tbuckley/cabot-search huggingface dataset:
Maternal thyrotoxicosis in the first trimester: a clinical analysis of 150 cases
Authors: Shunbin Li, Yueping Jin
Journal: BMJ (2016)

Clinical data of 150 pregnant women, who were confirmed with maternal thyrotoxicosis during January 2010 to January 2014, including 104 cases of gestational transient thyrotoxicosis (GTT)and 46 cases of Graves disease (GD), were retrospectively analyzed; 65 normal pregnant women served as controls. Patients with GD had lower body mass index (BMI) than those with GTT and normal controls [(18±5), (20±4)and (22±4) kg/m2, respectively, P<0.05]. The frequency of thyrotoxic history and hyperthyroidism symptoms in GD patients were significantly higher than that in GTT patients [33%(15/46) vs. 3%(3/104) and 52%(24/46) vs. 15%(16/104), respectively, both P<0.01]. In the first trimester, patients with GD presented lower TSH levels than those with GTT and controls(M=0.021, 0.045 and 1.660 mU/L, respectively, P<0.05)and higher free T4 (FT4) (M=24.99 vs.19.99 pmol/L, P<0.05), free T3 (FT3) (7.10 vs. 5.85 pmol/L, P<0.05), thyroid peroxidase antibody (TPOAb) (99.22 vs. 4.54 kU/L, P<0.05) and thyrotrophin receptor antibody(TRAb) (5.28 vs. 0.11 U/L, P<0.05) levels than patients with GTT. In the second trimester, there were 67%(70/104) GTT patientsand 4%(2/46) GD patients had normal TSH; and FT4 returned to normal in 82%(85/104) GTT patientsand 17%(8/46) GD patients. In the third trimester, there were 100% (104/104) GTT patients and 9% (4/46) GD patients had normal TSH; and FT4 returned to normal in 100% (104/104) GTT patients and 48% (22/46) GD patients.


Key words: 
Thyrotoxicosis, pregnant women; Graves disease
Abstract 12146: Cystatin C and Left Ventricle Function in Black Patients With Atrial Fibrillation and Acute Coronary Syndrome
Authors: Haroon Kamran, Daniel Fung, Roseann Chesler, Erdal Cavusoglu, Judith E Mitchell
Journal: Circulation (2017)

Introduction: Renal dysfunction, an independent risk factor for cardiovascular [CV] morbidity and mortality, has a higher prevalence in black patients. Along the spectrum of cardiovascular diseases...
Training demand for chronic wound management of general practitioners in Beijing
Authors: Liu Liu, Xue Zhang, Wentao Zhang
Journal: BMJ (2015)

General practitioners from community health service institutions in Shijingshan, Mentougou, Haidian, Chaoyang, Fengtai and Dongcheng Districts of Beijing were selected to take the examination of chronic wounds management. Questionnaire survey was also performed on the status of community chronic wounds management, medical service motivation, influencing factors and their demand for training. Among 204 general practitioners, 55(27.0%)had mastered basic knowledge, 98 (48.0%) passed the examination and 51(25.0%)failed. The results showed that 179 (87.7%) had changing dressing service, 36.8% offered out-patient consulting service, 17.6% performed surgical debridement, only 10 (4.9%) provided home chronic wounds care service and 2 (0.9%) of them carried out long-term follow-up. According to the motivation survey, all the practitioners expressed the willingness to help the patients and win their trust. Most of the practitioners claimed no supporting from their institutions(91.7%)and chronic wounds management was excluded from daily routine. Furthermore, heavy work load(82.8%)and lack of professional knowledge(80.9%)were also considered to be main obstructive factors. The survey showed that the majority of physicians required classroom teaching (90.1%), case analysis (86.8%), operating video (92.6%) and other teaching forms. More low level doctors(97.1%)had the desire to pursue further specialist training than higher level physicians (56.7%). The results of our investigation indicate that general practitioners in community health service institutions have strong learning motivation for chronic wounds management and systematic training of knowledge and practical skills in this field should be provided.


