tbuckley/cabot-search huggingface dataset:
Clinical value of neutrophil to lymphocyte ratio in maintenance hemodialysis patients
Authors: Xiuji Li, Guojuan Zhang, Jie Zheng, Wei Chen
Journal: BMJ (2018)

Objective
To investigate the clinical value of neutrophil to lymphocyte ratio (NLR) in evaluation of inflammation and prediction of cardiovascular events in maintenance hemodialysis (MHD) patients.


Methods
One hundred and eight stable MHD patients were recruited from Dialysis Center of Beijing Tongren Hospital from October 2015 to December 2015. The general information, complete blood count, hsCRP, biochemical test, iron metabolic indicators, pre-dialytic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. MHD patients were divided into the low NLR group and high NLR group according to the median of NLR (2.82). All patients were followed up for 18 months, cardiovascular events (CVE) were recorded during this period.


Results
In the high NLR group the dialysis vintage, white blood cell count, neutrophil count, NLR and hsCRP were significantly higher than those in the low NLR group [(88.0±50.4) vs. (62.4±40.6) months(t=2.48, P=0.02), (6.96±1.82)×109/L vs. (5.83±1.33)×109/L(t=3.14, P=0.00), (4.94±1.38)×109/L vs. (3.36±0.87)×109/L(t=6.08, P=0.00), (4.16±1.25) vs. (2.15±0.46) points(t=9.48, P=0.00), (7.85±4.92) vs. (3.13±2.23)mg/L(t=4.97, P=0.00)]. In the high NLR group lymphocyte count and transferrin saturation were significantly lower than those in the low NLR group[(1.25±0.40)×109/L vs. (1.58±0.34)×109/L, t=3.97, P=0.00; (25.7±10.2)% vs. (32.6±17.2)% , t=2.17, P=0.03] . There were no significant differences in age, sex, diabetes proportion, pre-dialytic SBP, pre-dialytic DBP, urea clearence index(Kt/V), hemoglobin, serum ferritin, serum calcium, serum phosphorus, intait parathyroid hormone, albumin, serum creatinine, carbon dioxide binding capacity and blood lipids between the two groups (P>0.05). Bivariate correlation analysis showed that NLR was positively correlated with dialysis vintage and hsCRP ( r=0.311, P=0.01; r=0.574, P=0.00); white blood cell count and neutrophil count were positively correlated with hsCRP (r=0.327, P=0.00; r=0.488, P=0.00). During follow-up period 9 cases of CVE (16.7%) and 20 cases of CVE (37.0%) occurred in the low NLR group and high NLR group, respectively (χ2=5.70, P=0.03). Cox regression analysis showed that age, NLR and serum phosphorus level were risk factors of CVE in MHD patients (HR=1.075, P=0.00, HR=1.646, P=0.00; HR=1.912, P=0.02).


Conclusion
NLR can predict inflammation and is one of the risk factors for CVE in MHD patients.


Key words: 
Renal dialysis; Neutrophil to lymphocyte ratio; Inflammation; Cardiovascular diseases
Mismatch between mortality burden and number of FDA registration trials in highly lethal cancers.
Authors: Bishal Gyawali, Peter C. Yang, Sam Rubinstein, Martin W. Schoen, Ali Raza Khaki, Jeremy Lyle Warner
Journal: Journal of Clinical Oncology (2020)

2072 Background: Treatment successes in cancer are achieved through new drugs tested in clinical trials. However, drug discovery has been disparate across cancer types for various reasons. We sought to investigate if the number of trials used to support United States Food and Drug Administration (FDA) drug approvals is proportional to the incidence and mortality burden of highly lethal cancers, i.e. those with an expected relative mortality of &gt;5% per Cancer Statistics, 2020 (Siegel et al.). Methods: All FDA labels for 258 antineoplastic cancer drugs approved as of January 2020 were reviewed for citations of registration trials supporting initial approval and additional indications. Trials were identified by matching described characteristics (e.g., patients enrolled, clinical trial NCT codes) to publications indexed on HemOnc.org. Trials were labeled by cancer type studied and type of trial (randomized vs non-randomized). Results: We identified 559 registration trials in total. Results for the six highly lethal cancers are shown in the table. The percent of registration trials was roughly proportional to incidence, but not mortality burden. For example, despite the 22% expected mortality burden of lung cancer, it had a share of only 11% of registration trials whereas breast cancer has an expected 7% mortality burden, with a share of 14% of registration trials. Chronic myeloid leukemia is expected to cause 1,130 deaths in 2020 (0.2%) and has had 20 registration trials (3.6%). The highly lethal cancers had a higher rate of randomized trials supporting approval than other cancers (84% vs 56%, p&lt;0.001 [Chi-square]). Conclusions: While the findings may in part be due to disease biology (e.g., pancreatic ductal adenocarcinoma has proven resistant to many novel therapies), our evaluation highlights a potential mismatch between resources and needs. Randomized trials were more often used to support new drug approvals in highly lethal cancers. These findings will be important in regulatory policy. [Table: see text]
An investigation on relevant symptoms, knowledge and behavior in climacteric women visiting an outpatient clinic
Authors: 孙爱军, 刘春梅, 孙智晶, 段洁, 任立新
Journal: BMJ (2005)

