tbuckley/cabot-search huggingface dataset:
Clinical analysis for 172 cases of pulmonary tuberculosis with liver lesion caused by antituberculotic drugs
Authors: 程书权, 侯淑君, 孔淑敏
Journal: BMJ (2005)

目的 探讨抗结核药物应用过程中产生的肝损害问题.方法对1995年1月至2002年12月住院的1 464例肺结核病患者中应用抗结核药物后出现肝损害的172例患者进行回顾性分析.结果抗结核药物肝损害的高发年龄为20～60岁,占70.3%,消化道症状出现和肝功能改变发生于用药后8周内强化治疗期的占73.8%,轻者加保肝药治疗可不需停用抗结核药物,重者须停药并着重保肝治疗.157例(91.3%)恢复正常,13例(7.6%)好转,2例恶化出院,41例(23.8%)需减量或停药,对化疗效果产生影响.结论应用抗结核药物易发生肝损害,体重<50 kg的老年男性、既往已有肝损害或嗜肝病毒感染、饮酒、合并肺外疾病、异烟肼、利福平、吡嗪酰胺三药联用等为易感因素.
气管及支气管疾病的影像学诊断
Authors: 马大庆
Journal: BMJ (2011)

气管、支气管疾病包括先天异常、肿瘤、支气管扩张、气道异物、小气道疾病和外伤等.X线胸片可以显示大气道狭窄引起的肺通气异常和继发改变,如肺不张和肺炎,也可显示小气道疾病引起的肺部弥漫性病变.CT能够清楚显示气道管腔内外的异常改变,准确显示肺内病变的形态和分布。
Particulars concerning specialist/general practitioner joint teaching rounds in community health center
Authors: Zhaoxia Yin, Xiaomin Jin
Journal: BMJ (2016)

专科和全科联合教学查房能满足知识、技能、全科思维全方位提高的要求，适合培养全科医师。目前社区卫生机构层面的联合教学查房经验不足，文章从选择恰当病例、查房前精心准备、查房中各司其职三方面阐述联合教学查房中的细节，为相关师资提供参考，以使教学查房达到更好的效果。
Survey on the management status of patients with type 2 diabetes mellitus in community health service centers in Beijing
Authors: Bin Li
Journal: BMJ (2019)

From January 2016 to June 2017, 1 002 outpatients with T2DM were recruited in Chuiyangliu Hospital (core hospital) and eleven community health service centers in Chaoyang district in Beijing. A questionnaire survey was conducted, the survey items included demographic information, complications of T2DM, comorbidities and status of treatments. Among 1 002 patients, there were 525 cases from the Southern Medical Consortium core hospital and 477 from the Southern Medical Consortium community health centers. The control rates of glycosylated hemoglobin, fasting blood glucose, 2 h postprandial glucose were 54.1%, 49.5% and 54.6%, respectively. The blood glucose control rates in lifestyle intervention, single OAD and multiple OAD groups of core hospital were all higher than those in corresponding groups of community health centers (P<0.05). There were 115 patients managed with lifestyle interventions only and 887 patients with medications, in whom 533 were treated with oral antidiabetic drugs (OAD) and 354 cases were treated with insulin+OAD. The use rates of metformin in the core hospital and in community health service centers were 58.3% and 35.4%, the use rates of insulin were 48.4% and 24.2%, respectively. The blood sugar control of patients in community health centers is less satisfactory than that in core hospital of Chaoyang District South Medical Consortium in Beijing. The communication and cooperation between core hospitals and community health service centers should be further strengthened for better management of T2DM patients.


