tbuckley/cabot-search huggingface dataset:
Risk factors fornon-alcoholic fatty liver disease in patients with type 2 diabetes mellitus
Authors: Lin Su, Yu-lan Liu
Journal: BMJ (2010)

：Two hundred male and 200female patients with type 2 diabetes mellitus admitted from January 2007 to April 2008were enrolled in the study. Of them, 267 were diagnosed as non-alcoholic fatty liverdisease (NAFLD) by ultrasonography. The measurements included:body mass index (BMI),waist-to-hip ratio (WHR) ,fasting blood glucose( FBG), ALT, AST, total bilirubin(TBIL),cholesterol(CHO),triglyceride(TG), high density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol ( LDL-C) ,serum creatinine (Cr), supersensitive C-reactiveprotein (hsCRP) and urine albumin/creatinine. The relationship of above factors with NAFLDwas determined. Our data showed that male NAFLD patients were in general younger thanfemale. The BMI ( t = 11. 361, P = 0. 000), waist circumference ( t = 9. 771, P =0. 000),hip circumference (t = 10. 469, P =0. 000) ,TG(t =7. 352, P =0. 000) and hsCRP (t =2.242,P =0. 026) of NAFLD patients were significantly higher than those without NAFLD. ThehsCRP of patients with central obesity was also significantly higher than those withoutcentral obesity (t = 0. 266, P = 0. 045 ).BMI and TG were positively correlated withNAFLD. Waist circumference was an independent factor of NAFLD in male patients, same aship circumference with NAFLD in female patients. In conclusion, gender,central obesity anddyslipidemia may be risk factors for NAFLD in patients with type 2 diabetes mellitus.
多功能电离子美容仪治疗睑黄瘤和汗管瘤的临床疗效观察
Authors: 孙莉, 连海燕, 包桂红, 卞金玲, 徐丽, 杨昭英
Journal: BMJ (2007)

睑黄瘤是脂质代谢障碍性皮肤病,多见于中年、更年期前后妇女,发展缓慢.汗管瘤为小汗腺导管肿瘤,中青年妇女发病率较高,研究提示孕激素可能在其发生中起重要作用[1].睑黄瘤和汗管瘤均是好发于面部影响美观的常见皮肤病[2],治疗方法各异.我科运用多功能电离子美容仪治疗,取得一定经验。
Assessing readmission after axicabtagene ciloleucel immunotherapy.
Authors: Paula Perkins, Aisling Cearley, Angela Kirk, Erin Mullane, Mazyar Shadman, David G. Maloney
Journal: Journal of Clinical Oncology (2020)

3024 Background: Axicabtagene ciloleucel (axi-cel) is an FDA approved CD19 targeted CAR-T for patients (pts) with diffuse-large-B cell lymphoma (DLBCL) after 2 lines of treatment. Pts are monitored inpatient for minimum 7 days after CAR-T infusion but remain at risk of complications after discharge that can lead to readmission. We report our institutional experience on the rate and etiology of readmissions after initial discharge. Methods: In this retrospective study, readmission was defined as an inpatient stay greater than 48 hours while under the auspice of the Immunotherapy service. Cytokine release syndrome (CRS) and neurotoxicity (NT) were graded based on the Lee and CTC v.4 criteria, respectively. Logistic regression models were used to study the association between clinical factors and readmission. Results: 44 pts received axi-cel. Median age was 62 (25-79). 33 pts (75%) had primary refractory disease and 14 (30%) had prior transplant. Pts had median 3 lines (2 -9) of treatment before axi-cel. Median time from most recent treatment to leukapheresis was 10 weeks (0.5-109). 22 pts (48%) received bridging therapy between leukapheresis and lymphodepletion (LD). Median duration of initial planned admission was 7.5 days (6-16). Incidence of CRS was 88% (all grades) and 12% (grade 3/4). Median time to start of CRS was 3 days (0-13). Incidence of NT was 61% (all grades) and 16% (grade 3/4) and median time to NT was 6 days (3-14). 6 pts (14%) were readmitted after initial hospitalization (1 had 2 readmissions). Median day of readmission was 13 (9-25). Median duration of subsequent hospitalization was 5 days (2-31). Reasons for readmission were: infection (2), CRS (2), GI bleed (1), progressive disease (PD) (1) and NT (1). 4 of 6 pts had no CRS or NT before readmission. 2 of the 4 were readmitted on days 9 and 13 for NT. The other 2 pts were readmitted for infection and GI bleed. 1 pt had grade 2 CRS and grade 2 NT during first admission and was readmitted on day 25 for PD. Last pt had grade 2 CRS and grade 3 NT during first admission with discharge day 13, readmission day 14 through day 17 with recurrent NT and second readmission day 30 for infection. 3 of 6 pts had ICU admissions during second admissions. There was no association between pre- and post- CAR-T variables and risk of readmission in multivariable models. Conclusions: Readmissions after discharge from initial planned hospitalization for axi-cel are not uncommon. This data supports our current policy of close monitoring until at least a month after CAR-T therapy and supports the requirement of a full-time caregiver until discharge from the Immunotherapy service.
The association of CD8<sup>+</sup> T-cell infiltration and PD-L1 expression with prognosis of Chinese pulmonary large cell neuroendocrine carcinoma.
Authors: Ye Li, Xinying Shi, Jinliang Wang, Beibei Mao, Jie Li, Yukai Hu, Baolin Qu, Henghui Zhang, Shun Chang Jiao
Journal: Journal of Clinical Oncology (2020)

