tbuckley/cabot-search huggingface dataset:
Significance of the depth and density of Helicobacter pylori infection in gastric mucosa
Authors: Yingsheng Zhu, Dongbing Zhu, Li Sha
Journal: BMJ (2014)

One hundred and seventy one gastric biopsy specimens from the patients undergoing gastroscopic examination from March to November 2010 were reviewed. HE, sliver and immunohistochemistry stains were performed in the specimens; the correlation of histopatholigy and the density and distribution of Helicobacter pylori in gastric mucosa was analyzed. The results displayed that spiral H. pylori mainly appeared on the surface mucus and in the gland lumen of gastric small concave, some were attached to the epithelial cells; coccoid H. pylori appeared within the apical cytoplasmic part of the epithelial cells and in the mucous membrane stroma. The depth of H. pylori infection was correlated with mucosal erosion, inflammation activities and amount of interstitial lymphocytes. The results suggest that spiral H. pylori infection may facilitate the invasive depth of coccoid H. pylori in gastric mucous membrane and the density of H. pylori infection is correlated with the extent and severity of inflammation.


Key words: 
Helicobacter pylori; Gastric mucosa
Teaching practice of general medical resident standardization training students in the composition of problem-based learning cases
Authors: Fang-yuan Yi, Dian-jun Qi, Ping Shi
Journal: BMJ (2012)

Problem-based learning (PBL) was carried out in general practice residency training program.Interview was used to evaluate the teaching performance.A total of 22 teachers and 198 students participated in evaluations.Among the teachers,17 (77％) were quite satisfied and 5 (23％) relatively satisfied.The overall satisfaction rates of teachers,problems and problem solutions were 87％,75％ and 91％ respectively. PBL stimulated the interests of students and was conducive for the combination of theoretical and practical knowledge.And it might improve the thinking ability of students and would be a good teaching method in general medicine residency training.

Key words: 
Problem based learning; General practitioner
通心络对冠心病患者血管内皮功能影响的临床研究
Authors: 郭靖涛, 张树良, 周江
Journal: BMJ (2008)

动物实验证实通心络可改善大鼠缺血心脏的血管内皮功能,临床研究表明该药对缓解冠心病心绞痛症状、改善心肌缺血有良好疗效[1-3].本研究拟通过观察冠心病患者血清内皮素、血管性假血友病因子、一氧化氮、可溶性血管细胞黏附分子-1、可溶性细胞间黏附分子-1和血流介导的血管扩张变化率等观察通心络胶囊对冠心病患者血管内皮功能的影响。
关于一例医疗事故技术鉴定的思考
Authors: 李国红
Journal: BMJ (2008)

基层医疗机构及医务人员承担着繁重的诊疗工作,在维护广大群众健康方面做出了巨大贡献,是我国卫生事业发展的重要力量.但由于设备条件、技术水平和临床经验的限制,患方与基层医疗机构或医务人员产生医疗纠纷时有发生.本文就鉴定中遇到的一个案例进行介绍和分析,此案过程看似简单,但其中折射出的问题却发人深思。
Nervous Breakdown-and-Across
Authors: Alison Rose Ohringer, Bruce Haight
Journal: JAMA (2020)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Obstacles to colorectal screening in general practice: a qualitative study of GPs and patients
Authors: 吴东
Journal: BMJ (2013)

背景
在普通人群中筛查粪便潜血有助于诊断大肠肿瘤。研究表明，对于50～74岁的患者，每2年检测一次粪便潜血，可降低大肠癌病死率达15%～18%。但要想取得理想效果，人群参与度至少要达到50%。关于法国患者的参与度，目前尚无研究资料。


目的
探讨在法国开展大肠癌筛查的主要障碍。


方法
于2009年纳入了法国5个不同地区的全科诊所，了解其开展粪便潜血检测的主要困难。采用半标准化量表进行访谈，评估患者方面的障碍。同时，有意识地让全科医师和患者均做粪便标本采样。3位研究人员应用Nvivo8软件处理医师方面的数据，访谈结果由2位研究人员手工录入。


