tbuckley/cabot-search huggingface dataset:
Association between serum estradiol levels and carotid atherosclerosis in middle-aged and elderly men with type 2 diabetes
Authors: Ye Ji, Lianxi Li, Hairong Tian, Yingdi Shen, Xinjuan Zhuang, Bo Liu, Fang Liu
Journal: BMJ (2018)

Objective
To investigate the association between serum estradiol levels and macrovascular complication of atherosclerosis in mid-aged and elderly male patients with type 2 diabetes mellitus (T2DM).


Methods
One hundred and twenty nine male diabetic patients aged over 45 years were recruited in this study. Serum estriol (E2), testosterone (T) and lipid levels were detected using chemiluminescent immunoassay. Carotid ultrasonography was taken to evaluate macrovascular complication of atherosclerosis. The demographic characteristics, clinical features including duration of diabetes and prevalence of carotid atherosclerosis and biochemical features were compared among patients with different serum E2 levels. Correlation analysis was also performed using binary logistic analysis.


Results
There were 43 patients with low serum E2 level (  198.2 pmol/L). Among 129 patients the carotid artery lesions were detected in 64 cases. There were significant differences in body weight [(61.0±10.4), (67.4±13.0)and(76.8±10.5)kg, t=3.40, P=0.00], waist circumference [(81.5±7.9), (86.6±10.7)and(90.0±8.0)cm, t=3.57, P=0.00], body mass index (BMI) [(21.6±3.2), (23.5±3.8)and(26.2±3.0)kg/m2,t=3.72, P=0.00], systolic pressure [(140.2±14.8), (143.9±18.1)and (155.0±13.1)mmHg(1 mmHg=0.133 kPa), t=3.18, P=0.04] and TG [(1.46±0.88), (2.23±1.08)and(3.35±0.9)mmol/L, t=2.66, P=0.04] among patients with low, intermediate and high serum E2 levels. The age-adjusted incidence of carotid atherosclerotic plaque in patients with low, intermediate and high E2 levels were 25.6%(11/43), 56.8%(25/44) and 66.7%(28/42), respectively (χ2=15.73, P=0.00). Compared to low E2 level, the risk ratio of carotid atherosclerosis in intermediate and high E2 levels was 1.60 (95%CI: 1.04-2.46, P<0.05) and 1.80 (95%CI: 1.17-2.76, P<0.05), respectively.


Conclusion
Serum E2 level is closely associated with carotid atherosclerotic plaque in middle-aged and elderly male type 2 diabetic patients.


Key words: 
Arteriosclorosis, carotid arteries; Testosterone; Diabetes mellitus, type 2; Meddle aged; Aged
The best dosage of magnesium isoglycurrhizinate in treating hepatitis B
Authors: Mao-wu Yang, Yu-sen Zhu, Chang-chun Jing, Xi-dan Shang, Gui-zhi Zhang
Journal: BMJ (2009)

Am investigation was done to identify the best and safe dosage of magnesium isoglycurrhizinate in treating hepatitis B.All 1 50 cases suffering from hepatitis B were randomly divided into five groups as A,B,C,D,E.Cases in group A were treated with magnesium isoglycurrhizinate in 100 mg per day for two weeks sololy,and in group B,C,D,E in 150 mg,200 mg,250 mg and 300 mg respectively.The changes of symptoms,index of hepatic function,clinical effective rates and side-effects were observed from treatment beginning to the end.The results that revealed there were no different effects among groups B to E,but less therapeutic effects in group A,and no obvious side-effects in all groups,suggesting that 150 mg dosage of magnesium isoglycurrhizinate should be a safe and the best dosage for treating hepatitis B.

