tbuckley/cabot-search huggingface dataset:
Cancer survivors with multiple chronic conditions: A rising challenge—Trend analysis from National Health Interview Survey.
Authors: Changchuan Jiang, Haowei Wang, Qian Wang, Binbin Zheng, Charles L. Shapiro
Journal: Journal of Clinical Oncology (2020)

e24089 Background: Cancer survivors are disproportionally influenced by chronic/comorbid diseases, which were linked to more psychological distress, increased healthcare service use, higher medical costs, adverse clinical outcomes, and financial hardship in cancer survivors. However, the trend in chronic diseases remains unknown among cancer survivors. Methods: We conducted a population-based study using serial samples of the National Health Interview Survey (NHIS) from 2002 through 2018. The outcomes include hypertension, diabetes, stroke, coronary artery disease (angina pectoris, coronary heart disease, heart attack), other heart diseases, COPD (emphysema, chronic bronchitis in the past 12 month), hepatitis, arthritis, morbid obesity (BMI &gt; 40 or BMI &gt; 35 with obesity-related diseases), asthma attack within 12 months, weak/failing kidney, any liver disease. We included adults who 1) have a history of cancer for except non-melanoma skin cancer; 2) report outcomes of diseases. Multiple chronic conditions(MCC) were defined as three or more non-cancer chronic conditions. Multivariable logistics regression was used to estimate the annual percent change(APC) in prevalence from 2002 to 2018, using SAS 9.4 and accounting for the design of NHIS. Results: 30728 adult cancer survivors and 485233 adults without a history of cancer were included in the final analysis. We found increasing prevalence in hypertension, diabetes, kidney disease, liver diseases and morbid obesity from 2002 to 2018, and decreasing prevalence in heart diseases, COPD, and hepatitis. The prevalence of MCC increased significantly in cancer survivors from 23.6% in 2002 to 29.6% in 2018 (APC 0.9%, p trend &lt; 0.01). This was especially evident in younger patients aged 18 to 44 (APC 4.4%, p trend &lt; 0.01) and African-American patients (APC 2.2%, p trend = 0.01). Conclusions: Our findings suggest that comorbid illnesses, especially MCC, have become an emerging public health burden for cancer survivors, which requires attention and more effective risk factors interventions. Future studies are needed to identify a better strategy to modify risk factors and prevent long term comorbidities for cancer survivors. It is also important to call for public health planning given severe chronic diseases burden for this rapid-growing but vulnerable community.
Comparison of contraceptive effects and adverse reactions of Gynifix and Mutile intrauterine devices
Authors: 钟宁, 王海文
Journal: BMJ (2006)

目的 比较两种宫内节育器(吉妮和母体乐)在不同时期放置的避孕效果及不良反应.方法 2000年6月至2002年6月,在240例自愿放置节育器者中,月经干净1～7 d放置的116例;停经6～9周,行人工流产术的同时放置者64例;在采取紧急避孕措施的同时放置者60例.将3组再均分为观察组和对照组,观察组(共120例)放置吉妮环,对照组(共120例)放置母体乐,术后随访12个月.结果 术后1个月时,吉妮组脱落率0.8%(1/120),母体乐组脱落率1.7%(2/120),两组差异无统计学意义(P﹥0.05);术后12个月时,吉妮组脱落率0.8%(1/120),母体乐组脱落率4.2%(5/120),之间差异仍无统计学意义(P﹥0.05).吉妮组妊娠率与母体乐组差异无统计学意义(分别为0.8%和1.7%,P﹥0.05).术后1个月和12个月时,两组出血及腹痛发生率比较差异均无统计学意义,因症节育器取出率差异亦无统计学意义(P﹥0.05).吉妮组的续用率97.5%(117/120),母体乐组续用率90.0%(108/120),之间差异有统计学意义(P﹤0.05).不同时期放置同种宫内节育器的脱落率、各组间妊娠率、因症取出率各组间差异均无统计学意义.结论 吉妮和母体乐宫内节育器在不同时期放置均安全有效,两种节育器的不良反应虽无统计学意义,但吉妮组续用率明显高于母体乐组。
Evaluation scales for doctor-patient communication in general practice
Authors: Meirong Wang, Dandan Zhang, Yingjie Liu, Caiying Ge, Juan Du
Journal: BMJ (2017)

Communication skills are the basic requirement for general practitioners, the continuous improvement of communication skills is the guarantee of the service quality. It is crucial to establish an effective evaluation system in the training of communication skills for general practitioners. This article reviews the current status of evaluation scales of doctor-patient communication skill commonly used in China and other countries to provide reference for the establishment of the communication skill evaluation system for general practitioners which is suitable for China′s condition.


