tbuckley/cabot-search huggingface dataset:
Correlation between somatic symptoms and social support in patients with depressive disorder
Authors: Li Chen, Shoumei Jia, Ying Zhao, Zhongying Shi, Yuemei Lu, Ping Li, Qi Zhao, Yu Miao, Yang Li
Journal: BMJ (2019)

Objective
To investigate the prevalence of somatization symptoms and its correlation with social support in patients with depressive disorder.


Methods
Two hundred and fourteen hospitalized patients with depressive disorder were recruited. Patients were evaluated with Somatic Symptom Inventory (SSI), Perceived Social Support from Family Scale (PSS-Fa), Social Support Rating Scale (SSRS) and the general questionnaire.


Results
The average SSI scores of depressive patients was 49.63±15.53, with 26.2% (56/214) of the patients having moderate to severe level of somatic symptoms. The most common moderate to severe somatic symptoms in depressive patients were  fatigued (61.3%, 131/214), weak (49.5%, 106/214), not feeling well (47.7%, 102/214), feeling faint or dizzy (48.6%, 104/214), or constipation (29.9%, 64/214) . The average SSRS scores of patients was low (33.24±7.16). The SSI scores and its non-painful dimension (39.05±12.14) were significantly negatively correlated with family support (11.03±3.45) (r=-0.150, P=0.03; r=-0.153, P=0.02) .The SSI scores, and its somatization dimension scores (49.63±15.53) and painful dimension scores (10.58±4.18) were negatively correlated with the total scores of social support (33.24±7.16) (r=-0.164, P=0.02; r=-0.183, P=0.01; r=-0.136, P<0.05) and subjective support (19.14±4.81) (r=-0.167, P=0.02; r=-0.163, P=0.02; r=-0.177, P=0.01) . The SSI scores and its non-painful dimension of patients were negatively correlated with support utilization (r=-0.179, P=0.01; r=-0.194, P=0.01) .


Conclusion
Somatic symptoms are prevalent and severe in patients with depressive disorder. The somatic symptoms of depressive patients was closely correlated with decreased social support, especially low subjective support and support utilization.


Key words: 
Depressive disorder; Somatic symptoms; Social support
De-escalated chemotherapy versus endocrine therapy plus pertuzumab+ trastuzumab for HR+/HER2+ early breast cancer (BC): First efficacy results from the neoadjuvant WSG-TP-II study.
Authors: Oleg Gluz, Ulrike Nitz, Matthias Christgen, Sherko Kuemmel, Johannes Holtschmidt, Jan Priel, Andreas Hartkopf, Jochem Potenberg, Kerstin Luedtke-Heckenkamp, Marianne Just, Pia Wuelfing, Raquel von Schumann, Monika Graeser, Rachel Wuerstlein, Ronald E. Kates, Hans Heinrich Kreipe, Nadia Harbeck
Journal: Journal of Clinical Oncology (2020)