目的 了解更年期妇女症状、行为和保健知识的状况,以进一步加强更年期妇女的预防保健工作.方法抽取2004年3月至4月就诊于北京协和医院更年期门诊的302例妇女,以问卷形式进行调查,回收有效问卷299份.结果绝经者213例,占63.9%,平均绝经年龄为(49±5)岁.更年期症状出现的平均年龄为(48±5)岁,主要症状包括烦躁、心慌(68.5%),盗汗(63.9%)和阴道干燥(59.8%).小于55岁有性生活的比例在70%以上,55岁后下降至41.4%.调查对象中了解更年期症状的占63.9%,接受激素治疗的占80.3%.结论自40岁开始即应注重更年期妇女心理卫生保健和性保健工作,加强多途径预防保健知识的宣传。
A patients with insulin autoimmune syndrome induced by methimazole: case report
Authors: Li Ying, Zhang Zhenwen, Liu Yan, Wang Yan
Journal: BMJ (2016)

1例64岁甲状腺功能亢进症男性患者，服用甲巯咪唑1个月后出现神志不清，多次低血糖发作，最低血糖0.56 mmol/L，胰岛素浓度>1 000 U/L，抗胰岛素自身抗体阳性，诊为甲巯咪唑导致的胰岛素自身免疫综合征，回顾其诊疗经过并文献复习，以提高临床医师对此疾病的认识。
Customized social media-based oncology education.
Authors: Udaykumar Punukollu, Jyothi Jonnadula, Abdul Rasheed, Purvish Mahendra Parikh, Numburu Srilanari, Ajay Chanakya, Joseph Thomas, Rajkumar Patlolla, Sadashivudu Gundeti, Stalin J. Bala, Rachana Chennamaneni, Meher Lakshmi Konatam, Venkateswar Rao P, Sarita Shrivastva
Journal: Journal of Clinical Oncology (2020)

11038 Background: Social media has profoundly impacted our professional lives. Quick access to reliable sources of information and engaging with like-minded experts certainly aids in professional development. The purpose of this study is to assess the perception of oncology experts towards social media based education and to develop a platform based on their feedbacks for constructive engagement of the professionals and to improve educational outcomes. Methods: Based on Kirkpatrick 4 level model, 15 questions were designed for oncology experts. We collected responses through online surveys and by distributing the questionnaires at oncology events. Based on the results obtained, we developed a customised social media application for oncologists in android version. User experience design was done in InVision Studio and Model View Presenter (MVP) design pattern was used in software development. Beta testing of the application was done with 50 experts and questionnaire was given to them at the end of beta testing period to compare the technical advantages of our mobile application with their currently preferred social media platform for oncology based education. Results: Among 311 responders, medical oncologists, radiation oncologists, surgical oncologists, hemato oncologists and oncopathologists constituted 45%, 29%, 16%, 7% and 3% respectively. Only 14% clearly denied that social media has improved educational outcomes. Eighty seven percent felt that they lack adequate knowledge in other areas of expertise and 67% of the oncologists were not well informed about the latest oncology updates. Only 60% could actively engage in interdiscliplinary collaboration due to reasons unspecified. When asked about the best way to learn a topic of interest, majority opined it through peer discussion with experts pertaining to that topic of interest. The two major problems faced by experts while seeking social media based education is academic discussions being unorganised and non-academic discussions unwelcomed. After considering these feedbacks, a mobile application in android version was developed. At the end of beta testing, 96% reported a technical advantage of our customised application over their preferred social media based oncology education. Conclusions: A minimum viable product has been developed after considering the feedbacks received from oncologists of various sub-specialities. Such a customised social media application is more appealing when easily applicable across low and middle income countries and in a manner that allows addition of local language options without changing the application software.
Long-term effects of Helicobacter pylori infection on gatric mucosa and the influencing facter of outcome
Authors: 谢勇, 吕农华, 陈江, 周小江, 徐萍, 黄德强, 王崇文
Journal: BMJ (2004)

