tbuckley/cabot-search huggingface dataset:
Pooled ctDNA analysis of the MONALEESA (ML) phase III advanced breast cancer (ABC) trials.
Authors: Fabrice Andre, Fei Su, Nadia Solovieff, Carlos L. Arteaga, Gabriel N. Hortobagyi, Stephen K. L. Chia, Patrick Neven, Aditya Bardia, Debu Tripathy, Yen-Shen Lu, Yingbo Wang, Karen Rodriguez-Lorenc, Tetiana Taran, Naveen Babbar, Dennis J. Slamon
Journal: Journal of Clinical Oncology (2020)

1009 Background: Biomarker analyses have been presented separately for each Phase III ML trial, which tested efficacy and safety of ribociclib (RIB) with different endocrine therapy (ET) combination partners as first- or second-line treatment for hormone receptor–positive, HER2-negative (HR+/HER2−) ABC. Here, using the largest pooled biomarker dataset of a CDK4/6 inhibitor in ABC to date, we identify potential biomarkers of response or resistance to RIB across ML trials. Methods: Baseline ctDNA from 1503 patients (pts) enrolled in ML-2, 3, and 7 was assessed using next-generation sequencing with a targeted panel of 557 genes. Genes with an alteration frequency ≥2% and in ≥15 pts per treatment arm were included (83 genes). Genetic alteration was defined as presence of a mutation, short insertion/deletion, or copy number alteration. Cox proportional hazard model of progression-free survival (PFS) was fit with gene-by-treatment interaction. Genes with interaction P&lt; 0.10 and genes of interest were investigated. Results: Pts with alterations in FRS2 and PRKCA (treatment interaction P&lt; 0.05) as well as MDM2, ERBB2, AKT1, and BRCA1/2 ( P&gt; 0.05 but considered actionable) had a trend for increased PFS benefit of RIB vs PBO (Table). Pts with alterations in CHD4, BCL11B, ATM, or CDKN2A/2B/2C derived little to no added PFS benefit with RIB vs PBO ( P interaction &lt; 0.10; hazard ratio [HR] &gt; 0.80). Data on genes implicated in the literature as potential mechanisms of resistance to ET and/or CDK4/6 inhibition ( ESR1, PTEN, FAT1, RB1, and NF1) will be presented. Conclusions: Results of this pooled analysis of the ML-2, 3, and 7 trials, the largest biomarker analysis of any CDK4/6 inhibitor in ABC, revealed several potential biomarkers of response ( FRS2, MDM2, PRKCA, ERBB2, AKT1, and BRCA1/2) or resistance ( CHD4, BCL11B, ATM, or CDKN2A/2B/2C) to RIB. Clinical trial information: NCT01958021; NCT02422615; NCT02278120 . [Table: see text]
腿痛的症状识别与诊断
Authors: 李子荣
Journal: BMJ (2012)

腿痛为临床常见症状,引起腿痛的病变包括骨、关节肌肉、周围血管及周围神经诸多系统病变,甚至包括精神心理因素,涉及专业除骨科外,尚有血管外科、神经内科、糖尿病科甚至精神心理专业.初诊医师应全面检查,确立诊断,非本专业病变及时转至相关专科.本文对膝关节以下的小腿痛的相关基础与临床进行了介绍。
Phase Ib clinical trial of OKN-007 in recurrent malignant glioma.
Authors: James D. Battiste, Alexandra Ikeguchi, Sukyung Woo, Satish Sharan, Yan D. Zhao, Andrew Cohoon, Sarah Sung, Deborah Wright, April M. Teague, Randy L. Jensen, Eun Ha Kim, Won S. Yang, Rheal A. Towner
Journal: Journal of Clinical Oncology (2020)