515 Background: HR+/HER2+ breast cancer (BC) is a distinct entity associated with better prognosis compared to HR-/HER2+ BC. However, combination of chemotherapy (CT) with (dual) anti-HER2 blockade is standard in HER2+ early BC (EBC), irrespective of HR-status. Despite of some promising data on combination of endocrine therapy (ET) with dual anti-HER2 blockade in EBC and metastatic HR+/HER2+ BC, no prospective comparison of neoadjuvant CT vs. ET + dual HER2-blockade has yet been performed. Methods: In the prospective WSG TP-II phase II-trial (NCT03272477; Sponsor: Palleos GmbH, Wiesbaden, Germany), 207 patients (pts) (257 screened; 40 centers) with centrally confirmed HR+/HER2+ EBC were randomized to 12 weeks of standard ET (n=100) vs. paclitaxel 80 mg/m 2 weekly (n=107) +trastuzumab+pertuzumab q3w for all pts. Primary endpoint was pCR (ypT0/is/ypN0). Secondary endpoints include safety, disease-free and overall survival, translational research, and quality of life (QoL). Omission of further CT was allowed in all pts with pCR; dual HER2-blockade was administered in the adjuvant setting in all pts. Results: Baseline characteristics were well balanced between the arms. Median age was 53 years; 58% had cT2-4, 28% had cN+; 43% had G3 tumors. pCR data were available in 198 pts (ET: n=96; Pac: n=102). pCR was observed in 24% (95% CI: 16-34%) with ET+T+P vs. 57% (95% CI:47-67%) with Pac+T+P (OR 0.24, 95% CI: 0-0.46, p&lt;0.001). In multivariable logistic regression analysis and corresponding sensitivity analysis (bootstrap/subsample inclusion frequencies and lasso regression) including study arm, BMI, menopausal, cT, and cN status, histological grade, HER2-status, Ki67, ER, PR as continuous variables, only study arm and HER2 3+ status were significantly associated with pCR. Neoadjuvant treatment was well tolerated in both study arms and completed per protocol in 93/92 (ET+P+T/Pac+P+T) patients. Only 9/13 SAEs (ET+P+T/Pac+P+T) were reported during neoadjuvant therapy. PAM50 and QoL analysis are ongoing. Conclusions: WSG TP-II is the first randomized prospective trial comparing two neoadjuvant de-escalation treatments in HR+/HER2+ EBC. The excellent pCR rate of 57% after only 12 weeks of Pac+P+T was clearly superior to the still promising 24% pCR rate in pts treated by ET+P+T. In both arms, treatment efficacy was most pronounced in HER2 3+ tumors. Survival results need to be awaited before definite recommendations for a de-escalated regimen in HR+/HER2+ EBC can be made. Clinical trial information: 2016-005157-21 .
Adverse event and outcome patterns in patients with advanced multiple myeloma in the United States.
Authors: Joshua Ryan Richter, Jason Yeaw, Drishti Shah, Ruthwik Anupindi, Suneel Kudaravalli, Stojan Zavisic
Journal: Journal of Clinical Oncology (2020)

e20544 Background: Multiple Myeloma (MM) is a hematologic malignancy with an estimated 5-year survival rate of just over 50%. Evolving paradigms arising from numerous FDA approvals continue to shape the treatment landscape for relapsed and refractory MM (RRMM) patients. As the number of approved drugs/regimens increases, the efficacy as well as toxicity profiles for the more heavily refractory patient change. The objective of this study was to evaluate adverse event rates and associated outcome patterns among RRMM patients treated with pomalidomide (poma) or daratumumab (dara). Methods: Adult patients with ≥1 claim of poma or dara (index) were identified between Jan 1, 2012 and Feb 28, 2018 using IQVIA’s Real-World Adjudicated US claims database. Patients were required to be continuously enrolled in the health plan ≥180 days prior and ≥360 days post index date, have a diagnosis or treatment claim for MM and a claim of any immunomodulatory drugs and proteasome inhibitors before index date. Mean time to new therapy and mean time to readmission were evaluated over the 1-year post-index period among RRMM patients. Overall survival (OS) was measured using Kaplan-Meier curves. Occurrences of adverse events (AEs) and mean length of stay for AE-related hospitalization were also reported. Results: There were 289 patients in the RRMM cohort with 67.8% of patients treated with combination therapy in the baseline period. Of index therapies, 81% of patients used poma and 40% used dara in post-index period. Overall, 42% of patients had a Charlson Comorbidity Score of ≥3. Among 258 patients with a new treatment post-index, mean (SD) time to a new treatment was 4.7(5.3) months. Median OS was 14.6 months. Post-index hematological AE were frequent such as anemia (72.0%), febrile neutropenia (52.6%), neutropenia (30.1%) and thrombocytopenia (36.0%, Table). Mean length of stay for AE-related hospitalizations was 10.1 days and mean time to readmission was 63.3 days. Conclusions: Low OS, high frequency of AEs and longer LOS for AE-related hospitalizations suggest that outcomes of these patients remain poor despite availability of newer treatment options. Further study is warranted to better manage the individual and system-wide toxicity in this clinical setting. [Table: see text]
Developing general medicine for Healthy China
Authors: Xiaosong Yu
Journal: BMJ (2018)

