tbuckley/cabot-search huggingface dataset:
Gastrointestinal Cancer Stage at Diagnosis Before and During the COVID-19 Pandemic in Japan
Authors: Kento Kuzuu, Noboru Misawa, Keiichi Ashikari, Takaomi Kessoku, Shingo Kato, Kunihiro Hosono, Masato Yoneda, Takashi Nonaka, Shozo Matsushima, Tatsuji Komatsu, Atsushi Nakajima, Takuma Higurashi
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages. <h3>Objective</h3> To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic. <h3>Design, Setting, and Participants</h3> This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals. <h3>Exposures</h3> The pre–COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020. <h3>Main Outcome and Measure</h3> Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared. <h3>Results</h3> The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre–COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre–COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; –26.87% change;<i>P</i> &lt; .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; –13.47% change;<i>P</i> = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; –35.51% change;<i>P</i> &lt; .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; –32.89% change;<i>P</i> = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; –34.04% change;<i>P</i> = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; –35.32% change;<i>P</i> = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.
Annals Graphic Medicine - The Scarf
Authors: Zachary G. Jacobs
Journal: Annals of Internal Medicine (2021)

Web ExclusivesSeptember 2021Annals Graphic Medicine - The ScarfFREEZachary G. Jacobs, MDZachary G. Jacobs, MDOregon Health & Science University, Portland, Oregon (Z.G.J.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G20-0108 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Oregon Health & Science University, Portland, Oregon (Z.G.J.)Disclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G20-0108.Author/Illustrator Information: Zachary G. Jacobs, MD, is a hospitalist at the Oregon Health & Science University. He uses creative writing, photography, and graphic arts to combine his passions of healing and storytelling. To see more of his work, visit https://zgjmd.wordpress.com (e-mail, [email protected]edu; Twitter, @ZacharyGJacobs).This article was published at Annals.org on 14 September 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics September 2021Volume 174, Issue 9Page: W83-W89 ePublished: 14 September 2021 Issue Published: September 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
System-wide depression screening implementation in ambulatory oncology care: Key strategies and early implementation outcomes.
Authors: Chao-Hui Huang, Ehimwenma Judith Ryans, Mayowa Otuada, Laquetta F Allen, Richard A. Taylor, Gabrielle Betty Rocque
Journal: Journal of Clinical Oncology (2021)

260 Background: Oncology Care Model (OCM) requires cancer programs to provide depression screening during each care episode to meet the quality measure benchmark of 85% screening rate. This quality improvement (QI) project aims to assess 1) key strategies to integrate system-wide depression screening into routine cancer care, and 2) early outcomes of depression screening implementation. Methods: A mixed-method study design was used to assess strategies to implement routine depression screening in a southeast comprehensive cancer center between July 2019 and December 2020. Two top high-volume hematological oncology clinics that covers sixty percent of ambulatory care participated in the depression screening implementation. Data were collected using 1) depression screening completion rate during OCM performance periods, 2) needs assessment to identify barriers and facilitators of implementation, and 3) semi-structured interviews to assess staff and provider feedback on sustainable implementation strategies. Data were analyzed using descriptive analysis for quantitative outcomes and thematic analysis for qualitative outcomes. Results: A total of 64 hematological oncology providers (n = 22) and staff (n = 42) participated in the depression screening implementation training during three OCM performance periods. Depression screening rate of total ambulatory oncology care increased from 12% (OCM-PR 5, Jul-Dec 19), to 51% (OCM-PR 6, Jan-Jun 20) to 77% (OCM-PR 7, Jul-Dec 20) after the two top-volume clinics integrated depression screening into clinic intake process. Themes emerged from needs assessment revealed multi-level implementation strategies including 1) patient education and psycho-oncological care, 2) staff training and practice modification, 3) provider education &amp; interdisciplinary Care, 4) leadership, administration, and staffing support, and 5) clinical informatics collaboration to build the infrastructure for integrating depression screen with clinic intake in the electronic medical record (EMR). Feedback from staff and provider interviews indicated high receptiveness and buy-in, especially during the COVID-19 pandemic to improve timely identification and triage of patients with depressive symptoms across all oncology care services. Conclusions: Depression screening is a key component of quality comprehensive cancer care that aims to provide timely identification and triage of cancer patients needing follow-up psychosocial care. Early implementation outcomes revealed significant improvement in depression screening completion rate after two clinics adopted depression screening into intake process. Further investigation is needed to refine system-wide implementation strategies across all ambulatory oncology sites and to assess long-term implementation outcomes meet the psychosocial care needs of cancer patients.
Rapid Macrosatellite Evolution Promotes X-Linked Hybrid Male Sterility in a Feline Interspecies Cross
Authors: Kevin R Bredemeyer, Christopher M Seabury, Mark J Stickney, John R McCarrey, Bridgett M vonHoldt, William J Murphy
Journal: Molecular Biology and Evolution (2021)

