratified by the presence of skin psoriasis and somatic comorbidity. Adjusted associations of skin psoriasis and somatic comorbidity with the development of PI were analyzed using Cox proportional hazards regression models, including interactions to assess synergistic associations. The 3 components of PI were also assessed individually. <h3>Results</h3> A total of 93 239 patients with skin psoriasis (mean [SD] age, 54 [17] years; 47 475 men [51%]) and 1 387 495 control participants (mean [SD] age, 54 [16] years; 702 332 men [51%]) were included in the study. As expected, patients with skin psoriasis were more likely to have somatic comorbidity and PI than control participants. Compared with those without skin psoriasis or somatic comorbidity, patients with psoriasis without somatic comorbidity had a 1.32 times higher risk of PI onset (hazard ratio [HR], 1.32; 95% CI, 1.27-1.36;<i>P</i> &lt; .001), whereas patients with psoriasis with somatic comorbidity had a 2.56 times higher risk of PI onset (HR, 2.56; 95% CI, 2.46-2.66;<i>P</i> &lt; .001). No synergistic associations of skin psoriasis and somatic comorbidity with the development of PI were found (HR, 0.93; 95% CI, 0.81-1.04;<i>P</i> = .21). <h3>Conclusions and Relevance</h3> This study found that somatic comorbidity appeared to alter PI onset even more than skin psoriasis. The observed association of skin psoriasis and somatic comorbidity with the development of PI reinforces the need for proactive, holistic treatment of patients with psoriasis.
Clinical and echocardiographic features of left ventricular diverticulum in adults: a report of 4 cases
Authors: Lingyun Kong, Yidan Li, Yafeng Wu
Journal: BMJ (2015)

To explore the clinical and imaging profiles of left ventricular(LV) diverticulum in adults and review the key points for its differential diagnosis. The clinical and imaging features were reviewed for 2 female and 2 male patients clinically diagnosed with LV diverticulum. Their clinical manifestations and electrocardio graphic presentations were nonspecific. On echocardiography, all diverticula, located at LV apex, had a thinned and weakened wall continuing and contracting synchronously with the adjacent LV wall. Two cases were diagnosed as congenital diverticulum without any other cardiac or thoraco-abdominal anomaly. And the other two had existing coronary artery diseases with significantly reduced global and apical LV systolic function. Mural thrombosis in diverticulum was determined in one congenital case. One patient died of cardiac failue. It suggested that LV diverticulum in adults may be congenital and secondary etiologically. The former is mostly isolated and apically situated while the latter often results from regional myocardial ischemia and elevated intracavitary LV pressure at an ill-perfused area. Echocardiography can demonstrate the 2-dimensional and flow hemodynamics of diverticulum in real time so as to facilitate its diagnosis and differential diagnosis.


Key words: 
Diverticulum; Heart ventricle; Echocardiography, Doppler, color
Clinical efficacies of full-thickness suturing plus subcutaneous negative pressure drainage in the prevention of postoperative abdominal wound infection: a report of 68 cases
Authors: Xi Chen
Journal: BMJ (2015)

From April 2011 to October 2013, 68 patients scheduled for complex hepatobiliary and pancreatic surgery underwent full-thickness suturing of abdominal incision with subcutaneous negative pressure drainage. There was no such complications as wound dehiscence or sinus formation. Except for 2 cases of wound infection, primary healing was achieved. Two infected cases were followed up for 1 year and there was incisional hernia. The full-thickness suturing of abdominal incision plus subcutaneous negative pressure drainage could prevent postoperative wound infection and promote wound healing. And this simple and practical approach is worthy of wider clinical application.


Key words: 
Surgical wound infection; Negative-pressure wound therapy
The association of molecular biomarkers with efficacy of pembrolizumab versus paclitaxel in patients with gastric cancer (GC) from KEYNOTE-061.
Authors: Charles S. Fuchs, Mustafa Özgüroğlu, Yung-Jue Bang, Maria Di Bartolomeo, Mario Mandalà, Min-hee Ryu, Caterina Vivaldi, Tomasz Olesinski, Christian Caglevic, Hyun Cheol Chung, Kei Muro, Eric Van Cutsem, Julie Kobie, Razvan Cristescu, Deepti Aurora-Garg, Jia Lu, Chie-Schin Shih, David Adelberg, Z. Alexander Cao, Kohei Shitara
Journal: Journal of Clinical Oncology (2020)