结果
部分全科医师们认为，自己在筛查方面的训练还不够，有些则质疑筛查的效果。对于医师而言，检测粪便潜血的主要障碍在于缺少足够的时间，管理和实践层面也有诸多困难。有些医生发现很难说服无症状的患者接受筛查。患者则认为，由他们自己进行筛查的困难较大，医疗机构提供的帮助还不够。信息和管理方面也需要改进。医师和患者都认为现有筛查方法操作繁琐，不够简便。


结论
无论医生还是患者层面，筛查大肠肿瘤都有不少障碍。要想提高人群筛查效果，最重要的仍然在于提高大家的认识水平，以及对疾病重要性的理解。
Wallenberg综合征一例
Authors: 艾民玲, 滕红
Journal: BMJ (2008)

患者男,45岁,因头晕、恶心、呕吐0.5 h于2006年4月21日急诊入院.门诊测血压180/100 mm Hg(1 mm Hg=0.133 kPa),考虑为高血压引起的脑供血不足,即在门诊静脉滴注盐酸培他啶500 ml,口服硝苯地平10mg。
Role of adjuvant chemotherapy in patients with pathological stage I NSCLC with high-risk features.
Authors: Lubina Arjyal, Dipesh Uprety, Susan M Frankki, Andrew J Borgert, David E. Marinier
Journal: Journal of Clinical Oncology (2020)

9022 Background: Lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC). There is a lack of prospective data on the benefit of adjuvant chemotherapy (CT) in patients with negative margins but with high-risk features: lympho-vascular invasion (LVI) or visceral pleural invasion (VPI). We aimed to investigate the benefit of adjuvant CT in patients with pathological stage I NSCLC with high-risk features. Methods: The 2016 National Cancer Database was queried to identify patients with pathological stage I NSCLC (8 th edition AJCC staging) diagnosed from 2010-2015 who received lobectomy/pneumonectomy with clear surgical margins. Patients were stratified into high risk (tumor size ≥2 cm with LVI and/or VPI) or low risk group. Multivariate Cox proportional hazards regression and propensity score matched Kaplan-Meier survival analysis were used to compare overall survival between those who received adjuvant CT and those who did not. Results: 34,556 patients were identified with 1114 (3.2%) receiving adjuvant CT. On multivariate Cox regression analysis, high risk tumors (hazard ratio [95% confidence interval] = 1.31 [1.25-1.38]) and lack of adjuvant chemotherapy (1.25 [1.09-1.44]) were associated with worse overall survival (OS). Additionally, male sex, age ≥ 60 years, higher comorbidity burden, lack of insurance, low facility volume, low median income, non-squamous histology were associated with worse OS. After propensity score matching, Kaplan-Meier survival analysis of the high risk subgroup (n = 2923) showed a significant difference in overall survival (OS) between those who received adjuvant CT (n = 1032, 5 year OS, 74.7%; 95% CI, 70.9%-78.0%) and those who did not (n = 1891, 5 year OS, 66.9%; CI, 63.9%-69.6%; p = 0.0002). In patients with no high risk factors for recurrence (n = 384), OS was not significantly different between the patients who received adjuvant CT (n = 78, 5 year OS, 75.8%; CI, 61.3%-85.5%) and those who did not receive adjuvant CT (n = 306, 5 year OS, 77.1%; CI, 70.0%-82.7%; p = 0.3). Conclusions: Our study showed better survival with adjuvant CT in patients with pathological stage I NSCLC who have tumor size greater than 2 cm, LVI and/or VPI.
Effects of botulinum toxin type A injection plus biofeedback therapy on motor function in children with spastic cerebral palsy
Authors: Xiao-yan Yang, Qing Du, Pei-jie Chen, Jian-an Li, Xuan Zhou, Li Zhao, Nan Chen, Zheng Yu, Yan-juan Zhang, Shu-xin Zhang, Jing-fen Luan, Xiao-jie Li, Chen-hui Pan
Journal: BMJ (2013)

Objective
To explore the effects of botulinum toxin-A (BTX-A) injection plus biofeedback therapy on lower limb motor function with spastic cerebral palsy.