Abstract The sterility or inviability of hybrid offspring produced from an interspecific mating result from incompatibilities between parental genotypes that are thought to result from divergence of loci involved in epistatic interactions. However, attributes contributing to the rapid evolution of these regions also complicates their assembly, thus discovery of candidate hybrid sterility loci is difficult and has been restricted to a small number of model systems. Here we reported rapid interspecific divergence at the DXZ4 macrosatellite locus in an interspecific cross between two closely related mammalian species: the domestic cat (Felis silvestris catus) and the Jungle cat (Felis chaus). DXZ4 is an interesting candidate due to its structural complexity, copy number variability, and described role in the critical yet complex biological process of X-chromosome inactivation. However, the full structure of DXZ4 was absent or incomplete in nearly every available mammalian genome assembly given its repetitive complexity. We compared highly continuous genomes for three cat species, each containing a complete DXZ4 locus, and discovered that the felid DXZ4 locus differs substantially from the human ortholog, and that it varies in copy number between cat species. Additionally, we reported expression, methylation, and structural conformation profiles of DXZ4 and the X chromosome during stages of spermatogenesis that have been previously associated with hybrid male sterility. Collectively, these findings suggest a new role for DXZ4 in male meiosis and a mechanism for feline interspecific incompatibility through rapid satellite divergence.
P12.07 The potential of cannabinoids to improve quality of life in glioma patients: A meta-analysis in patients with neurological and oncological disease
Authors: V Belgers, J G Röttgering, L Douw, M Klein, P M van de Ven, J C F Ket, K Bacher Svendsen, M Weber, J Lopez-Sendon, M G Olde Rikkert, M H N Chagas, M E van Linde, M C M Kouwenhoven, P C de Witt Hamer
Journal: Neuro-Oncology (2021)

Abstract BACKGROUND Gliomas are primary brain tumors with a dismal prognosis. Reducing symptoms and maintaining quality of life (QoL) are main treatment aims in glioma patients. Mental well-being is an important subdomain of QoL. Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety or depression. Glioma patients frequently report unprescribed cannabinoid use for these reasons. We performed a meta-analysis of the current evidence on cannabinoid efficacy on QoL and mental well-being to identify its added value in treatment of glioma patients. MATERIAL AND METHODS We performed a systematic PubMed, Embase and Web of Science search according to the PRISMA guidelines on September 22nd and 23rd, 2020. The effects of any dose of tetrahydrocannabinol (THC) or cannabidiol (CBD) on both general QoL and mental well-being were evaluated. The intervention had to be given for at least a week to establish a steady-state concentration. Effect size was calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane’s Risk of Bias tool 2.0. RESULTS We retrieved no publications on cannabinoids use and QoL in glioma and, therefore, we expanded the search to cannabinoid use in other cancer types and chronic central nervous system (CNS) diseases. Sixteen studies were identified: four in cancer and twelve in CNS disease. Meta-analysis showed no effect of cannabinoids on general QoL (twelve studies in 1,740 patients; g = -0.02, 95% CI -0.11 to 0.07, p = 0.65) and mental well-being (twelve studies in 1,587 patients; g = -0.00, 95% CI -0.15 to 0.14, p = 0.96). Risk of bias was low in five studies, raised some concern in one study and was high in ten studies, mainly due to possible unblinding of patients after psychoactive adverse effects. CONCLUSION No studies on the effects of cannabinoids on QoL in glioma patients have been reported. A pooled analysis of studies in oncological patients and patients with CNS disease showed no effect of cannabinoids on QoL or mental well-being. However, studies were clinically heterogeneous and only one small study investigated monotherapy CBD with undecided results. As many glioma patients currently use cannabinoids, and monotherapy CBD has not been sufficiently investigated, future studies are necessary to evaluate its value in this specific population. SUPPORT/DISCLOSURE This meta-analysis has been funded by The Anita Veldman Foundation (CCA-2019-2-21).
Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab
Authors: Nicholas A Kennedy, James R Goodhand, Claire Bewshea, Rachel Nice, Desmond Chee, Simeng Lin, Neil Chanchlani, Jeffrey Butterworth, Rachel Cooney, Nicholas M Croft, Ailsa L Hart, Peter M Irving, Klaartje B Kok, Christopher A Lamb, Jimmy K Limdi, Jonathan Macdonald, Dermot PB McGovern, Shameer J Mehta, Charles D Murray, Kamal V Patel, Richard CG Pollok, Timothy Raine, Richard K Russell, Christian P Selinger, Philip J Smith, Jack Bowden, Timothy J McDonald, Charlie W Lees, Shaji Sebastian, Nicholas Powell, Tariq Ahmad
Journal: Gut (2021)