Key words: 
Glycyrrhizic acid; Hepatitis B
Clinical analysis for five cases of primary hypothyroidism with main manifestations of muscular damage
Authors: 胡玲, 秦洁, 柳洁
Journal: BMJ (2005)

目的 提高对重症原发性甲状腺功能减退症伴随肌病患者临床特征、病变特点及其治疗的认识.方法回顾性分析1996年3月至2003年11月收治的5例重症原发性甲状腺功能减退伴肌损害患者的临床资料及治疗转归,并结合相关文献对该病的临床特点进行分析.结果5例患者突出的临床表现为对称性近端肌无力、气短、胸痛、呼吸及吞咽困难.血肌酸激酶均显著增高(2 885～10 450U/L).结论应将伴有肌损害的原发性甲状腺功能减退症患者与多发性肌炎鉴别,及时给予甲状腺激素替代治疗对甲状腺功能减退相关性肌病有较好疗效。
Covid-19: UK deaths approach 50 000, but rate declines
Authors: Shaun Griffin
Journal: BMJ (2020)

Deaths from cancer in the UK are expected to overtake those from covid-19 this week, as mortality related to the virus continues to decline week on week, although the total number of covid deaths is now approaching 50 000.

In the year to 22 May covid-19 was mentioned on 43 837 death certificates in England and Wales,1 3779 in Scotland,2 and 709 in Northern Ireland,3 showed figures from the Office for National Statistics (ONS) and devolved nations. Excluding any covid related deaths since then, these figures, combined with hospital deaths in England since 22 May, bring the total to more than 48 300.

However, the weekly death toll from covid-19 continues to decline. The week to 22 May had 2589 deaths, the lowest number in seven weeks and 1221 fewer than the previous week.

In the wake of this decline, deaths from cancer are now predicted to outnumber those from covid-19 this week, said Steven McIntosh, …
Exploration of disciplinary construction of general practice in Beijing Fangzhuang community health service center
Authors: Xiumei Liu, Hao Wu, Caiying Ge, Hongyan Jia, Xinying Liu
Journal: BMJ (2016)

全科医学是社区卫生服务中心的重点学科，全科医学学科建设是社区卫生服务体系建设的基础工程，是一项亟待解决的工作。目前国内全科医学学科建设尚存在诸多问题，在社区卫生服务中心更是缺乏完整建设体系。本文对北京方庄社区卫生服务中心的全科医学学科建设进行总结探讨，阐述社区卫生服务中心开展全科医学学科建设的作用，以为相关机构提供参考。
Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis
Authors: 姚方, 陆星华
Journal: BMJ (2001)

目的：
判定对晚期局灶或转移性直结肠癌患者进行姑息化疗的利弊，并对年轻与年老患者的结果进行比较。


设计：
汇总分析个体病例数据及已发表的临床试验所归纳的统计资料。


研究内容：
经计算机与手工进行文献及参考文献浏览或直接与研究者联系后，确认关于比较晚期直结肠癌患者姑息化疗与支持治疗的随机对照试验。


主要比较项目：
生存情况、疾病进展、生活质量及毒性分析。


结果：
13项随机对照试验共有1365位患者符合入选标准。对其中7项提供个体病例数据的试验（包括866位患者）进行汇总分析。结果表明，姑息化疗可以降低35%的死亡危险性（95%可信区间为24%~44%）。这意味着6个月及12个月生存期的比例均提高了16%，中位数生存期3.7个月。化疗效果没有表现出与年龄相关的差异，尽管老年患者也参加了临床试验。在所有资料中，与治疗毒副作用、症状控制和生活质量相关的数据质量太差，以至无法进行相关分析。


结论：
化疗对于晚期直结肠癌患者延缓疾病进程及延长生存期是有效的。由于有部分对照组的患者也接受过化疗，因而，在这项分析中化疗对于生存期延长的作用可能被低估。
CT manifestation and its diagnostic value of gastrointestinal stromal tumors
Authors: Nan Zhou, Zhi-ping Wang, Hai Zhou
Journal: BMJ (2010)

The CT images of 42 pathologically confirmed cases of gastrointestinal stromal tumors were reviewed, and compared with pathological results. In 20 cases, the lesions were located in stomach, 21 in small intestine, 1 in mesentery. In 18 cases pathologically confirmed as benign tumors, 16 were positive on CT scan, which presented round solid mass with homogeneous density, mean diameter of 3.8 cm (2 -6 cm), homogeneous enhancement on post-contrast scan. In 21 malignant cases all were on CT scan, which presented irregular or lobulated solid mass with heterogeneous density and cystic change inside, mean diameter of 10. 1 cm (4 - 30 cm) , heterogeneous enhancement with no enhancement in cystic part. In 3 potentially malignant cases, CT images showed irregular solid mass with homogeneous density, diameter of 4 - 8 cm, homogeneous enhancement in post-contrast scan. CT scan can accurately show the location and size of gastrointestinal stromal tumors, and is of important diagnostic value.

