tbuckley/cabot-search huggingface dataset:
Sonographic characteristics of thickened gall bladder wall by varied causes and their clinical significance
Authors: Li-fang Xue, Xue Wang, Yi-chao Zhao, Shan-shan Zhang
Journal: BMJ (2010)

Objective To study characteristics of ultrasonic scanning of thickened wall of the gall bladder by varied causes and their clinical significance. Methods Totally, 127 patients with thickened wall of the gall bladder were selected from the People's Hospital, Beijing University during January 2007 to December 2008, including 33 cases of acute cholecystitis, 24 cases of chronic cholecystitis, 40 cases of heart, liver and kidney diseases, and 30 cases with other diseases, according to their clinical data and surgically pathological examinations. Another 88 healthy persons who visited the hospital during March to December 2008 for regular physical checks-up, without history of gall bladder illness and other illness that could cause thickening of wall of the gall bladder, were selected as controls, including 52 fasting and 36 non-fasting controls. Thickness of wall of the gall bladder were measured for each of them, and characteristics of their ultrasonographs were analyzed. Results Thickness of wall of the gall bladder was (2.4 ±0.3) mm in fasting controls, statistically significant different from those of non-fasting controls [(3.4±0.2) mm], those with acute cholecystitis [(5.6 ±0.4) mm], those with chronic cholecystitis [ (4. 2±0. 3) mm], those with heart, liver and kidney diseases [ (8.6±0. 5) mm] , and those with other diseases [ ( 3. 4 ±0.3) mm] , respectively ( P   0.05 ) .Ultrasonographs showed more severe changes in the intima of wall of the gall bladder in those with acute cholecystitis and double layer thickened in those with heart, liver and kidney diseases, which could easily be differentiated from those of chronic cholecystitis with changes similar to those of other diseases with single layer hyper-echo of wall of the gall bladder. Conclusions Thickening of wall of the gall bladder is a non-specific pathological manifestation, which can be caused by changes in the gall bladder perse and illness other than it Thickening of wall of the gall bladder in ultrasonograph should be differentiated from that by other causes based on combination of their clinical data and ultrasonographic characteristics.

Key words: 
Gallbladder;  Ultrasonography;  Diagnosis
Thyroid cancer incidence in India between 2006 and 2014 and impact of overdiagnosis.
Authors: Aju Mathew, Luigino Dal Maso, Chiara Panato, Diego Serraino, Silvia Franceschi, Partha Basu, Kevin Wang, Feitong Lei, Quan Chen, Bin Huang, Salvatore Vaccarella
Journal: Journal of Clinical Oncology (2020)

e18574 Background: Increases of thyroid cancer (TC) incidence emerged in the last decades in several countries. This study aimed to estimate time trends of TC incidence in India and the proportion of TC cases potentially attributable to overdiagnosis by sex, age, and area. Methods: TC cases aged 0-74 years reported to Indian cancer registries during 2006- 2014 were included. Age-standardized incidence rates (ASR) and TC overdiagnosis were estimated by sex, period, age, and area. Results: Between 2006-2008 and 2012-2014, the ASRs for TC in India increased from 2.5 to 3.5/100,000 women (+37%) and from 1.0 to 1.3/100.000 men (+27%). However, up to a 10-fold difference was found among regions in both sexes. Highest ASRs emerged in Thiruvananthapuram (14.6/100,000 women and 4.1/100,000 men in 2012- 2014), with 93% increase in women and 64% in men compared to 2006-2008. No evidence of overdiagnosis was found in Indian men. Conversely, overdiagnosis accounted for 51% of TC in Indian women: 74% in those aged &lt; 35 years, 50% at ages 35-54 years, and 30% at ages 55-64 years. In particular, 80% of TC overdiagnosis in women emerged in Thiruvananthapuram, while none or limited evidence of overdiagnosis emerged in Kamrup, Dibrugarh, Bhopal, and Sikkim. Conclusions: Relatively high and increasing TC ASRs emerged in Indian regions where better access to healthcare was reported. In India, as elsewhere, new strategies are needed to discourage opportunistic screening practice, particularly in young women, and to avoid unnecessary and expensive treatments. Present results may serve as a warning also for other transitioning countries.
Association of immune-related adverse effects and survival in responders treated with immune checkpoint inhibitors.
Authors: Akhil Kapoor, Vanita Noronha, Vijay Maruti Patil, Amit Joshi, Nandini Sharrel Menon, Kumar Prabhash
Journal: Journal of Clinical Oncology (2020)