e21003 Background: Pulmonary large cell neuroendocrine carcinoma (LCNCE) is a high-grade neuroendocrine tumor with poor prognosis. The genomic profile and immune feature of LCNEC have been reported in many studies. However, the relationship between immune microenvironment and the prognosis of LCNEC patients is poorly understood. Our study was aimed to examine the infiltration of CD8 + T cell and PD-L1 + cells in LCNEC patients, and explore whether CD8 + T cell and PD-L1 + cells are related to LCNEC patients’ prognosis. Methods: 37 eligible LCNEC patients (stage I-III) with received the treatment of surgical operation (27 among 37 patients underwent adjuvant radiochemotherapy) were included, tumor tissues were collected from the first medical center of Chinese PLA General Hospital. Multiplex immunohistochemistry (Multi IHC) was performed using the antibodies of CD8 and PD-L1. The univariate and multivariate cox proportional hazards analyses were used to assess the association between the abundance of CD8 + T cell and PD-L1 + cells with the clinical outcome of LCNEC patients. Results: Patients were divided into high and low group using the median positive percentage of CD8 or PD-L1 as cutoff. The univariate analysis showed that patients with stromal high CD8 + T cell infiltration or stage I had significantly longer disease free survival (DFS) (CD8, p = 0.03; stage I, p = 0.036), and patients with high PD-L1 expression in stroma region, I stage, adjvant radiochemotherapy had notably increased overall survival (OS) (p = 0.049, p = 0.031, p = 0.023, respectively). However, the infiltration of CD8 + T cell or PD-L1 expression in total or tumor region had no correlation with survival of LCNEC patients. Furthermore, multivariate analysis demonstrated that low CD8+ T cell density in stroma region was an independent risk factor for PFS (p = 0.03), advanced TNM stage (II-III stage, p = 0.0009) and low stromal PD-L1 expression were independent risk factors for OS (p = 0.013). Conclusions: High infiltration of CD8 + T cell or PD-L1 + cell in stroma region were independent good prognosis factors of LCNEC patients. However, these findings need a larger LCNEC cohort to validate.
甲型H1N1流行性感冒预防控制知识问答
Authors: 乌正赉
Journal: BMJ (2009)

编者按:这声突如其来的甲型H1N1流行性感冒疫情正在全球蔓延,对此,我们即不必惊慌,又要保持高度的警惕.为提高医生们对甲型H1N1流行性感冒的认识和预防控制能力,本刊编辑部紧包邀请我国著名流行病学专家乌正赉教授编撰本文.由于时间仓促,谨以活插页的方式快速送达读者手中。
导致误诊的原因
Authors: 曾昭耆
Journal: BMJ (2011)