Key words: 
Gastrointestinal stromal tumors;  Tomography,X-ray computed
A Novel predictive probability algorithm to determine risk for malignancy between uterine fibroids versus uterine sarcoma.
Authors: Alexandra Michelle Blackman, Alexandra Samborski, Michael Craig Miller, Rakesh Singh, Kyu Kwang Kim, Rachael Turner, Geralyn Messerlian, Richard G. Moore
Journal: Journal of Clinical Oncology (2020)

e18098 Background: The combination of HE4 and CA125 can be used as a predictive probability algorithm to determine the risk of malignancy in women with a uterine mass. Many studies have been done looking at ways to differentiate between benign fibroids and uterine sarcomas with limited success. This study examined the utility of using a logistics regression algorithm containing biomarkers HE4 and CA 125 to predict risk of malignancy of a uterine mass. Methods: This was an IRB retrospective study using de-identified data form 5 pelvic mass studies. Patients were included if they were diagnosed with either uterine fibroids or uterine sarcoma on final pathology. Pre-operative serum levels of HE4 and CA125 were obtained for each patient. A logistics regression analysis was performed in a prior pelvic mass prospective trial and utilized in this analysis. The predictive probability algorithm was used to classify patients into high and low risk groups for sarcoma. Wilson’s score interval was used to determine confidence intervals. Results: There were 71 patients identified with a uterine mass. The mean age of study participants was 54 (range 22-85). There were 10 (14.1%) sarcomas and 61 fibroids (85.9%) identified. Six of the sarcomas were leiomyosarcomas (60.0%). There was 1 adenosarcoma (10%), 1 mixed sarcoma (10%) and 2 sarcomas which were not further characterized. A threshold of 13.1% was used to classify masses as low or high risk. The predictive probability algorithm was found to have a sensitivity of 90.9% (CI 55.5-99.7%), specificity of 60.7% (CI 47.3-72.9%), PPV of 27.3% (13.3-45.5%), and NPV of 97.4% (86.2-99.9%). An elevated risk of malignancy was noted in 9 (90%) sarcomas and 24 (39%) of fibroids. Conclusions: A predictive probability algorithm using HE4 and CA 125 had a high sensitivity for determining high and low risk of malignancy in patients with presumed uterine fibroids with a sensitivity of 90.9% for detecting sarcoma. This algorithm will be validated in a prospective clinical trial.
Feasibility of developing a Twitter journal club for hematology/oncology education.
Authors: Elizabeth Henry, Devika Govind Das, Martina Cathryn Murphy
Journal: Journal of Clinical Oncology (2020)

11004 Background: Medical trainees are increasingly utilizing social media platforms for professional development, networking and education. Twitter chats (TC) are a growing tool to engage health professionals in virtual multi-institutional, cross-discipline discussions. A meta-analysis of Twitter as a tool in residency education demonstrated high rates of satisfaction and concept retention. Despite rapid uptake, few studies address needs for social media use and implementation in graduate medical education. Methods: We created a Twitter account (@HOjournalclub) and registered a certified hashtag (#HOJournalClub) with healthcare symplur. For each monthly TC, a specific tumor type and relevant publication was selected. This information was disseminated and amplified to reach trainees on Twitter. A content expert was invited to each TC to provide additional commentary. During TCs, participants answer questions based on domains of critical journal appraisal. Qualitative and quantitative analysis was performed. Basic demographics and tracked hashtag use to measure impressions, participants, and tweets per TC were gathered. Responses were collated and general themes were assessed. Participants were surveyed on ease of participation, article accessibility, and prior use of social media for education. Results: Since inception, @HOJournalClub has grown to &gt;650 followers. Most are US-based (83%) medical trainees or healthcare professionals. Additional followers are in South America, Africa, UK, Europe, Middle East, India, East Asia and Australia. Gender is evenly distributed (51% male, 49% female.) Five #HOJournalClub chats have been held to date. Each attracted a mean of 30 participants, generating a mean of 217 tweets. Chats garnered a mean of 270,000 impressions (221,000-319,000) in the 48h after TC. Most participants accessed the chat in real time, with a small subset responding at alternate times. This asynchronous use has enhanced international participation. In post-TC surveys, majority of respondents report being new (48%) or sporadic (48%) users of TCs. Survey participants reported TC participation increased interaction with others in the field, improved literature appraisal skills and led to changes in clinical practice. Conclusions: Implementation of a Twitter-based journal club is feasible and attracts participation from trainees, promoting engagement and networking. It represents a novel educational tool for engagement in multi-institutional, multi-national and cross-discipline discussion of relevant hematology/oncology literature.
Prognostic value of B-type natriuretic peptide in non-ST segment elevation acute coronary syndrome
Authors: Wei Du, Yun-ying Wang, Xue-qin Dong, Yanc-hun Ren, Jian Shi
Journal: BMJ (2008)

