tbuckley/cabot-search huggingface dataset:
Impact of tumor side on clinical outcomes in stage II and III colon cancer with known microsatellite instability status.
Authors: Katerina Mary Zakka, Shayla Williamson, Renjian Jiang, Olatunji B. Alese, Walid Labib Shaib, Christina Wu, Madhusmita Behera, Bassel F. El-Rayes, Mehmet Akce
Journal: Journal of Clinical Oncology (2020)

4068 Background: Microsatellite instability high (MSI-H) status indicates better prognosis in early stage colon cancer (CC) compared to microsatellite stable (MSS). However, the impact of tumor side, left side (L) versus right side (R), is not described on clinical outcomes based on MSI status. Methods: Patients with pathological stage II and III primary adenocarcinoma of the colon between 2010 and 2015 were identified in the National Cancer Database (NCDB) using ICD-O-3 morphology and topography codes: 8140-47, 8210-11, 8220-21, 8260-63, 8480-81, 8490 and C18.0, 18.2,18.3, 18.5,18.6, 18.7. Univariate (UVA) and multivariable (MVA) survival analyses were conducted, and Kaplan-Meier Curves were used to compare overall survival (OS) based on tumor location and treatment received with Log-rank test. Results: A total of 35,071 patients with stage II (n = 17,629) and III (n = 17,442) CC were identified. 51.3% female; 81.5% Caucasian; median age 66 (range, 18-90). Majority of stage II and III tumors were R, 61.2% (n = 10,794) and 56.0% (n = 9,763). MSI-H was more common in stage II compared to III, 23.3% (n = 4,115) vs 18.2% (n = 3,171) (p &lt; 0.0001). Survival was better in stage II MSI-H compared to MSS, 5 year-OS 75.1% vs 71.8% (p = 0.0057). However, stage III CC survival was better in MSS compared to MSI-H, 5-year OS 60.5% vs 58.0% (p &lt; 0.001). In stage II MSI-H CC R was more common than left, 78.3 % (n = 3223) vs 21.7% (n = 892). There was no significant difference in survival between stage II MSI-H L vs R (5-year OS 76.2% vs 74.7%, p = 0.1578). Stage II MSS CC R was more common than L, 56.0% (n = 7571) vs 44.0% (n = 5943), and survival was better in L vs R (5-year OS 73.2% vs 70.8%, p = 0.0029). Stage III MSI-H CC was more common in R than L, 75.6% (n = 2397) vs 24.4% (n = 774) and survival was better in L (5-year OS 62.5% vs 56.5%, p = 0.0026). Stage III MSS CC was more common in R than L, 51.6% (n = 7366) vs 48.4% (n = 6905), and survival was better in L vs R (5-year OS 67.0% vs 54.4%, p &lt; 0.001). Conclusions: Survival was better in left sided tumors compared to right in stage II MSS, stage III MSS and stage III MSI-H CC.
全科医生需了解的心血管疾病介入治疗的适应证
Authors: 李拥军
Journal: BMJ (2007)

介入心脏病学是通过经皮穿刺血管,在体外操纵导管进行心脏病诊断和治疗的一门新兴学科.30余年来,随着大量新技术、新器械的不断涌现,并迅速、广泛地应用于临床,介入性心脏病学已成为与药物治疗、外科手术并驾齐驱的治疗手段,使心脏病的治疗发生了革命性的变化.本文概括介绍冠心病、心律失常及先天性心脏病介入治疗的发展现状。
Damage of autonomic nerve function in diabetic patients with gastrointestinal symptoms
Authors: 张月霞, 蓝宇
Journal: BMJ (2010)