Key words: 
Community health services; Questionnaires; Chronic wounds
水痘并发耳带状疱疹致周围性面瘫一例
Authors: 于红岩
Journal: BMJ (2006)

患者男,14岁.因全身散在水疱样皮疹伴高热2 d于我院儿科诊断为水痘.给予口服利巴韦林(病毒唑)及退热药对症治疗,3 d后出现左耳跳痛、口角歪、左眼闭合不全而来我科就诊.查体:左侧额纹消失,左眼睑闭合不全,左侧鼻唇沟浅,左耳廓皮肤充血肿胀,局部有成簇水疱样皮疹,外耳道及鼓膜未见异常.诊断:耳带状疱疹,左侧周围性面瘫.给予阿昔洛韦、青霉素、地塞米松静脉滴注,肌内注射维生素B1、B12,并针刺治疗.2周后耳廓及全身疱疹消退,继续针刺治疗10 d面瘫治愈。
疱疹病毒感染的诊断与处理
Authors: 陈志海, 姜民慧
Journal: BMJ (2011)

陈志海:随着社会发展,器官移植、肿瘤、艾滋病及应用糖皮质激素后免疫功能下降等情况导致疱疹病毒感染增多,受到大家重视.疱疹病毒是一类病毒,共8型,本次讨论前3型,即单纯疱疹病毒Ⅰ型( HSV-1)、单纯疱疹病毒Ⅱ型(HSV-2)、水痘-带状疱疹病毒(VSV),后5型是EB病毒、巨细胞病毒(CMV)、人疱疹病毒6～8型.EB病毒与伯基特淋巴瘤和鼻烟癌有关。
Demographic trends and in-hospital mortality data in patients with hepatocellular carcinoma.
Authors: Bolanle Adepoju, Stuthi Perimbeti, Daniel Kyung, Michael Styler, Maneesh Rajiv Jain
Journal: Journal of Clinical Oncology (2020)

e16648 Background: Hepatocellular carcinoma (HCC) remains the 4th leading cause of cancer related mortality in the US. The incidence of HCC in the US appears to be increasing in specific demographic subgroups (Caucasian males, Hispanics and in the Southern US). Older studies identified substantial racial and ethnic differences in treatment and survival in HCC. There is a lack of large scale studies exploring the mortality patterns in patients hospitalized with HCC. Methods: The National Inpatient Sample was used to extract admissions for HCC using the ICD-9 code 155.0 from the years 2010 to 2014. The sample was weighted to approximate the full inpatient population of the U.S. over the 5-year interval. Univariate analysis was performed to determine the frequency distribution and bivariate analysis was performed using Chi Square test to determine the in-hospital mortality percentage. Results: A total of 52,868 (weighted = 262845) admissions were extracted from the years 2010 to 2014. While the number of patients admitted with HCC steadily increased over the 5-year study period, the overall in-hospital mortality decreased significantly from 9.35% to 7.68% (p &lt; 0.0001). The mortality was highest for patients with African American ethnicity at 11.2% and for uninsured patients at 13%. The mortality rate among patients in the low income group (0-25th percentile) was 10.2 %, significantly higher (p = 0.0005) than other income groups. Conclusions: Even though the incidence of in-hospital mortality in HCC patients is decreasing, there appears to be a disparity in mortality data among patients of low socioeconomic status, self-pay or uninsured status and among African Americans. Our study further confirms the persistence of racial,economic and social disparities and highlights the need for additional equity research to understand the reasons for these differences and to improve outcomes for these subgroups of patients.
计算机软件在我国健康管理服务中的应用
Authors: 李浴峰, 纪宇, 翟凤红
Journal: BMJ (2008)

健康管理是预防医学和管理科学有机结合的产物,是一个同传统疾病管理有显著区别的新理念[1-2],被认为是目前提高居民健康水平和降低医疗费用最有效的手段之一[3-5].健康管理的过程首先是通过体检等手段收集健康信息,然后进行健康评估形成健康档案和健康维护计划,最终实施健康干预[6]。
Three cases of parathyroid crisis and a literature review
Authors: Lulu Song, Jinping Zhang
Journal: BMJ (2014)