诊断,是医生面对患者要做的第一件事情.因为没有正确的诊断,就没有正确的治疗处理.从主观愿望说,每个医生都总是希望自己的诊断正确,但是由于种种原因,这个愿望有时很难达到.所谓误诊,指的就是医生在诊断上发生的失误.本文试图结合实例,对导致误诊的原因做一些分析。
Multi-omics analysis of mantle cell lymphoma reveals an immune-cold tumor microenvironment associated with ibrutinib resistance.
Authors: Krystle Nomie, Preetesh Jain, Nikita Kotlov, Vitaly Segodin, Qingsong Cai, Yang Liu, Lucy Navsaria, Viktor Svekolkin, Alexander Bagaev, Felix Frenkel, Ravshan Ataullakhanov, Nathan Hale Fowler, Michael Wang
Journal: Journal of Clinical Oncology (2020)

8055 Background: Mantle cell lymphoma (MCL) is an aggressive and incurable B-cell lymphoma. Although the role of the MCL tumor microenvironment (TME) in survival and therapeutic response has been studied, greater knowledge regarding the tumor-immune interaction is needed to develop MCL immunotherapeutic strategies. Methods: Whole exome sequencing (WES; n = 41) and RNA-seq (n = 93) were performed on fresh peripheral blood, apheresis, or biopsy MCL patient primary samples. Joint WES and RNA-seq mutation calling, expression analysis were performed by BostonGene. Results: Both tumor and TME molecular signatures were characterized based on ibrutinib response. Concurrent analysis of MCL biopsy samples with an additional previously published cohort (n = 122; Scott et al., JCO, 2017) identified 4 MCL microenvironment signatures (Nomie et al., Blood, 2019) in which the ibrutinib-resistant MCL samples primarily belonged to the “stroma-enriched” subtype (29%; 6/8 resistant, non-immune with increased stromal signature and tumor-promoting cytokines), whereas most of the ibrutinib-sensitive samples were assigned to the “immune-hot” subtype (53%, 9/9 sensitive; anti-tumor infiltration, high immune and checkpoint molecule expression with low stromal expression, Chi-square test p-value = 0.001). NOTCH1 gain-of-function mutations (25%, 3/12 resistant) in the PEST domain were found exclusively in the ibrutinib-resistant cohort associated with the microenvironment-depleted subtype. Frequent recurring inactivating mutations in the epigenetic modifier KMT2D (30%) were identified in MCL cells associated with the ‘immune-suppressed” subtype (p &lt; 0.05). Loss-of-function mutations in epigenetic modifiers have been tied to immune evasion. PD-L1 was significantly downregulated in the ibrutinib-resistant MCL tumors (p = 0.03), indicating that targeting the PD-L1 and PD-1 immune checkpoint axis may not be beneficial. Conclusions: Ibrutinib sensitivity and resistance were defined by immune-hot and immune-cold TME portraits, respectively, suggesting that the TME has a prominent role in mediating ibrutinib response. Ibrutinib has been suggested to activate the immune TME through its off target inhibition of interleukin 2–inducible T-cell kinase (ITK). The immune activation by ibrutinib suggests that anti-tumor activity of ibrutinib may be better harnessed by combining ibrutinib with immunotherapy.
Efficacy, safety, and immune priming effect of tazemetostat in patients with epithelioid sarcoma.
Authors: Mrinal M. Gounder, Silvia Stacchiotti, Patrick Schoffski, Gregory Michael Cote, Victor Manuel Villalobos, Thierry Marie Jahan, Tom Wei-Wu Chen, Ravin Ratan, Abha A. Gupta, Palma Dileo, Mark Agulnik, Antoine Italiano, Steven Attia, Olivier Mir, Joseph Gerald Pressey, Laura Sierra, Trupti Lingaraj, Jay Yang, Shefali Agarwal, Robin L. Jones
Journal: Journal of Clinical Oncology (2020)