e15172 Background: The development of immune-related adverse effects (irAEs) can corroborate with the response to immune checkpoint inhibitors (ICIs). However, there is very limited data on the association of irAEs with survival in patients who have shown response to ICIs. Methods: This study is a retrospective audit of prospectively collected database of patients who received ICIs for advanced solid tumors. Responders were defined as patients who attained best response of either complete response (CR) or partial response (PR). Time-to-event analysis was done using Kaplan-Meier estimator and hazard ratio was calculated by using Cox proportional model. Results: A total of 155 patients who received ICI during the specified period were evaluated for this study. The response rate was 19.4%. One year OS for responders was 75.6% (SD 8.8) versus 26.1% (SD 5.1). The median OS for patients who developed irAE was 12.3 months (95% CI: 8.9-15.6) while it was not reached for patients without irAE (HR 10.5, 95% CI 1.2-NR, p=0.007). One-year OS for the corresponding group of patients was 53.6% (SD 15.6) versus 92.9% (SD 6.9), respectively. Conclusions: This study reports negative association of immune-related adverse effects and survival in responding patients of solid tumors treated with immune checkpoint inhibitors. [Table: see text]
Mapping PRO-CTCAE responses to clinician-graded adverse events, dose reductions, interruptions, and discontinuations in phase I cancer trials.
Authors: Geoffrey Alan Watson, Zachary William Neil Veitch, Daniel Shepshelovich, Zhihui (Amy) Liu, Anna Spreafico, Albiruni Ryan Abdul Razak, Philippe L. Bedard, Lillian L. Siu, Lori M. Minasian, Aaron Richard Hansen
Journal: Journal of Clinical Oncology (2020)

2014 Background: Typically symptomatic adverse events (sy-AEs) on clinical trials are reported by clinicians using the CTCAE. To complement clinician collected sy-AEs and understand tolerability better, the patient report outcome version of the CTCAE (PRO-CTCAE) has been developed to provide the patient (pt) perspective on severity of AEs (graded scale 0-4) and their interference in daily life (scale 0-4). The aim of this study was to correlate PRO responses with the grade (G) of AEs, dose interruptions/reductions and dose limiting toxicities (DLTs). Methods: Pts enrolled on phase 1 clinical trials at Princess Margaret were surveyed electronically on tablet using the full library of items for PRO-CTCAE. The PRO-CTCAE was administered at baseline (prior to therapy), mid-cycle 1, and mid-cycle 2. AEs on study were recorded by physicians using the CTCAE. The electronic medical records were analyzed for an association between reported sy-AEs and PRO score. Summary statistics were used to describe patient and disease characteristics, as well as the outcomes. Spearman’s method was used to correlate PRO severity and interference responses. Logistic regression was used to assess which factors were associated with CTCAE G 3-4 vs G 2 AEs. Results: We analyzed 158 pts: median age 60yrs, 77 (49%) were male; all were ECOG ≤1 and 22, 55 and 81 pts completed 1, 2 and 3 surveys, respectively. Clinician reported G2, 3 and 4 sy-AEs occurred in 81, 47 and 3 pts, respectively and all of these were related to a PRO item except 5% (4/81), 9% (4/47) and 33% (1/3), respectively because either the AE occurred after 3 rd time point or patient not able to complete the PRO (encephalitis). Sy-AEs causing dose interruptions, reductions, DLTs and discontinuations occurred in 45 (28%), 12 (7.5%), 5 (3%) and 12 (7.5%) pts, respectively; with a corresponding PRO item in 40 (89%), 12 (100%), 4 (80%) and 11(92%) pts, respectively. For patients who had CTCAE G2, G3/4 AEs, interruptions and discontinuations, their severity and inference levels were positively correlated (coefficient 0.49, p &lt; 0.001; 0.45, p &lt; 0.001 0.59, p &lt; 0.001, 0.86, p &lt; 0.001). Dose interruptions (p = 0.0027) and reductions (p = 0.0061) were significantly associated with G3-4 compared to G2 AEs. Conclusions: This is the first time an association between PRO-CTCAE severity and interference; and CTCAE G2, 3, 4 AEs, dose interruptions and discontinuations has been demonstrated. Additional modelling and more patient data are being analyzed to explore the relationship.
Clinical observation on binocular vision in patients with vertical muscle paralysis
Authors: Jing-hui Wang, Wei Lu
Journal: BMJ (2009)

