tbuckley/cabot-search huggingface dataset:
Analysis of 4-year trend of the prevalence of hyperuricemia and related metabolic factors in urbanized community population in Hangzhou
Authors: Chengcheng Ma, Wenyun Dai, Aijun Wu, Wei Ding, Xiaoyan Lu
Journal: BMJ (2015)

Objective
To understand the trends of the prevalence of hyperuricemia of urbanized community residents Sijiqing Streets in Jianggan district in Hangzhou in the past 4 years, and analyze the correlation between hyperuricemia and metabolic factors, which provide scientific endence for prevention and treatment of hyperuricemia in communities.


Methods
1 670 cases equal to or greater than 20 years old were randomly selected to analyze the trends of the prevalence of hyperuricemia in the past 4 consecutive years, which from urbanized community physical examination in 2010 to 2013(male 749 cases, female 921cases). Comparative analysis of age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin (HbA1C), TG, TC, LDL-C, and HDL-C levels between hyperuricemia group(male 264 cases, female 181 cases) and non hyperuricemia group(male 485 cases, female 740 cases) on 2013, and analyze the related metabolic factors to hyperuricemia by using non conditional logistic regression analysis.


Results
①From 2010 to 2013, male hyperuricemia prevalence rates were 27.9% (209/749, standardized rates were 27.4%)、29.1%(218/749, standardized rates were 27.9%), 33.2%(249/749, standardized rates were 31.8%)and 35.2%(264/749, standardized rates were 32.9%). The prevalence rates of female were 12.6%(116/921, standardized rates were 11.7%), 13.5%(124/921, standardized rates were 11.9%), 18.0%(166/921, standardized rates were 15.7%) and 19.7(181/921, standardized rates were 17.2%), showed a increased tends year by year (the χ2 of tends of male and female were 11.907 and 22.759, respectively, all P 0.05). ③The non conditional Logistic regression analysis showed that, independent risk factor for male hyperuricemia were overweight (OR: 2.151, 95%CI: 1.439-3.215) or obese (OR: 2.882, 95%CI: 1.541-5.389), hypertension (OR: 1.564, 95%CI: 1.100-2.224), dyslipidemia (OR: 1.678, 95%CI: 1.165-2.417) and abdominal obesity (OR: 1.708, 95%CI: 1.146-2.547), independent risk factors for hyperuricemia in women were overweight (OR: 2.067, 95%CI: 1.290-3.313) or obese (OR: 2.843, 95%CI: 1.523-5.309), hypertension (OR: 1.530, 95%CI: 1.042-2.248), dyslipidemia (OR: 1.784, 95%CI: 1.191-2.672) and hyperglycemia (OR: 1.768, 95%CI: 1.221-2.561).


Conclusions
The community people have a higher prevalence of hyperuricemia, which showed a increased trend, especially in the middle and old age year by year; overweight or obesity, abdominal obesity, hypertension and dyslipidaemia influence male prevalence rate of hyperuricemia, overweight or obesity, hypertension, hyperglycemia and dyslipidemia influence female prevalence rate of hyperuricemia, we should strengthen the comprehensive prevention and treatment of hyperuricemia in this community.


Key words: 
Hyperuricemia; Prevalence; Risk factors
Status of aspirin prescription for primary and secondary prevention of cardiovascular diseases among general practitioners in Beijing
Authors: Zhiyi Ma, Xueping Du, Ningling Sun
Journal: BMJ (2017)

Objective
To assess the current status of aspirin use in primary and secondary prevention of cardiovascular diseases among general practitioners in Beijing.


Methods
A questionnaire survey was conducted from September 2014 to January 2015 among 60 000 patients visiting general practice clinics in 60 community health service centers in Beijing. The questionnaire on the aspirin use for primary and secondary prevention of cardiovascular disease was designed by Chinese Medical Doctor Association (CMDA).