11564 Background: Epithelioid sarcoma (ES) is a rare, aggressive soft tissue sarcoma characterized by loss of inhibitor of integrase 1 (INI1), allowing enhancer of zeste homologue 2 (EZH2) to repress cell differentiation and promote tumorigenesis. Tazemetostat (TAZ) is a selective inhibitor of EZH2 approved by the FDA for treatment of patients (pts) aged ≥16 years with metastatic or locally advanced ES ineligible for complete resection. Methods: This open-label, multicenter, multi-cohort phase 2 study (NCT02601950) evaluated safety and efficacy of TAZ in pts with INI1-negative tumors. ES pts were enrolled in Cohorts 5 and 6; pts in Cohort 6 underwent mandatory pre-dose (at screening) and post-dose biopsies (at Day 1 of cycle 2). Herein, we report the interim efficacy and safety data from Cohort 6. Results: As of July 31 2019, 44 pts were enrolled into Cohort 6 and treated with TAZ 800 mg BID. The objective response rate (ORR) was 11.4%; 4 pts (9.1%) had a partial response and 1 pt (2.3%) had a complete response (Table). Another 17 pts (38.6%) had stable disease (SD). 18 pts had progressive disease; 13 of these pts remained on study beyond progression. Progression-free survival (PFS) and overall survival (OS) at 56 weeks were 19.4% and 59.4%, respectively. In a pooled posthoc analysis of 106 ES pts from Cohorts 5 (n = 62), and 6, ORR was 13.2%. Grade 3–4 adverse events (AEs) were reported in 16 pts (36.4%), most commonly anemia (6.8%; n = 3) and tumor pain (6.8%; n = 3). 3 pts (6.8%) experienced grade 3–4 treatment-related AEs. One pt discontinued study drug and there were no treatment-emergent dose reductions or treatment-related deaths. These safety data from Cohort 6 are consistent with previously reported data from Cohort 5. 19 paired biopsies were included for translational endpoint analyses. Preliminary RNA seq and pathway analyses are currently ongoing and updated data, including additional biomarker data will be presented. Conclusions: Consistent with previously reported data from the completed Cohort 5, TAZ demonstrated clinically meaningful, durable, single agent activity in ES pts. Efficacy data from Cohort 6 continue to mature with 8 patients still on treatment. TAZ was well tolerated with a low incidence of treatment related AEs. Clinical trial information: NCT02601950 . [Table: see text]
Survey on attitude to sexually transmitted disease testing among physicians in community health service centers of 20 cities in China
Authors: Minghui Peng, Shanzhu Zhu, Sunfang Jiang, CW Wong William
Journal: BMJ (2018)

Objective
To survey the attitude to sexually transmitted disease (STD) testing among physicians in community health service centers (CHC) of 20 cities in China.


Methods
A cross-sectional survey using stratified random sample was conducted in September to December 2015, among 1 734 physicians from 158 CHCs in 20 cities of 6 provinces and 2 municipalities.


Results
The average age of participants was (39.7±10.6) years, the time for present position was (15.8±11.5) years, and 47.0% (799/1 700) were general practitioners (GPs). The survey showed that in the last month, 8.1% (138/1 699) of the physicians contacted with the specific  of STD (sex worker, MSM, drug user, etc), and 18.3% (313/1 706) of them managed STD patients or provided services to suspected STD patients; 62.0% (1 048/1 689) of them received the STD-related training previously; 46.5%(784/1 686) thought the lack of training in STD testing as the biggest barrier for carrying out STD testing in CHC. As for the specific populations, 73.4%(1 241/1 692)of physicians thought that it was meaningful, 62.0% (1 043/1 683) of them worried about have difficulty to deal with their STD clinically , and only 5.8% (97/1 683) of them expressed their dislike of specific population .


Conclusions
Most physicians in CHCs believe that STD testing should be included in the routine tests, and it is feasible to carry out STD testing in CHCs. Lack of training is the main barrier for STD testing, so it is necessary to conduct STD testing related trainings in CHCs.


Key words: 
Sexually transmitted diseases; Community health centre; Attitude of health personnel
高校学生胃食管反流病治疗体会
Authors: 王丽
Journal: BMJ (2010)

胃食管反流病(gastroesophageal reflux disease,GERD)是一种常见病、多发病,病情多反复.我们对本校青年学生GERD患者采用常规西药、中西药治疗,并对疗效仍欠佳者加用抗精神心理治疗,收到较好疗效。
Loss of Protease-Activated Receptor 4 Prevents Inflammation Resolution and Predisposes the Heart to Cardiac Rupture After Myocardial Infarction
Authors: Mikhail A. Kolpakov, Xinji Guo, Khadija Rafiq, Liudmila Vlasenko, Bahman Hooshdaran, Rachid Seqqat, Tao Wang, Xiaoxuan Fan, Douglas G. Tilley, John C. Kostyak, Satya P. Kunapuli, Steven R. Houser, Abdelkarim Sabri
Journal: Circulation (2020)