A retrospective clinical study was conducted to observe the changes of the binocular vision in patients with vertical muscle paralysis . All patients were examined by using synotophore and stereoscopic vision chart. The results were analyzed by SPSS( statistical product and service solutions) and the variations of synotophore and stereoacuity were mainly observed. Our study revealed that out of 50 patients, 45 (90%) maintained the stereocauity, and all the 50 had fusion function, but with horizontal fusion range smaller than the normal, and their vertical fusion ranges were greater than the normal, showing there was statistically significant difference ( P   0. 05). Among those with vertical deviation ≤10△, as comparing with those > 10△ ( chi-square test P   0. 05). It suggested that all cases with vertical muscle paralysis might maintain the fusion function, while 90% cases keep the stereoscopic vision. The angle of vertical deviation might affect the near stereopsis, showing that increasing vertical fusion range shouled be a compensation for maintaining the binocular vision caused by vertical deviation.

Key words: 
Strabismus;  Depth perception
Case analysis of a male patient with uncomplicated urinary tract infection in general practice clinic
Authors: Jiatang Zheng, Jinglan Shao, Xiuwen Fei, Yuxia Kong, Aimei Dong, Song Gao
Journal: BMJ (2018)

Urinary tract infection(UTI)is a common disease of the urinary system. Based on a case of male outpatient with primary acute uncomplicated pyelonephritis and the relevant guidelines, this article analyzes the identification, diagnosis and differential diagnosis as well as comprehensive management of uncomplicated upper urinary tract infection, in order to provide information and clinical thinking for general practitioners.


Key words: 
Urinary tract infection; Pyelonephritis, acute; General practitioner
Outcomes of sepsis in patients with multiple myeloma.
Authors: Krishna Rekha Moturi, Prasanth Lingamaneni, Ishaan Vohra, Binav Baral, Muhammad Zain Farooq, Kunnal Batra
Journal: Journal of Clinical Oncology (2020)

e20513 Background: Patients with Multiple Myeloma (MM) are at risk for developing sepsis due to defective humoral immunity, underlying disease factors like renal failure, iron overload, and treatment with immunosuppressive agents. Sepsis is a significant cause of morbidity and mortality in patients with MM. In this study, we aimed to study trends of inpatient outcomes and health care burden of patients with sepsis in MM. Methods: Adult patients with MM admitted to the hospital from 2012 to 2017 were identified from the Nationwide Inpatient Sample database and were stratified into two groups based on the diagnosis of sepsis. Multivariate regression analysis was used to adjust for confounders when calculating for mortality. Statistical tests for trends of mortality, length of stay and hospital charges were performed. Results: A total of 513,615 patients with MM met the inclusion criteria. Sepsis was found to be the most common cause of admission amongst these patients (12.2%) and of the patients with MM who died in the hospital, 38.1% carried the primary diagnosis of sepsis. Mean age of the patients was 70.1 years and they were predominantly Caucasian (62.1%) with male preponderance (57.7%). MM patients admitted with sepsis were found to have higher mortality (15.7 and 3.5% P &lt; 0.0001),higher hospital costs (22,082$ vs 15,206; P &lt; 0.0001) and longer hospital stays (8.1 days vs 6.0 P &lt; 0.0001) when compared to those admitted for other reasons. Temporal trends have been noted to improve over the years, with mortality decreasing from 18% to 13.1%, (p trend &lt; 0.001). Length of stay (in days) decreased from 8.3 to 7.7 days (p trend = 0.009) and hospital charges (in dollars) decreased from 22,407 to 21,209 (p trend &lt; 0.001). Conclusions: Although the improving trends are promising, sepsis still continues to be significantly contributing to morality and morbidity in patients with MM. Measures to identify the changing spectrum of infectious diseases, their predisposing risk factors along with strategies to recognize and prevent early stages of sepsis could have a significant impact on lowering mortality and health care burden. [Table: see text]
Correlation of serum uric acid level with acute cerebral infarction and carotid artery lesions in type 2 diabetic patients
Authors: He Xu, Changshan Liu, Jianxin Dou
Journal: BMJ (2018)