2538 Background: Despite therapeutic advances, the median overall survival for patients with recurrent, high-grade gliomas remains poor. Thus, there is an urgent need for efficacious new therapies. The nitrone compound, OKN-007 (disodium 4-[(tert-butyl-imino) methyl] benzene-1,3-disulfonate N-oxide) is a promising novel anti-cancer agent. In orthotopic glioblastoma xenografts, OKN-007 reduces cell proliferation and angiogenesis, and increases apoptosis. Here we report on the safety, efficacy, and pharmacokinetics (PK) of OKN-007 in adults with recurrent glioma. Methods: NCT01672463 is a phase Ib trial of OKN-007 in adults with recurrent gliomas previously treated with standard therapy. Patients with recurrence, adequate performance status and organ function, receiving clinically appropriate doses of steroids, with a life expectancy greater than 8 weeks were eligible. OKN-007 was administered by IV. The study comprised a 3+3 dose escalation design followed by an expansion cohort at the maximum tolerated dose (MTD). The dose escalation drug levels were 20 (n = 3), 40 (n = 3), and 60 mg/kg (n = 3), treating on a schedule of thrice weekly for 4 weeks, then twice weekly for 4 weeks, then once weekly until progression. Drug PK was determined in the dose escalation cohorts. The expansion cohort was treated with 60 mg/kg thrice weekly for 12 weeks, then twice weekly for 12 weeks, then once weekly until recurrence (n = 6). Kaplan-Meier analysis was used to determine progression-free (PFS) and overall survival (OS). Results: Median age was 51 years (range, 25-62). No dose-limiting toxicities were observed and 60 mg/kg was chosen for the expansion dose. Of 123 adverse events (AE), 34 were deemed probably (1.6%) or possibly (26%) treatment-emergent (TEAE). The most commonly-occurring TEAE were fatigue (4.1%) and headache (3.3%). No drug-attributable grade 4 or 5 AE were observed. Grade 3 TEAE included headache, urinary tract infection, and increased prothrombin time (0.8% each). Only two grade 1 AE, hypokalemia and dizziness, were considered probably attributable to OKN-007. In patients receiving 60 mg OKN-007/kg, median PFS was 1.4 months and OS was 21 months (log rank p = 0.08 for comparison across doses). Systemic PK exposure was dose proportional. The average half-life of OKN-007 is 2.8 hours. Conclusions: OKN-007 appears safe for patients with recurrent glioma. The MTD was not reached. Our data suggest that, compared to standard therapy, OKN-007 may prolong OS in recurrent glioma. Based on new data, a trial of OKN-007 plus temozolomide is underway in patients with newly diagnosed glioblastoma (NCT03587038). Clinical trial information: NCT01672463 .
4R program results in breast cancer: The impact of 4R Care Delivery Model on timing and sequence of guideline recommended care.
Authors: Christine B. Weldon, Julia Rachel Trosman, Della F. Makower, Bruce D. Rapkin, Claudia Beth Perez, Swati Kulkarni, Cathleen M. Schaeffer, Kent Hoskins, Christopher Gallagher, Shelly S. Lo, Cathy Grace-Louthen, Alyssa Throckmorton, Editha A. Krueger, Jennifer Van Horn, Brieyona Chardee Reaves, Arliene Ravelo, Elaine Yu, Al Bowen Benson, Lidia Schapira, William John Gradishar
Journal: Journal of Clinical Oncology (2020)

15 Background: We previously proposed a 4R care delivery model which enables patients and care teams to manage timing and sequence of interdependent, time sensitive care with a novel multimodality 4R Care Sequence plan (NCI ASCO Teams Project; Trosman, JOP 2016). We report final results of a program which tested 4R at 10 US centers (4 academic and 6 non-academic) from 2016 to 2019. Methods: 4R Sequences were provided to stage 0-III breast cancer patients (4R cohort, N = 422) at participating centers. Analyses of clinical and patient-reported data compared the 4R cohort to a historical control cohort of patients who received care pre-4R at the same centers (N = 466). Results: We significantly improved 5 guideline recommended referral metrics and 4 referral completion metrics indicating receipt of care by patients who were referred (Table). Although significantly increased, referrals to dental visit and smoking cessation before treatment remained low (&lt; 20% and &lt; 10% respectively). Patient survey comments indicated that insufficient lead time to quit smoking or obtain fertility consult before cancer treatment was a key barrier for completing these referrals. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care for most metrics. Future 4R program should optimize the timing of referrals within the 4R Care Sequence to allow sufficient time for smoking cessation and fertility care before treatment initiation. [Table: see text]
绝经后骨质疏松的判断和处理
Authors: 吴宜勇
Journal: BMJ (2004)