随着医药卫生体制改革的深化及健康中国建设的推进，全科医学发展的意义愈加凸显。文章以加大全科医生培养力度为着眼点，从高等医学院校重视全科医学教育、高水平综合医院加强全科医学学科建设，以及专业行业学(协)会引领全科医学学科发展等多个角度，对如何强化全科医学的发展进行了系统阐述。
肝硬化门脉高压合并自发性腹腔内大出血11例临床分析
Authors: 姜洪磊, 吴丹, 金俊哲, 刘星, 梁健
Journal: BMJ (2011)

肝硬化门脉高压致自发性腹腔内大出血临床罕见,死亡率高.本文回顾性分析我院2001年1月至2011年1月共收治的11例患者的临床资料,探讨该病的诊断及治疗经验.一、临床资料1.一般资料:11例中,男8例,女3例,年龄28 ～72岁.既往均有肝硬化病史,其中肝炎后肝硬化4例,酒精性肝硬化5例,其他原因者2例. 关键词：腹腔内大出血
Serum level of anti-monomer C-reactive protein antibody in systemic lupus erythematosus
Authors: 赵卫, 苏茵, 贾汝琳, 孙晓云, 栗占国
Journal: BMJ (2007)

目的 探讨抗C反应蛋白单体(mCRP)抗体在系统性红斑狼疮(SLE)中的意义.方法 以天然的mCRP为抗原,用ELISA的方法检测113例SLE患者、疾病对照组(65例,包括类风湿关节炎、原发性干燥综合征、骨关节炎、强直性脊柱炎、系统性硬化症、混合结缔组织病)和正常对照组(32例)血清抗mCRP抗体水平,同时检测SLE患者血清CRP水平,记录其各种临床表现及实验室指标,分析抗mCRP抗体与CRP水平及疾病活动性的关系.结果 SLE患者的抗mCRP抗体水平显著高于疾病对照组和正常对照组(t=2.502,5.352,P均＜0.05).抗mCRP抗体阳性的SLE患者的红细胞沉降率(ESR)较抗mCRP抗体阴性患者明显增快(t=2.869,P＜0.01),但两者的外周血CRP水平相似(H=-0.432,P＞0.05).SLE患者抗mCRP抗体水平与SLE疾病活动指数的高低及血清IgG水平的高低呈明显的正相关(r=0.248,0.392,P均＜0.01),与合并感染无明显相关性(t=0.658,P＞0.05).结论 SLE患者血清抗mCRP抗体水平明显增高,并与患者的SLE疾病活动指数的高低呈明显的正相关;抗mCRP抗体可作为判断SLE疾病活动性的指标之一。
Classifying inpatient deaths among liver and intrahepatic bile duct cancer and the effect of palliative care utilization on overall health care burden.
Authors: Saqib Abbasi, Anup Kasi, Anwaar Saeed, Weijing Sun, Raed Moh'd Taiseer Al-Rajabi
Journal: Journal of Clinical Oncology (2020)

e16673 Background: Liver cancer and bile duct cancer remain among of the most deadly cancers with a dismal 5 year survival of 2-15%. Patients often end up dying in an in-hospital setting as a result of acute complication of cancer progression. The purpose of this study is to identify annual trends in this sub-population, including cause of admission, palliative care utilization and economic impact on healthcare. Methods: From the years of 2002 to 2014, admissions for patients with a diagnosis of liver and bile duct cancer were identified using the National Inpatient Sample. Annual trends in incidence were compared to overall deaths via the SEER database. Trends were identified in hospital length of stay (LOS), total charges (TC), as well as utilization of palliative care. The effect of palliative care utilization on hospital length of stay and costs were also studied. Results: 73,833 (weighted) patient deaths were recorded from 2002 to 2014, 4,577 in 2002, compared to 6,595 in 2014. Signifying 33% (2002) to 32% (2014) of total deaths related to these cancers. The most common billed primary diagnosis was liver failure at 16.9%, sepsis (15.3%) and renal failure (6.7%). Overall LOS trended down from 5.9 days to 4.8 days (p &lt; 0.001). Palliative consults increased from 8.2% in 2002 to 39.4% in 2014. In 2014, the mean TC for those who received palliative consults versus those who did not was $52,612 and $64,388 respectively (p &lt; 0.001). LOS among these patients did not significantly change at 5.9 and 5.6 days (p = 0.13). When looking at patients with sepsis who did not die, a palliative care consult decreased costs from $87,564 to $75,223 (p &lt; 0.001). LOS was not significantly different at 8.8 days to 8.5 days (p = 0.15). Conclusions: A third of patients with liver and bile duct cancers die in an in-hospital setting. More effort needs to be undertaken to identify these patients and establish appropriate goals of care prior to such an event. Nonetheless, palliative involvement decreased health care resource utilization. Even among patients with sepsis who did not die, a palliative care consult decreased total charges of admission.
A Man in His 20s With New-Onset Severe Heart Failure and Ventricular Tachycardia
Authors: Haider J Warraich, David Manly
Journal: JAMA Cardiology (2020)