The clinical data of 103 patients with type 2 diabetes (diabetic group) and 111 diabetic patients with acute cerebral infarction (ACI) admitted from August 2016 to October 2017 were reviewed and 101 health subjects served as normal controls (group NC). The examination results of carotid ultrasound, serum uric acid (SUA) levels and blood biochemistry were compared among three groups. The results show that SUA in diabetic patients with ACI was significantly higher (P<0.01). The correlation analysis showed that SUA was positively correlated with intimal medial thickness (IMT) of carotid artery, diabetes with ACI (r=0.521 and 0.489, P<0.01). Logistic regression analysis showed that SUA was an independent risk factor for diabetes with ACI (OR=1.012, 95%CI: 1.007-1.017, P<0.01). Multiple stepwise regression analysis showed that high SUA and systemic blood pressure (SBP) were independent risk factors of increased IMT. Logistic regression analysis showed that SUA was an independent risk factor for vulnerable carotid plaques (OR=1.052, 95%CI: 1.039-1.065, P<0.01).


Key words: 
Uric acid; Brain infarction, acute; Diabetes mellitus, type 2; Tunica intima, carotid arteries
Survey on work satisfaction among general practitioners in Shanghai
Authors: Jian Wang, Qi Zhao, Li Yuan, Zhigang Pan
Journal: BMJ (2017)

Objective
To survey the status quo of work satisfaction of general practitioners (GPs) in Shanghai.


Methods
The status of work satisfaction was investigated with Minnesota job satisfaction questionnaire (MSQ) and self-designed job satisfaction questionnaire among 1 159 GPs working in 223 community healthcare centers from 17 districts/county in Shanghai from February 2014 to June 2016.


Results
Total 1 041 valid MSQ were collected with a recovery rate of 89.8%(1 041/1 159)and 988 valid self-designed job satisfaction questionnaire were collected a recovery rate of 85.3%(988/1 159). The total score of the job satisfaction was (69.63±10.44) points. The highest score of work satisfaction was for moral value (3.98±0.73) points, and the lowest score was for work remuneration and workload (2.70±1.06) points; 20.0%(197/985)of the participants thought that their working environment is extremely poor; 58.4%(575/985)thought that the workload was very or quite heavy; 21.8%(214/982)felt a sense of accomplishment; 69.8%(686/983)had a monthly income of 3000-5000 Yuan, while they expected a median of 10 000 Yuan; 37.4%(366/979)were not satisfied with their job mainly for the reason of low income (94.5%, 346/366), other reasons included incapability of competence improvement (64.5%, 236/366), poor working conditions (47.8%, 175/366) and unsatisfactory professional titles (37.4%, 137/366); 9.7% of participants expressed their intention to quit and start other career.


Conclusion
The work satisfaction of community-based GPs in Shanghai is not high. It has become an urgent issue to give them career incentives to improve their work satisfaction.


Key words: 
Job satisfaction; Questionnaires; General practitioner
Self-reported memory problems in adult-onset cancer survivors in the United States with or without: Type 2 diabetes mellitus, hypertension and hyperlipidemia.
Authors: Valerie Thimothee, Alexis Kendall, Ashley Perez, Elora Friar, Catherine Rothman, Francesca Carpenteiri, Paul Winters, Temple Robinson, Pascal Jean-Pierre
Journal: Journal of Clinical Oncology (2020)