Key words: 
Diabetes mellitus, type 2; Community health services; Hierarchical diagnosis and treatment
Development and validation of a novel EHR-based tumor progression outcome to support biomarker discovery.
Authors: Kenneth L. Kehl, Michael J. Hassett, Katherine A. Stafford, Wenxin Xu, Bruce E. Johnson, Deborah Schrag
Journal: Journal of Clinical Oncology (2020)

e19297 Background: Obtaining clinical outcomes for analysis has historically been a critical barrier to cancer genomics research. EHRs could constitute an important data source to bridge this gap, but EHRs rarely capture structured outcomes such as cancer progression. Novel, robust methods are needed to capture clinically relevant outcomes from EHRs. Methods: Among patients with lung adenocarcinoma whose tumors were sequenced via the Dana Farber Cancer Institute/Brigham and Women’s PROFILE study from 2013-2018, imaging reports following first palliative-intent systemic therapy were annotated using natural language processing (NLP) models trained to capture cancer progression according to the structured “PRISSMM” framework. NLP-based cancer progression and imaging report frequency were jointly modeled using inverse-intensity weighted generalized estimated equations, censored at six months, to explore associations between alterations in lung cancer biomarkers (ALK, EGFR, ROS1, BRAF, KRAS, SMARCA4) and progression. Among patients with KRAS mutations who received immunotherapy, we also analyzed the association between STK11 mutations and progression. The novel outcome generated by the model – imaging report-based progression (iPROG) – corresponded to the difference in the mean log odds of progression per inverse-intensity weighted report associated with a given biomarker; it was reported as adjusted mean probability and in exponentiated form as an odds ratio (OR). Results: Among 690 patients with lung adenocarcinoma, associations between tumor mutations and the iPROG outcome are listed in the Table. Conclusions: A deep NLP model applied to EHR data can capture a novel cancer progression outcome, which is associated with known prognostic markers in lung cancer. Application of this method to large “real world” datasets, with attention to interactions between treatment and genomics, could speed biomarker discovery. [Table: see text]
手淫异物症15例临床分析
Authors: 任中志, 张宏, 谢斌耀, 贺义广, 蔡体章
Journal: BMJ (2007)

1995年3月至2006年12月我们共收治手淫所致阴茎、尿道异物患者15例,现报告如下. 一、对象与方法 1.研究对象:本组均为未婚男性.年龄13～35岁,平均16岁.学生12例,其中11例为长期住校学生;农民1例;工人2例.15例中,前尿道长管形异物5例,病程2～9 h,平均4 h,排尿刺痛,肉眼血尿;阴茎嵌留螺帽2例、轴承8例,病程16～53 h,平均22 h,阴茎远端包皮水肿,其中3例合并包皮嵌顿.异物远端距尿道外口2～5 cm,平均3 cm.15例患者均有观看黄色影视及网络史.
真空辅助乳房活检系统诊断、治疗乳腺疾病的适应证选择
Authors: 刘娟娟, 王永胜
Journal: BMJ (2009)

随着乳腺钼靶摄片、超声检查技术的改进和MRI应用于高危乳腺癌人群的普查,越来越多的影像学检查能发现、临床却不可触及的早期乳腺病被检出.乳腺病变活检也由切开活检占主导地位,经历细针穿刺细胞学诊断,过渡到目前的影像引导微创活检技术占主导地位.微创活检技术包括常规空芯针活检和更先进的真空辅助活检。
Patient self-management and health maintenance at lung cancer diagnosis and during treatment.
Authors: Josephine Louella Feliciano, Julia Rachel Trosman, Christine B. Weldon
Journal: Journal of Clinical Oncology (2020)