Methods
A total of 31 spastic cerebral palsy children from February to December 2012 were divided into observation group (n=15) and control group (n=16) respectively. All cases received systematic rehabilitation therapy for 3 months. The observation group was injected with BTX-A at baseline and received biofeedback therapy and other rehabilitations at Day 1 post-injection. Modified Ashworth scale (MAS), composite spasticity scale (CSS) and passive range of ankle motion (PROM) were assessed at baseline, Days 3, 7, 14, 30 and 90 post-therapy. And gross motor function measure-88 and walking velocity were examined at baseline and Day 90 post-therapy.


Results
In observation group, the MAS pre- and 3, 7, 14, 30, 90 d post-treatment were 2.6±0.6, 2.0±0.5, 1.2±0.5, 0.6±0.6, 0.5±0.6, 1.0±0.5; CSS were 14.1±1.1, 12.0±1.1, 10.2±1.2, 8.2±1.4, 8.0±1.5, 9.0±1.6 respectively; PROM were (-8.5±9.4)°, (-1.5±7.6)°, (6.9±8.3)°, (11.7±6.8)°, (15.2±6.6)°, (13.7±7.8)°respectively. All children showed significant decreases in spasticity (MAS, CSS, PROM) and improvements in GMFM and walking velocity. And the difference of children in observation group was earlier than that in control group. Statistically significant differences existed between two groups in MAS, CSS and PROM (P<0.01). There were also statistically significant differences between two groups in GMFM-88, stand and walking function scores, walking velocity (P<0.05).


Conclusion
BTX-A injection plus biofeedback therapy can quickly and effectively improve lower extremity motor function in children with spastic cerebral palsy.


Key words: 
Botulinum toxin type A; Biofeedback(psychology); Cerebral palsy
艾滋病高效抗逆转录病毒治疗
Authors: 陈谐捷, 唐小平
Journal: BMJ (2006)

艾滋病(AIDS)的治疗包括抗逆转录病毒治疗(ART)和机会性感染的治疗.ART的研究经历了多个阶段.1987年第1个抗逆转录病毒药物(ARV)齐多夫定(zidovudine, ZDV或AZT)问世,开始使用单一的核苷类逆转录酶抑制剂(NRTIs)治疗人类免疫缺陷病毒(HIV)感染者和艾滋病患者,为第1个阶段。
交叉克式针内固定术治疗肩锁关节脱位41例
Authors: 齐春贵, 吴瑞森, 王西林
Journal: BMJ (2006)

重度肩锁关节脱位较常见,治疗复杂.以往多采用非手术治疗,因不能进行有效的外固定,治疗效果不佳,大多残存一定的畸形.虽然目前采用的手术治疗方法较多,但效果仍不十分满意.1999至2004年我们采用交叉克式针内固定术治疗41例,报道如下。
A 3-year lifestyle intervention for adults at moderate to high risk of cardiovascular disease is cost effective when added to standard care and improves physical health-related quality of life
Authors: Bengt, Josson, 刘冰
Journal: BMJ (2011)

无论对个体还是群体健康而言，包含饮食习惯和体力活动在内的生活方式都是一项重要的影响因素。致力于维护健康的医疗卫生体系，应考虑采取可行措施来改变目前的局面。然而医疗资源不足，采取这样的措施将与其他潜在促进健康的预防和治疗活动形成竞争。
重度阻塞性睡眠呼吸暂停低通气综合征表现为扩张型心肌病二例
Authors: 柴林强, 左彩凤, 林秀, 姜美, 李洁
Journal: BMJ (2005)