目的 探讨幽门螺杆菌(Hp)长期感染对胃黏膜的作用及其转归的影响因素.方法随访114例10年前诊断Hp感染的患者,分析对比10年前后其Hp感染情况、胃镜和病理组织学变化.并检测了其中80例Hp持续感染者血清抗Hp CagA-IgG和抗Hp IgE,分析它们与Hp长期感染不同转归的关系.结果 114例患者中34例(29.8%)Hp转阴,80例(70.2%)Hp持续阳性.Hp感染持续10年后消化性溃疡的发生率、胃黏膜慢性炎症程度、肠上皮化生(IM)和糜烂的发生率均显著增加,其IM严重程度显著加剧.而Hp转阴者消化性溃疡的发生率、胃黏膜慢性炎症程度均显著低于10年前,并显著低于Hp持续阳性者.Hp长期感染后发展为消化性溃疡(PU)者血清抗Hp CagA-IgG和抗Hp IgE阳性率显著高于持续保持慢性浅表性胃炎(CSG)不变者,发生黏膜糜烂和IM者血清抗Hp CagA-IgG阳性率显著高于不发生黏膜糜烂和IM者,均P<0.005,而胃黏膜的慢性炎症程度是否加剧与CagA无关.结论 Hp持续感染可增加消化性溃疡的发生率,加剧胃黏膜的炎症程度,并促进肠上皮化生的形成和发展,根除Hp不仅能减轻胃黏膜的炎症程度,而且能阻止肠上皮化生的发生和发展.CagA 阳性菌株和产生抗Hp IgE的个体,其Hp长期感染后病变的转归均较阴性者严重,因此,对于这类患者应给予Hp根除治疗。
Risk factors of electrocoagulation syndrome after endoscopic submucosal dissection in patients with colorectal lesions
Authors: Mingzhu Wang, Shiyun Tan, Hesheng Luo, Ming Li, Pengbo Wu, Fang Guo
Journal: BMJ (2016)

Objective
To investigate the risk factors of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in patients with colorectal lesions.


Methods
Clinical data of 145 patients with colorectal mucosal lesions undergoing ESD in People's Hospital of Wuhan University between September 2010 and September 2015 were retrospectively studied.


Results
Among 45 patients, post endoscopic submucosal dissection electrocoagulation syndrome (PEECS) was developed in 32 cases (22%). The median age in PEECS group was higher (t=-5.783, P=0.000), the median lesion size was larger(t=-5.590, P=0.000), the median length of hospital stay was longer(t=-6.841, P=0.000) than those in non-PEECS group. Univariate regression analysis showed PEECS was associated with the age, lesion size, lesion location, length of hospital stay, malignant tumor, polyps type, resection modality. Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were age >65 year (OR=1.123, 95%CI: 1.013-1.244, P=0.027), lesion size >3.5 cm (OR=1.173, 95%CI: 1.015-1.357, P=0.031), malignant tumor (OR=3.498, 95%CI: 1.460-8.379, P=0.005), hospital stay >10 d (OR=2.480, 95%CI: 1.346-4.569, P=0.004), non-rectal lesions (OR=12.612, 95%CI: 3.446-46.157, P=0.000).


Conclusion
Attention should be paid for colorectal lesion patients with high risk of PEECS, when endoscopic submucosal dissection is performed.


Key words: 
Risk factors; Endoscopic submucosal dissection; Colorectal lesion; Electrocoagulation syndrome
Retrospective analysis of factors associated with refractory asthma
Authors: Zhi-jian Huang, Qin Luo, Zulipeiya, Wei Wang, Min Ling, Fen-yu Li
Journal: BMJ (2009)

Seventy four patients with severe asthma were admitted from January of 2006 to February of 2008. Among them 36 patients suffered from controlled severe asthma, 38 with difficult controlled asthma. The demographic information, occupational environmental exposure, smoking history and accompanied diseases were analyzed. In refractory asthma group, occupational and environmental exposure (24, 63.2%) and poor compliance (22, 57.9%)were significantly associated with the disease (P   0. 05). Conclusions Occupational exposure, environmental exposure and poor compliance were the major risk factors for refractory asthma.