e24036 Background: Health maintenance is an integral part of lung cancer care starting at diagnosis and throughout cancer care continuum. Patient self-management (pSM) is a key strategy thought to contribute to promotion of health maintenance in cancer patients (McCorkle, CA Cancer J Clin. 2011, NAM 2014), but its role in lung cancer has been unexplored. We conducted this study as baseline before conducting a quality improvement (QI) to optimize health maintenance utilization and patient self-management in lung cancer. The Q will implement the 4R model (Right Info / Care / Patient / Time) for care delivery, patient self-management and teamwork (Trosman, JOP 2016). Methods: We surveyed patients with lung cancer stages I-IV undergoing cancer treatment at a tertiary cancer center 2018-2019, assessing pSM and health maintenance utilization by patients. We used simple frequencies and Fisher’s exact test in analyses. Results: Survey response rate: 81%, 149/185. We found gaps of at least 20% in all 6 assessed pSM metrics: “know stage of your cancer” (78%), “ability to explain your care to others” (73%), “clarity of care plan” (72%), “ability to manage your own care” (71%), “seldom overwhelmed, not in control of your care” (65%), and “clarity of timing and sequence of care” (35%). High level of composite pSM score ( &gt; 2.8 on 0-4 scale) was found for 50% of patients. Patients also reported insufficient utilization of health maintenance along the 7 metrics we assessed (Table). The level of pSM impacted receipt of health maintenance: patients with high composite pSM score were significantly more likely to obtain 4 of the 7 health maintenance metrics than patients with lower composite pSM score (Table). Conclusions: While serious gaps exist in health maintenance utilization in lung cancer, it is significantly associated with the level of patient self-management. Strategies to improve patient self-management should be utilized to promote health maintenance during lung cancer treatment. Our program to implement the 4R model of cancer care delivery will evaluate if and how 4R facilitates these improvements. [Table: see text]
Application of enhanced rehabilitation program in colorectal cancer surgery
Authors: Hua-chong Ma, Bo Zhao, Hui-min Xu, Jin-jie Cui, Guang-hui Wei, Zhen-jun Wang
Journal: BMJ (2010)

Objective To assess efficacy and safety of enhanced rehabilitation program for patients with colorectal cancer surgery. Methods One hundred and ten consecutive patients admitted to general surgery department at Beijing Chaoyang Hospital during October 2007 to October 2009 undergone with fasttrack colorectal cancer surgery and enhanced rehabilitation were prospectively studied, with 117 patients undergone with same colorectal cancer surgery by traditional perioperative treatment during May 2005 to September 2007 as controls. Restoration of their gastrointestinal function, occurrence of complications, fatality and length of hospital stay after surgical operation were observed in the group of enhanced rehabilitation and control group. Results Demographic characteristics, stage classification of illness and surgical operation methods were comparable in both groups. The first day with air discharge from the flux was earlier in enhanced rehabilitation group than that in controls (2. 5 vs. 3. 5 day after surgery, P ＜ 0. 05 ), and the former could tolerate solid food earlier than the latter (6.0 vs. 6.7 days after surgery, P=0.028). Overall morbidity of complications was less in the group with enhanced rehabilitation than that in controls (23.6% vs. 39. 3%,P =0. 011 ) and shorter length of hospital stay was observed in the former than that in the latter (9. 0 vs. 10. 8 days after surgery, P =0. 041 ). There was no difference in mortality, incidence of anastomotic leakage, and infectious and non-infectious complications between the two groups. Conclusions Enhanced rehabilitation program is safe and effective following colorectal cancer surgery to accelerate restoration of gastrointestinal function, reduce complications and shorten hospital stay after colorectal cancer surgery.

Key words: 
Colorectal surgery; Enhanced-recovery programmes; Gastrointestinal function; Complications
A first-in-human phase I study of CYH33, a phosphatidylinositol 3-kinase (PI3K) α selective inhibitor, in patients with advanced solid tumors.
Authors: Xiao-Li Wei, Rui-hua Xu, Hongyun Zhao, Yang Zhang, Ben-Yan Zou, Feng Wang, Jihong Liu, Zhiqiang Wang, Miao-Zhen Qiu, Qiuqiong Yu, Yun Liu
Journal: Journal of Clinical Oncology (2020)