To explore the clinicopathological characteristics of parathyroid crisis. The data of 3 cases from our hospital and 125 cases reported domestically were retrospectively analyzed. All 3 cases were male. And their disease course was 3 months to 10 years. The serum calcium ranged from 3.72 to 5.19 mmol/l. Among 177 retrieved cases, 125 had complete basic data. The male/female ratio was 1∶1.17, average age (46±14) (15-75) years and average serum calcium (4.30±0.58)(3.75-7.28) mmol/L. There was no difference between genders or benign and malignant pathological types. Among 117 cases with pathological diagnosis, the most common type was adenoma (74.4%). The ratio of parathyroid carcinoma was higher in males than that in females (33.3% vs. 11.7%). Misdiagnosis rate was 25.0% upon initial presentations. Case fatality rate stood at 9.4% (17/180) and half of them died preoperatively.


Key words: 
Parathyroid crisis; Hyperparathyroidism, primary
Asymptomatic cardiotoxicity in long-term breast cancer survivors.
Authors: Mohammed Alaeddine Saidi, Soumeyya Ghomari
Journal: Journal of Clinical Oncology (2020)

e24084 Background: Multimodal approach in the adjuvant treatment of early breast cancer has led to a significant number of survivors. However, the combination of these treatments may increase the risk of long-term cardiotoxicity, particularly in the presence of cardiovascular risk factors (CVRF). Methods: We examined cardiac function in patients who had previously been treated for early breast cancer. Echocardiograms were performed at least 2 years after therapy. We measured left ventricular ejection fraction (LVEF) and reported pre-treatment LVEF and all CVRF. The initial Framingham Risk Score (FRS) has been calculated. Asymptomatic cardiotoxicity was defined by decrease of 5% or more in the LVEF value without clinical symptoms of CHF. Doxorubicin, Trastuzumab, Radiotherapy, older age, and CVRF (hypertension (HTN), diabetes, dyslipidemia, obesity, Waist circumference) were evaluated as potential risk factors for the development of cardiotoxicity. All statistical analysis was performed using SPSS version 25.0. Results: A total of 143 breast cancer survivors with a median age of 46 ± 10 years (range: 26-72) underwent Echocardiogram imaging after a median follow-up of 9,22 years (range: 2 - 22). 48 women were postmenopausal at diagnostic. 32,2% were obese. HTN was present in 15%, diabetes in 12%, and dyslipidemia in 12% of patients. ARA-II was the most used treatment of HTN (55%). 11,9% of patients were under statin therapy. FRS was low in 69%, moderate in 22% and high in 9% of patients. 4 patients had received endocrine therapy alone, none of whom developed cardiotoxicity. There was only one case of symptomatic cardiotoxicity. In the remaining 138 women who received multimodal treatment (Anthracyclines:100%, Docetaxel:62,9%, Endocrine therapy:72%, Trastuzumab:7%, Radiotherapy:83,2%), a statistical but non-clinically significant decrease was observed in LVEF (67.7 ± 3.6 to 65.4 ± 5.1, p &lt; 0.001). 39 women (28,3%) developed asymptomatic cardiotoxicity. In multivariate analysis, factors that contributed to decreased LVEF were HTN (p = 0,006), diabetes (p = 0,008) and dyslipidemia (p = 0,03). Conclusions: The use of adjuvant therapy in breast cancer may increase long term cardiotoxicity particularly in survivors with CVRF. Long-term cardiac follow-up is essential in order to initiate cardioprotective therapy at the right time.
Segmental chromosome aberrations and clinical response impact outcome of inss stage III patients ≥18 months with unfavorable histology and without MYCN amplification: A Children’s Oncology Group (COG) report.
Authors: Navin R. Pinto, Arlene Naranjo, Emily Hibbitts, Xiangming Ding, Rachelle Tibbetts, Rebekah Kennedy, Ruthann Pfau, Michael D. Hogarty, Susan G. Kreissman, Meredith Irwin, Julie R. Park, Shahab Asgharzadeh
Journal: Journal of Clinical Oncology (2020)