骨质疏松的原因是骨组织退化,造成这种退化的原因一方面与随年龄增长的自然衰老有关,另一方面与后天的生长、发育、营养、运动、疾病、生活习惯及生存环境等因素有关.人的一生骨骼代谢一直处于活跃状态,成骨细胞与破骨细胞处于不断更新之中,骨质疏松的病理特点是骨矿含量与骨基质等比例减少,骨皮质变薄,骨小梁减少、变细,甚至断裂.骨量变化可分成3个阶段:骨量上升期,自出生到35岁左右;骨代谢平衡期,女性自30岁到绝经期(50岁左右),男性30岁至70岁左右;第三阶段为骨量减少期,骨量减少导致骨质疏松.骨质疏松的后果是骨折,骨折严重损害患者身体健康,影响生活质量,甚至缩短寿命,骨质疏松引起的经济消耗也会造成社会及家庭的沉重负担.骨折最常见的部位是前臂远端、椎体、髋部,髋部骨折是造成伤残及死亡的最重要原因.妇女绝经后雌激素水平下降,骨丢失率明显高于男性,所以绝经后妇女发生骨质疏松的年龄比男性早约10年,发生比例也显著高于男性,因此对绝经后骨质疏松的防治具有重要意义。
Author Correction: Biallelic mutations in SORD cause a common and potentially treatable hereditary neuropathy with implications for diabetes
Authors: Andrea Cortese, Yi Zhu, Adriana P. Rebelo, Sara Negri, Steve Courel, Lisa Abreu, Chelsea J. Bacon, Yunhong Bai, Dana M. Bis-Brewer, Enrico Bugiardini, Elena Buglo, Matt C. Danzi, Shawna M. E. Feely, Alkyoni Athanasiou-Fragkouli, Nourelhoda A. Haridy, Rosario Isasi, Alaa Khan, Matilde Laurà, Stefania Magri, Menelaos Pipis, Chiara Pisciotta, Eric Powell, Alexander M. Rossor, Paola Saveri, Janet E. Sowden, Stefano Tozza, Jana Vandrovcova, Julia Dallman, Elena Grignani, Enrico Marchioni, Steven S. Scherer, Beisha Tang, Zhiqiang Lin, Abdullah Al-Ajmi, Rebecca Schüle, Matthis Synofzik, Thierry Maisonobe, Tanya Stojkovic, Michaela Auer-Grumbach, Mohamed A. Abdelhamed, Sherifa A. Hamed, Ruxu Zhang, Fiore Manganelli, Lucio Santoro, Franco Taroni, Davide Pareyson, Henry Houlden, David N. Herrmann, Mary M. Reilly, Michael E. Shy, R. Grace Zhai, Stephan Zuchner
Journal: Nature Genetics (2020)
Long-term outcome of 117 patients with Erdheim-Chester disease and mixed histiocytosis receiving targeted therapies (BRAF and MEK inhibitors): A monocentric experience.
Authors: Fleur Cohen-Aubart, Frédéric Charlotte, Ahmed Idbaih, Stéphane Barete, NeLa Benameur, Jean-François Emile, Zahir Amoura, Jean-Philippe Spano, Julien Haroche
Journal: Journal of Clinical Oncology (2020)