Antitumour necrosis factor (anti-TNF) drugs impair protective immunity following pneumococcal, influenza and viral hepatitis vaccination and increase the risk of serious respiratory infections. We sought to determine whether infliximab-treated patients with IBD have attenuated serological responses to SARS-CoV-2 infections.Antibody responses in participants treated with infliximab were compared with a reference cohort treated with vedolizumab, a gut-selective anti-integrin α4β7 monoclonal antibody that is not associated with impaired vaccine responses or increased susceptibility to systemic infections. 6935 patients were recruited from 92 UK hospitals between 22 September and 23 December 2020.Rates of symptomatic and proven SARS-CoV-2 infection were similar between groups. Seroprevalence was lower in infliximab-treated than vedolizumab-treated patients (3.4% (161/4685) vs 6.0% (134/2250), p<0.0001). Multivariable logistic regression analyses confirmed that infliximab (vs vedolizumab; OR 0.66 (95% CI 0.51 to 0.87), p=0.0027) and immunomodulator use (OR 0.70 (95% CI 0.53 to 0.92), p=0.012) were independently associated with lower seropositivity. In patients with confirmed SARS-CoV-2 infection, seroconversion was observed in fewer infliximab-treated than vedolizumab-treated patients (48% (39/81) vs 83% (30/36), p=0.00044) and the magnitude of anti-SARS-CoV-2 reactivity was lower (median 0.8 cut-off index (0.2-5.6) vs 37.0 (15.2-76.1), p<0.0001).Infliximab is associated with attenuated serological responses to SARS-CoV-2 that were further blunted by immunomodulators used as concomitant therapy. Impaired serological responses to SARS-CoV-2 infection might have important implications for global public health policy and individual anti-TNF-treated patients. Serological testing and virus surveillance should be considered to detect suboptimal vaccine responses, persistent infection and viral evolution to inform public health policy.ISRCTN45176516.
Association of Timing and Duration of Prenatal Analgesic Opioid Exposure With Attention-Deficit/Hyperactivity Disorder in Children
Authors: Johanne Naper Trønnes, Angela Lupattelli, Marte Handal, Svetlana Skurtveit, Eivind Ystrom, Hedvig Nordeng
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Prior studies have reported that the use of illicit opioids during pregnancy is associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring; however, evidence regarding the association of analgesic opioids is limited. <h3>Objective</h3> To examine the association of timing and duration of prenatal analgesic opioid exposure with ADHD in children. <h3>Design, Setting, and Participants</h3> This cohort study uses data from the Norwegian Mother, Father and Child Cohort study (1999-2008), a nationwide birth cohort study linked to national health registries, with a mean (SD) follow-up of 10.8 (2.2) years. A total of 73 784 live-born singleton children born to 62 013 mothers who reported a pain-related condition before and/or during pregnancy were included, with 2 comparator groups: (1) mothers who did not use any opioids and (2) mothers who used opioids before pregnancy only. Data were analyzed from June to December 2020. <h3>Exposures</h3> Maternal self-report of analgesic opioid use during pregnancy, by timing (early and middle and/or late) and duration (≥5 weeks vs ≤4 weeks). <h3>Main Outcomes and Measures</h3> Diagnosis of ADHD or filled prescription for ADHD medication in children and symptoms of ADHD at child age 5 years, measured by Conners' Parent Rating Scale–Revised. Inverse probability of treatment weights were used to control for measured confounding. Cox regression was used to estimate hazard ratios (HRs) and 95% CIs. <h3>Results</h3> The analyses of ADHD diagnosis and ADHD symptoms included 73 480 children (35 996 [49.0%] girls; mean [SD] maternal age, 30.0 [4.6] years) and 31 270 children (15 377 [49.2%] girls; mean [SD] maternal age, 30.5 [4.4] years), respectively. Overall, 1726 children in the ADHD diagnosis sample (2.3%) and 667 children in the ADHD symptom sample (2.1%) were exposed to an analgesic opioid at least once during gestation. No associations between timing of prenatal analgesic opioid exposure and ADHD diagnosis or symptoms was found. Exposure for 5 or more weeks was associated with an increased risk of ADHD diagnosis (HR, 1.60, 95% CI, 1.04-2.47) compared with exposure for 4 weeks or less; however, there was no such association for the risk of ADHD symptoms. <h3>Conclusions and Relevance</h3> In this cohort study, a slightly elevated risk of ADHD diagnosis after prenatal analgesic opioid exposure for 5 or more weeks was found compared with exposure for 4 weeks or less. This result may be driven by longer duration of use; however, the role of residual or unmeasured confounding cannot be excluded. This finding needs to be replicated in other studies.
Retaining the doctors we train
Authors: Gabriella S Quiney
Journal: BMJ (2021)