10502 Background: Patients with INSS stage III neuroblastoma represent a heterogeneous population with respect to disease presentation and prognosis and controversy exists regarding the most effective treatment algorithms. Patients ≥18 months of age with INSS Stage 3 tumors that are unfavorable histology (UH) and MYCN-non-amplified ( MYCN-NA) represent a small cohort of patients with an outcome intermediate of those with favorable histology tumors and MYCN amplified tumors. The presence of Segmental Chromosome Aberrations (SCA) may predict outcome; however, their impact specifically in this cohort of patients has not been reported. Methods: Eligible patients enrolled on therapeutic protocols A3973 (n=34), ANBL0532 (n=27), and biology protocol ANBL00B1 (n=101 with 29 treated on A3973/ANBL0532) with stage III disease, MYCN–NA, UH and age ≥18 months at diagnosis were analyzed. Copy number alterations and loss of heterozygosity (LOH) for relevant loci were scored for gains/losses by two independent reviewers. Results: The 5-year EFS/OS for children ≥18 months with stage III, MYCN–NA, UH disease treated on A3973 and ANBL0532 was 73.0±8.1%/87.9±5.9% and 61.4±10.2%/ 73.0±9.2%, respectively, with no statistical differences in EFS or OS between the two cohorts (p=0.1286 and p=0.2180, respectively). In the combined cohort of patients enrolled on A3973 and ANBL0532, statistically significant differences were found (p(s) &lt;0.0001) in patients with CR/VGPR (n=39) and PR (n=13) having better outcomes than &lt;PR (n=5) (5-year EFS: 74.0±7.6% vs. 75.0±12.5% vs. 0%; 5-year OS: 84.4±6.2% vs. 100% vs. 20.0±17.9%). Subjects with chromosome 11q loss/LOH had an inferior outcome in comparison to those without 11q loss/LOH (10-year EFS: 44.4+/-24.1% vs. 78.1+/-9.4%, p=0.01; 10-year OS: 62.4+/-15.9% vs. 85.9+/-7.8%, p=0.02)). Patients with 1p loss/LOH and 2p gain also showed trend towards worse event-free survival (p=0.086 and p=0.088, not statistically significant) but not in overall survival. Conclusions: High-risk therapy that included single myeloablative therapy led to an 81.6±5.3%5-year OS in patients ≥18 months with UH and MYCN–NA stage III neuroblastoma. Response to therapy is a powerful predictor of survival and the presence of chromosome 11q loss/LOH is also associated with inferior outcomes. These patients should continue to be treated on high-risk clinical trials.
An exploratory study of PD-1 inhibitor for high-risk multiple ground-glass nodules (mGGNs) in synchronous stage I non-small cell lung cancer patients.
Authors: Lin Xu, Meiqi Shi, Ming Li, Wenjia Xia, Wenrong Shen, Jingyuan Zhang, Jun Zhu, Yang Shao, Rong Yin
Journal: Journal of Clinical Oncology (2020)