7560 Background: Erdheim–Chester disease (ECD), an inflammatory myeloid neoplasm from the L group, is an histiocytosis associated with multisystem infiltration. Around 1500 cases have been reported worldwide since 1930. In 15% of cases, ECD is associated with another histiocytosis corresponding to mixed histiocytosis. Before 2004, 60% of patients died within 3 years after diagnosis. The targetable BRAF V600E mutation is present in as much as 70% of all ECD cases. Targeted therapies (BRAF inhibitors in April 2012, followed by MEK inhibitors after 2015) have revolutionized the therapeutic options and prognosis of refractory ECD and mixed histiocytosis. Methods: This retrospective study was conducted between April 2012 and December 2019 on 117 ECD patients who received targeted therapies in the French National Referral Center for Histiocytosis at Pitié-Salpêtrière Hospital in Paris, France. 28 patients (pts) (24%) had a mixed histiocytosis. Results: 43 (36.7%) pts were female and 95/116 exploitable pts (81.9%) had a BRAF V600E mutation. 12 (10.3%) pts had a co-ocurring hemopathy (myeloproliferative neoplasm or myelodysplastic syndrom). Age at diagnosis was 57.2 yr (+/- 13.8). The main sites of involvement were: vascular (“coated aorta”) in 85 pts (73%), heart in 83 pts (71%), xanthelasma in 30 pts (26%), central nervous system in 56 pts (48%) and peri-renal (“hairy kidney”) in 84 pts (72%). 34 pts (29%) had previously received corticosteroids, and 63 pts (54%) interferon alpha regimen (mainly PEG interferon). 86 (74%) pts received the BRAF inhibitor vemurafenib, and 42 (36%) pts the MEK inhibitor cobimetinib (some patients receiving both). 25 pts died during follow-up. The median survival of patients with targeted therapies in december 2019 was undefined, whereas the patients with no targeted therapies had a median survival of 133 months (HR 0.64 (0.42-0.99); p = 0.04). Among the 117 pts, only 2 had a progression of VAF of mutations within genes frequently mutated in myeloid neoplasms. The most serious adverse events were cutaneous (squamous cell carcinoma, basocellular carcinoma, DRESS) and acute pancreatitis with BRAF inhibitors, whereas chorioretinitis and left ventricular dysfunction were seen with MEK inhibitors. None of the patients receiving targeted therapies progressed. Conclusions: Targeted therapies (BRAF and/or MEK inhibitors) were found dramatically efficacious in 117 patients with severe and refractory ECD and mixed histiocytosis, improving survival of patients.
Epigenetic imprinted gene biomarkers significantly improve the accuracy of presurgical bronchoscopy diagnosis of lung cancer.
Authors: Jian Zhou, Tong Cheng, Xing Li, John P. Pineda, Shaohua Lu, Hongyu Yu, Ming Ding, Xiaonan Wang, Han Si, Panying Shi, Ning Zhou, Chunxue Bai
Journal: Journal of Clinical Oncology (2020)

e21055 Background: The ability to diagnose earlier stages of carcinogenesis using less invasive presurgical tissue samples is especially desirable, but is often inconclusive because of insufficient morphological evidences of cancer. Many of the epigenetic biomarkers are involved in lung cancer, but are challenging to clinically evaluate. In this study, Quantitative Chromogenic Imprinting Gene In-Situ Hybridization (QCIGISH) was applied to directly visualize and quantitatively assess the biallelic and multiallelic alterations of imprinted gene expressions in order to characterize lung cancer carcinogenesis and progression. We updated an imprinted gene panel and developed an accurate lung cancer diagnostic grading model from minimally invasive biopsies using the QCIGISH method. Methods: 225 surgical (151 lung cancer, 74 benign lung lesion) and 95 pre-surgical samples (77 lung cancer, 18 benign lung lesion) were collected from 320 patients under clinical trial NCT03882684 involving five medical centers between 2015 and 2019. The QCIGISH method was applied to detect the allelic expression status of the GNAS, GRB10, SNRPN and HM13 imprinted gene panel. A diagnostic grading model for lung cancer progression was trained using 225 retrospectively collected surgical tissue set with known diagnosis, refined using 25 presurgical samples, and blindly validated using 70 presurgical samples. Results: The diagnostic grading model collectively achieved high sensitivity (98.7%) which is significantly higher than standard presurgical bronchoscopy diagnostic methods including transbronchial brushing (58-74%), transbronchial biopsy (61-75%), alveolar lavage (35-64%) and the combination of the aforementioned three methods (64-80%). Thus, epigenetic imprinted gene biomarkers significantly improve bronchoscopy diagnostic accuracy by 18.7% (98.7% vs 80%), while demonstrating even higher specificity (100% vs 94-96%). Conclusions: Epigenetic imprinted gene biomarkers are shown to be highly accurate in effectively differentiating benign lesions and malignant lung cancer cases. In addition, the improved accuracy demonstrated by QCIGISH over standard presurgical bronchoscopy diagnostic procedures makes it a viable and revolutionary epigenetics-based cancer detection method for practical clinical applications especially for small samples and less advanced grades of lung cancer.
急性亚硝酸钠中毒28例临床分析
Authors: 张瑛, 唐群科, 刘丽君, 陈宗茹, 袁春萍
Journal: BMJ (2007)

2006年3月26日我院急诊收治28例亚硝酸钠急性中毒患者.经积极救治,全部治愈. 一、临床资料 1.一般资料:28例患者系同一村庄农民,因在祭祀活动时误将亚硝酸钠当作食盐炒菜,集体进食后引起中毒.首例发病为32岁男性,发病时间约为进餐后30 min.此后村民们相继发病,误食亚硝酸钠后发病时间为30～90 min.其中男15例,女13例,年龄2～76岁,平均年龄36岁.其中重症患者8例.
肺水肿和急性呼吸窘迫综合征的影像诊断
Authors: 马大庆
Journal: BMJ (2011)