例1 患者男,40岁,因活动后心悸、气促4个月于2002年10月4日入院.患者于4个月前出现活动后心悸、气促,反复发作,进行性加重,逐渐出现夜间阵发性呼吸困难、腹胀、下肢浮肿等.打鼾16年,夜间频繁出现呼吸暂停现象,无冠心病、高血压病史.查体:身高172 cm,体重98 kg,体重指数(BMI)33.1,血压120/75 mm Hg(1 mm Hg＝0.133 kPa),口唇略紫绀,颈静脉怒张,双肺呼吸音粗,中下肺野可闻及湿啰音,量较多,心界扩大,心率92次/min,节律欠整齐,心音低钝,可闻及早搏,约1～2个/min,二尖瓣听诊区可闻及Ⅲ/6级收缩期杂音,无传导,腹软,无压痛、反跳痛,肝脾肋下未触及,移动性浊音(-),双下肢中度凹陷性水肿。
Pathway-flux based biomarker for immunotherapy response in melanoma.
Authors: Jian Li, Qi Mei, Weiting Cheng, Guangyuan Hu, Xianglin Yuan, Ulrich Robert Mansmann
Journal: Journal of Clinical Oncology (2020)

e22064 Background: Immune checkpoint therapy (ICT) refers to therapeutic interventions that specifically target immune evasion mechanisms to restore the host immunity with anti-tumor ability. The ICT has revolutionized the immune-based treatment across &gt; 30 different cancers including solid tumors and hematopoietic malignancies, with an ORR of 30% and a 7%-12% grades 3-5 irAEs in average. However, a substantial unmet point is the development of a biomarker with which response of ICT can be predicted before treatment for individual patients. Methods: In order to face this challenge this study developed an advanced genome-scale pathway flux analysis (GPFA) to evaluate the strength of signaling transduction and metabolic flux in immune system. The input of GPFA is the gene expression profiles of individual objects and the output of GPFA can be summarized in a index system, IM.Index, with following definition: IM.Index = 1.78E-4 * Σ flux(P) + 2.37E-4 * Σ flux(P) p ∈ signaling transduction p ∈ energy metabolism . Subsequently, the IM.Index was applied to analyze genetic data of two independent cohorts of melanoma patients treated with anti-PD-1 therapy (nivolumab a. pembrolizumab). Results: The IM.Index predicted the response of anti-PD-1 therapy (nivolumab) in the first cohort with an odds ratio (OR) of 3.14 (95%CI: 1.16-8.45; p = 3.10E-3; AUC = 0.82) and with a sensitivity 89% and specificity 76%. The prediction on overall survival (OS) of this cohort achieved an hazard ratio (HR) of 1.53 (95%CI: 1.22-1.92; p = 7.8E-3). Subsequently, the prediction result for the anti-PD-1 therapy (pembrolizumab) in the second cohort achieved an OR of 2.12 (95%CI: 1.22-3.66; p = 4.50E-4; AUC = 0.87) and the OS prediction in this cohort reached an HR of 1.24 (95%CI: 1.04-1.47; p = 1.40E-2). Comparison with other four potential biomarkers (TMB, TNB, neo-peptide load and cytolytic score) related to immunotherapy showed a comparative outcome of the IM.Index regarding diagnosis and prognosis in melanoma. For instance, IM.Index showed a superior performance on objective response rate (ORR) of 70% and AUC of 0.83. Conclusions: In conclusion this study demonstrated that a pathway flux analysis at a genome-scale may be explorative in biomarker research in immunotherapy, since this type of analysis could reflect the strength or functional status of the immune system. The IM.Index developed in this study may also be applied to investigation the treatment response of immunotherapy in other types of cancer.
Post-bone-traumatic hepatic injury and its preventions
Authors: 阴英, 蓝宇
Journal: BMJ (2009)