Background: Cardiac rupture is a major lethal complication of acute myocardial infarction (MI). Despite significant advances in reperfusion strategies, mortality from cardiac rupture remains high. Studies suggest that cardiac rupture can be accelerated by thrombolytic therapy, but the relevance of this risk factor remains controversial. Methods: We analyzed protease-activated receptor 4 (Par4) expression in mouse hearts with MI and investigated the effects of Par4 deletion on cardiac remodeling and function after MI by echocardiography, quantitative immunohistochemistry, and flow cytometry. Results: Par4 mRNA and protein levels were increased in mouse hearts after MI and in isolated cardiomyocytes in response to hypertrophic and inflammatory stimuli. Par4-deficient mice showed less myocyte apoptosis, reduced infarct size, and improved functional recovery after acute MI relative to wild-type (WT). Conversely, Par4 −/− mice showed impaired cardiac function, greater rates of myocardial rupture, and increased mortality after chronic MI relative to WT. Pathological evaluation of hearts from Par4 −/− mice demonstrated a greater infarct expansion, increased cardiac hemorrhage, and delayed neutrophil accumulation, which resulted in impaired post-MI healing compared with WT. Par4 deficiency also attenuated neutrophil apoptosis in vitro and after MI in vivo and impaired inflammation resolution in infarcted myocardium. Transfer of Par4 −/− neutrophils, but not of Par4 −/− platelets, in WT recipient mice delayed inflammation resolution, increased cardiac hemorrhage, and enhanced cardiac dysfunction. In parallel, adoptive transfer of WT neutrophils into Par4 −/− mice restored inflammation resolution, reduced cardiac rupture incidence, and improved cardiac function after MI. Conclusions: These findings reveal essential roles of Par4 in neutrophil apoptosis and inflammation resolution during myocardial healing and point to Par4 inhibition as a potential therapy that should be limited to the acute phases of ischemic insult and avoided for long-term treatment after MI.
Skeletal muscle loss under chemotherapy and its association with survival and systemic treatment toxicity in metastatic colorectal cancer: An AGEO prospective multicenter study.
Authors: Claire Gallois, Camille Bourillon, Edouard Auclin, Pascal Artru, Astrid Lievre, Thierry Lecomte, Christophe Locher, Lysiane Marthey, Roger Faroux, Simon Pernot, Maximilien Barret, Julien Taieb
Journal: Journal of Clinical Oncology (2020)

4025 Background: We showed in a previous work that “Patient Generated-Subjective Global Assessment” (PG-SGA) was independently associated with survival and treatment toxicities in non-pretreated metastatic colorectal cancer (mCRC) patients. We have evaluated here if muscle mass in these patients can provide useful additional information for clinical practice. The objective of the present work was to evaluate the association between baseline sarcopenia, and the variation of the Skeletal Muscle Index (SMI) under treatment with survival and chemotherapy-related toxicities in our population of non-pretreated mCRC patients. Methods: This prospective multicenter observational study enrolled non-pretreated mCRC patients. Measurement of SMI was performed on routine CT scan at day 0 (D0) and day 60 (D60). PG-SGA score and other nutritional factors were collected at D0. Progression-free survival (PFS) and overall survival (OS) were calculated from treatment start. Treatment related toxicities were registered according to the NCI CTCAE v4.0. Results: 149 patients were included in eight French centers from 7/2013 to 11/2016. Sarcopenia at baseline was not significantly associated with survival outcomes or chemotherapy-related toxicities. The best cut-point value of SMI variation (between D0 and D60) for OS prediction obtained with a log-rank maximisation method was -14%. The decrease in SMI &gt; 14%, with a median follow-up of 23 months, was significantly associated with shorter PFS (6 vs 9 mo; HR 1.8, 95%CI 1.1-3.1, p = 0.02) and OS (8.5 vs 26 mo; HR 2.4, 95%CI 1.3-4.4, p = 0.004), independently of hypoalbuminemia and malnutrition defined by PG-SGA, in multivariate analysis. 40% of patients with a SMI decrease &gt; 14%, and 22% of patients with a SMI increase or stable or decrease &lt; 14% developed grade ≥ 2 clinical toxicities (OR 3.0, 95%CI 1.2-7.7, p = 0.02), but the difference was not statistically significant in multivariate analysis (OR 2.3. 95%CI 0.8-6.7, p = 0.1). Conclusions: To our knowledge, this study is the first study assessing the association of skeletal muscle loss with survival and treatment toxicities in patients with mCRC prospectively. In our population of non pre-treated mCRC patients, baseline sarcopenia was not associated with poor survival outcomes, but the decrease in SMI &gt; 14% during the first two months of treatment was significantly associated with decreased PFS and OS, independently of other prognostic and nutritional factors.
Effect of intensive follow-up on correction of mild anemia among infants in community
Authors: Lan Yang, Rongya Zheng, Ying Luo, Hui Shi, Huaiyan Wang
Journal: BMJ (2018)