一、肺水肿肺水肿是指肺脏血管外液体增多的病理状态。病变早期液体积聚在肺间质内为间质性肺水肿。病变进展后终末气腔内有液体积聚为肺泡性肺水肿。心源性肺水肿由左心功能不全引起。非心源性肺水肿主要有肾性肺水肿、神经源性肺水肿、高原性肺水肿和复张后肺水肿等。本病主要采用X线胸片检查，典型病例X线胸片可诊断。CT检查用于和其他疾病鉴别[1-2]。
The impact of pattern of tumor response and other post-treatment histologic features on local recurrence in patients treated with neoadjuvant chemotherapy and breast conservation.
Authors: Alison Laws, Ricardo G. Pastorello, Jungeon Choi, Olga Kantor, Samantha Grossmith, Stuart J. Schnitt, Mehra Golshan, Elizabeth A. Mittendorf, Tari A. King
Journal: Journal of Clinical Oncology (2020)

581 Background: Residual disease after neoadjuvant chemotherapy (NAC) is a poor prognostic factor. The relationship between the pattern of tumor response and other post-treatment histologic features on local recurrence (LR) is not well studied. Methods: We identified 380 patients (pts) treated with NAC, breast-conserving surgery and radiation from 2002-2014. Pts with available surgical slides underwent detailed pathology review. Pathologic complete response (pCR) was defined as no invasive or in situ disease in the breast or axilla. Pattern of tumor response was defined as: none, scattered, or concentric. The degree of treatment effect was categorized as: absent, mild or marked. Univariate (UVA) and multivariate analyses (MVA) were performed to identify factors associated with LR. Results: 243 (64%) cases had complete slides available and formed the study cohort. 76 (31%) were ER+/HER2-, 90 (38%) ER-/HER2- and 77 (31%) HER2+. 98% of HER2+ pts received neoadjuvant trastuzumab; 89% of ER+ pts received adjuvant endocrine therapy. At median follow-up of 75 months, 10/243 (4.1%) pts had LR and 5-yr LR-free survival was 95.7%. LR occurred in 1/76 (1.3%) pts with breast pCR, 1/19 (5.2%) with residual DCIS, and 8/148 (5.4%) with residual invasive disease; including 6/78 (7.7%) with scattered tumor response, 2/46 (4.3%) with concentric response and 0/24 with no response. On UVA, age (OR &lt; 50 vs ≥50 5.9, p = 0.03) and residual DCIS with comedonecrosis (OR 8.2, p &lt; 0.01) were significantly associated with LR. Presence of tumor bed at the margin (OR 4.6, p = 0.06) approached significance. The odds of LR were higher with scattered regression (OR 1.83 vs. concentric, p = 0.47) and lower with breast pCR (OR 0.23, p = 0.17), but these results were not statistically significant. Multicentric disease, receptor status, ypT, ypN, RCB score, degree of treatment effect, high-grade residual invasive disease, margin status of residual disease and lymphovascular invasion were not associated with LR (all p &gt; 0.05). Age (OR &lt; 50 vs ≥50 7.4, p = 0.04) and residual DCIS with comedonecrosis (OR 7.5, p = 0.02) remained significant on MVA. Conclusions: With modern systemic therapy, LR rates after NAC, breast-conserving surgery and radiation are low, with less than 5% of patients experiencing a LR after a median follow-up of over 6 years. Young age and residual DCIS with comedonecrosis were associated with LR, but not pattern of tumor response.
芬太尼贴剂治疗癌症疼痛48例疗效观察
Authors: 张燕, 冯斌, 孙雅红, 张保轩, 范开席, 韩明勇, 郭其森, 宋丽华
Journal: BMJ (2005)

疼痛是严重影响晚期癌症患者生活质量的重要因素之一,控制癌痛愈来愈受到广泛关注.根据WHO三阶梯癌症疼痛治疗方案,阿片类药物已成为治疗中重度癌痛的标准药物.芬太尼透皮缓释贴剂与传统的口服药物相比具有用药方便、副作用小等优点.我科应用芬太尼透皮贴剂治疗晚期癌痛患者48例,取得较好疗效,现报告如下。
下肢深静脉血栓形成的诊断和治疗
Authors: 吴庆华, 寇镭
Journal: BMJ (2012)