One hundred and five patients with non-ST segment elevation acute coronary syndrome were followed up for 1 year.They were assigned to the event group or non-event group according to the presence of endpoint events(cardiac death and nonfatM myocardial infarction).B-type natriuretic peptide level was measured at 30 days and 1 year and compared between the two groups.The results showed that the level of B-type natriuretic peptide was higher in the event group[(235±107)μg/L vs(154±49)μg/L at 30 days;(259±100)μg/L vs(143±57)μg/L at 1 year].Thus,B-type natriuretic peptide is an important prognostic factor for patients with non-ST segment elevation acute coronary syndrome.

Key words: 
Natriuretie peptide,brain;  Acute coronary syndrome
A phase I dose-escalation trial of alpha-tocopheryloxyacetic acid and concurrent trastuzumab in patients with treatment refractory HER2+ metastatic breast cancer.
Authors: William R Gwin, Jennifer Childs, Doreen Higgins, Kellie Ann Burton, Kristin Kuano, Lauren Corulli, James Dai, Emmanuel T Akporiaye, Mary L. Disis
Journal: Journal of Clinical Oncology (2020)

TPS1103 Background: Metastatic HER2+ breast cancer, while initially responsive to trastuzumab, pertuzumab, and TDM-1, eventually progresses. The FDA recently approved trastuzumab deruxtecan, showing benefit in progression free survival but not in overall survival to date. Thus, additional therapies are needed for patients who progress on these HER2 directed agents. In metastatic HER2+ breast cancer, HER2-specific Th1 immune responses and higher CD4+ Th1 and CD8+ TIL levels are associated with a survival benefit. As this Type 1 immunity occurs in a minority of patients, additional immune modulation is needed. Alpha-tocopheryloxyacetic acid (α-TEA) has been reported to augment Type 1 immunity through increasing activated effector memory CD4+ and CD8+ T cells and decreasing immune suppressive CD4+CD25+ regulatory T cells in the tumor microenvironment. When given concurrently with an anti-HER2 antibody (7.16.4) in a pre-clinical tumor model, α-TEA synergized with 7.16.4 to induce tumor regression. We hypothesize that α-TEA and trastuzumab combination therapy in metastatic HER2+ breast cancer will be well tolerated, induce a clinical response, and augment anti-tumor Th1 immunity. Methods: Trial Design: Phase I dose escalation trial of α-TEA in combination with trastuzumab. Patients with metastatic HER2+ breast cancer will receive one of four doses sequentially of α-TEA: 0.6 mg/kg, 1.2 mg/kg, 2.4 mg/kg, and 4.8 mg/kg. Toxicity is assessed at baseline and through end of study. Blood and tumor tissue will be collected for immunologic monitoring and evaluation. Clinical response will be evaluated according to RECIST 1.1. Eligibility : Patients with progressive metastatic HER2+ breast cancer who have previously progressed on trastuzumab/pertuzumab and TDM-1. Specific Aims: Determine: (1) safety of four escalating doses of α-TEA with concurrent trastuzumab, (2) clinical response rate of α-TEA with concurrent trastuzumab (3) if concurrent α-TEA and trastuzumab increases activated effector memory CD4+ and CD8+ T cells, and (4) if concurrent α-TEA and trastuzumab increase the number of HER2-specific T cells. Statistical Methods: (1) The sample size of 24 and cohort size of 6 are determined by simulation experiments and practical consideration, (2) clinical response will be evaluated; overall PFS and OS will be calculated, (3) activated effector memory CD4+ and CD8+ T-cells will be analyzed (4) HER2-specific IFN-g/IL-10 ratios will be evaluated. Targeted Accrual : Twenty-four (24) patients. Clinical trial information: NCT04120246 .
Comparison of LI-RADS 2018 and KLCA-NCC 2018 for noninvasive diagnosis of hepatocellular carcinoma using magnetic resonance imaging
Authors: Sunyoung Lee, Seung-seob Kim, Dong ryul Chang, Hyerim Kim, Myeong-Jin Kim
Journal: Clinical and Molecular Hepatology (2020)