e21068 Background: Surgical resection is recommended for the stage I NSCLC patients. However it is lack of standard therapies for synchronous mGGNs. This study aims to explore the feasibility of a PD-1 inhibitor (sintilimab) in high-risk residual mGGNs in post-surgery synchronous stage I NSCLC patients. Methods: This is a single arm phase I trial intending to recruit 20 subjects. Eligible patients contained at least one high-risk residual mGGN (confirmed by MDT discussion) after surgical resection of stage I NSCLC. Patients received sintilimab (200mg i.v., Q3W) for 10 cycles since 6 weeks post-surgery. Radiological evaluations were performed at every 3 cycles in treatment period and every 3 months during follow-up. Whether re-operation is needed depends on MDT evaluation. The primary endpoints were safety and ORR. The secondary endpoints included DOR, MPR of re-operated GGNs, and the one-year PFS. Results: As data cutoff (23 Jan 2020), 20 patients (9 males and 11 females) were enrolled. The pathological results revealed that all were lung adenocarcinoma. The median treatment cycles was 6 (range 3 to 10). All lesions were evaluated as stable disease by RECIST 1.1. Six patients underwent re-operation safely and12 GGNs were resected. Pathology showed that 1 had no tumor cells residue, 4 had 20-35%, and 7 had over 80% residues. Whole-exome sequencing of 12 GGNs showed 6 harboring EGFR and 2 harboring KRAS mutations. Interestingly, 3 out of 6 with EGFR-mut showed less tumor cells residues (23.3%, 30%, and 80%). The highest TMB (15.7 mut/Mb) was observed in the complete response GGN. 65% patients experienced treatment-related 1-2 grade AEs. Conclusions: The PD-1 inhibitor showed well tolerability and a certain degree anti-tumor activity was seen from the pathologic results of re-operated GGNs. Radiological evaluation using RECIST 1.1 might be unsuitable for mGGNs. Further studies are needed to demonstrate the clinical benefits. ChiCTR: 1900022159 Clinical trial information: 1900022159 .
Bevacizumab biosimilar and reference bevacizumab in subjects with stage IIIB/IV no squamous non-small cell lung cancer (NSCLC) (STELLA study): Results for the primary endpoint in a confirmatory, double-blind, randomized, controlled study.
Authors: Susana Millan, Dmytro Trukhin, Oleksii Kolesnik, Elena Poddubskaya, Andric Zoran, Igor Bondarenko, Serhii Shevnia, Felicitas Bullo, Cristina Sarnago
Journal: Journal of Clinical Oncology (2020)

e21542 Background: MB02 is a proposed biosimilar of the reference bevacizumab. A multinational, double-blind, randomized, parallel group clinical study (STELLA) is undergoing to confirm clinical similarity between MB02 and bevacizumab in patients with stage IIIB/IV no squamous NSCLC. Methods: Subjects were randomized 1:1 to MB02 or bevacizumab (15 mg/kg) plus chemotherapy (paclitaxel [P] 200 mg/m 2 and carboplatin [C] AUC6) on Day 1 of every 3-week cycle for 6 cycles (Week 18) followed by MB02/bevacizumab in blinded monotherapy until disease progression, treatment intolerance, death, patient withdrawal or end of study (Week 52). As primary study endpoint, the efficacy by means of the objective response rate (ORR) evaluated by an independent radiological committee (IRC) was compared between arms at Week 18. Secondary endpoints were Progression Free Survival (PFS) and Overall Survival (OS), safety and immunogenicity (assessed at 18 and 52 weeks). Results: 627 patients were randomized: MB02 (n = 315) and bevacizumab (n = 312). Demographic and baseline characteristics were well balanced between arms. The ORR results were comparable for subjects receiving MB02 or bevacizumab plus P/C. A Risk Ratio (RR) of 1.013 (90% CI: -0.037% to 0.059) and a Risk Difference (RD) of 0.011 (90% CI: -0.037% to 0.059), were within the similarity margin predefined by FDA (0.73, 1.36) and EMA (-12%, +12%) respectively. This ORR assessed by IRC was consistent with the investigator assessment criteria. There was no significant difference between arms for secondary efficacy endpoints (PFS/OS) at week 18. Up to primary endpoint cut-off point, the safety assessment showed no significant differences between MB02 and bevacizumab arms (including the immunogenicity assessment) in terms of nature, frequency and severity of the adverse events (AE), being anaemia and hypertension the most common IMP-related AEs, with a RD between treatment groups &lt; 5%. New signals or observable trends were no reported for MB02-treated subjects. Additional information on the secondary endpoints will be available at week 52 (end of monotherapy period). Conclusions: The statistical analysis executed for ORRs confirm the equivalence of MB02 and bevacizumab, supporting the clinical activity of MB02 treatment. MB02 was well tolerated with manageable AEs in patients with Stage IIIB/IV NSCLC. Clinical trial information: NCT03296163.
Methotrexate reduces withdrawal rates of TNF inhibitors due to ineffectiveness in rheumatoid arthritis but only in patients who are seropositive
Authors: Mandy Greenwood, Muhammad Shipa, Su-Ann Yeoh, Euthalia Roussou, Dev Mukerjee, Michael R Ehrenstein
Journal: Annals of the Rheumatic Diseases (2020)