创伤对人直接造成局部器官组织损伤的同时,还可通过应激反应、炎症反应等多种途径导致全身其他组织器官的功能改变[1].骨创伤后出现肝功能异常在临床上并不少见.有资料显示,在同期因骨创伤入院的719例患者中,肝损害的发生率为14.6%[2].创伤后肝功能障碍将会影响整个机体的预后和转归[3].明确创伤后产生肝损害的原因及肝功能的变化规律,积极有效地加以预防,对骨创伤患者的整体康复与保护肝功能具有重要意义.现结合国内外近期文献,对骨创伤后肝损伤的原因、临床表现及当前防治措施加以综述。
Assessment of patient-reported outcomes in patients treated with radiation therapy to brain malignant tumors.
Authors: Li Yang, Zhiyuan Xu, Hang Zhang, Feng-Ming Spring Kong
Journal: Journal of Clinical Oncology (2020)

e14521 Background: Patient reported outcome is limited in patients with radiation therapy (RT) to brain tumors. The purpose of this study is to exam Patient Reported Outcome Measures (PROM) at baseline and end for RT in patients receiving RT to brain malignant tumors. Methods: This is a prospective study of quality of life. Patients ≥ 18-year old requiring RT to brain primary or metastatic malignant tumors were eligible. The PROM was assessed by self-administrated questionnaire PROMIS-29 Profile v2.1 and was completed prior to and at end of RT. Raw scores directly got from the PROMIS questionnaire were translated to T-scores according to the recommendation by the PROMIS INSTRUMENTS. A T-score of 50 is the average for general population and a higher PROMIS T-score represents more of the concept being measured. Results: Between July 2019 and December 2019, a total of 23 patients enrolled and completed PROMIS questionnaire and 19 completed questionnaire at end of RT. The median age was 55 (range 21-67), fifteen were men. The median doses of local brain RT and WBRT were 60Gy (range 40.05-60Gy) and 25Gy (range 20-36Gy), respectively. For the seven domain teams, physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in social roles and activities and pain interference, the number of patients with each T-score greater than 50 was 8 (34.8%), 13 (56.5%), 8 (34.8%), 6 (26.1%), 6 (26.1%), 13 (56.5%) and 9 (39.1%) at baseline and 7 (36.8%), 9 (47.4%), 7 (36.8%), 6 (31.6%), 6 (31.6%), 9 (47.4%) and 5 (26.3%) at end of RT, respectively. Physical function and sleep disturbance at end of RT was correlated with the corresponding value at baseline (Fisher’s exact test P = 0.045 and 0.017, respectively). None of the 7 domain teams’ T-scores changed significantly at end of RT. Pain intensity evaluated by NRS decreased significantly (mean 0.89 vs 1.53, P = 0.048). There is no difference in the mean T-score for all the 7 domain teams and NRS pain intensity between the local or whole brain RT patients at baseline and end of RT. Conclusions: This preliminary study demonstrated that brain RT did not alter PROM significantly in patients with primary or metastatic malignant brain tumors but decreased pain intensity in those patients.
高IgE综合征一例
Authors: 唐晓艳, 沙悦
Journal: BMJ (2011)

患者男，31岁，自述自出生2个月起反复发作皮肤溃疡、疖肿、肺炎，多达10余次/年。20年前始反复出现左踝黄色丘疹，破溃溢脓，愈合后再发。7年前曾于外院行皮肤活检，病理学检查示：少许纤维结缔组织伴炎性坏死。3年前出现全身散在皮下囊性肿物，伴瘙痒，头孢类抗生素治疗肿物略减小，但左足部仍反复出现皮肤溃疡并渐至皮肤挛缩、左足小关节变形。1年前就诊于我院，体检：全身散在色素沉着及皮下囊性肿物，肿物直径约0.5 ～3.0 cm,伴触痛瘙痒，左下肢踝部、足背部皮肤大片溃疡，左踝关节活动受限，心肺腹无异常，移动性浊音（一），双下肢不肿。 关键词：Job综合征
A phase Ia/Ib, open-label first-in-human study of the safety, tolerability, and feasibility of gene-edited autologous NeoTCR-T cells (NeoTCR-P1) administered to patients with locally advanced or metastatic solid tumors.
Authors: Bartosz Chmielowski, Samuel Ejadi, Roel Funke, Todd Stallings-Schmitt, Mitch Denker, Mark Walter Frohlich, Alexis J. Franzusoff, Mehrdad Abedi, Mihaela C. Cristea
Journal: Journal of Clinical Oncology (2020)