Results
Total 56 969 valid questionnaires were retrieved with a recovery rate of 94.9%. Total 39 424 participants met the criteria for primary and secondary prevention of cardiovascular disease, including 13 177 for primary prevention(33.42%)and 26 247 for secondary prevention(66.58%). Among 39 424 patients, 29 952 received aspirin for prevention (75.97%), the rate of aspirin use for primary prevention was 70.52%(9 293/13 177) and for secondary prevention was 78.71%(20 659/26 247). The rates of aspirin use for primary and secondary prevention were increased with the age, and those aged ≥60 years had the highest rate (72.66% and 80.06%, respectively). After adjusted by age and gender, general practitioners preferred to prescribed aspirin for primary prevention in patients with hypertension or diabetes(P<0.001)and for secondary prevention in patients with hypertension, diabetes, hypercholesteremia, smoking, hyperuricemia and obesity (all P<0.05).


Conclusion
Prescription rate of aspirin for prevention of cardiovascular disease among general practitioners in Beijing is generally high, especially for secondary prevention.


Key words: 
Aspirin; General practitioners; Questionnaires
Preliminary clinical pharmacokinetics and dose-response to support a phase II dose selection for CX-2009: A masked probody drug conjugate to CD166.
Authors: Mark Stroh, Rachel Li, Hong Lu, Russ Wada, Jennifer Hope Richardson, John W. Frye, Amy C. Peterson
Journal: Journal of Clinical Oncology (2020)

3599 Background: PROBODY therapeutics are antibody prodrugs with cleavable peptide masks designed to reduce off-tumor, on-target toxicities. The mask blocks binding in the periphery and is removed by tumor-associated proteases resulting in intratumoral binding. CX-2009 is a PROBODY drug conjugate directed against CD166/ALCAM, which is a target overexpressed in carcinomas but not suitable for traditional ADC targeting because it is expressed in normal epithelium. CX-2009 is conjugated to DM4, a potent microtubule inhibitor. Here we report preliminary clinical pharmacokinetic (PK) and exploratory dose-response (DR) analyses for CX-2009 from the ongoing phase 1/2 PROCLAIM-CX-2009 study (NCT03149549). Methods: Human PK and anti-drug antibody (ADA) data were obtained at selected times post-dose following IV 0.25–10 mpk CX-2009 Q3W and of 6 mpk Q2W. Covariates were selected for population PK (POPPK) based on multivariate screening at P&lt; 0.01. Preliminary exploratory DR analyses were conducted for selected endpoints including adverse events of special interest and response data (CR, PR, SD, and PD). Results: Preliminary CX-2009 PK data from 92 subjects were available as of October 2019. Median free DM4 levels circulated at ≤0.3% of Total CX-2009 (masked + activated CX-2009) levels across the 1–10 mpk dose levels. A two-compartment POPPK model with linear elimination was fit to the Intact (masked form) CX-2009 data. The preliminary CX-2009 POPPK model estimates for Intact CX-2009 clearance (CL), volume of distribution, and half-life were 0.47 L/day, 4.51 L, and 7.14 days, respectively, with 91% of CX-2009 circulating as Intact CX-2009. ADA was not a statistically significant covariate on Intact CX-2009 CL. Evidence of clinical activity was observed at doses of 4 mpk Q3W or higher. DR analysis suggested that the frequency of grade ≥3 ocular toxicity events increased significantly at dose equivalents ≥8 mpk Q3W. POPPK simulations suggested that the targeted 90 nM trough concentration (based on nonclinical data) would be contained within the 90% prediction interval of predicted Intact CX-2009 levels following CX-2009 7 mpk. Conclusions: Preliminary CX-2009 PK data following CX-2009 0.25-10 mpk suggest that CX-2009 circulates predominantly as Intact CX-2009, and that Intact CX-2009 PK is not strongly influenced by target-mediated drug disposition or ADA. Preliminary DR and POPPK simulations support further evaluation of 7 mpk CX-2009 Q3W in selected cohort expansions. Clinical trial information: NCT03149549 .
Selection of patients for surveillance imaging after radiotherapy for squamous cell carcinoma of oral cavity and oropharynx.
Authors: Johnathan Zeng, Christopher W Fleming, Maxwell Lee, Rujul H Parikh, Lisa A. Rybicki, Nikhil Joshi, Neil McIver Woody, Jamie Ku, Brandon Prendes, Eric Lamarre, Robert R Lorenz, Joseph Scharpf, Brian B. Burkey, Deborah Chute, Larisa Schwartzman, Jessica Lyn Geiger, David J. Adelstein, Shlomo A. Koyfman
Journal: Journal of Clinical Oncology (2020)