Objective To observe autonomic nerve function damage in diabetic patients with gastrointestinal symptoms. Methods Twenty-four patients of diabetes mellitus (DM) with gastrointestinal symptoms, as well as 20 cases of DM without gastrointestinal symptoms and 17 health volunteers were recruited from the clinic of gastroenterology, Jishuitan Hospital, Beijing during December 2008 to May 2009, and standard cardiovascular reflex test was performed for all of them to determine their functions of the autonomic nerve. Results Respiratory rate (an indicator of parasympathetic nerve function) was ( 14 ± 5 ) times per minute in patients of DM without dyspepsia, obviously lower than that in healthy controls [(20±10) times per minute], and that in patients of DM with dyspepsia was (9 ±6) times per minute, obviously lower than that in healthy controls and asymptomatic ones ( P ＜ 0. 05 ). Scores of five indicators of the autonomic nerve functions, and the sympathetic, parasympathetic nerve and overall autonomic nerve functions were significantly higher in patients of DM with gastrointestinal symptoms than those in the patients without dyspepsia and healthy controls. Abnormality rate of autonomic nerve functions was 96 percent (23/24) in the patients with dyspepsia, 58 percent (14/24) in those definitely and seriously involved, and five percent (1/20) in those without dyspepsia. Conclusions Autonomic neuropathy exists in most diabetic patients with dyspepsia, both sympathetic and parasympathetic nerve involved. Impairment of parasympathetic nerve function occurs earlier than that of sympathetic nerve in patients of DM.

Key words: 
Diabetes mellitus ;  Autonomic nervous system ;  Cardiovascular reflex test ;
Bartter综合征一例
Authors: 李岩, 卢勇
Journal: BMJ (2005)

患者男,49岁.因反复四肢无力3年入院.3年前患者因上呼吸道感染在卫生室输液(具体不详)治疗,于当天下午出现双下肢无力,并进行性加重至四肢无力,说话、吞咽及呼吸困难,查血钾1.9 mmol/L,按低钾性周期性麻痹给予补钾治疗2 d症状缓解,第5天症状消失,复查血钾3.2 mmol/L。
Effects of Mycobacterium vaccae vaccine in a mouse model of tuberculosis: protective action and differentially expressed genes
Authors: Wen-Ping Gong, Yan Liang, Yan-Bo Ling, Jun-Xian Zhang, You-Rong Yang, Lan Wang, Jie Wang, Ying-Chang Shi, Xue-Qiong Wu
Journal: Military Medical Research (2020)

Abstract Background Tuberculosis is a leading cause of death worldwide. BCG is an effective vaccine, but not widely used in many parts of the world due to a variety of issues. Mycobacterium vaccae ( M. vaccae ) is another vaccine used in human subjects to prevent tuberculosis. In the current study, we investigated the potential mechanisms of M. vaccae vaccination by determining differentially expressed genes in mice infected with M. tuberculosis before and after M. vaccae vaccination. Methods Three days after exposure to M. tuberculosis H37Rv strain (5 × 10 5 CFU), adult BALB/c mice randomly received either M. vaccae vaccine (22.5 μg) or vehicle via intramuscular injection ( n = 8). Booster immunization was conducted 14 and 28 days after the primary immunization. Differentially expressed genes were identified by microarray followed by standard bioinformatics analysis. Results M. vaccae vaccination provided protection against M. tuberculosis infection (most prominent in the lungs). We identified 2326 upregulated and 2221 downregulated genes in vaccinated mice. These changes could be mapped to a total of 123 signaling pathways (68 upregulated and 55 downregulated). Further analysis pinpointed to the MyD88-dependent TLR signaling pathway and PI3K-Akt signaling pathway as most likely to be functional. Conclusions M. vaccae vaccine provided good protection in mice against M. tuberculosis infection, via a highly complex set of molecular changes. Our findings may provide clue to guide development of more effective vaccine against tuberculosis.
Analysis of risk factors for high-normal blood pressure in residents of urban Xuzhou, China
Authors: 娄培安, 陈培培, 余加席, 张雷, 张宁, 张盼
Journal: BMJ (2011)