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Diffusion kurtosis imaging in predicting the chemotherapeutic response of colorectal liver metastases: The result of the FDZL-MRinCLM study.
Authors: Wenhua Li, Weijian Guo, Huan Zhang, Zhiyu Chen, Wen Zhang, Tong Tong
Journal: Journal of Clinical Oncology (2020)

e16034 Background: Colorectal liver metastatic (CLM) patients are a special population who have potential of cure with effective conversion treatment. The conventional radiological imaging commonly evaluates the response 6-8 weeks after the medication. A response marker for earlier prediction could avoid further use of ineffective drugs and guide the medical change for optimal regimen. This study is to evaluate the feasibility of early parameter change assessed by functional MR in predicting clinical response to chemotherapy and investigate its prognostic value in CLM patients. Methods: From August 2016, CLM patients were consecutively enrolled and examined by functional MRI with diffusion kurtosis imaging (DKI) sequence of liver at baseline and one cycle after the initiation of chemotherapy. The whole-lesion histogram and texture analyses of DKI was analyzed and features were extracted from the inline-generated parametric maps included K and D. The primary endpoint of the study was the DKI-predicted ORR of liver metastases, and the secondary endpoint were the DKI-predicted PFS and OS. The efficacy response was assessed by the RECIST Version 1.1 every two cycles of treatment. The association between the baseline DKI parameters, value change ratio (delta-DKI parameters = (Value baseline -Value cycle1 )/ Value baseline ) and ORR and survival were examined. Results: Up to Dec 2019, one-hundred consecutively enrolled patients (65 Male, 35 Female, Age from 30-75 years old) received the treatment (FOLFOX 13, XELOX 53, FOLFIRI 34) and complete the liver functional MRI scanning. A total of 42 responding (CR+PR) and 58 nonresponding (SD+PD) patients were evaluated. Lower baseline D values (D-mean, D-std and D-median, P &lt; 0.005), higher baseline K values (K-mean, K-median, P &lt; 0.005), lower delta-D values (delta-D-DiffEntropy, P = 0.000) and higher delta-K value (delta-K-median, P = 0.022) were significantly associated with a higher ORR, and the combination of all the significant parameters yielded an AUC of 0.834 (sensitivity 76.19%, specificity 77.59%) in predicting the early efficacy of CLMs. Patients with higher delta-D-diffEntropy value showed a longer PFS (9.0 vs 5 mons, P = 0.002) and OS (30.5 vs 14.8 mons, P = 0.032). Conclusions: The baseline value and early parameter change in DKI might be a good predictive marker for the chemotherapeutic response of CLMs, and the early increase of D value in liver metastases could be a promising factor for survival of patients undergoing standard chemotherapy. Clinical trial information: NCT03088163 .
Application of buried drainage tube in treatment of complex anal fistulas
Authors: Zhangyu Cai, Yanping Qing, Tong Li, Weiming Wu, Xionghua Xiang
Journal: BMJ (2020)

Twelve patients with complex anal fistulas were treated in the Affiliated Hospital of Medical School of Ningbo University from June to December 2018. All the patients were successfully operated, and after the operation the wound was rinsed twice a day by buried drainage tube. Patients were followed up for 3 months, the wound was healed in 11 cases and relapsed in 1 case with a mean wound healing time of (25.2±7.0) d; the pain scores at 1 d, 3 d and 5 d after surgery were 3.21±1.27, 2.34±1.22 and 1.89±0.78, respectively. There was no significant difference in preoperative and postoperative Wexner scores, anal resting pressure, and anal maximum systolic pressure (P>0.05).This innovative technique with buried drainage tube is safe and effective, which can shorten the recovery time and reduce the recurrence rate.