4512 Background: KEYNOTE-061 (NCT02370498) was a randomized, open-label, phase 3 study of pembrolizumab vs paclitaxel in patients with advanced gastric or gastroesophageal junction adenocarcinoma with tumor progression after first-line therapy (N =592). We explored the association of tissue tumor mutational burden (tTMB) status and clinical outcomes in patients with GC enrolled in KEYNOTE-061, including the relationship with PD-L1 combined positive score (CPS) and microsatellite instability-high (MSI-H) status. Methods: In patients from KEYNOTE-061 with evaluable tumor and matched normal whole exome sequencing (WES) data (N = 420; pembrolizumab, 218; paclitaxel, 202), the association of tTMB (continuous log 10 scale) with confirmed ORR and PFS by blinded central radiology review per RECIST v1.1, and OS was evaluated within each treatment arm using logistic regression (ORR) and Cox proportional hazards regression (PFS; OS). The clinical utility of tTMB was assessed using the prespecified cutoff of 175 mut/exome. Clinical data cutoff: October 26, 2017. Results: tTMB was significantly associated (α=0.05) with ORR, PFS, and OS in patients treated with pembrolizumab (one-sided P&lt;0.001) but not paclitaxel (two-sided P&gt;0.600). The area under the receiver operating characteristics curve for tTMB and response (pembrolizumab vs paclitaxel) was 0.68 (95% CI, 0.56-0.81) vs 0.51 (95% CI, 0.39-0.63). Patient outcomes by tTMB cutoff are reported in Table. There was low correlation between tTMB and PD-L1 CPS in both treatment arms (r&lt;0.18). tTMB remained significantly associated with all clinical end points with pembrolizumab after adjusting for PD-L1 CPS and with PFS and OS after excluding MSI-H patients. Conclusions: This exploratory analysis from KEYNOTE-061 is the first to demonstrate a strong association between tTMB and response to pembrolizumab in patients with GC. Data further suggest tTMB is a significant and independent predictor beyond PD-L1 status. Clinical trial information: NCT02370498 . [Table: see text]
Need for systematic de-escalation of care in HER2+ breast cancer patients.
Authors: Tushar Pandey, Tyler M Earnest, John A Cole, Eduardo Braun
Journal: Journal of Clinical Oncology (2020)

e12657 Background: Over the last decade, there has been incredible progress in HER2-positive breast cancer patients with the adoption of targeted therapies like Trastuzumab and Pertuzumab to complement existing chemotherapies. Increasingly neoadjuvant therapy is the preferred method of therapy as it is better able to predict prognosis via pCR as well as guide adjuvant therapeutic strategy in cases with residual tumor. There are now a variety of combination therapies recommended for HER2-positive patients. As new therapies are developed, the standard-of-care shifts towards the regimen with highest pCR rate. The latest regimen being TCHP which produced pCR rates over 60% in clinical trials. While the improvement in pCR rates at a population level is encouraging, there is a growing sentiment among physicians that we may be over treating patients impacting both costs and resulting toxicity. Methods: We performed an analysis of Breast Cancer trials with pCR as the primary end point and stratification available based on HER2+ status. The cost (median insurance reimbursement) was also referenced from a recent ASCO observational study as a proxy for direct costs of drugs. Toxicities were referenced and each regimen scored (TS) from NCCN Evidence Blocks and adverse events from clinical trials. Potential savings were evaluated if a clinician had the ability to individualize regimen choice by patient. We utilized the SimBioSys TumorScope platform to perform in silico simulations to predict response to alternate therapies as it had previously used to analyze potential deescalate between AC-T vs TC in a HER2- cohort. Results: The following regimens were evaluated HP (pCR:17%,TS:1), TH (pCR: 29%,TS: 2) THP (pCR: 46%, TS: 3), TCH (pCR: 43%, TS: 4), TCHP (pCR: 64%, TS: 5), AC-TH (pCR: 43%, TS: 6), AC-THP(pCR: 55%, TS: 7). Based on an in-silico analysis and selection (where pCR was likely with multiple regimens), the lowest cost &amp; toxicity regimen was selected. The estimated average saving per case of over $100,000 for the overall treatment plan . The calculated toxicity score was also reduced by this method to under 4 from the TCHP(5) standard of care. Conclusions: While the results above are estimates and perfection in such individualization may not be possible, an in-silico approach provides a promising solution.
Genital Powder Use and Ovarian Cancer—Reply
Authors: Katie M. O’Brien, Dale P. Sandler, Nicolas Wentzensen
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
Experience of financial burden and distress among people with ovarian cancer.
Authors: Branlyn W. DeRosa, Alexandra Katherine Zaleta, Angela J. Johnson, Kelly A. Clark, Jemeille Ackourey, Sarah DeFeo, Marcia Donziger, Sue J. Friedman, Shannon La Cava, Nita Karnik Lee, Ritu Salani, Alexi A. Wright
Journal: Journal of Clinical Oncology (2020)