Objective To study risk factors for high-normal blood pressure (HNBP) in residents of urban Xuzhou, Jiangsu province, China. Methods A cross-sectional survey was conducted among 17 500 residents in urban area of Xuzhou from June to December 2008 by cluster sampling with self-designed questionnaire to collect their demographic information and measurements of body height, weight and blood pressure. Data were approached to univariate and multivariate non-conditional logistic regression analysis. Results In total, 17 306 residents finished the survey, with an overall response rate of 98.9percent. Results of univariate analysis revealed that 13 variables such as living region, sex, age,occupation, annual average family income, history of dyslipidemia, smoking, alcohol drinking, intake of pork, and vegetables, daily length of sleeping, body mass index (BMI), abdominal obesity, all were related to HNBP ( P ＜ 0. 05 ). Results of multivariate logistic regression analysis showed that living region, sex,age, annual average family income, alcohol drinking, intake of vegetable, BMI, abdominal obesity all associated with HNBP (P＜0. 05). Conclusions Older age, history of alcohol drinking, increased BMI,abdominal obesity all are risk factors to prompt occurrence of HNBP, and intake of large amount of vegetables is its protective factor.

Key words: 
Blood pressure ;  Risk factors ;  Sickness impact profile ;
男性更年期综合征一例
Authors: 洪岭, 张胜兰
Journal: BMJ (2006)

患者男,56岁,因感胸腹部经常跳动伴有气短、乏力1年于2005年4月就诊.患者1年前无明显诱因感觉胸、腹部内经常跳动,呈游走性,夜间发作较多,常半夜坐起,叹气后症状减轻,跳动可自行消失,情绪不稳定,心烦、易怒,伴有头昏、乏力、多梦、睡眠差.在当地中心医院行心电图、高频心电图及头颅CT检查未见异常,跟骨骨密度超声检查无骨质疏松征象.因心脏ECT显示心内膜下供血不足,在心内科服用中西药(具体不详)治疗1年,病情无减轻,感四肢酸软,乏力逐渐加重,为进一步确诊来我院治疗.既往体健,3年前查出有慢性浅表性胃炎,已愈.身体检查:心率110次/min,律齐,未闻及病理性杂音,其余未见异常。
Concurrent and sequential chemoradiation therapy are associated with improved survival among unresected stage III non-small cell lung cancer patients in the United States.
Authors: Zhiyuan Zheng, Ramesh Rengan, Jingxuan Zhao, Helmneh M. Sineshaw, Stephen G. Chun, Xuesong Han, Candice Yong, Brian S. Seal, Doris Makari, Charles B. Simone
Journal: Journal of Clinical Oncology (2020)

