tbuckley/cabot-search huggingface dataset:
Chief coroner’s guidance on covid-19 deaths: workers outside the NHS are also vulnerable to risk
Authors: Andrew E Watterson
Journal: BMJ (2020)

A surgically successfully treated case of (2.8kg) Trichobezoar presenting with severe epigastric pain, vomiting, associated with anemia and dark stool of one days duration. Complicated on admission by an acute intestinal obstruction. There has been no report of such a case from Saudi Arabia up to the present time. The presenting symptoms and signs, and management strategies are discussed.
A case of acute drug-induced liver injury caused by oral metformin sustained-release tablets
Authors: Zhengyan Chen
Journal: BMJ (2020)

二甲双胍致肝功能损伤较少见。本文报道1例老年新发糖尿病患者口服二甲双胍缓释片（500 mg/d）治疗2个月后出现乏力、厌食、恶心等症状，伴血清丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平升高，排除恶性肿瘤、病毒性肝炎、自身免疫性肝病，诊断为口服二甲双胍缓释片致急性药物性肝损伤。停药后症状消失，肝功能恢复正常。
The variance of lymphatic vascular invasion (LVI) diagnosis and its impact on overall survival(OS) independent of node stage in patients undergoing surgical resection on NSCLC.
Authors: Christine Hebert, Isabel M Emmerick, Rick Voland, John M. Varlotto, Debra Maddox, Malcolm DeCamp, John Charles Flickinger, Mark Maxfield, Ferian Lou, Negar Rassaei, Dani Zander, Lacey McIntosh, Thomas J. Fitzgerald, Molly Griffin, Paul Rava, William Vincent Walsh, Jennifer Baima, Karl Uy
Journal: Journal of Clinical Oncology (2020)

e21060 Background: The criteria for diagnosis of lymphatic vascular invasion(LVI) have not been standardized. Our investigation uses the National Cancer Database(NCDB) to assess the impact of this factor on survival(OS) and whether there are differences in the diagnosis of LVI based upon institution type and regional location in patients undergoing definitive resection. Methods: The NCDB was queried from the years 2010-2014 to find a patient population who underwent (bi)lobectomy with at least ten lymph nodes examined. Multivariable analysis was used to find factors associated with diagnosis of LVI, and the impact of LVI on OS. Propensity score matching(PSM) was used to adjust for bias in diagnosing LVI while testing the impact of LVI on OS. Results: 18,057 patients were eligible for our study with a median follow-up of (36.1 months). LVI status was determined in 91.8%. 19.1% of surgical specimens were found to be LVI positive. 2,323 patients had positive nodes with 50.8% of specimens having LVI, while 14.0% of specimens with negative nodes had LVI. Academic medical centers(AC); Medical centers associated with populations &gt; 1,000,000(1M); and Mid-Atlantic(MA) region had higher rates of LVI(all p values &lt; 0.0001, AC 22.7% vs 16.5%, OR = 1.49; 1M 21.1% vs 16.8%, OR = 1.32; MA 27.6% vs 17.1%, OR = 1.85), and higher rates of LVI associated with positive nodes (all p values &lt; 0.0001, AC 34.6% vs 7.9%, OR = 6.14; 1M 36.4% vs 7.7%, OR = 6.82; MA 31.0% vs 6.2%, OR = 6.76). LVI was most frequently diagnosed in the MA region and least frequently found in the Mountain location( 27.6% vs 12.2%, OR = 2.73). LVI was associated with a significant decrement in OS that was independent of institution type, regional population, and institution location. PSM demonstrated that LVI was associated with a decrement in OS to the same degree per each nodal stage(N0,N1,N2) (p &lt; 0.0001, HRs = 1.21 N0, 1.26 N1, 1.18 N2). Conclusions: LVI diagnosis and its association with positive nodes varies based upon hospital location/type and population. LVI was associated with a decrement in OS that was independent of N-Stage. LVI must be standardized and considered as a prognostic factor for staging cancer patients.
Relationship between increased serum activity of alanine aminotransferase and metabolic parameters in non-alcoholic population
Authors: Ning-shuang Wang
Journal: BMJ (2008)