e15645 Background: PI3Kα is the only subtype in PI3K family of which activated mutations occur frequently in tumors. CYH33 is a potent PI3Kα–selective inhibitor with anti-tumor activity in xenograft models. An open-label, Phase I dose-escalation &amp; expansion study of CYH33 monotherapy (NCT03544905) is underway in patients (pts) with advanced solid tumors. Methods: This study evaluates the safety, pharmacokinetics (PK), and anti-tumor activity of CYH33 administered daily orally in 28-day cycles until intolerable toxicity or disease progression (PD). Adult pts with advanced solid tumors who have progressed despite standard therapies are enrolled to this trial, and pts with or without PIK3CA mutant are eligible for dose-escalation and pts with PIK3CA mutant are eligible for dose-expansion. Results: As of the cut-off date 20 Dec 2019, 17 pts (median age 47.0 y) were enrolled in the first 6 dose levels (1mg, 5mg, 10mg, 20mg, 40mg and 60mg) of the dose-escalation cohorts, and 3 pts were enrolled in expansion cohort of 40 mg. Cohorts 1 mg to 20 mg were completed without dose-limiting toxicities (DLT), cohort 40mg was completed with 1 DLT (Grade 3 hyperglycemia) out of 6 evaluable pts, and 3 enrolled pts at 60 mg are still in the DLT evaluation. Most frequent treatment-related adverse events (TRAEs) (all grades, ≥ 20%) included hyperglycemia (17 pts, 85%), decreased appetite (5 pts, 25%), diarrhea (4 pts, 20%). Grade≥3 TRAEs were hyperglycemia (8 pts, 40%), nausea (1 pt, 5%) and decreased appetite (1 pt, 5%). Hyperglycemia was generally manageable with anti-hyperglycemic medications. The preliminary PK profile of CYH33 showed dose proportionality across the tested dose levels, half-life (t1/2) was about 20 hours with minimum accumulation, and the maximum concentration (Cmax) achieved 2-4 hours after dosing. Over all, among 15 tumor response evaluable pts, partial response (PR) was observed in 2 pts treated with 40mg (1 colorectal cancer with unknown PIK3CA mutation status, 1 breast cancer with PIK3CA mutant), and stable disease (SD) was observed in 3 pts with unknown PIK3CA mutation status. After the cut-off date, 1 more pt (ovarian cancer with PIK3CA mutation) treated with 40mg achieved PR, so that 2 out of 3 enrolled PIK3CA mutant pts treated with 40mg achieved PR. Conclusions: The first-in-human study of the PI3Kα selective inhibitor CYH33 demonstrated a manageable safety profile, linear PK, and encouraging preliminary anti-tumor activity. CYH33 single agent and in combination with other anti-tumor agents have be planned in future studies. Clinical trial information: 03544905.
胃癌误诊心绞痛一例
Authors: 薛宏芳, 陈苏明
Journal: BMJ (2005)

患者男,78岁.因间断发作性胸闷、胸痛22年,加重半年,晕厥10 min收入我院心脏内科.半年来,患者因胸闷、胸痛发作住院2次,诊断:①冠心病,不稳定性心绞痛;②高血压病Ⅲ级.经扩冠、降压治疗后好转出院.半个月前,患者胸闷、胸痛逐渐加重,发作频繁,无规律,含服硝酸甘油后疼痛无明显缓解,伴食欲不振、乏力、面色苍白,并发生晕厥1次,因怀疑心肌梗死,第3次住院治疗.追问有黑便史,经上消化道造影及胃镜检查于临近幽门区发现一溃疡型胃癌,转入普通外科,择期行远端胃癌根治术.术后病理回报:胃溃疡型黏液腺癌Ⅱ～Ⅲ期,侵及全层,上下断端未见癌细胞,淋巴结可见转移癌(3/7).术后第10天给予1个疗程化疗.术后半个月出院,未再出现胸闷、胸痛症状。
糖尿病抗血小板治疗
Authors: 张楚, 季伟琴
Journal: BMJ (2010)

糖尿病人群是心血管疾病的高危人群,糖尿病血栓性事件已成为糖尿病患者死亡的最主要原因之一.据统计,男性糖尿病患者发生冠心病的风险是非糖尿病患者的2～3倍,女性则可达3～5倍[1].美国国家胆固醇教育计划成人治疗组第三次报告(NCEP-ATPⅢ)指出,糖尿病是冠心病的等危症[2].由于糖尿病患者常具有多种动脉粥样硬化及血栓形成的危险因素,包括血脂异常、肥胖、高血压、高凝状态等,因此75%的糖尿病患者最终的死亡原因是血栓性疾病,其中血小板激活在其中起关键作用.因而,抗血小板治疗可显著减少缺血性事件的发生。
Genomic characterizations of KIT and PDGFRA in Chinese pan-cancer patients.
Authors: Xianze Xiong, Feng Zhou, Ming Luo, Jingdong Li, Haiping Zheng, Changjun Liu, Xiong Chen, Wenjing Wang, Weifeng Wang, Kai Wang
Journal: Journal of Clinical Oncology (2020)