7043 Background: Concurrent chemoradiation therapy (cCRT) has been shown to improve survival outcomes among inoperable stage III non-small cell lung cancer (NSCLC) patients compared to sequential CRT (sCRT) and single-modality therapy in clinical trials. However, many “real world” patients do not receive CRT, and less is known about the survival benefits of concurrent CRT vs other treatment modalities in pragmatic, non-clinical trial settings. Methods: We used the National Cancer Database (2004-2011) to identify unresected stage III NSCLC patients (ages 18-79 years) with Charlson comorbidity score ≤1 and 5-year follow up through the end of 2016. cCRT was defined as the initiations of chemotherapy (CT) and radiation therapy (RT) that were ≤14 days (n = 30,290) apart, whereas sCRT was defined as &gt; 14 days apart (total n = 10,596). The remaining three treatment groups included CT only (n = 11,216), RT only (n = 7,772), and neither CT/RT during first course treatment (n = 10,694). Cox proportional hazard model was used to examine the 5-year survival by treatment modalities, controlling for patient demographics, comorbidity score, health insurance, facility type, area-level social deprivation index (SDI, a composite measure for area-level socio-economic status), driving time to the treatment facility, diagnosis year, and region. Adjusted hazard ratios (HR), and medium survivals were generated by treatment modalities. Results: Among 70,568 unresected stage III NSCLC patients, 61,487 (87.1%) patients died within the 5-year follow-up period. In adjusted analyses, cCRT and sCRT had similar survival (median survivals: 15.3 months), whereas other treatment modalities were associated with worse survival compared to cCRT: CT only (median survival: 10.8 months; HR [95%CI]: 1.46 [1.43-1.50]), RT only (median survival: 6.7 months; HR [95%CI]: 1.93[1.88-1.99]), and no treatment (median survival: 3.2 months; HR [95%CI]: 2.64 [2.58-2.71]), all p &lt; 0.001. Higher comorbidity score (Charlson score 1 vs 0, HR [95%CI]: 1.18 [1.16-1.21]), non-private insurance (Medicaid: 1.16 [1.12-1.20]; Medicare: 1.10 [1.08-1.13]; uninsured: 1.21 [1.16-1.26]) were all associated with worse survival (all p &lt; 0.001). Conclusions: Concurrent CRT and sequential CRT have similar survival outcomes among unresected stage III NSCLC patients with minimum comorbidities, however, single modality and no therapy are associated with much poorer survival among “real world” patients, and should be avoided unless clinically appropriate.
The mutational landscape of the adjacent paracancerous tissues confirmed the safe margin of 2-5cm in colorectal cancer resection.
Authors: Jin Gu, Jianfei Yao, Lele Song, Dandan Huang, Zhaoya Gao, Qingkun Gao, Pengfei Niu, Qingmin Zeng, Yanzhao Wang, Denglin Wang, Danni Liu, Zhang Jing, Fuming Lei
Journal: Journal of Clinical Oncology (2020)

e16060 Background: Margin of 2-5cm is regarded as the safe margin in surgical resection of colorectal cancer (CRC) by macroscopic pathological examinations. However, whether 2-5cm is safe has never been verified by molecular evidence. Methods: We systematically analyzed the mutational profile of 35 CRC tissues and paired adjacent paracancerous tissues 2-3cm and 5cm adjacent to the cancer margin by whole-exome sequencing. Results: The number of SNV/INDEL mutations in the adjacent 2-3cm and 5cm tissues was much less than that in cancer. The number of common SNV/INDEL mutations between cancer and the adjacent tissues ranged from 0 to 2. Although TP53, APC and KRAS SNV/INDEL mutations exhibited the highest frequency in CRC, the APC SNV/INDEL mutations were observed in only one adjacent 5cm tissue, and no TP53 or KRAS SNV/INDEL mutations were observed in any adjacent tissues. We further determined the potential driver gene mutations in adjacent tissues by searching databases including COSMIC CGC, IntOGen, OncoKB, TCGA and Vogelstein databases. A certain mutation was determined as a driver gene mutation if all five databases predict it to be a driver gene mutation. As a result, 9 SNV/INDEL driver gene mutations (1 ATM, 1 BRCA1, 1 BRCA2, 1 MET, 1 NF1, 3 PTEN and 1 STAG2 mutations) were found in the adjacent 2-3cm group, and 9 SNV/INDEL driver gene mutations (1 APC, 1 ARID1A, 1 FBXW7, 3 PTEN, 2 STAG2 and 1 BRCA2 mutations) were found in the adjacent 5cm group. No common SNV/INDEL driver gene mutations were found between cancer tissues and the paired 2-3cm or 5cm tissues, suggesting the driver gene mutations predicted in adjacent normal tissues may not be cancer-relevant. Conclusions: We established the mutational landscape of the adjacent 2-3cm and 5cm tissues to CRC, and found almost no key driver gene SNV/INDEL mutations in adjacent tissues. No common SNV/INDEL driver gene mutations were found between cancer and the adjacent tissues, supporting a safe resection with a margin at 2 to 5cm.
治疗高脂血症中成药的合理应用
Authors: 苏江, 梁晓春
Journal: BMJ (2010)