This study aimed to compare the diagnostic performances of Liver Imaging Reporting and Data System (LI-RADS) 2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.This retrospective study included 273 treatment-naïve patients (71 patients with extracellular contrast agent [ECA]-MRI and 202 patients with hepatobiliary agent [HBA]-MRI; 352 lesions including 263 HCCs) with high risk of HCC who underwent contrast-enhanced MRI between 2016 and 2017. Two readers evaluated all lesions according to the criteria of LI-RADS 2018 and KLCA-NCC 2018. The per-lesion diagnostic performances were compared using the generalized estimating equation method.On ECA-MRI, the sensitivity and specificity of LI-RADS 2018 and KLCA-NCC 2018 were not significantly different (LR-5 vs. definite HCC: 75.8% vs. 69.4%, P=0.095 and 95.8% vs. 95.8%, P>0.999; LR-5/4 vs. definite/probable HCC: 87.1% vs.83.9%, P=0.313 and 87.5% vs. 91.7%, P=0.307). On HBA-MRI, definite HCC of KLCA-NCC 2018 showed significantly higher sensitivity (79.1% vs. 68.2%, P<0.001) than LR-5 of LI-RADS 2018 without a significant difference in specificity (93.9% vs. 95.4%, P=0.314). Definite/probable HCC of KLCA-NCC 2018 had higher specificity (92.3% vs. 80.0%, P=0.003) than LR-5/4 of LI-RADS 2018. The sensitivity was lower for definite/probable HCC than for LR-5/4 without statistical significance (85.6% vs. 88.1%, P=0.057).On ECA-MRI, LI-RADS 2018 and KLCA-NCC 2018 showed comparable diagnostic performances. On HBA-MRI, definite HCC of KLCA-NCC 2018 provided better sensitivity than LR-5 category of LI-RADS 2018 without compromising the specificity, while definite/probable HCC of KLCA-NCC 2018 revealed higher specificity than LR-5/4 of LI-RADS 2018 for diagnosing HCC.
Analysis of pre-hospital treatment characteristics of patients with cerebrovascular disorders
Authors: Zhi-gang Chen, Su-qin Lu, Yi-ping Sun
Journal: BMJ (2013)

The medical records of stroke patients at Zhenjiang Emergency Medical Center from January 1 to December 31, 2011 were analyzed. A total of 797 stroke patients were managed, accounting for 10.42 percent of the emergency number over the same period. The average ages of males and females were (67±14) and (72±14) years old respectively (P<0.01). The incidence rate increased with age (P<0.05). The highest incidence occurred from 9:00 to 10:00 (n=61, 7.7%), while the lowest incidence at 4:00 to 5:00 (n=9, 1.1%). A total of 552 (69.3%) cases were sent to class 3A hospitals; the number of patients who independently option hospital were 626 cases (78.5%). Emergency response time (from call to arrival) was an average of 13.49 minutes. A total of 318 cases (39.9%) took no more than 10 minutes and first aid an average of 38.11 minutes.


Key words: 
Emergency medical services; Cerebrovascular accident
同期手术治疗膀胱癌合并良性前列腺增生21例
Authors: 虎华静, 吴建军, 庞健
Journal: BMJ (2006)

同期施行经尿道膀胱肿瘤电切术及经尿道前列腺电汽化术治疗膀胱癌合并良性前列腺增生患者21例,手术时间80～150 min,平均95 min;住院时间7～14 d,平均9 d.21例患者术后随访0.6～3年,术后3例肿瘤复发,其中1例为膀胱颈复发,无原位复发,无尿道及前列腺窝转移。
Most common illnesses in outpatient clinic of one primary health center in Shanghai
Authors: Ruo-ming Li
Journal: BMJ (2012)