O’Dowd reports the proposed expansion in medical school places to meet the demand of students fulfilling their A level requirements.1

More doctors are needed, but simply adding more newly qualified students to the workforce fails to tackle the “holes in the bucket” that have caused thousands of highly skilled and knowledgeable doctors to work abroad, retire early, or leave medicine entirely.

The General Medical Council estimates that 4% of doctors …
Correspondence on “European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance”
Authors: Xavier Bossuyt, Walter Fierz, Pier Luigi Meroni
Journal: Annals of the Rheumatic Diseases (2021)

Antinuclear antibodies (ANA) are important laboratory markers for the diagnosis and classification of systemic lupus erythematosus (SLE). In the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE, ANA with titre ≥1:80 are an entry criterion.1

Even though ANA 1:80 are highly sensitive for SLE, they have a low specificity. This has recently been reinforced by Aringer et al 2 who analysed the performance of the individual items included in the 2019 EULAR/ACR classification criteria for SLE on a large group of patients with SLE (n=1197) and non-SLE disease controls (n=1074), including patients with other connective tissue diseases (two-thirds of the controls). In this study, ANA with titre ≥1:80 were highly sensitive (99.5%), but only 19.4% specific for SLE.2 As ANA are an entry criterion for the 2019 EULAR/ACR classification criteria, the low specificity of ANA for SLE does not affect the specificity of the 2019 SLE classification criteria. An important item that conferred specificity to the 2019 SLE classification was the attribution rule.2 The authors stressed that ANA are a useful screening test, but not specific and that the classification criteria should not be used as diagnostic criteria.2

As ANA are employed in the context of both classification and diagnosis, it is …
Postresection Period-Specific Hazard of Recurrence as a Framework for Surveillance Strategy in Patients with Hepatocellular Carcinoma: A Multicenter Outcome Study
Authors: Ha Il Kim, Jihyun An, Ji Yoon Kim, Hyun Phil Shin, Seo Young Park, Gi-Won Song, Han Chu Lee, Ju Hyun Shim
Journal: Liver Cancer (2021)

In spite of the high frequency of recurrence of hepatocellular carcinoma (HCC) after resection, little evidence exists to directly help to plan a reasonable schedule for the frequency and intensity of postoperative surveillance for recurrence.1,918 consecutive patients with Child-Turcott-Pugh class A who had T1- or T2-staged HCCs detected by active surveillance and underwent curative resection for their tumors at 3 teaching hospitals in Korea, followed by recurrence screening at 6-monthly or shorter intervals. To set an evidence-based timetable for postoperative surveillance, we investigated the annual hazard rate of recurrence through postoperative year 10 in patients undergoing hepatectomy for HCC, and the clinical and morphological phenotypes associated with early versus late recurrence.The estimated hazard rate for recurrence peaked during year 0-1 (21.7%), with a subsequent gradual decrease through 5 years, followed by stabilization at <7.0% until year 10, except in the case of cirrhotics, who had a rate of 10.5% during year 4-5. Multivariate time-to-recurrence analysis by recurrence period revealed that serum alpha-fetoprotein ≥200 ng/mL, larger size of tumor, tumor multiplicity, microvascular invasion, capsular invasion, and higher METAVIR fibrosis stage were significantly related to disease recurrence within 5 years after resection, while cirrhosis (METAVIR F4) alone was related to disease recurrence beyond 5 years (Ps < 0.05). Post-relapse overall survival was better in the latter group (p = 0.033).Our chronological and morphological insights into recurrence after resection of primary HCCs may help implement an optimal intensity of surveillance for recurrence.