Key words: 
General practitioners; Doctor-patient communication; Assessment
The genomic characterization of different progression patterns in advanced lung cancer (LC) patients upon immune checkpoint inhibitor (ICI) treatment.
Authors: Hua Zhong, Jingwen Li, Chan Xiang, Yue Wang, Yan Zhou, Shuhui Cao, Xuxinyi Ling, Junyi Ye, Jingjing Zheng, Lin Shao, Yuchen Han
Journal: Journal of Clinical Oncology (2020)

e21653 Background: Hyperprogressive disease (HPD), characterized by a rapid increase in tumor growth rate (TGR), has been reported in 13.8% NSCLC patients (pts) treated with ICI. Besides, 10.4% of NSCLC pts experience FP (fast progression) and/or early dearth (ED) upon atezolizumab. Although defined differentially, it has been shown that these progression patterns have overlapped portions. The molecular characteristics in different progression patterns have not been well elucidated and compared. Methods: 117 advanced LC pts treated with ICI were recruited, whose progression pattern was assessed according to the following criteria: FP was defined as ≥ 50% increase in the sum of long diameters within 6 weeks (wks) of ICI start; ED was defined as deaths within 12 wks. HPD was defined as the change in TGR greater than 50% compared with that prior to the initiation of ICI (TGR2/TGR1 &gt; 1.5). There were 14, 8 and 9 ED, FP and HPD patients respectively. 5 patients were qualified for than one definition and 1 patient qualified for all 3 definitions. Tissue samples from 36 pts (18 FP/ED/HPD patients) were subjected to genomic profiling using a panel of 520 cancer-related genes. For genomic comparison, additional 693 non-HPD, non-ED and non-FP LC samples with matched TMB and histology were retrieved from our internal database. Results: The FP, HPD and ED occurred in 7.21%, 9.38% and 11.97% pts, respectively. The PFS was comparable among the 3 groups (P = 0.541). The median OS for FP, HPD and ED was 3.19, 11.2 and 1.84 months, respectively (P &lt; 0.001). The genomic landscape of 18 FP/ED/HPD pts revealed 1 EGFR amp, 1 ALK fusion, 6 KRAS mutations, 1 ERBB2 amp, 1 MET amp and 1 RET fusion. Two ED pts harbored concomitant STK11 and KRAS mutations. MDM2 and MDM4 mutations co-occurred in 1 ED patient. 1 patient with ED and HPD had MDM4 mutation. Genomic comparison analysis revealed that ED pts had higher mutation frequency in KRAS (P &lt; 0.01) and CDKN1B (P &lt; 0.01) comparing with the 693 controls. Furthermore, FP pts were more likely to have RAD54L (p = 0.018) an MYC (p = 0.04) mutations. HPD pts showed higher rate of RAD54L (P &lt; 0.001) and ARID1A (p = 0.04) than controls. Conclusions: We revealed FP, HPD and ED have comparable PFS but significant difference is OS. We also demonstrated different genomic characteristics associated with different progression patterns upon ICI treatment, which might further facilitate clinicians to stratify pts for ICI therapy.
The impact of the use of opioids among older breast cancer survivors and adverse events.
Authors: Aaron N Winn, Devon Check, Nicole Fergestrom, Joan Marie Neuner, Andrew Roberts
Journal: Journal of Clinical Oncology (2020)