下肢深静脉血栓形成和肺动脉栓塞是血管外科常见疾病,有很高的致残和致死率,也是全科医师经常要处理的一种疾病.本文结合国内外指南和专家共识,介绍如何早期识别和诊断本病,告知诊断的方法、治疗的原则.希望通过本文有助于全科医师的临床工作。
Apatinib to prolong overall survival from recurrence to death in metastatic breast cancer: A single-center experience from east China.
Authors: Lei Shi, Zhanhong Chen, Xiaojia Wang
Journal: Journal of Clinical Oncology (2020)

e13090 Background: To observe the efficacy and side effects of apatinib in patients with metastatic breast cancer in non-clinical trial setting. Methods: Patients with metastatic breast cancer who were treated in Zhejiang Cancer Hospital from January 2014 to September 2019 were collected from the hospital information system. According to whether patients were treated with apatinib, they were divided into apatinib group and control group. There were significant differences in baseline data such as the age of onset between the two groups, and the propensity score match was used to ensure balance. The survival time from the first recurrence to death was compared between the two groups. The progression-free survival, the incidence of side effects and the types of side effects of apatinib were observed. The prognostic factors of apatinib were also analyzed. Results: There were 297 patients who met the criteria, of whom 40 received apatinib treatment. After propensity score match, the balance of the two groups was guaranteed. Compared with the control group, the hazard ratio of apatinib group was 0.111 from first recurrence to death (95% confidence interval: 0.022 to 0.556, p = 0.007). The median progression-free survival of apatinib was 8 months. Patients often received apatinib at the end of the disease. And 67.5% (27/40) of patients received apatinib at the end line. 52.5% (21/40) of patients had adverse reactions, and common adverse reactions included myelosuppression (7/40), fatigue (6/40), hypertension (6/40), proteinuria (5/40), skin and mucosal reactions (5/40) and so on. Three of them had grade Ⅲ to Ⅳ adverse reactions, including hypertension, myelosuppression and skin ulceration. Severe adverse reactions increased the risk of progression-free survival with apatinib. Its hazard ratio is 10.103 (95% confidence interval: 1.149 to 88.825, p = 0.037). Conclusions: As the choice of multi-line therapy for metastatic breast cancer, apatinib can prolong the survival time after recurrence. The adverse reactions are common, so it is necessary to guard against the severe adverse reactions that lead to poor prognosis.
Logistic regression analysis of risk factors for systemic inflammatory response syndrome with preoperative Stanford type B aortic dissection
Authors: Xiuhui Pang, Liang He, Yukui Du, Xiubin Yang, Maimaitiaili Aizezi, Li Zhang, Ayibieke Naibi, Sheng Guo, Yongzhong Guo, Jun Liu, Zonggang Zhang
Journal: International Journal of Surgery (2016)
Health education in community health-care service in Shanghai
Authors: Qian Chen, Xiang-jie Zhang, Ming-hui Peng, Shan-zhu Zhu
Journal: BMJ (2009)

Objective To study current status of health education and explore its pattern in community health-care service(CHS)in Shanghai.Methods A total of 200 health-care workers(HCWs)from five CHS centers in Shanghai were investigated by questionnaire of health education knowledge.Results Among 200 HCWs investigated,96.5%(193/200)of them have recognized importance of health education,98.0%(196/200)could undertake health education in their clinical work,only 60.5%(121/200)had receired regular training on it,and 85.5%(171/200)thought they should be further trained regularly.Correct awareness of knowledge was 94.O%.47.0%and 33.6%for health education perception,healthy life-style and health education knowledge for chronic disease.respectively in them.There was very significant difference in correct awareness of knowledge between HCWs with varied ages and districts(χ2=17.663 and 82.376,P=0.001 and 0.000,respectively),but no significant difierence was found between men and women and those with varied professional titles(χ2=0.015 and 2.406,P=0.903 and 0.300.respectively).Short of time(48.5%),lack of relevant knowledge(15.0%)in HCWs and poor compliance of patients(33.0%)were main factors influencing their implementation of health education.Conclusions HCWs in CHS have already recognized importance of health education.but have not known enough its theoretical knowledge and skills.It is necessary to set guidelines of health education intervention for HCWs in CHS,and perfect monitoring and evaluation.as well as mechanism for rewards and penalties to promote development of health education in CHS.

Key words: 
Community health services; Health education; Questionnaries