TPS3151 Background: Neoepitopes (neoE) derived from private tumor-exclusive mutations represent compelling targets for personalized TCR-T cell therapy. An ultra-sensitive and high-throughput process was developed to capture tumor mutation-targeted CD8 T cells from patient blood. NeoTCRs cloned from the captured CD8 T cells, when engineered into fresh CD8 and CD4 T cells, effected killing of patients’ autologous tumor cells in vitro. These observations have been leveraged for the development of a fully personalized adoptive T cell therapy (NeoTCR-P1). A Phase 1 clinical trial testing NeoTCR-P1 in subjects with solid tumors is ongoing (NCT03970382). Methods: During the initial trial phase, escalating doses of NeoTCR-P1 T cells administered without and with IL-2 in the regimen, and following conditioning chemotherapy, will be evaluated in subjects with advanced or metastatic solid tumors (melanoma, urothelial cancer, colorectal cancer, ovarian cancer, HR + breast cancer, and prostate cancer). The objective of the Phase 1a study is to establish a recommended Phase 2 dose. Primary endpoints include the incidence and nature of DLTs and overall process feasibility. The proliferation, persistence, and trafficking of NeoTCR-T cells will be characterized. In the expansion trial phase, preliminary anti-tumor activity of NeoTCR-P1 will be assessed in selected tumors. The combination of NeoTCR-P1 dosing plus nivolumab will be tested in a Phase 1b study. Conclusion: This is the first clinical study of an autologous, fully personalized adoptive T cell therapy directed against private tumor-exclusive mutations, generated without using recombinant viral vectors. Clinical trial information: NCT03970382 .
Applications of preventive T-shaped enterostomy
Authors: Li-qun Pang, Ren Yu, Xiao-jun Tang, Ye-liu Liu
Journal: BMJ (2013)

To apply preventive T-shaped enterostomy in protective defunctioning stoma. Technique of enterostomy closure was only made in abdominal wall rather than abdominal cavity. A total of 78 patients undergoing protective ostomy from January 2005 to April 2012 were divided into two groups of routine enterostomy (group A, n=52) and protective T-shaped enterostomy (group B, n=26). The length of operation and average hospital stay in group A with stoma closure were (98±16) min and (15.3±5.2) days while those of group B (52±9) min and (9.5±2.3) days. The inter-group differences were statistically significant respectively (P<0.05). Therefore protective T-shaped enterostomy, showing advantages in operative skills, operative trauma and postoperative recovery time, is an effective technique and its application should be further promoted.


Key words: 
Enterostomy; Abdominal wall
Breast cancer events in women with atypical ductal hyperplasia who do not undergo surgical excision.
Authors: Lyndsey Jo Kilgore, Min Yi, Therese Bartholomew Bevers, Robin Coyne, Marita Lazzaro, Deanna L Lane, Constance T. Albarracin, Isabelle Bedrosian
Journal: Journal of Clinical Oncology (2020)