12098 Background: Older adults and cancer survivors are underrepresented in the literature underpinning recent opioid prescribing guidelines. As prevention of unnecessary persistent opioid use and inadvertent opioid-related harms gains importance in clinical practice, it is necessary to fully capture the risks of opioid related adverse events among patients with cancer pain. The objective of this study was to determine the association between opioid use after cancer diagnosis and comprehensive opioid-related adverse events among older adult breast cancer survivors. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results tumor registry data linked with Medicare administrative claims data from 2007-2016 of women with newly diagnosed non-metastatic breast cancer. The study observation period was the year following a patient’s end of active cancer treatment. The primary exposure was a daily measure of opioid exposure based on Part D prescription claims. The primary outcomes were daily indicators of all-cause hospitalization, substance use event and a composite of other opioid-related adverse events (infections, gastrointestinal events, falls/fractures, cardiovascular events) and each component of the composite adverse event. We estimated the association of current opioid use and the immediate risk of an outcome event the following day using modified Poisson generalized estimating equation models. We adjusted for patient demographics, cancer characteristics and cancer treatments received. Results: We found that opioid exposure more than doubled the immediate risk of all-cause hospitalization (aRR = 2.77; 95%CI = 2.57, 2.99; p &lt; 0.001) and having a composite adverse event (aRR = 2.50; 95%CI = 2.18, 2.87; p &lt; 0.001) and dramatically increases the immediate risk of a substance use event (aRR = 14.26; 95%CI = 7.11, 28.59; p &lt; 0.001). We find consistent results when looking at individual components of the composite adverse event measure. Conclusions: Older adult breast cancer survivors with continued prescription opioid use in the year after completing active cancer treatment experienced an immediate increased risk of all-cause hospitalization, substance use events, and myriad opioid-related adverse effects.
Genomics of esophageal squamous cell carcinoma in African Americans.
Authors: Robert George Wadleigh, Nirmala Akula, Susan Lazerow, Gustavo Marino, Suman Chauhan, Edina Paal, Min-Ling L Liu, Jack Lichy, Hayriye Verda Erkizan
Journal: Journal of Clinical Oncology (2020)

e16552 Background: Esophageal cancer (EC) is one of the most lethal cancers with 90% mortality rate. Uneven Worldwide geographical distribution and varying etiologic factors contribute to the heterogenic nature of EC worldwide. In the US, 75% esophageal squamous cell carcinoma (ESCC) is diagnosed in African Americans (AA). However, despite comprehensive and multi-geographical efforts to understand the genomic basis of ESCC, the knowledge of molecular and genetic mechanisms leading to genomic subtyping of AA has been limited due to the underrepresentation of AAs in these studies. We hypothesized that the differences in mutational events in AA ESCC might, in part, cause the disparity in outcome and the mutational events may determine treatment options. Methods: Whole exome sequencing (WES) of matched- tumor and normal-cell DNA from late-stage ESCC of ten AA patients were performed by using Agilent SureSelect XT Human All Exon V6+UTR. Somatic variants per tumor samples called by two or more methods (Mutect2, VarScan2, and Strelka2) were combined and used for downstream population filtering. Somatic copy number changes were determined by using CNVKit in SevenBridges Genomics. Results: Somatic variants called by two or more algorithms filtered and sorted for rare mutations (equal to or less than 1% African originated population frequency) demonstrated an average of 23 nonsynonymous mutations per MB in high mutation rate AA ESCC. The remaining four samples had two or fewer nonsynonymous mutations per MB. TP53 was one of the most frequently mutated gene with 50% of mutation frequency. ARID2 mutated in 30%, EP300 in 20%, and RB1 in 10% of our cohort. Multiple amplified and deleted regions ranging from 94 to 46 were observed in seven samples in contrast to three samples that were silent in terms of copy number variations ranging from 29 to 9. Significant CNV were mostly seen in proliferation, cell cycle and checkpoint genes, squamous cell homeostasis, epithelial to mesenchymal transition, invasion and metastasis, receptor tyrosine kinase and signaling pathways, chromatin remodeling, detoxification, RNA/DNA editing and angiogenesis. Conclusions: WES of ten AA ESCC samples demonstrated a higher mutation rate in a group of patients with many passenger mutations and complex and recurrent copy number changes that affect oncogenic driver genes, which might suggest enhanced subtyping of ESCC in AA.
Characterization of patients with multiple primary tumors.
Authors: Karen Anne Cadoo, Semanti Mukherjee, Aliya Khurram, Yelena Kemel, Kaitlyn Tkachuk, Ying L Liu, Maria Isabel Carlo, Michael Francis Walsh, Alicia Latham, Marianne E Dubard-Gault, Diana Mandelker, Yuhan Wang, Erin E. Salo-Mullen, Michael F. Berger, Vignesh Ravichandran, Zsofia Kinga Stadler, Vijai Joseph, Mark E. Robson, Venkatraman E. Seshan, Kenneth Offit
Journal: Journal of Clinical Oncology (2020)