Objective The aim of this study is to identify association between increased serum activity of alanine aminotransferase (ALT) and metabolic parameters in non-alcoholic population of north China. Methods A total of 5351 subjects who came to visit Yuquan Hospital of Tsinghua University for health examinations during May to December 2007 were divided into two groups based on their serum ALT activities, one with equal to or more than 40 U/L and the other with less than 40. Anthropometric data, blood pressure, serum ALT, serum levels of triglyceride (TG), total cholesterol (TC), high-dense lipoprotein-cholesterol (HDL-C), low-dense lipoprotein-cbolesterol (LDL-C) and fasting blood glucose (FBG) were measured for all of them. Results Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), TG, TC, HDL-C, LDL-C and FBG were significantly different between the two groups. BMI, TG, TC, HDL-C, LDL-C and FBG all associated with increased ALT both in males and females. DBP associated with increased ALT in males and SBP with it in females, logistic regression analysis showed that male, younger age, raised BMI, TG, TC, FBG and reduced HDL-C were strongly associated with increased serum ALT. Conclusions Results showed that metabolic disturbance such as obesity, hypertension, dyalipidemia, hyperglycemia, and so on associated with increased ALT in non-alcoholic population of north China.

Key words: 
Alanine transaminase;  Lipid metabolism;  Hypertension;  Overweight; Carbohydrate metabolism
Breast cancer incidence and behavior in younger patients: A study from the surveillance, epidemiology, and end results (SEER) database.
Authors: Zuha Nasim, Christine Girtain, Ishan Patel, Varsha Gupta, Mohammad Hossain
Journal: Journal of Clinical Oncology (2020)

e13581 Background: Breast cancer screening for women less than 40 years old is practically nonexistent. Since screening can detect cancer at an early stage, not having a surveillance guideline for breast cancer in younger women can result in detection of the cancer at advanced stage. The purpose of this study was to investigate the incidence and behavior of breast cancer in younger women. Methods: The Surveillance Epidemiology, and End Results (SEER) registry data from 2004-2014 was accessed for the study. All women diagnosed with breast cancer and with complete information were included in the study. The data was further divided into two groups based on the age of the patient at the time of diagnosis. The younger group consisted of women &lt; 40 years old (group 1) and the older group consisted of women ≥40 years old (group 2). Both groups were compared on demography and characteristics of the cancer. The continuous variables were tested using student t-tests and categorical variables were compared using Chi-squared or Fisher exact tests. Multivariate analysis was done to find the association of high-grade cancer using a logistic regression model. All p-values are two sided and values &lt; 0.05 were considered statistically significant. Results: Of 599,782 patients who satisfied the inclusion criteria, 28, 243 (4.71%) diagnosed with breast cancer were younger women age &lt; 40 years old. A higher proportion of these younger women presented with larger tumor sizes (between 5.1-10.0 cm), poorly differentiated cancer cells (55.88% vs. 32.85%, P &lt; 0.001) and triple negative receptors (6.83% vs. 3.81%, P &lt; 0.001) than older women respectively. Younger age was significantly associated with high-grade tumor at presentation when controlling for race and marital status. There was roughly 3% increased risk of a high-grade tumor with each decrease of 1 year (odds ratio 0.97, 95% confidence interval [CI] [0.96, 0.99], P = 0.001). Conclusions: This study found that the incidence of breast cancer in younger women was just below 5%, however, when the cancer was diagnosed, these group presented in advanced stages and more aggressive cancer types.
Effects of angiotensin converting enzyme gene polymorphism on endothelial function in patients with essential hypertension
Authors: Li-hua Zhai, Sha-yan Wang, Ying Wu, Ruan-zhang Zhang, Chun-yu Yang, Zeng-ying Wang, YU-hua Hu
Journal: BMJ (2008)

Objective To investigate effects of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism on endothelial function in elderly patients with essential hypertension. Methods Seventy-three elderly patients with uncomplicated essential hypertension and 55 normal elderly people as control were recruited into the study. Their humeral arterial endothelial vasodilatation function was studied with high-resolution ultrasonography and ACE I/D genotypes were determined by polymerase chain reaction (PCR) technique. Results Endothelium-dependent vasodilatation function of the three-genotype subgroups of the elderly patients with essential hypertension was significantly lower than that in the controls with the same genotypes (5.5±1.9 vs 11.9±1.3 in Ⅱ genotypa, 4.7±2.0 vs 10.9±1.6 in ID genotype and 2.9±1.9 vs 9.4±2.6 in DD genotype, with all P<0.01 ). In both groups of hypertensives and normotensives, humeral arterial endothelium-dependent vasedilatation function was significantly lower in those with DD genotype than that in those with Ⅱ genotype (2.9±1.9 vs 5.5±1.9 in hypertensive group and 9.4±2.6 vs 11.9±1.3 in control group, both P<0.05 ). Multivariate linear regression analysis showed that endothelium-dependent vasodilatation function in hypertensive elderly people correlated in linearity with their ACE genotype (P<0.01 ). Conclusions ACE gene I/D polymorphism is associated with abnormal humeral arterial endothelium-dependent vasodilatation function of humeral artery in patients with essential hypertension.