Key words: 
Rectal fistula; Drainage; Deep postanal space; Deep postanal space
Obstructive sleep apnea syndrome is an important risk factor of common chronic non-communicable disease
Authors: Baoyuan Chen
Journal: BMJ (2016)

睡眠呼吸暂停综合征特有的间歇性低氧和睡眠结构紊乱等病理生理学特点，极易导致机体多系统损伤，主要包括高血压、冠心病、脑卒中、糖尿病等。研究一再证实睡眠呼吸暂停综合征的合并症与常见的慢性非传染性疾病(慢病)一致，睡眠呼吸暂停综合征是常见慢病的重要危险因素和源头疾病。慢病的防治一定要与睡眠呼吸暂停综合征的治疗相结合，才能更有效地提高慢病的防治效果，提高患者的生命质量。
Barriers to caring for survivors of childhood cancer: Primary care providers’ and oncologists’ perspectives.
Authors: Aminat Adewumi, Cynthia Gerhardt, Randal S. Olshefski, Micah Skeens
Journal: Journal of Clinical Oncology (2020)

e19194 Background: Advances in treatment have resulted in a growing population of childhood cancer survivors. As most survivors will develop at least one late effect from treatment, it is important to continue to monitor their health. The incidence of late effects increases with age and often are not clinically apparent until decades after cancer treatment. The Institute of Medicine has recommended models of care delivery that include collaboration between oncologists and primary care physicians (PCP). Thus, we explored PCP and pediatric oncologists’ perceptions and experiences with survivors of childhood cancer in primary care. Methods: Recruitment of primary care physicians occurred utilizing the state Board of Medicine listings. A link and a paper copy of the survey were supplied via mail to approximately 3,000 pediatricians. Pediatric oncologists from a large Midwestern hospital completed the survey via email. Results: A total of 197 participants (19 oncologists/ 178 PCPs) completed the survey. The response rate was 95% for oncologists and 6% for PCPs. Although most PCPs (76%, n=134) had cared for a childhood cancer survivor, some respondents (16%, n=8) reported an unwillingness to care for a survivor. Using a ten-point scale, PCPs mean comfort level in caring for survivors of pediatric cancer was 5.78 ( SD= 2.37). PCPs identified the following barriers: limited knowledge of late effects (64%; n=114), lack of communication with oncologist (47%; n=83), and comfort level (38%; n=67). Nearly all oncologists (86%, n=19) reported referring patients to PCPs. Oncologists typically (83%, n=15) referred patients within the first year after treatment. Overall, oncologists were comfortable referring survivors to a PCP ( M=7.5; SD=1.97) and over half were satisfied with the PCP’s care of survivors (57%, n=12). Years in practice and sex of the oncologist were unrelated to comfort level referring to PCP. Conclusions: Barriers faced by PCPs in caring for survivors illustrate a need for increased education and communication between PCPs and oncologists. Attention to these concerns may improve follow-up care and comfort in the referral process.
Sarcopenia and sarcopenic obesity in pancreatic ductal adenocarcinoma (PDAC) patients undergoing surgery after neoadjuvant therapy (NAT): Clinical implications.
Authors: Ilaria Trestini, Salvatore Paiella, Marta Sandini, Thomas Hank, Tommaso Pollini, Isabella Sperduti, Davide Melisi, Alessandra Auriemma, Caterina Soldà, Daniela Tregnago, Alice Avancini, Giuseppe Malleo, Mirko D'Onofrio, Luca Gianotti, Sara Pilotto, Emilio Bria, Roberto Salvia, Carlos Fernandez del Castillo, Claudio Bassi, Michele Milella
Journal: Journal of Clinical Oncology (2020)