1502 Background: 17% of patients (pts) with a cancer diagnosis in the U.S. have a prior malignancy. We sought to characterize pts with multiple (≥2) primary cancers (MPC) &amp; identify potential drivers of cancer risk to guide management. Methods: Pts prospectively consented (1/2013-2/2019) to tumor-normal sequencing via custom targeted NGS panel. A subset consented to testing of &gt;76 germline cancer predisposition genes. IARC 2004 rules for defining MPC were applied.Age adjusted gender specific standardized incidence ratios (SIR) for cancer event combinations occurring in at least 5pt were calculated using R statistical package. Results: Of 24417 pts sequenced, 4341 had MPC (18%). (Table) 3465 (80%) had 2, 4% had &gt;4 cancers. Cancer pairs where SIR of 2nd cancer was higher than expected included: colon-colon, prostate-pancreas, bladder-prostate in men &amp; lung-lung, breast-pancreas, thyroid-pancreas in women. 1580 (36%) pts had germline testing; 324 (21%) had 361 pathogenic/likely pathogenic (P/LP) variants (vts). Of these, 157 (48%), 66(20%), pts had high, moderate penetrance vts. The remainder had low penetrance, recessive or vts of uncertain utility. Of pts with high penetrance vt, 132 (84%) had at least one tumor type concordant with germline findings. Conclusions: 18% of pts in this cohort had MPC. There was a significant excess over expected incidence in some cancer combinations. Of pts with germline testing, 21% had a P/LP vt, with most (69%) being high or moderate penetrance. Assessment for loss of heterozygosity in tumor &amp; germline sequencing of the full MPC cohort is ongoing. [Table: see text]
Hypertension management for migrant workers in the community of Shenzhen city
Authors: Bin Zhen, Xiao-bing Liao, Ling-yi Zhang, Shi-hong Li
Journal: BMJ (2012)

The management model “primary care in community,team service,first contact physician responsibility and two-way referral” was implemented for migrant workers with hypertension in the community.The hypertensive patients under the management for over six months were assigned as management group; the patients who were registered but not under management for over six months served as the control group.The number of new cases detected in hypertension screening increased from 32 in 2008 to 701cases in 2010; and number of hypertensive patients under management increased from 7 cases to 348 accordingly.A questionnaire survey was conducted in 464 hypertensive patients,including 196 cases in management group and 268 cases in control group with a response rate of 94.9％ (186/196) and 92.5％ (248/268) respectively.The results showed that drug compliance rate in management group (168/186,90.3％ ) was significantly higher than that in the control group ( 26.6％,66/248,P =0.00 ).The rate of blood pressure control in management group (87.1％,162/186 ) was significantly higher than that in the control group (25.8％,64/248,P =0.00).The overall satisfaction (98.9％) in management group was significantly higher than that in the control group (88.7％,P =0.00 ).The results indicate that implementation of the hypertension management in migrant workers improves the health seeking behavior and blood pressure control of patients.

Key words: 
Hypertension; Disease management
风湿性心脏病心房颤动并发多部位动脉血栓栓塞一例
Authors: 张变花
Journal: BMJ (2005)

患者女,54岁,农民,因突发胸憋伴左下肢麻木、感觉消失2 h于2002年10月21日来我院急诊.既往有风湿性心脏病史30余年,近2年有时测血压偏高,140～150/90～95 mm Hg(1mm Hg=0.133 kPa),无糖尿病史,平时可耐受一般家务劳动,未作定期检查及特殊治疗.10 d前出现一次左侧腹背部疼痛,无恶心、呕吐、腹泻,在当地予静脉点滴抗生素,解痉止痛治疗后症状好转,未做进一步检查.此次在做家务时突发胸憋伴左下肢麻木、感觉消失,家属给予按摩后左下肢感觉逐渐恢复,但仍感麻木.查体:左下肢小腿以下皮肤略苍白,有花斑,足背动脉搏动较右侧明显减弱,皮温降低,心律绝对不齐、双肺无异常,腹部无压痛,心电图提示心房颤动,II、III、AVF、V4～V9 ST段下移,T波倒置,并有动态演变.立即口服阿司匹林300 mg,皮下注射低分子肝素钙 4 100 U,2次/d,静脉点滴硝酸甘油,患者胸憋症状逐渐好转,左下肢麻木减轻,即收住心内科。
YAP1 positive small-cell lung cancer subtype is associated with the T-cell inflamed gene expression profile and confers good prognosis and long term survival.
Authors: Taofeek Kunle Owonikoko, Bhakti Dwivedi, Zhengjia Chen, Chao Zhang, Benjamin Barwick, Melissa Gilbert-Ross, Vinicius Ernani, Benjamin Barwick, Guojing Zhang, Jennifer W Carlisle, Fadlo Raja Khuri, Walter J Curran, Sagar Lonial, Suresh S. Ramalingam, Shi-Yong Sun, Edmund K. Waller, Gabriel Sica
Journal: Journal of Clinical Oncology (2020)