e19400 Background: The impact of ovarian cancer (OC) is wide-reaching; this study explored cancer-related financial burden related to cost of care in people ever diagnosed with OC. Methods: 64 OC patients enrolled in Cancer Support Community’s Cancer Experience Registry. Participants provided demographic and clinical history, and completed 1) CancerSupportSource, a validated 25-item tool with anxiety and depression risk subscales, and 2) the 11-item COmprehensive Score for financial Toxicity (COST). Descriptive statistics were calculated for responses; Pearson/Spearman correlations and one-way ANOVA (Tukey post-hoc) were used to explore bivariate associations between financial burden, depression/anxiety risk, and demographic/clinical variables. Results: Participants were 91% non-Hispanic White, mean age = 57 years, SD= 15. 55% were currently receiving treatment (47% chemotherapy); 33% ever experienced metastatic disease. 22% reported annual income of ≤$40,000; 19% were not-employed due to disability. 13% spent $500+/month on out-of-pocket costs; 63% reported that a health care team member did not discuss cost of care with them. 36% did not know if they had enough assets to cover cancer treatment costs; 1 in 10 (11%) reported they could not meet monthly expenses. 1 in 3 reported (“quite a bit” to “very much”) worry about future financial problems resulting from illness/treatment (39%) and frustration that they cannot work or contribute as much as usual (34%). Greater financial burden was associated with lower income ( r= -.40, p= .001), greater out-of-pocket costs ( r= .24, p= .03), and not working due to disability F(5,58) = 3.84, p= .01. Among respondents, 38% were at risk for clinical depression; 44% for anxiety; greater financial burden was related to depression risk ( r = .51, p&lt; .001) and anxiety risk ( r= .32, p= .012). Conclusions: Financial burden affects many people with ovarian cancer and is associated with poorer psychosocial outcomes. Ovarian cancer patients and survivors can benefit from access to comprehensive supportive care resources, including financial counseling. Cancer Support Community offers resources that may help, including a toll-free Helpline with a dedicated financial counselor. Future work will examine multivariate predictors of financial burden in ovarian cancer. Clinical trial information: NCT02333604 .
Prevalence and risk factors of stress urinary incontinence in women in Miyun County in Beijing
Authors: Ai-yang Li, Wan-hui Sun, Yu-hua Zhao, Xiu-hua Zhao, Ai-ju Meng
Journal: BMJ (2012)

To investigate the prevalence and risk factors of stress urinary incontinence in women of Miyun County.Questionnaire survey was conducted in 8665 residents selected from urban and rural areas of Miyun County.Total 8663 questionnaires were completed with a response rate of 99.98％.The prevalence of urinary incontinence was 34.43％ (2983/8663),among which 1790 cases were of stress type with a prevalence rate of 20.66％,414 cases were of urgent type with a prevalence rate of 4.78％ and 779 cases were of mixed type with a prevalence rate of 8.99％.The risk factors of the stress urinary incontinence were advanced age(OR =1.555),BMI≥24 kg/m2 (OR =0.556),alcohol drinking(OR =1.308),constipation (OR =1.360),delivery times≥3(OR =1.998),history of macrosomia-bearing (OR =0.572).

Key words: 
Urinary incontinence,stress; Women
Efficacy of sublingual immunotherapy with Dermatophagodies farianae drops in patients with five type of allergic conjunctivitis
Authors: Hongmei Liu, Fengru Zhong, Xuerong Xiong, Weidong Ye, Xinghua Liu, Xia Liu, Lixia Chen, Jianping Kuang
Journal: BMJ (2014)

A total of 400 patients with 5 types of allergic conjunctivitis were divided into control and treatment groups (n=200 each). The control group took conventional medication while the treatment group received sublingual immunotherapy (SLIT). After 2-year treatment, for perennial allergic, seasonal allergic or atopic angle conjunctivitis, the decreases of medication score in the treatment group were all significantly more than those in the control group (all P<0.01). No serious adverse event was reported. SLIT with Dermatophagodies farianae drops is both safe and effective in patients with perennial allergic, seasonal allergic and atopic angle conjunctivitis. However its efficacies for vernal and giant papillary conjunctivitis require further studies.