Key words: 
Hypertension;  Peptidyl-dipeptidase A;  Genotype;  Endothelium , Vascular
Early recognition and comprehensive prevention of peripheral vascular diseases
Authors: Qihong Ni
Journal: BMJ (2019)

外周血管疾病（PVD）指除心脑血管之外的所有周围血管疾病。近年来随着社会的老龄化和人们饮食结构的变化，PVD发病率逐年增高，常见的有动脉性疾病如主动脉瘤或夹层、颈动脉狭窄、下肢动脉硬化闭塞症等，以及静脉性疾病如下肢深静脉血栓、慢性下肢静脉功能不全等。PVD早期往往无症状或仅有轻微症状，如不重视进入进展期则严重影响患者健康，因此根据临床表现、体格检查以及辅助检查早期识别并进行综合防治，十分重要。
External validation of two predictive scores of chemotherapy toxicities among older patients with solid cancer, from ELCAPA prospective cohort.
Authors: Maxime Frelaut, Philippe Caillet, Stephane Culine, Elena Paillaud, Christophe Tournigand, Florence Canoui-Poitrine
Journal: Journal of Clinical Oncology (2020)

12050 Background: Severe chemotherapy toxicities are frequent among older patients, and may have a major impact on mortality, comorbidities, and quality of life. Two scores were developed to predict severe toxicities: Chemotherapy Risk Assessment Scale for High-age patients (CRASH) score, and Cancer and Aging Research Group Study (CARG) score. The main objective of the present study was to evaluate the predictive value of both scores on an external cohort. Secondary objective was to identify individual predictive factors of severe chemotherapy toxicities. Methods: The Elderly Cancer Patients (ELCAPA) survey consists in a prospective cohort including patients aged 70 years or older referred for a geriatric assessment (GA) before anticancer treatment, such as chemotherapy for solid cancer. CARG and CRASH score were retrospectively collected. Main endpoint was grade 3/4/5 toxicities for CARG-score, hematologic grade 4/5 and non-hematologic grade 3/4/5 toxicities for CRASH-score. Calibration and discrimination (Area Under ROC Curve, AUC) were evaluated. Results: From July 2010 to March 2017, 248 patients were included. Among them, 150 (61%) experienced severe toxicity as defined in CARG study, and 126 (51%) as defined in CRASH study. There was no increased risk of toxicity in intermediate and high risk groups of CARG-score compared to low risk group (OR = 0.3, IC 95% [0.1 – 1.4], p= 0.1; and OR = 0.4, IC 95% [0.1 – 1.7], p= 0.2 respectively, AUC-ROC = 0.55). Similarly, there was no more risk of severe toxicities in intermediate low, intermediate high, and high risk groups compared to low risk groups of CRASH combined score (respectively OR = 1, IC 95% [0.3 – 3.6], p= 0.99; OR = 1, IC 95% [0.3 – 3.4], p= 0.9; OR = 1.5, IC 95% [0.3 – 8.1], p= 0.67; AUC-ROC = 0.52). A multivariate predictive model including cancer type, performance status (PS 0 vs. PS 1-2), number of severe comorbidities (Cumulative Illness Rating Scale for Geriatrics, CIRS-G, ≥1 grade 3 or 4 comorbidity), body mass index (BMI &gt; 25 kg/m² protective vs. normal BMI), and Chemotox score (1 vs. 0) had an AUC of 0.78. Conclusions: Neither CARG nor CRASH score was predictive of severe chemotherapy toxicities in the ELCAPA cohort. There is a need to identify new predictors of chemotherapy toxicity in older patients with solid cancers.
Could soluble levels of CD40L and galectin-9 be possible prognostic biomarkers and therapeutic targets in NSCLC?
Authors: Guilherme Jorge Costa, Marina Catena da Matta, Leuridan Cavacante Torres, Dulce Elena Casarini
Journal: Journal of Clinical Oncology (2020)