9019 Background: The dominant expression of transcription factors ASCL1, NeuroD1, YAP1 or POU2F3 characteristically defines four small cell lung cancer (SCLC) subtypes (SCLC-A, SCLC-N, SCLC-Y and SCLC-P). The clinical validation and biological relevance of these emerging SCLC subtypes is currently lacking. Methods: Using the Illumina TruSeq RNA Exome Kit, we generated RNA-Seq data from 61 cases of SCLC and pulmonary carcinoid to interrogate gene expression differences in SCLC subtypes as well as in survival outliers (top and bottom decile) matched for clinically relevant prognostic factors and treatment. We also assessed YAP1 protein expression in a blinded fashion by immunohistochemistry in 130 SCLC cases. Results: We successfully classified 68% of SCLC into one of the four SCLC subtypes whereas 81.5% of carcinoids did not fit into any of these categories. GSEA for differentially expressed genes between outlier subgroups showed significant upregulation of interferon gamma and interferon alpha response genes in late survivors. Moreover, a previously validated 18-gene T-cell inflamed gene expression profile was upregulated in late survivors and in the SCLC-Y subtype. Furthermore, the SCLC-Y subtype and late survivors showed higher expression of HLA gene family and reduced expression of cancer testis antigens. The median (95%CI) OS was 14 (4.3, 28.8), 16.7 (0.9, NA), 8.1 (2, 9.7) and 20.1 (0.6, 39.5) months respectively, for SCLC-A, N, P and Y subtypes. YAP-1 protein expression was positive in 17 of 130 (13%) SCLC cases. The majority of cases with positive YAP1 expression by immunohistochemistry, 12 of 17 cases (70.6%), were limited stage SCLC at the time of original diagnosis. Conclusions: SCLC subtypes have clinical implication as predictive and prognostic biomarker. SCLC-Y subtype is enriched for T-cell inflamed phenotype and long term survival, and may predict for clinical benefit of immunotherapy.
妊娠和产后甲状腺疾病诊治指南(节选二)
Authors: 中华医学会内分泌学分会, 中华医学会围产医学分会
Journal: BMJ (2012)

一、妊娠期甲状腺功能相关指标参考值问题1:妊娠期甲状腺相关激素和甲状腺自身抗体有哪些变化?(1)在雌激素的刺激下,肝脏甲状腺素结合球蛋白(TBG)产生增加,清除减少.TBG从妊娠第6～8周开始增加,妊娠第20周达到顶峰,一直持续到分娩.一般较基础值增加2～3倍.TBG增加必然带来总T4(TT4)水平增加,所以TT4这一指标在妊娠期不能反映循环甲状腺激素的确切水平。
Angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe <scp>COVID‐19</scp> infection in a multi‐site <scp>UK</scp> acute hospital trust
Authors: Daniel M. Bean, Zeljko Kraljevic, Thomas Searle, Rebecca Bendayan, O'Gallagher Kevin, Andrew Pickles, Amos Folarin, Lukasz Roguski, Kawsar Noor, Anthony Shek, Rosita Zakeri, Ajay M. Shah, James T.H. Teo, Richard J.B. Dobson
Journal: European Journal of Heart Failure (2020)

The SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID-19 infection.
An observation on preprocedural white blood cell count and long-term patency of stent implanted in subclavian artery
Authors: Pei Yang, Qing-hua Wu, Han Zhou, Yu-ya Zhang, Zhong Chen
Journal: BMJ (2009)

Objective To study relationship between preprocedural white blood cell count(WBC) and long-term patency of stent implanted in the subelavian artery.Methods Data of 113 cases with stents implanted in the atherosclerotic SUbclavian arteries in Anzhen Hospital,Beijing during January 2005 to January 2008 were analyzed.Student t-test was used to compare the difierence in WBC count between those with patency and those with stenosis after the procedure and chi-square test was used to compare the difference in stent pateney between those with higher and lower WBC counts.Results There Was significant difference in WBC counts between 102 cases with patency and 11 cases with stenosis of the stents after implantation(t=-5.051.P 7.195×109/L)was significantly higher than that in 77 cases with lower WBC count(≤7.195× 109/L)before the procedure(P=0.001).Among 113 cases with stents implanted,109 cases(96.5%) could keep their stents patent one year after implantation,and 60 cases(89.6%)could keep stents patent three yeats after implantation.Conclusions In addition to those traditional factors associated with long-term patency of stents after their implantation,inereased WBC count alSO associated with stenosis or occlusion of the stents after the procedure.