Key words: 
Conjunctivitis, allergic; Immunotherapy
A phase II, randomized study of nivolumab (NIVO), NIVO plus linrodostat mesylate, or NIVO plus intravesical bacillus Calmette-Guerin (BCG) in BCG-unresponsive, high-risk, nonmuscle invasive bladder cancer (NMIBC): CheckMate 9UT.
Authors: Noah M. Hahn, Sam Chang, Maxwell Meng, Neal D. Shore, Badrinath R. Konety, Gary D. Steinberg, Juergen Gschwend, Hiroyuki Nishiyama, Joan Palou, John A Taylor, Alexandre Lambert, Li Zhu, Toshiki Maeda, Bradley Raybold, Bruce S. Fischer, Chandrika Jeyamohan, Dimitrios Zardavas, Fred Witjes
Journal: Journal of Clinical Oncology (2020)

TPS5090 Background: Immune checkpoint inhibitors, including NIVO (anti–PD-1), have demonstrated favorable tolerability and efficacy profiles, ushering in a new treatment (tx) paradigm for advanced bladder cancer (advBC). However, an unmet need exists for new effective tx options in earlier stages of disease, specifically for patients (pts) with BCG-unresponsive, high-risk NMIBC. Increased IDO and PD-L1 expression in NMIBC tumors (Inman, et al. Cancer 2007; Hudolin, et al. Anticancer Res 2017), support the combination of anti–PD-1 and IDO1 inhibition in NMIBC. Linrodostat mesylate, a selective, potent, once-daily IDO1 inhibitor, has demonstrated clinical activity in combination with NIVO in pts with immunotherapy-naive advBC who received ≥ 1 prior line of therapy (objective response rate, 37%; Tabernero, et al. J Clin Oncol 2018;36(suppl) [abstr 4512]). Furthermore, high levels of PD-L1 expression have been reported in patients not responding to BCG tx. These findings provide a rationale for investigation of NIVO ± linrodostat ± intravesical BCG therapy in BCG-unresponsive high-risk NMIBC. Here we describe a phase 2, randomized, open-label study assessing the safety and efficacy of NIVO ± linrodostat ± intravesical BCG in pts with BCG-unresponsive, high-risk NMIBC (NCT03519256). Methods: Pts aged ≥ 18 years with BCG-unresponsive (per February 2018 FDA guidance), high-risk NMIBC, defined as carcinoma-in-situ (CIS) with or without papillary component, any T1, or Ta high-grade lesions, will be enrolled. Pts must have urothelial carcinoma as the predominant histological component ( &gt; 50%). Key exclusion criteria include locally advanced or metastatic BC, upper urinary tract disease within 2 years, prostatic urethral disease within 1 year, and prior immunotherapy. Using a novel adaptive-type design, pts will be randomized to 1 of 4 tx arms with NIVO ± linrodostat ± BCG. Primary endpoints include proportion of pts with CIS with complete response (CR) and duration of CR in pts with CIS. Secondary endpoints are progression-free survival and safety. This global study in 14 countries is underway, with a target enrollment of 436 pts. Clinical trial information: NCT03519256 .
Rates of primary prophylaxis for venous thromboembolism in high-risk patients with pancreatic and gastric cancer: A single tertiary care academic center experience.
Authors: Karlyn Martin, Rebecca Molsberry, Sadiya S Khan, Al Bowen Benson
Journal: Journal of Clinical Oncology (2020)

e19274 Background: Venous thromboembolism (VTE) causes significant morbidity and mortality in patients with cancer. The International Society of Thrombosis and Hemostasis published guidelines in 2014 recommending a risk-based approach to VTE prophylaxis in ambulatory cancer patients, but uptake in real-world clinical practice is unknown. This study's objective was to describe rates of primary VTE prophylaxis in ambulatory patients with gastric and pancreatic cancer receiving chemotherapy and at increased risk of VTE. Methods: We identified patients at a single academic tertiary care center who received chemotherapy from 1/1/2015 to 10/1/2018 for a diagnosis of pancreatic or gastric cancer through retrospective query of electronic health records. Data abstracted included the Khorana score components (body mass index, leukocyte, hemoglobin, and platelet counts) on day of chemotherapy initiation, anticoagulation prescription, and VTE diagnosis within 6 months of chemotherapy initiation. Patients were excluded if they had contraindications to anticoagulation or alternate indications for anticoagulation. Results: We identified 437 patients, of which 72% had pancreatic cancer and 29% had gastric cancer. Mean (standard deviation) age was 64.2 (11.7) years, and patients were predominately male (54%) and white (75%). Overall, only 13% of patients received a prescription for anticoagulation with similar rates in patients with pancreatic cancer (14%) compared to gastric cancer (9%). Anticoagulation prescription rates by Khorana score (2 or ≥3) are shown in Table. Approximately 10% of patients had a VTE within 6 months of chemotherapy initiation. Conclusions: Our results show that in a cohort of patients with gastric and pancreatic cancer at intermediate to high-risk of VTE by Khorana score (≥2), only 1 in 10 received a prescription for prophylactic anticoagulation. In addition, we observed high rates of incident VTE in 6-month follow-up confirming the high-risk nature of this group. Opportunity remains to enhance implementation of primary VTE prevention in clinical practice to reduce VTE morbidity and mortality in patients with cancer. [Table: see text]