e21508 Background: Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all cases of lung cancer. The immune system is now recognized to have the potential to destroy cancer cells. TIM-3 binds to Galectin-9 (GAL9) causing suppression of cytokine production, cell cycle arrest and cell death. Soluble CD40L (sCD40L) that is released by activated T lymphocytes and platelets. Therefore, we hypothesized that soluble forms immune checkpoint receptors and their ligands, such as TIM-3, GAL9 and CD40L may also prognostic implications of NSCLC. Objectives: Evaluate the soluble levels of CD40L, TIM-3 and GAL9 in patients with NSCLC in III and IV stages of disease. Methods: Samples of blood were collected from a cohort prospective involving 32 patients between 50 and 80 years old (65 + 8,6 years). Enzyme-linked immunosorbent assay was used to quantify expression these receptors. A non-parametric test was used to compare all groups (Mann-Whitney U-test). Statistical significance was defined as p&lt;0.05. Data analysis was performed using GraphPadPrism v8.3. Results: Our results showed higher levels GAL-9 and TIM3 in patients with stage III and IV than controls ( p&lt;0.05). As also, higher expression of CD40L was identified in patients stage III than stage IV ( p&lt;0.0001) and controls ( p=0.007). It wasn’t seen significant different expression of CD40L between stage IV patients and controls. Analyzing GAL9, it was identified higher level in patients stage III than stage IV ( p&lt;0.0001). Expression of TIM-3 wasn’t significant difference between patients with stage III and IV. When analysing in ratio between CD40L/TIM3, TIM3/GAL9 and CD40L/GAL9 in all groups, only TIM-3/GAL9 ratio had a positive correlation in patients stage IV (r=0.688; p&lt;0.0001). By histology, patients with squamous cell carcinoma had higher levels of CD40L than adenocarcionoma ( p=0.01), but no significant difference was identified between expression of TIM3 e GAL9 and histological subtypes. Conclusions: This study showed expression sCD40L and GAL9 were higher stage III than stage IV in patients NSCLC. It can be inferred that soluble CD40L and GAL9 receptors are possible prognostic biomarkers and potential therapeutic targets in NSCLC.
缺血性结肠炎52例临床分析
Authors: 钱铖, 刘明东, 陈隆典, 邹晓平
Journal: BMJ (2011)

缺血性结肠炎是由于各种原因引起结肠血液灌注不足或回流障碍,导致肠壁不同程度的结构破坏和功能障碍的病变.现就近5年来我院经临床、内镜明确诊断的52例缺血性结肠炎的临床特点和内镜表现进行总结。
A survey on clinical features of somatization disorder
Authors: Zhi-yang Wang, Shen-xun Shi, Li-wei Wang
Journal: BMJ (2009)

To investigate clinical features of somatization disorder. Methods Seventy-nine paeeeeee with somatization disorder (SD), diagnosed based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, version 3 ( CCMD-3 ) during September 2006 to August 2008, were selected and assessed by serf-edited somatic symptom list ( SSSL), symptom checklist-90 ( SCL-90 ), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Results Sixty-two symptoms in two to six systems were involved in SDs, with a mean and standard deviation of 12.4 ± 6.6 symptoms in 4.2 ± 0.9 systems. The skin, nervous system, gastrointestinal system, respiratory and circulatory systems were the most involved in those symptoms. Depression, anxiety and hostile mood, number and total score of somatic symptoms all correlated positively with the total scores of HAMA and scores of somatic anxiety and mental anxiety (P   0.05 ). Conclusions Multiple systems were involved in SD, usually with complicated symptoms including depression and anxiety, which was prone to inappropriate medical diagnoses. Number and severity of somatic symptoms positively correlated with severity of anxious symptoms.

Key words: 
Somatization disorder;  Somatic symptoms;  Psychiatric status rating scales
Do Gut Bacteria Play a Role in Preeclampsia?
Authors: Tracy Hampton
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
结核病的化学治疗
Authors: 朱莉贞
Journal: BMJ (2006)

化学治疗(化疗)是肺结核病和肺外结核病的基本治疗方法.正确选择用药,制定合理的方案,遵循化疗原则以及科学的管理是治愈患者,消除传染和控制结核病流行的最有效措施.为便于治疗和管理、依照治疗状况将肺结核患者划分为初治、复治、耐药三种人群,每种人群在药物选择、治疗方案和疗程上均各不相同.由于肺结核病占整体结核病的90%以上,在此主要介绍肺结核病治疗的有关问题。
异位妊娠破裂或流产出血临床分析
Authors: 吴泰荣
Journal: BMJ (2005)