高脂血症是动脉粥样硬化的首要危险因素,随着人们生活条件的改善,高脂血症发病年龄逐渐年轻化,发病率逐年上升,控制和预防血脂代谢异常,对于有效预防心脑血管疾病具有重要的理论价值和现实意义.高脂血症是现代医学的名称,中医学虽无血脂、高脂血症名称,但对其却早有认识,且中医药防治高脂血症已成为当前研究的热点.对高脂血症的辨证及其中成药的选择体现了中医辨证论治的思想。
Abstract 154: CMR Feature Tracking in Kawasaki Disease convalescence
Authors: Konstantinos Bratis, Pauline Hackmann, Nicholas Child, Sophie Mavrogeni, Thomas Krasemann, Hussain Tarique, Rene Botnar, Reza Razavi, Gerald Greil
Journal: Circulation (2015)

Objective: To determine whether left ventricular (LV) myocardial deformation indices can detect subclinical myocardial abnormalities in Kawasaki Disease (KD) convalescence. We hypothesized that subclinical myocardial abnormalities due to inflammation represent an early manifestation of the disease that persist in convalescence. Background: Myocardial inflammation has been described as a global finding in the acute phase of Kawasaki Disease. Despite normal LV systolic function by routine functional measurements, reduced longitudinal strain (S) and strain rate (SR) have been detected by echocardiography in the acute phase, which may potentially predict late onset heart failure. Method and results: Peak systolic LV myocardial longitudinal, radial and circumferential S and SR were examined in 29 KD convalescent patients (15 males; mean (SD) age 11 (6.6) years, range 3- 27 years; median interval from KD onset 5.8 (5.4) years) and 10 healthy volunteers (5 males; mean age 14 (3.8) years, range 6- 19 years) with the use of cardiac magnetic resonance feature tracking (CMR-FT). Routine indices of LV systolic function were normal in both groups. Comparisons were made between normal controls and (i) the entire KD group, (ii) KD group subdivided by coronary artery involvement. Compared to controls, KD patients had lower longitudinal S. Average longitudinal and circumferential S at all levels was lower in KD patients compared normal controls. In subgroup analysis, both KD patients with and without any history of CAD had similar longitudinal and circumferential S at all levels and lower when compared against controls. There was a non-significant trend for lower circumferential and longitudinal values in KD patients with persisting CAD when compared against those with regressed CAD. Conclusion: In this CMR-FT study in KD convalescent patients with preserved conventional functional indices, we observed a trend for lower circumferential and longitudinal strain in KD patients compared to normal controls, irrespective of their coronary artery status.
Blood cytokines and glucose levels in patients with systemic inflammatory response syndrome
Authors: Shuo Wang, Chun-sheng Li, Xue Mei
Journal: BMJ (2009)

Objective To investigate the changes of serum inflammatory factors and blood glucose in patients with systemic inflammatory response syndrome (SIRS) . Methods Seventy eight SIRS patients were divided into survival subgroup (n =37) and fatal subgroup ( n = 41), 35 non-SIRS patients were designated as control group. Thirty eight out 76 patients whose blood glucose was higher than 6. 1 mmol/L were randomly selected for intensive insulin therapy. Serum IL-6, IL-10, IL-13, TNF-α and blood glucose were measured; HLA-DR expression on monocytes was detected. Results Serum IL-6, TNF-αand blood glucose levels were (80±8) vs. (42±7)×10~3μg/L, (52±20) vs. (17±6) ×10~3μg/L and (11.9±1.1)vs.(6.5±1.5)mmoL/L in SIRS vs.non-SIRS group respectively(all P＜0.05);those were(108±21)vs.(66±22)×10~3μg/L,(28±8)vs.(16±9)×10~3μg/L,(14.4±2.1)vs.(7.0±1.0)mmol/L in fatal vs.survival group,respectively(all P＜0.05).The changes of IL-10,IL-13 and HLA-DR expression intensity of monocyte showed a reverse trend.The intensive insulin therapy reversed the above tendency and reduced the fatality rate.Conclusions Blood glucose levels are corrected with serum cytokines in SIRS patients and reflex the immune status and disease prognosis.Intensive insulin therapy can improve the prognosis of SIRS patients.