e13654 Background: KIT and PDGFRA gene mutations have been identified as biomarkers for targeted therapy in gastrointestinal stromal tumor. Mutations and amplification of KIT and PDGFRA are also considered as potential targets in solid tumors in clinical trials. We assessed the characteristics of KIT and PDGFRA alterations in a variety of cancers and tried to provide genomic landscape of these genes. Methods: Formalin-fixed, paraffin-embedded (FFPE) tumors and their matched blood samples were collected from 10,010 patients for 450 cancer genes targeted next-generation sequencing (NGS) panel.The testing was carried out in a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Genomic alterations including single nucleotide variations, short and long insertions/deletions, copy number variations, and gene rearrangements were assessed. Results: Alterations of KIT and PDGFRA were detected 2.1% and 1.6% respectively in Chinese pan-cancer patients. KIT alterations was detected most frequently in gastrointestinal stromal tumor (68.8%), soft tissue sarcoma (10.8%), melanoma (10.3 %), thymic tumors (7.7%) and small cell lung cancer (5.1%), and PDGFRA alterations was detected in gastrointestinal stromal tumor (18.7%), melanoma (5.2 %), primary hepatic carcinoma (4.3%), bone sarcoma (4.2%) and soft tissue sarcoma (3.4%). Particularly, KIT and PDGFRA amplifications accounted for 0.68% and 0.58% respectively in pan-cancer patients and were highly co-existed. Conversely, KIT and PDGFRA mutations were mutually exclusive which indicated an independent role of driver genes. Furthermore, tumor with microsatellite instability high (MSI-H) status had a significantly higher rate of KIT or PDGFRA mutations compared to microsatellite stable (MSS) tumors (p &lt; 0.001). Conclusions: KIT and PDGFRA alterations occurred in 2.1% and 1.6% respectively in Chinese pan-cancer patients and mutually exclusive with known driver genes. KIT and PDGFRA alterations may act as driving oncogenic factors across cancers and warrant drug development strategy.
National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018
Authors: David C. Classen, A. Jay Holmgren, Zoe Co, Lisa P. Newmark, Diane Seger, Melissa Danforth, David W. Bates
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Despite the broad adoption of electronic health record (EHR) systems across the continuum of care, safety problems persist. <h3>Objective</h3> To measure the safety performance of operational EHRs in hospitals across the country during a 10-year period. <h3>Design, Setting, and Participants</h3> This case series included all US adult hospitals nationwide that used the National Quality Forum Health IT Safety Measure EHR computerized physician order entry safety test administered by the Leapfrog Group between 2009 and 2018. Data were analyzed from July 1, 2018 to December 1, 2019. <h3>Exposure</h3> The Health IT Safety Measure test, which uses simulated medication orders that have either injured or killed patients previously to evaluate how well hospital EHRs could identify medication errors with potential for patient harm. <h3>Main Outcomes and Measures</h3> Descriptive statistics for performance on the assessment test over time were calculated at the overall test score level, type of decision support category level, and EHR vendor level. <h3>Results</h3> Among 8657 hospital-years observed during the study, mean (SD) scores on the overall test increased from 53.9% (18.3%) in 2009 to 65.6% (15.4%) in 2018. Mean (SD) hospital score for the categories representing basic clinical decision support increased from 69.8% (20.8%) in 2009 to 85.6% (14.9%) in 2018. For the categories representing advanced clinical decision support, the mean (SD) score increased from 29.6% (22.4%) in 2009 to 46.1% (21.6%) in 2018. There was considerable variation in test performance by EHR. <h3>Conclusions and Relevance</h3> These findings suggest that despite broad adoption and optimization of EHR systems in hospitals, wide variation in the safety performance of operational EHR systems remains across a large sample of hospitals and EHR vendors. Hospitals using some EHR vendors had significantly higher test scores. Overall, substantial safety risk persists in current hospital EHR systems.
Large dose of pamidronate disodium in treatment for patients with painful bone metastases of prostate cancer
Authors: Bo Luo, Peng Liu, Jian-bo Hao, Bao-lian Song, Jin-feng Zhang
Journal: BMJ (2010)