异位妊娠发生破裂或流产出血时病情凶险,在基层医院常由非妇产科医生接诊.作者对福建省沙县医院2000年1月至2003年11月间确诊为该病的144例患者临床资料进行分析,旨在交流急诊首诊体会。
Weight loss after minimally-invasive esophagectomy for esophageal cancer.
Authors: Malcolm Hart Squires, Jennifer H Benbow, Sally Jeanne Trufan, Della Mann, Emily M Burchins, Meredith M Byrne, Joshua Hill, Nicole Lee Gower, Jonathan C. Salo
Journal: Journal of Clinical Oncology (2020)

e16565 Background: Nutritional deficiencies are common in esophageal cancer patients after esophagectomy. Patients frequently present with weight loss due to obstruction. Cancer therapies (chemoradiation and esophagectomy) further compromise nutrient intake through alterations in appetite, gastrointestinal function, and the catabolic effects of therapy. We aimed to understand and identify risk factors associated with post-esophagectomy weight loss. Methods: Patients undergoing minimally-invasive esophagectomy via laparoscopic and thoracoscopic techniques with intra-thoracic anastomosis between January 2015 and July 2019 were identified. Post-operative weight loss at 3- and 6-months post-surgery was calculated as percent change from preoperative weight. Univariate and multivariable generalized linear method (GLM) analysis was performed. Results: 176 patients (145 male, 31 female) underwent esophagectomy, with a median age of 64 [IQR 57-71] and median 3-month postoperative weight loss of 7.9% [IQR 1.5-12.3%]. The majority of patients were Caucasian (89%), histologically diagnosed adenocarcinoma (90%), and received neoadjuvant chemoradiation (71%). Median preoperative BMI was 28.3 [IQR 25.5-32.5]. Preoperative enteral feeding tubes were placed in 86 patients (49%). Five patients (2.8%) were converted to open surgery (laparotomy) and anastomotic leaks occurred in 12 (6.8%) patients. The median length of stay was 9 days [IQR 8-13]. Among a subset of 147 patients with data available, the median 6-month postoperative weight loss was 10% [IQR 5.3-15.0%]. On multivariable analysis, greater preoperative BMI and anastomotic leak were associated with increased weight loss at 3 and 6 months post-esophagectomy. Conclusions: Significant postoperative weight loss is common among minimally-invasive esophagectomy patients. Higher preoperative BMI and postoperative anastomotic complications are significantly associated with increased postoperative weight loss at 3 and 6 months. Need for preoperative feeding tube and conversion to open surgery were further associated with postoperative weight loss. [Table: see text]
Targeted sequencing analysis of predominant histological subtypes in resected stage I invasive lung adenocarcinoma.
Authors: Chong Li, Yan Li, Yan Tan, Zhantao Yan, Jun Xie, Xian Zhang, Song Hu, Yun Zong, Qing Li, Junyi Ye, Xi Li, Han Han-Zhang
Journal: Journal of Clinical Oncology (2020)

e21067 Background: Lung adenocarcinoma (LADC) is classified into 5 main histological subtypes with distinct clinicopathologic characteristics: lepidic-predominant adenocarcinoma (LPA), acinar-predominant adenocarcinoma (APA), papillary-predominant adenocarcinoma (PPA), micropapillary component (MPC) and solid-predominant adenocarcinoma (SPA). However, the mutational profiles of predominant histological subtypes have not been well defined. In this study, we aimed to reveal the genomic landscape of the 5 main histological subtypes. Methods: Surgically resected tumor samples were obtained from 86 patients with pathological stage I invasive lung adenocarcinoma who underwent surgery between January 2015 and December 2018. No patient had received preoperative chemotherapy or radiotherapy. Capture-based targeted sequencing was performed in a cohort of 86 stage I invasive adenocarcinoma (IAC) patients spanning 5 subtypes using a panel consisting of 168 lung cancer-related genes. Results: Our analysis identified a total of 302 genomic alterations. Five subtypes showed distinct mutation profiles with LPA, APA, PPA, MPC and SPA had an average mutation rate of 1.95 (range: 0–5), 2.56 (range: 1–6), 3.5 (range: 1–7), 3.75 (range: 1-8) and 6.05 (range: 2-12), respectively (p = 4.17e-06). In this cohort, 96.55% (83/86) of all patients had mutations in classic lung cancer drivers with EGFR (73.3%), KRAS (9.3%), ALK (4.7%) and MET (4.7%) being the most commonly mutated drivers. TP53 is the top mutated tumor suppressor gene. It has been reported that SPA and MPC have unfavorable prognosis comparing to the rest subtypes. Interestingly, LRP1B mutations, which has been reported to be associated with high tumor mutation burden and better response to immunotherapy, were only detected from 5 SPA patients (p = 0.001). No MPC patients from this cohort harbored LRP1B mutations. Conclusions: We revealed distinctive mutation landscape of the 5 major histological subtypes of LADC, evident by distinctive average mutation rate with SPA and PLA having the highest and lowest average mutation rate, respectively. Furthermore, we also showed that SPA patients harboring LRP1B mutations may benefit from immunotherapy.