Key words: 
Systemic inflammatory response syndrome; Cytokines; Blood glucose
Association of neutrophil to lymphocyte ratio (NLR) with efficacy from JAVELIN Renal 101.
Authors: Mehmet Asim Bilen, Brian I. Rini, Robert J. Motzer, James M. G. Larkin, John B. A. G. Haanen, Laurence Albiges, Lance C. Pagliaro, Eric Voog, Elaine Tat Lam, Nikolai Kislov, Bradley Alexander McGregor, Bo Huang, Alessandra di Pietro, Stan Krulewicz, Toni K. Choueiri
Journal: Journal of Clinical Oncology (2020)

5061 Background: The phase 3 JAVELIN Renal 101 trial (NCT02684006) in treatment-naive patients with advanced renal cell carcinoma (aRCC) demonstrated significantly improved progression-free survival (PFS; hazard ratio [HR], 0.69; 95% CI, 0.56, 0.84; P &lt; 0.001) and higher objective response rate (ORR; 51.4% vs 25.7%) with avelumab + axitinib vs sunitinib (Motzer RJ, et al. N Engl J Med. 2019;380:1103-15). NLR has emerged as a potential prognostic biomarker in aRCC; elevated NLR is associated with poorer prognosis. Here, we describe the association of NLR with the efficacy of avelumab + axitinib from JAVELIN Renal 101. Methods: We examined baseline NLR and its association with efficacy outcomes. PFS, best overall response (per blinded independent central review using RECIST 1.1), and overall survival (OS) data from the avelumab + axitinib arm from the first interim analysis of JAVELIN Renal 101 were analyzed (data cutoff, June 20, 2018). Multivariate Cox regression analyses of PFS and OS were also conducted. Results: In the avelumab + axitinib arm, patients with &lt; median NLR (N = 217) had longer observed PFS (stratified HR, 0.85; 95% CI, 0.634, 1.153) and longer observed OS (stratified HR, 0.51; 95% CI, 0.300, 0.871) than patients with ≥ median NLR (N = 217). The ORR was 57.1% in patients with &lt; median NLR vs 47.5% in patients with ≥ median NLR, with complete response in 5.5% vs 1.4%. Multivariate analysis showed that low NLR was associated with longer PFS and OS by treating baseline NLR as either a continuous variable or a binary variable (dichotomized by median). Conclusions: Low NLR was associated with better observed treatment outcomes in patients with aRCC who received avelumab + axitinib. Clinical trial information: NCT02684006 .
Phase I study (PAYLOAD) of RRx-001 + irinotecan in patients with advanced solid malignancies.
Authors: Edward Jae-Hoon Kim, Corey Allan Carter, Tony R. Reid, Scott Caroen, Bryan Oronsky, Nacer D Abrouk, Mary Flanagan Quinn, Elizabeth Poplin
Journal: Journal of Clinical Oncology (2020)