Objective To study efficacy and safety of large dose of pamidronate disodium in treatment for patients with painful bone metastasis of prostate cancer. Methods A total of 100 patients with painful bone metastasis of prostate cancer were randomized into large dose group and conventional dose group, with 50 cases each. Pamidronate disodium was administered by intravenous infusion, 90 mg on the first day and 60 mg on the second day for large dose group, and 60 mg on the first day and 30 mg on the second day for conventional dose group, respectively, every 4 weeks for two courses. Changes of pain,mobility, quality of life and adverse effect in patients before and after treatment were observed. Results After treatment, pain was relieved in 43 of 50 patients ( 86% ) in large dose group, significantly more than that in conventional dose group (21/50, 42% ) (χ2 = 22.79, P ＜ 0. 01 ). Both mobility and quality of life were improved in 39 and 33 patients ( 87% and 66% ), respectively in large dose group and 21 and 18 (46% and 36% ), respectively in conventional dose group (χ2 = 17.04 and 9. 00, P ＜0. 01 ). No severe adverse effect in both groups was observed. Conclusions Pain in patients with bone metastasis of prostate cancer can be significantly relieved with large dose of pamidronate disodium, as well as their quality of life improved.

Key words: 
Neoplasm metastasis;  Bone;  Bisphosphonates;  Prostatic neoplasms;  Pain
Clinical significance of changes in maximal expiratory flow in 50% and 25% vita l capacity before and after bronchodilator reversibility testing in asthmatics
Authors: Han-xiang Nie, Min Liu, Xu-hong Ding, Yi Huang
Journal: BMJ (2013)

To explore the clinical significance of changes in maximal expiratory flow in 50% and 25% vital capacity (Vmax50% & Vmax25%) before and after bronchodilator reversibility testing in patients with asthma. Forced expiratory volume in one second (FEV1), Vmax50% and Vmax25% were measured before and after bronchodilator reversibility testing in 118 patients with asthma and 82 with chronic obstructive pulmonary disease (COPD). The rate of positive reversibility in Vmax50% was significantly higher than that in FEV1 in 118 asthmatics (χ2=7.995, P=0.007). The rates of positive reversibility in Vmax50% and Vmax25% were significantly higher in asthmatics than those in COPD patients (χ2=9.335, P=0.009).


Key words: 
Asthma; Respiratory function tests
SARS-CoV-2 pandemic: clinical picture of COVID-19 and implications for research
Authors: Marc Lipman, Rachel C Chambers, Mervyn Singer, Jeremy Stuart Brown
Journal: Thorax (2020)

<h3>Abstract</h3> Immune correlates of protection from COVID-19 are incompletely understood. 2,826 keyworkers had T-SPOT<sup>®</sup><i>Discovery</i> SARS-CoV-2 tests (measuring interferon-γ secreting, SARS-CoV-2 responsive T cells, Oxford Immunotec Ltd), and anti-Spike S1 domain IgG antibody levels (EuroImmun AG) performed on recruitment into a cohort study. 285/2,826 (10.1%) of participants had positive SARS-CoV-2 RT-PCR tests, predominantly associated with symptomatic illness, during 200 days followup. T cell responses to Spike, Nucleoprotein and Matrix proteins (SNM responses) were detected in some participants at recruitment, as were anti-Spike S1 IgG antibodies; higher levels of both were associated with protection from subsequent SARS-CoV-2 test positivity. In volunteers with moderate antibody responses, who represented 39% (252/654) of those with detectable anti-Spike IgG, protection was partial, and higher with higher circulating T cell SNM responses. SARS-CoV-2 responsive T cell numbers predict protection in individuals with low anti-Spike IgG responses; serology alone underestimates the proportion of the population protected after infection.