6533 Background: NCCN guidelines do not recommend routine surveillance imaging for distant failure (DF) after definitive treatment of head &amp; neck squamous cell carcinoma (SCC). We hypothesized that there exists a subset of patients with sufficiently high enough risk for DF to benefit from surveillance imaging. This study attempts to define high risk cohorts of oropharynx (OP) and oral cavity (OC) patients. Methods: A retrospective review was conducted of patients with SCC of the OP or OC at a single tertiary care institution from 1994-2019. Patients were staged according to AJCC 7 th edition and included in this study if they completed definitive-intent treatment and received 60 Gray or higher of radiotherapy (RT). Local, regional, and distant failure were estimated with cumulative incidence. Univariable &amp; multivariable risk factors for DF were identified with Fine &amp; Gray competing risk regression. Significant variables were compiled to calculate a risk score. Results: 863 patients were included (676 OP/187 OC). OC patients were 60.4% male, median age 61, with median follow up of 77.5 months. Smoking status was 27.3% current, 44.4% former, 28.3% never, with 30 median pack years. Disease was 57.3% T1-2, 42.7% T3-4, 55.6% N0-2a, 44.4% N2b-3. 94.1% had surgery &amp; 34.3% had concurrent systemic therapy. OP patients were 87.9% male, median age 58, 96.3% HPV+, with median follow up of 60.8 months. Smoking status was 20.9% current, 44.5% former, 34.6% never, with 20 median pack years. Disease was 67.9% T1-2, 32.1% T3-4, 29.9% N0-2a, 70.1% N2b-3. 11.5% had surgery &amp; 87.3% had concurrent systemic therapy. Specifically, 52.2% of OP patients received concurrent cisplatin, 10.6% concurrent cetuximab, and 24.5% other systemic therapies. 11.7% of patients experienced DF, of which 77% failed in the lung. Within the OC cohort, nodal stage 2b or higher was the only predictive factor (HR 3.26, p &lt; 0.001), conferring a 3 year risk of DF of 34% vs 10%. Within the OP cohort, a high risk cohort of 87 patients (12.9%) was identified with a 3 year incidence DF of 22%, compared to 10% or less in lower risk cohorts. This high risk cohort consisted of active smokers treated with definitive RT and either concurrent cisplatin or no concurrent therapy, with at least T3 and N2b disease, as well as any patients treated with definitive RT and concurrent cetuximab. Conclusions: We identified groups of OC &amp; OP patients with greater than 20% risk of developing DF at 3 years, the majority of which occurred in the lung. Surveillance imaging of the chest should be considered for patients meeting these criteria.
Long-term adherence to chemoprevention agents among women at high risk of breast cancer
Authors: Ning Ma, Chongzhu Hu, Enqing Wang, Ruixue Yue, Huan Li, Hui Zhang, Jiani Liu, Wenjuan Zhang, Zhiying Bian
Journal: BMJ (2017)

One hundred and eighty three women with high risk of breast cancer identified in Baoding First Central Hospital from June 2007 to June 2014, were enrolled in the study. In these 183 cases, 41 received preventive therapy (22.4%), 142 did not. Factors associated with acceptance of chemoprevention included older age, menopause, comorbidities, lower level education, being married, higher BMI, having high level hyperplasia of ductal epthelia and counseling to breast specialists (P<0.05); while  not informed by doctors was the main reason for failed taking preventive agents(95.1%, 135/142). Thirteen of 41 women receiving chemoprevention discontinued the therapy (31.7%); no-insurance, no side-effects and higher BMI were related to the discontinuing (P<0.05). The 1-, 2-, 3-, and 5-year adherence rates of chemoprevention was 86.1%(31/36), 65.4%(17/26), 59.1%(13/22), 8/13 and 5/10, respectively. The results show that chemoprevention rate is low among Chinese women at high risk of breast cancer, and the long-term adherence to preventive therapy is poor. Corresponding measures should be taken to strengthen the chemoprevention of breast cancer.