1562 Background: Atypical ductal hyperplasia (ADH) found on core needle biopsy is associated with an upgrade to carcinoma in 10-30% of women, thus surgical excision remains the standard of care. We sought to review the incidence of breast cancer in women with ADH managed by either observation or surgical excision over a 15 year period. Methods: Our prospectively maintained registry was reviewed to identify patients with ADH diagnosed by core needle biopsy between 1/2004 and 10/2018. Observed patients were deemed low risk for upgrade after multidisciplinary review confirmed adequate sampling, limited atypia and concordance between imaging and histology. Surgical patients were excluded if upstaged to carcinoma following excision. Patients with &lt; 1 year follow-up were excluded. Subsequent breast cancer was classified as ipsilateral or contralateral to the previous ADH and was further classified as index site if the new cancer was identified in the same quadrant as prior ADH. Multivariate logistic regression models were used to assess potential predictors of subsequent breast cancer events. Results: Four hundred and seventy-eight women with 483 ADH lesions met criteria; 305 were observed and 173 underwent excision. Median follow-up was 5.2 years, range 1.1-15.3. At the time of ADH diagnosis, 91 women had a personal history of breast cancer. Age &lt; 50 was the only statistically significant difference between the groups (24.6% vs. 33.3%, p = 0.04). Race, receipt of chemoprevention, prior breast cancer history and median follow-up were not significant between the groups. Prior history of breast cancer was associated with subsequent breast cancer risk in multivariate analysis (OR 2.25, 95% CI 1.04-4.87, p = 0.04). After excluding patients with a history of breast cancer, multivariate analysis demonstrated no association of age, race, use of chemoprevention or surgical excision with future cancer risk. Among the 387 patients without a prior breast cancer history, 21 patients developed a subsequent cancer; 10 in the surgical group and 11 in the observed group (7.3% vs. 4.4% respectively, p = 0.2). Two cancers were identified at the index site in the surgery group (2/137, 1.5%) and three in those observed (3/250, 1.2%). Conclusions: Observation, rather than surgical excision, is safe in selected women that have a core biopsy diagnosis of ADH. Index site failures are rare and are superseded by cancer risk elsewhere in the breast. National screening and diagnosis recommendations should consider recommending observation for this select group of patients with ADH.
Efficacy of nateglinide combined with metformin in patients with newly diagnosed drug-na(i)ve type 2 diabetes
Authors: Bao-cheng Chang, Miao-yan Zheng, Chun-yan Shan, He-chao Li, Xin-li Wang, Jian-xin Zhou, Li-ming Chen
Journal: BMJ (2011)

Objective To compare efficacy of nateglinide or acarbose combined with metformin in patients with newly diagnosed type 2 diabetes.Methods Ninety-six patients with newly diagnosed type 2 diabetes in Metabolic Diseases Hospital of Tianjin Medical University,were randomly to receive nateglinide combined with metformin (group A,n =46) or acarbose combined with metformin (group B,n =42) for four months.Drug dose was adjusted every two weeks.Before and after treatment,oral glucose tolerance test and insulin release test were performed to observe changes of their glucose tolerance,homeostasis model assessment for insulin resistance (HOMA-IR) ,insulin secretion function of β-cells and glucose disposition index (DI) in the two groups.Results After four-month treatment,six patients restored to normal glucose tolerance and 13 patients returned to impaired glucose tolerance (IGT) in group A and 12 patients restored to IGT in group B.Their HOMA-IR was markedly improved compared with baseline in both groups,decreased to 7.1 ± 1.3 from 8.6 ± 1.2 in group A and to 6.9 ± 1.7 from 8.6 ± 1.7 in group B ( P ＜ 0.05 ).Compared with group B,early insulin secretion ( LN△I30/△G30 ) obviously improved in group A [( 1.9 ±0.8) vs.(1.6±0.6) mU/mmol] (P＜0.05) and DI also increased (1.05±0.25 vs.0.89±0.21,P＜0.05 ).Conclusions Nateglinide combined with metformin can obviously restore early insulin secretion and improve insulin resistance in patients with newly diagnosed type 2 diabetes,thus facilitate restoration of their glucose tolerance.

Key words: 
Diabetes,type 2; Nateglinide; Metformin