Key words: 
Asthma;  Associated factors
What constitutes high-quality NSCLC care? Overarching quality considerations for improving NSCLC care at US cancer centers.
Authors: Mark A. Socinski, Leigh Boehmer
Journal: Journal of Clinical Oncology (2020)

e19181 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on specific individual components of care and advocate multidisciplinary collaboration, guidance on multidisciplinary care spanning the complete patient journey is lacking. Quality-focused recommendations for the multidisciplinary team, along with selected clinical criteria for ideal NSCLC care, were compiled, and a new set of metrics encompassing the entire care continuum was proposed. These metrics were used to set a new benchmark for ideal NSCLC care through the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy, who identified and compiled evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Ideal quality recommendations were organized within key care areas of the patient journey: care coordination, diagnosis, and treatment. Results: A total of 32 recommendations were included. Of these, 9 were key unpublished recommendations on NSCLC care, including diagnosis and biomarker testing, treatment planning, care coordination, and patient education (Table). Conclusions: These recommendations define the criteria for ideal NSCLC care and serve as a valuable resource to guide multidisciplinary practice and quality improvement initiatives. [Table: see text]
An international cohort study investigating the impact of age on clinical outcome in patients with hepatocellular carcinoma treated with sorafenib.
Authors: Rohini Sharma, Saur Hajiev, Leila Motedayan Aval, Dominik Bettinger, Tadaaki Arizumi, Mario Pirisi, Lorenza Rimassa, Nicola Personeni, Tiziana Pressiani, Laura Giordano, Masatoshi Kudo, Robert Thimme, Joong-Won Park, Tamar Hamosh Taddei, David Edward Kaplan, Ramya Ramaswami, David James Pinato, Elias Allara
Journal: Journal of Clinical Oncology (2020)

12049 Background: There is no consensus on the effect of sorafenib dosing on efficacy and toxicity in elderly patients with hepatocellular carcinoma (HCC). Older patients are often empirically started on low dose therapy with the aim to avoid toxicities whilst maximising clinical efficacy. We aimed to verify whether age impacts on overall survival (OS) of patients with HCC, and whether a reduced starting dose of sorafenib impacts on OS or rates of toxicity experienced by the elderly. Methods: In this international, multicentre cohort study, patients with a confirmed diagnosis of advanced-stage HCC receiving sorafenib were recruited from seven specialist centres. Demographic and clinical data including development and grade of sorafenib toxicity and sorafenib starting dose were collected prospectively. Survival time (months) was recorded prospectively. Outcomes for those &lt; or &gt; 75 years were determined Results: A total of 5598 patients were recruited; 792 (14.1%) were over the age of 75. The elderly were more likely to have larger tumours ( &gt; 7cm)(39 vs 33%, p = 0.07) with Child-Pugh A liver function(67 vs 57.7%) and less portal vein thrombosis compared to those &lt; 75years(22.1 vs 29.4)(p &lt; 0.001). They were more likely to be commenced on lower starting dose of sorafenib i.e 400mg/200mg (38.7 vs 37.2%, P &lt; 0.01). In terms of OS, there was no difference in the median OS of those &gt;75 years and patients &lt; 75 (7.3months vs 7.2months; HR 0.98 (95% CI 0.90–1.06), p = 0.63). There was no relationship between starting dose of sorafenib, 800mg vs 400mg/200mg, and OS between those &lt; or &gt; 75years. The elderly experienced a similar incidence of grade 2-4 sorafenib-related toxicity compared to &lt; 75years(74.3 vs 61.7%, p = 0.051)(except for anorexia (14.0 vs 7.2%, p &lt; 0.01) and rash (3.1 vs 6.3%, p &lt; 0.05), irrespective of the dose prescribed. The elderly were more likely to discontinue sorafenib due to toxicity (27.0 vs 21.6%, p &lt; 0.01). This did not vary between different starting doses of sorafenib. The mean duration of treatment was similar between those &lt; and &gt; 75 and, again, the starting dose of sorafenib did not affect treatment duration in the elderly. Conclusions: The median OS in the elderly is the same for that of patients under 75 years and is independent of the dose of sorafenib prescribed. Therefore, sorafenib should be offered to elderly patients and they should not be excluded from therapy
Long-term efficacy of replanlation vesus prosthetic replacement for complex severed lower legs
Authors: Zhi-gang Xia, Ai-xi Yu, Bai-wen Qi, Shao-bo Zhu
Journal: BMJ (2009)