Key words: 
Breast neoplasms; Carcinoma; Chemoprevention; Medication adherence
Clinical efficacy of pelvic floor reconstruction with autologous tissue in treatment of pelvic organ prolapse
Authors: Lingxiao Huang, Lixiao Sha, Luhang Ma
Journal: BMJ (2019)

One hundred and twenty nine patients with pelvic organ prolapse (stage Ⅲ to Ⅳ according to POP-Q staging) diagnosed in our hospital from January 2010 to December 2016 were enrolled, among whom 66 cases underwent vaginal hysterectomy plus vaginal anterior and posterior wall repair (TO group), 63 cases underwent vaginal hysterectomy plus pelvic floor reconstruction with autologous tissue (AT group). Clinical parameters, perioperative and postoperative complications were analyzed. There was no statistically significant difference in intraoperative blood loss, indwelling urethral catheter time, length of hospital stay, and anal exhaust time between group AT and group TO (P>0.05). The average operation time of group AT was significantly longer than that of group TO (P 0.05), while the BND at 12 months after operation in group TO was increased compared to 3 months after operation (P<0.05). There were significant differences in scores of PFIQ-7 and PISQ-12 before surgery and 12 month after surgery in both groups (P<0.05). There was no statistically significant difference between the two groups in the incidence of postoperative recurrence and pressure incontinence (P<0.05). It is suggested that the stability of pelvic floor anatomical structure after pelvic floor reconstruction with autologous tissue is better than that of the traditional surgery, especially for patients with severe pelvic organ prolapse.


Key words: 
Uterine prolapse; Urinary incontinence, stress; Rrepair of vaginal anterior and posterior wall; Pelvic floor reconstruction surgery with autologous tissue
Dynamic 30-day readmission prediction for cancer patients via clinical embeddings.
Authors: Chi Wah Wong, Chen Chen, Lorenzo A. Rossi, Jerry Wang, Monga Abila, Janet Munu, Zahra Eftekhari
Journal: Journal of Clinical Oncology (2020)

2040 Background: Existing models typically predict unplanned 30-day readmission for cancer patients at discharge 1 . Performing prediction dynamically during hospital stay may allow earlier intervention for high risk patients. In addition, readmission risk may be associated with the outcome of a variety of labs and diagnoses. Models including all those elements may not be practical due to large number of variables relative to number of samples. Embeddings have the potential to represent medical concepts in low dimensional spaces 2 . In this study, we developed a machine learning model utilizing embedding representations of ICD and LOINC codes to dynamically predict readmission risk. Methods: This is a single institutional study examining inpatient 30-day unplanned readmissions from Jan 2013 to Dec 2016 (n = 16361 total, n = 5685 in hematology). The readmission rate was 18% (24% for hematology). We used gradient boosted trees models with 10-fold cross validation and included baseline factors that are typically available shortly after admission: gender, age, service, admission count within 6 months, insurance, emergency admission, admission year, allogeneic or autologous stem cell transplant (hematology only). For dynamic factors, we randomly selected a timepoint (TP, median = 2.4 days) during each visit. We utilized publicly available clinical embeddings 2 to generate 300 dimensional representations for ICD9s and LOINCs in the patients’ Electronic Medical Records. We considered diagnoses (ICD9) between 6 months prior to admission and TP, and lab tests (LOINC) ordered between admission time and TP. We used records from Jan 2017 to Dec 2017 for prospective validation (n = 3785 total, n = 1424 in hematology), with 17% readmission rate (22% for hematology). Results: Prospective validation Area Under Receiver Operating Characteristic Curve (AUC) using baseline factors were 0.72 (average precision “AP” = 0.33) and 0.65 (AP = 0.32) for overall and hematology populations, respectively. By including dynamic factors, we obtained AUCs of 0.74 (AP = 0.4) and 0.7 (AP = 0.39) for overall and hematology populations, corresponding to 3% and 8% AUC (21% and 22% AP) improvements, respectively. Conclusions: We found that dynamic readmission prediction utilizing clinical embeddings improves the prediction performance comparing with using baseline factors only. The model shows potential to improve patient care and reduce costs by predicting and preventing readmissions when the patient is still in the hospital. 1 J Surg Oncol 2018; 117:1113-1118. 2 AMIA Jt Summits Transl Sci Proc. 2016;41-50.
小儿对结肠镜检查耐受性的研究
Authors: 罗艳红, 游洁玉, 陈昌斌, 张爱莲
Journal: BMJ (2004)