There were 461939 outpatient visits in Shanghai Tianping Primary Health Center from January to December 2010,the data were retrospectively analyzed based on the electronic outpatient record.The 20 most common illnesses accounted for 73.67％ of total outpatient consultations (340310/461 939),hypertension ranked the first position of all illnesses ( 21.06％ ) and followed by coronary heart disease (8.36％).Patients aged over 65y accounted for 72.35％ of all patients,the frequency of consultations was positively correlated with age of patients(P ＜0.01 ).The frequency of consultations varies according to the gender,age of the patients as well as the organ system involved (P ＜ 0.01 ).It can be concluded that the most frequently encountered illnesses in primary health center are common illnesses and chronic diseases.There are different needs for primary health service between genders and different age groups.

Key words: 
Community health centers; Outpatients
Stress related to electronic health record (EHR) use among oncology trainees: A quality improvement study to optimize information gathering.
Authors: Teja Ganta
Journal: Journal of Clinical Oncology (2020)

11015 Background: Poor EHR usability is associated with physician burnout [1]. Oncology providers are tasked with coordinating data from multiple sources/tabs within an EHR (biomarkers, genetic data, imaging, etc.) to make treatment plan decisions. It is hypothesized that oncology trainees will have decreased stress using an EHR tool to optimize data gathering. Methods: This single-institution quality improvement study aims to decrease the time and stress associated with navigating the EHR to review/document laboratory data among first-year clinical oncology fellows rotating on consult services at The Mount Sinai Hospital as measured by self-reported survey data. An EHR tool was built that pulls into the note a drop-down list of user-selectable laboratory panels grouped according to hematologic/oncologic disease presentations. A survey was sent to all fellows in the program to assess attitudes toward the EHR. All 1st-year fellows were given access to the EHR tool as they are the ones who primarily rotate on consult services. After 3 months, a follow-up survey was sent to 1st-year clinical fellows to assess satisfaction with the EHR intervention. Results: For the baseline survey, there are a total of 17 respondents (response rate 77%). 70.6% of fellows believe using the EHR increases their level of stress. The most prevalent reasons cited for frustrations with the EHR are “Hard to read other providers’ notes” (82.4%), “Gathering information from multiple different pages” (76.5%), “Increased documentation requirements” (76.5%), “Inability to quickly navigate the system” (64.7%). For the follow-up survey targeting 1st-year fellows, there are a total of 6 respondents (response rate 100%). 5 fellows tried the EHR tool at least once. Of those 5 fellows, 100% use it daily in clinical practice while on consult services, believe it makes notes more legible, believe it saves time spent in chart review, and believe it decreases their stress associated with navigating the EHR. Conclusions: A majority of clinical oncology fellows believe that the EHR contributes to their stress. The reasons cited suggest that interventions that optimize note-writing and chart-reviewing may decrease stress. The majority of fellows who used this EHR tool believe the tool improved their efficiency and stress levels. This suggests more widespread use of this tool among oncology clinicians may contribute to wellness although further studies to increase utilization must be taken.
Spontaneous bilateral internal carotid artery dissection: a case report and literature review
Authors: Fanlong Ye, Zigao Wang, Xiaoli Pan, Jie Chen, Ruiman Xie, Chunjiu Zhong, Lirong Jin
Journal: BMJ (2017)

A patient with multiple ischemic stroke due to spontaneous bilateral internal carotid artery dissection (ICAD) was reported and the epidemiology, neuroimaging, clinical characteristics and treatment of spontaneous bilateral ICAD were reviewed. Spontaneous bilateral ICAD mostly occurs in young and middle-aged individuals and the clinical manifestations are mainly stroke(71.1%), headache and neck pain(62.2%), Horner′s syndrome(15.6%) and cranial nerve palsy(11.1%). Cervical axial T1-weighted fat-suppressed image is an alternative to DSA to make the definite diagnosis. Antithrombotic therapy is regularly used and the general clinical outcome is good. Cervical arterial dissection is one of the most common causes of stroke in young and middle-aged patients. Cervical MRI T1-weighted fat suppressed image is crucial for timely diagnosis and initiation of appropriate clinical intervention.


Key words: 
Carotid artery internal; Stroke; Cervical MRI