Objective
To investigate the effect of intensive follow-up on the correction of mild anemia among infants in the community.


Methods
Eighty four infants aged 6-12 months with mild anemia managed systematically in the child health clinic of Changzhou Lanling Community Health Service Center were enrolled from April 2016 to January 2017. Seventy five cases completed the study, including 36 cases managed with intensive follow-up (study group) and 39 cases managed with routine procedure (control group). The hemoglobin(Hb) levels, Hb changes, the rates of correction and closure of anemia and the medication of iron treatment were compared between two groups during the 2 and 6 month-follow-up.


Results
The Hb value, Hb changes, the rate of correction in study group were significantly higher than those in control group after 2 monthsof treatment [(113.50±5.40)g/L vs. (109.13±7.91)g/L, t=2.772, P=0.007; (13.22±4.56)g/L vs. (7.54±6.75)g/L, t=4.240, P<0.001; 77.8%(28/36) vs. 46.2%(18/39), χ2=6.617, P=0.010, respectively]. In 6 month-follow-up, the Hb value, the rate of correction and closure rate in study group were significantly higher than those in control group [(116.22±3.72)g/L vs. (112.23±5.90)g/L, t=3.471, P=0.001; 88.9%(32/36) vs. 66.7%(26/39), χ2=4.082, P=0.043; 77.8%(28/36) vs. 41.0%(16/39), χ2=8.967, P=0.003, respectively]. For infants receiving iron treatment, the proportion of standardized medication in study group was significantly higher than that in control group after 2 months (14/14 vs. 4/8, χ2=5.525, P=0.019); the Hb values in study group were significantly higher than those in control group after 2 months[(109.93±3.51)g/L vs. (102.88±2.88)g/L, t=4.820, P<0.001)and 6 months[(114.50±4.00)g/L vs. (108.55±5.04)g/L, t=3.297, P=0.003] of follow-up.


Conclusion
The intensive follow-up management can significantly improve the Hb values, the rates of correction and closure rate of infants with mild anemia in the community.


Key words: 
Hospitals, community; Infant; Anemia
Diagnosis of small bowel bleeding with double balloon endoscopy
Authors: Xiao-ling Wang, Jun-da Li, Qua Huang, Shao-hua Xia
Journal: BMJ (2012)

Sixty two patients with small bowel bleeding underwent double balloon endoscopy (DBE).Clinical features were compared between patients with positive DBE findings (50 cases) and those with negative findings (12 cases).Results revealed that the causes of melena were discovered in 75.0％(21/28) patients via oral approach,while the lesions were found in 81.8％ (18/22) patients with hematochezia via anal approach ( P ＜ 0.01 ). Duration of bleeding was longer and number of bleeding episodes was higher in patients with positive DBE findings than those with negative findings (P ＜ 0.05 or P ＜ 0.01 ).The time interval between the latest bleeding and DBE was significantly shorter in patients with positive DBE findings (P ＜ 0.05).Positive diagnostic rate was significantly higher in patients with three or more bleeding episodes than those less than three times (92.5％ vs.11.1％,P ＜ 0.01 ).DBE performed within seven days or less increased the positive diagnostic rate significantly than that after seven days (97.1％ vs.59.3％,P＜0.01).

Key words: 
Gastrointestinal hemorrhage ;  Diagnosis