Objective To explore indications for replantation and amputation of complex severed lower legs. Methods Fifteen lower legs in 25 cases with complex severed lower limbs were replanted including four finally amputated again, and other 10 legs were amputated directly after trauma. Those with successful replantation were repaired with microsurgical technology and limb lengthening procedure for complications such as soft tissue defect, bone defect and limb shortening. The amputated cases were fitted with prosthetic limb after wound healing. Results All cases were followed-up for three to 10 years (6.4 years in average), and 11 lower legs were survived in 15 replanted cases and other four were finally amputated and fitted with prosthetic replacement. The limbs of those with successfully replantation shortened to varied extent, and one can be categorized as grade Ⅰ, four as grade Ⅱ, four as grade Ⅲ and two as grade Ⅳ, according to Chen's classification of function evaluation for replanted limbs. Appearance of prosthetic limbs in 14 cases had no significant difference from the normal, and 12 of them could walk with load and two had slight claudication. Those with prosthetic limbs were more satisfactory than those with replantation of the limbs. Conclusion Replantation for complex severed lower legs should be comprehensively considered based on mangled extremity severity score (MESS), their local condition and function prognosis.

Key words: 
Leg injuries;  Surgical procedures;  Fractures,open;  Artificial limbs
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.
Authors: Reid Christian Bowers, Michael A. Thompson, Sandra Tomany Korman, Sherjeel Sana, Manish Krishna Pant, Federico Augusto Sanchez
Journal: Journal of Clinical Oncology (2020)

e14142 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were &lt; 13 g/dL in men and &lt; 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2019, 180 were referred to the Anemia Clinic and 301 were not. Anemia Clinic identified iron (N = 114), vitamin B12 (N = 24), and folate (N = 18) deficiencies. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (65.6% vs. 61.8% Chi-Square p = 0.44). Of preoperatively anemic Pts who were transfused in 2019, an average of 2.34 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (Poisson Means p = 0.46). Length of stay (LOS) which was a median 10d ( P 25 = 7d, P 75 = 17d) in the referred group vs a median 12d ( P 25 = 7d, P 75 = 19d) in the non-referred group was not statistically different between groups (Smirnov p = 0.39). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2019 through Nov. the referred group had an O/E = 1.03 (observed LOS μ geo = 11.58 days, expected LOS μ geo = 11.21 days, N = 167). The not referred group had an O/E = 1.06 (observed LOS μ geo = 12.24 days, expected LOS μ geo = 11.58 days, N = 272). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year. Subsequent addition of Anemia Clinic services has not decreased PRBC use further. There is a trend toward shorter LOS for patients referred to Anemia Clinic but it is not statistically significant. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]
Towards data-driven decision-making for breast cancer patients undergoing mastectomy and reconstruction: Prediction of individual patient-reported outcomes at two-year follow-up using machine learning.
Authors: André Pfob, Babak Mehrara, Jonas Nelson, Edwin G. Wilkins, Andrea Pusic, Chris Sidey-Gibbons
Journal: Journal of Clinical Oncology (2020)

520 Background: Post-surgical satisfaction with breasts is a key outcome for women undergoing cancer-related mastectomy and reconstruction. Current decision making relies on group-level evidence, which may not offer optimal choice of treatment for individuals. We developed and validated machine learning algorithms to predict individual post-surgical breast-satisfaction. We aim to facilitate individualized data-driven decision making in breast cancer. Methods: We collected clinical, perioperative, and patient-reported data from 3058 women who underwent breast reconstruction due to breast cancer across 11 sites in North America. We trained and evaluated four algorithms (regularized regression, Support Vector Machine, Neural Network, Regression Tree) to predict significant changes in satisfaction with breasts at 2-year follow up using the validated BREAST-Q measure. Accuracy and area under the receiver operating characteristics curve (AUC) were used to determine algorithm performance in the test sample. Results: Machine learning algorithms were able to accurately predict changes in women’s satisfaction with breasts (see table). Baseline satisfaction with breasts was the most informative predictor of outcome, followed by radiation during or after reconstruction, nipple-sparing and mixed mastectomy, implant-based reconstruction, chemotherapy, unilateral mastectomy, lower psychological well-being, and obesity. Conclusions: We reveal the crucial role of patient-reported outcomes in determining post-operative outcomes and that Machine Learning algorithms are suitable to identify individuals who might benefit from alternative treatment decisions than suggested by group-level evidence. We provide a web-based tool for individuals considering mastectomy and reconstruction. importdemo.com . Clinical trial information: NCT01723423 . [Table: see text]