e16769 Background: Nutritional status may be markedly affected by NAT for PDAC. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher morbidity and mortality. The present study assessed the impact of sarcopenia/sarcopenic obesity and changes in body composition (BC) following NAT on surgical and survival outcomes in patients (pts) undergoing surgery for PDAC. Methods: PDAC pts with available CT-scans (both at diagnosis and preoperatively) undergoing surgical resection after NAT at two academic medical institutions from 2013 to 2015 were retrospectively evaluated. BC was assessed by analyzing axial L3 CT images before and after NAT. Data were correlated with overall survival (OS) using a Cox regression model. Kaplan-Meier curves were compared with Log-Rank test. Results: The final cohort consisted of 108 pts, with a median age of 63 years and a median follow-up of 16 months. Ninety-one pts (89.8%) received FOLFIRINOX. Sarcopenia and sarcopenic obesity were found at diagnosis in 41.7% and 16.7% of pts, respectively. After NAT, all body compartments significantly changed (p &lt; 0.001); the prevalence of sarcopenia and sarcopenic obesity decreased to 30.5% and 10.2%, respectively, after NAT. These BC phenotypes were related to a higher overall complications rate after surgery (69.7% vs. 30.3%, p = 0.027 and 81.8% vs. 18.2% %, p = 0.048, respectively). Particularly, cardiac complications were associated with sarcopenia (9% vs. 0%, p = 0.028) and pts that developed postoperative complications had higher preoperative total adipose tissue (300 vs. 229 cm2, p &gt; 0.05). With regards to OS, sarcopenic obesity at baseline (HR 3.45, p = 0.023) was found to be a significant independent predictor for OS at multivariate analysis. Conclusions: Our data provide evidence that BC impacts on both surgical and survival outcomes in PDAC pts undergoing NAT before resection. The associations with worse clinical outcomes emphasize the role of nutritional evaluation, as well as the need to develop appropriate evidence-based nutritional interventions during NAT.
Abstract 17242: Effects of Tolvaptan on Early Outcomes for Patients Undergoing Cardiac Surgery and Predictors for its Responders
Authors: Kazuki Morimoto, Satoshi Numata, Sachiko Yamazaki, Keiichi Itatani, Hidetake Kawajiri, Suguru Ohira, Hitoshi Yaku
Journal: Circulation (2016)

Introduction: The efficacy of tolvaptan, a vasopressin V2 receptor antagonist, on refractory fluid retention after cardiac surgery is unknown. The aim of this study was to investigate the safety an...
Relationship between ambulatory blood pressure and urine microalbnmin level in the elderly with non-diabetic hypertension
Authors: Ya-juan Chen, Gao-zhong Huang, Jin-wei Xia, Yuan Zhong
Journal: BMJ (2008)

Objective To investigate the relationship between 24-hour ambulatory blood pressure and urine microalbumin(UMA)level in the elderly with non-diabetic essential hypertension.Methods One hundred elderly cases with essential hypertension were selected from the Department of Geriatrics,the Sixth People's Hospital,Shanghai and divided into two groups,one with UMA less than 30 mg/24h,and the other with UMA equal to or greater than 30 mg/24h.Ambulatory blood pmssure,serum level of creatinine (sCr),UMA and other characteristics were measured for all the subjects studied and compared to find possible relationship between blood pressure and UMA.Results Level of sCr,diastolic blood pressure at night (nDBP),24-hour average blood pressure,average blood pressure at night were all significantly higher in the group with UMA equal to or greater than 30 mg/24h than that with UMA less than 30 mg/24h(P<0.05 or P<0.01). Multivariate logistic regression analysis indieated that both sCr and nDBP were indispensable predictors for high microalbuminuria in patients with essential hypertension.Conclusions Ambulatory blood pressure monitoring,especially blood pressure variation at night,has more important predictive value for severity of renal damage caused by hypertension in the elderly with non-diIlbetic essential hypertension.

Key words: 
Hypertension; Microalbuminuria; Aged