e24062 Background: Cancer and chronic diseases (CD) are independent predictors of cognitive dysfunction, especially memory problems that can impact patients’ psychosocial functioning and quality of life. We examined the prevalence of memory problems in cancer patients with or without CD, including Type 2 Diabetes mellitus (DM), hypertension (HTN) and hyperlipidemia (HLD). Methods: We examined data from people who completed the US National Health and Nutrition Examination Survey from 2009 to 2016 to determine the prevalence of memory problems in cancer survivors vs. non-cancer survivors with and without a history of CD. Participants answered the ‘yes’ or ‘no’ question: “Are you limited in any way because of difficulty remembering or because you experience periods of confusion?” History of Cancer, DM, HTN and HLD were self-reported. We used Rao-Scott Modified Chi-Square Test (X 2 test) for cross-classified categorical data from complex sample survey. Age, sex, race-ethnicity, education, poverty, and general health were controlled using logistic regression. Results: The sample included 21813 adults, ³ 20 years old, and ≈52% female. There were 40% Whites, 22% Blacks, 25% Mexican American/Other Hispanics, and 13% other race/multi-racial. About 46% graduated high School/had a GED (21.2%) or completed less than high school (24.4%). Of those with cancer ( N= 2025), memory problems were associated with DM (17.72%; X 2 test, p= 0.003) and (HTN, 13.42%; X 2 test, p= 0.007), but not HLD (11.66%; X 2 test, p= 0.786). Of those without cancer, memory problems were associated with DM, HTN and HLD (all p&lt; 0.0001). Prevalence of CD was much greater in cancer survivors with memory problems ( p&lt; .05). Conclusions: Strategies to mitigate memory problems in cancer survivors should consider the implications of DM, HTN and HLD, particularly given the prevalence of these chronic morbidities in cancer populations.
Comparison of two chemotherapy regimens in Ewing sarcoma (ES): Overall and subgroup results of the Euro Ewing 2012 randomized trial (EE2012).
Authors: Bernadette Brennan, Laura Kirton, Perrine Marec-Berard, Javier Martin -Broto, Hans Gelderblom, Nathalie Gaspar, Sandra J Strauss, Ana Sastre Urgelles, Jennifer Anderton, Valerie Laurence, Jeremy Whelan, Keith Wheatley
Journal: Journal of Clinical Oncology (2020)

11500 Background: In 2010, different chemotherapy regimens were standard in Europe and the USA for newly diagnosed ES. In the absence of novel agents to investigate, comparison of these two strategies was considered worthwhile. Methods: Newly diagnosed localised or metastatic ES patients aged 5-50 were eligible. Patients were randomized to receive either the European regimen (Arm A) of VIDE (vincristine [V], ifosfamide [I], doxorubicin [D] and etoposide [E]) induction and VAI or VAC (V, actinomycin D and I or cyclophosphamide [C]) consolidation or the USA regimen (Arm B) of compressed VDC/IE induction and IE/VC consolidation. The primary outcome measure was event-free survival (EFS); secondary outcomes included overall survival (OS) and toxicity. The design was Bayesian with interpretation based on posterior probabilities (with non-informative priors) – i.e. probability that true hazard ratio (HR) &lt; 1.0 given the data [Pr(HR&lt;1.0|data)], with 95% credible intervals (CrI) reported. HRs were obtained from Cox models adjusted for baseline stratification parameters. Heterogeneity tests (HT) were used to investigate whether the treatment effect differed according to baseline parameters. Analysis was intention-to-treat. Results: Between December 2013 and May 2019, 640 patients were randomised (320 to each arm) from 10 European countries. Baseline stratification factors were: sex (58% male; 42% female); age (41% &lt;14 years; 59% 14+ years); disease type (74% localised, 17% lung/pleural metastasis, 9% other metastasis); tumour volume (56% &lt;200 ml, 44% &gt;200 ml); country (37% UK, 31% France, 32% other). Median follow-up was 1.7 years. The HRs (95% CrI) were 0.70 (0.51, 0.95) for EFS and 0.64 (0.42, 0.96) for OS in favour of Arm B, with posterior probabilities of 98% for both that Arm B was better. Subgroup analyses showed no evidence that this benefit differed depending the baseline features, with no HT being close to significance (table). There were no major differences in acute toxicity: 68% of patients in Arm A experienced serious adverse events and 67% in Arm B. Conclusions: VDC/IE chemotherapy is superior to VIDE for both EFS and OS, with no excess toxicity. This benefit is consistent across all baseline stratification parameters. Clinical trial information: ISRCTN92192408 . [Table: see text]
Resistance to natural killer cell immunosurveillance confers a selective advantage to polyclonal metastasis
Authors: Hin Ching Lo, Zhan Xu, Ik Sun Kim, Bradley Pingel, Sergio Aguirre, Srikanth Kodali, Jun Liu, Weijie Zhang, Aaron M. Muscarella, Sarah M. Hein, Alexander S. Krupnick, Joel R. Neilson, Silke Paust, Jeffrey M. Rosen, Hai Wang, Xiang H.-F. Zhang
Journal: Nature Cancer (2020)