电子结肠镜检查是一种侵入性检查,小儿的肠腔小,肠壁薄,操作较困难,且小儿不能完全主动配合.因此家长与儿科医师对小儿能否耐受肠镜检查及安全性均存有顾虑[1].对此,我们总结分析了近2年来在我院内窥镜中心进行小儿肠镜检查的耐受情况。
Lyme borreliosis: diagnosis and management
Authors: Bart Jan Kullberg, Hedwig D Vrijmoeth, Freek van de Schoor, Joppe W Hovius
Journal: BMJ (2020)

Abstract Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.
Perioperative blood transfusion and postoperative outcomes in patients undergoing radical cystectomy for bladder cancer.
Authors: Leonidas Nikolaos Diamantopoulos, Rishi Robert Sekar, Ali Raza Khaki, Natalie Miller, Adam John Gadzinski, Sarah P. Psutka, John L. Gore, George R. Schade, Daniel W. Lin, Maria S. Tretiakova, Funda Vakar-Lopez, Lawrence D. True, Andrew Caleb Hsieh, Heather H. Cheng, Evan Y. Yu, Michael Thomas Schweizer, Todd Yezefski, Robert B. Montgomery, Petros Grivas, Jonathan L. Wright
Journal: Journal of Clinical Oncology (2020)

e17012 Background: Perioperative blood transfusion (PBT) has been associated with worse outcomes in surgical oncology across tumor types. We report our institutional experience of postoperative outcomes related to PBT utilization, in patients (pts) with bladder cancer (BC) treated with radical cystectomy (RC). We hypothesized that PBT is associated with worse clinical outcomes. Methods: Pts with BC treated with RC were retrospectively identified. Clinicopathologic and peri/post-operative data were extracted. PBT was defined as red blood cell transfusion during RC or postoperative hospitalization. Overall survival (OS, diagnosis to death) and recurrence free survival (RFS, RC to recurrence/death) were estimated with the KM method. T-test, χ 2 and log-rank test were used for group comparison analysis. Univariate/multivariate logistic (LR) and Cox regression (CR) were used to identify variables associated with dependent dichotomous outcomes and OS/RFS, respectively. Results: 784 consecutive pts (78% men; median age 67) were identified. At least one post-operative complication (POC) occurred in 407 (52%) pts; most common were pyelonephritis and sepsis (11% each). PBT was administered to 238 pts (30%). Those with PBT had a higher proportion of POCs (35% vs 28%, p = .02). Median follow-up, OS and RFS were 66 (95% CI: 60 - 72), 94 (95% CI: 79 - 109) and 66 months (95% CI: 50 – 82), respectively. Pts who received PBT had shorter OS (51 vs 130 months, p &lt; .001) and RFS (27 vs 86 months, p &lt; .001). In multivariate LR and CR, PBT was independently associated with higher odds of POCs (OR 1.5, 95% CI: 1.03 – 2.2, p = .03), length of hospital stay (LOS) &gt; 10 days (OR 2.0, 95% CI 1.1 – 3.5, p = .02), shorter OS (HR 1.6, 95% CI 1.2-2.0, p = .001), and RFS (HR 1.5, 95% CI 1.2 - 1.9, p = .001), after adjustment for other relevant clinicopathologic variables (age, gender, performance status, neoadjuvant chemotherapy, baseline hemoglobin, open/robotic approach, pT/N stage, surgical margins, lymphovascular invasion at RC, variant histologies). Conclusions: Pts who received PBT had higher odds of POC, longer LOS and poor outcomes after RC. This is hypothesis-generating due to inherent study limitations. Further studies are needed to validate this finding, explain underlying mechanisms and explore putative interventions to improve outcomes.