The benefits of coprescribing methotrexate (MTX) with tumour necrosis factor (TNF)-inhibitors are well documented in rheumatoid arthritis (RA), though rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) status have not always been taken into account.1 Increasing doubt about the value of combination MTX and anti-TNF therapy in psoriatic arthritis2 3 led us to evaluate whether MTX reduced withdrawal rates due to ineffectiveness of anti-TNF therapy equally in seropositive and seronegative RA. Treatment durations for adalimumab or etanercept were analysed for 301 patients with RA using retrospective, real-world data from a single centre. All had started adalimumab or etanercept as a first-line biologic from 2003 onwards. Rates of ineffectiveness-related withdrawal during the first 5 years of anti-TNF therapy were analysed using Kaplan-Meier and Cox regression, with comparison of rates with respect to concomitant MTX at anti-TNF initiation. Fifty-two withdrawals for adverse events and 10 for other reasons constituted censored cases as did 136 still on anti-TNF at 5 years and 60 …
由病例分析看痛风性关节炎的诊治
Authors: 曾学军, 郑文洁
Journal: BMJ (2006)

痛风是一组尿酸代谢异常的异质性疾病,特征是尿酸盐结晶在关节或其他结缔组织中沉积,临床表现包括高尿酸血症、急性痛风性关节炎、痛风石、痛风性肾病以及关节畸形和功能障碍等,常见于中老年男性和绝经后妇女.一直以来,人们认为痛风是一种西方病,在中国的患病率很低.但是近年的研究提示,随着人民生活水平的提高,痛风在中国的患病率正逐渐上升.在此,我们按照目前国际较为公认的标准对急性痛风性关节炎的诊断和治疗进行讨论。
Efficacy of chronic disease management in the treatment and quality of life for rheumatoid arthritis
Authors: Jing Zhang, Li Long, Qiao Zhou, Tong Wu, Jiang Su
Journal: BMJ (2014)

Objective
To explore the effects of chronic disease management in the treatment and quality of life for rheumatoid arthritis (RA).


Methods
A total of 160 patients with active RA were selected from June 2011 to August 2012 and randomly assigned into experimental and control groups (n=80 each). Based upon oral medication, the experimental group had chronic disease management for 6 months. Before and after therapy, DAS28 score, erythrocyte sedimentation rate (ESR), ACR50 and quality of life score were measured.


Results
The number of regular medication in experimental group was significantly more than that in the control group (68 vs.37, χ2=26.625, P=0.000). The inter-group difference of DAS28 score reduction was statistically significant (2.46±1.09 vs. 3.68±1.65, t=1.655, P=0.002). After intervention, ESR significantly decreased in experimental group (66.09±41.98 vs. 21.27±19.61, t=1.655, P=0.029) and the reduction of control group was not statistically significant(t=1.976, P=0.059). The number of ACR50 in experimental group was more than that in control group (60 vs.44, χ2=4.314, P=0.038). The score of life quality of experimental group increased dramatically (56.58±20.24 vs. 63.71±18.35, t=1.655, P=0.013) and it was significantly higher than control group (63.71±18.35 vs. 48.76±19.88, t=1.906, P=0.020).


Conclusion
Chronic disease management can improve the life quality and clinical indices of RA patients. Thus it may be widely applied clinically as an adjunct treatment.


Key words: 
Disease management; Arthritis, rheumatoid
Rationale and study design of <scp>OUTSTEP‐HF</scp>: a randomised controlled study to assess the effect of sacubitril/valsartan and enalapril on physical activity measured by accelerometry in patients with heart failure with reduced ejection fraction
Authors: Frank Edelmann, Tiny Jaarsma, Josep Comin‐Colet, Jessica Schorr, Laurent Ecochard, Rizwan I. Hussain, Massimo F. Piepoli
Journal: European Journal of Heart Failure (2020)