Key words: 
Stents;  Subclavian artery;  Arteriosclerosis;  Inflammation; Leukocytes
Pembrolizumab or Placebo Plus Etoposide and Platinum as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer: Randomized, Double-Blind, Phase III KEYNOTE-604 Study
Authors: Charles M. Rudin, Mark M. Awad, Alejandro Navarro, Maya Gottfried, Solange Peters, Tibor Csőszi, Parneet K. Cheema, Delvys Rodriguez-Abreu, Mirjana Wollner, James Chih-Hsin Yang, Julien Mazieres, Francisco J. Orlandi, Alexander Luft, Mahmut Gümüş, Terufumi Kato, Gregory P. Kalemkerian, Yiwen Luo, Victoria Ebiana, M. Catherine Pietanza, Hye Ryun Kim
Journal: Journal of Clinical Oncology (2020)

Pembrolizumab monotherapy has shown antitumor activity in patients with small-cell lung cancer (SCLC). The randomized, double-blind, phase III KEYNOTE-604 study compared pembrolizumab plus etoposide and platinum (EP) with placebo plus EP for patients with previously untreated extensive-stage (ES) SCLC.Eligible patients were randomly assigned 1:1 to pembrolizumab 200 mg once every 3 weeks or saline placebo for up to 35 cycles plus 4 cycles of EP. Primary end points were progression-free survival (PFS; RECIST version 1.1, blinded central review) and overall survival (OS) in the intention-to-treat population. Objective response rate (ORR) and duration of response were secondary end points. Prespecified efficacy boundaries were one-sided P = .0048 for PFS and .0128 for OS.Of the 453 participants, 228 were randomly assigned to pembrolizumab plus EP and 225 to placebo plus EP. Pembrolizumab plus EP significantly improved PFS (hazard ratio [HR], 0.75; 95% CI, 0.61 to 0.91; P = .0023). Twelve-month PFS estimates were 13.6% with pembrolizumab plus EP and 3.1% with placebo plus EP. Although pembrolizumab plus EP prolonged OS, the significance threshold was not met (HR, 0.80; 95% CI, 0.64 to 0.98; P = .0164). Twenty-four-month OS estimates were 22.5% and 11.2%, respectively. ORR was 70.6% in the pembrolizumab plus EP group and 61.8% in the placebo plus EP group; the estimated proportion of responders remaining in response at 12 months was 19.3% and 3.3%, respectively. In the pembrolizumab plus EP and placebo plus EP groups, respectively, any-cause adverse events were grade 3-4 in 76.7% and 74.9%, grade 5 in 6.3% and 5.4%, and led to discontinuation of any drug in 14.8% and 6.3%.Pembrolizumab plus EP significantly improved PFS compared with placebo plus EP as first-line therapy for patients with ES-SCLC. No unexpected toxicities were seen with pembrolizumab plus EP. These data support the benefit of pembrolizumab in ES-SCLC.
脑卒中的步态异常和治疗对策
Authors: 励建安
Journal: BMJ (2005)

从运动障碍学的角度,脑卒中属于上运动神经元综合征(UMNS).开始时主要是肌肉的神经控制失常,而并没有骨关节、肌肉和结缔组织的形态损害.对于脑卒中患者而言,肌肉张力提高是低位神经中枢的代偿性改变,具有一定的积极意义.康复治疗不是以全部纠正肌肉张力过高为目标,治疗的关键目标是恢复肢体功能活动而不是单纯的肌肉张力。
肺通气功能检查结果的解读
Authors: 刘锦铭
Journal: BMJ (2011)

肺功能检查结果的解读应该是清楚、准确及有价值的,只有充分考虑临床医生对受试者的初步诊断、受试者完成肺功能测试的质量、假阳(阴)性的可能、检查结果实测值以及与预计值的比较,最后才能对受试者的肺功能做出合理评估。