e16031 Background: RRx-001 is a downregulator of CD-47 and SIRP-alpha, which demonstrated a clinically meaningful improvement in OS and PFS vs. regorafenib when dosed sequentially with irinotecan in a 3 rd /4 th line colorectal cancer randomized trial called ROCKET (NCT02096354). Recently, RRx-001 has been shown to downregulate PD-L1 on circulating tumor cells. This phase 1 trial named PAYLOAD (NCT02801097) was performed to assess the safety and tolerability of the combination of RRx-001 and irinotecan and to determine a recommended phase II dose (RP2D). Methods: Eligible patients (pts) had adequate organ and bone marrow functions and an ECOG of 0-2 and evaluable refractory advanced solid tumors. RRx-001 was administered once per week for 3 weeks and thereafter once every two weeks. RRx-001 was administered as a 10-15 min IV infusion with irinotecan, which began on Week 4 and which was also given every other week, staggered with RRx-001 . Dose escalation followed a standard 3 + 3 design with co-escalation of RRx-001 and irinotecan as follows: 1: Irinotecan 120 mg/m 2 + RRx-001, 0.5 mg 2: Irinotecan 120 mg/m 2 + RRx-001, 2 mg 3: Irinotecan 120 mg/m 2 + RRx-001, 4 mg 4: Irinotecan 150 mg/m 2 + RRx-001, 4 mg Radiological imaging was performed every 8 weeks. Results: 12 pts; 1 gallbladder, 1 ampullary carcinoma, 1 cholangiocarcinoma, 5 colon, 1 GE junction, 2 pancreatic and 2 rectal cancers were enrolled from January 2018 to November 2018. 1 and 18 doses (median: 6 doses) of the combination of RRx-001 and irinotecan were received. The median number of prior treatments was 4 (range 1-5). There were 2 Grade 3 events, leukopenia and anemia, judged not related to RRx-001 but related to irinotecan, 1 Grade 4 event, leukopenia, judged not related to RRx-001 but related to irinotecan and 1 Grade 5 event, neutropenic enterocolitis, also judged not related to RRx-001 but related to irinotecan. No dose-limiting toxicities were identified. The median overall survival was ~ 6.5 months. Conclusions: Alternating weekly infusions of 150 mg/m 2 of irinotecan and 4 mg of RRx-001 were well tolerated. No Grade 2 or above diarrhea was observed with irinotecan treatment, which suggests that RRx-001 may protect against gastrointestinal (GI) toxicities, since RRx-001 has also demonstrated anti- oral mucositis and anti-diarrheal properties in other studies.This dose level is the recommended phase 2 dose for future trials. Clinical trial information: NCT02801097 .
Epidemiology of haemodialysis catheter complications: a survey of 865 dialysis patients from 14 haemodialysis centres in Henan province in China
Authors: 王凯, 王沛, 梁献慧, 陆晓青, 刘章锁
Journal: BMJ (2016)

目的
探讨中国河南省不同地区患者血液透析导管相关并发症的发病率及危险因素。


设计
横断面研究。


研究地点
河南省14家医院。


参与者
2013年10月—2014年10月865例使用导管的血液透析患者。


主要观察指标
并发症、危险因素及患者特征。血液透析导管相关并发症包括：感染（出口感染、隧道感染及血流感染）、功能不良（血栓、异位或扭曲及纤维蛋白鞘）及中心静脉狭窄。


结果
血液透析导管总体感染例次发生率为7.74/1 000导管日、患者总体发生率为38.61%；功能不良例次发生率为10.58/1 000导管日、总体患者发生率为56.65%；中心静脉狭窄例次发生率为0.68/1 000导管日、总体患者发生率为8.79%。多因素回归分析显示：高龄、原发病为糖尿病、小学以下文化程度、农村户口、未口服预防导管血栓药物、低白蛋白及高铁蛋白血症分别为血液透析导管感染的独立危险因素。农村户口、未口服预防导管血栓药物、导管置入后未进行影像学检查、导管类型为非隧道式导管、自费医疗、血液透析治疗前无肾病专科就诊及未提前建立血液净化长期血管通路、左侧部位置管、股静脉穿刺入路、高血红蛋白浓度是血液透析导管功能不良的独立危险因素。原发病为糖尿病、血液透析治疗前无肾病专科就诊及未提前建立血液净化长期血管通路、未口服预防导管血栓药物、左侧部位置管及多次置管手术是中心静脉狭窄的独立危险因素。


结论
血液透析导管相关并发症在河南省终末期肾脏病患者中发生率较高，需要采取相应的策略以改善现状。
Adverse Consequences of Rushing a SARS-CoV-2 Vaccine
Authors: Brit Trogen, David Oshinsky, Arthur Caplan
Journal: JAMA (2020)

This Viewpoint discusses the importance of carefully evaluating SARS-CoV-2 vaccine candidates for safety and efficacy in the context of political pressure to accelerate the process, widespread vaccine hesitancy and refusal, and distrust of science.