tbuckley/cabot-search huggingface dataset:
Genomic landscape and immune phenotype of malignant pleural mesothelioma.
Authors: Meera Patel, Andrew Elliott, Stephen V. Liu, Chul Kim, Luis E. Raez, Rebecca Feldman, Sachin Gopalkrishna Pai, Antoinette J. Wozniak, Misako Nagasaka, Gilberto Lopes, Alexander I. Spira, Edward S. Kim, Wolfgang Michael Korn, Hirva Mamdani
Journal: Journal of Clinical Oncology (2020)

9056 Background: Malignant pleural mesothelioma (MPM) is a relatively uncommon malignancy with poor prognosis and no major therapeutic breakthroughs over the past decade. Better understanding of the genomic landscape and distribution of immune biomarkers in this disease has the potential to enable development of novel therapies. Methods: We analyzed molecular profiles of 222 MPM tumors using next-generation sequencing of 592 genes utilizing Caris Life Sciences platform. Genes were grouped into pathways: DNA damage repair (DDR) ( ATM, BRCA2, BRIP1, BAP1, CHEK2, ERCC2, FANCA/D2/E/L, MLH1, MSH6, MUTYH, NBN, PMS2, RAD50/51B, WRN), cell cycle regulation including TP53 ( RB1,CCNE1, CDKN2A, CCND1, CCND3, CDKN1B), chromatin remodeling (CR) ( ARID2, ASXL1, DNMT3A, EP300, EZH2, KDM6A, KMT2C, KMT2D, NSD3, PBRM1, SMARCB1/A4, SETD2), RAS/MAPK ( KRAS, MAP2K1, NF1, NF2), and PI3K/AKT ( AKT, PIK3CA, PIK3R1/R2, PTEN, RICTOR, TSC1, TSC2, ZNF703). Tumor mutational burden (TMB), PD-L1 expression (SP142 IHC, tumor staining), and MSI/MMR were analyzed. Seventy-two cases also had whole transcriptome sequencing data. Differences in alterations were compared for age, gender, and pathways. Results: Median age of patients (pts) was 72 yr (range, 37-90), 73% were male. Gene pathway alterations were seen in 81% of cases. DDR, specifically homologous recombination (HR), was the most commonly mutated pathway (36.9%), followed by RAS (25.2%) and CR (18.9%). Genes mutated in ≥5% of cases included BAP1 (26.3%), NF2 (23.5%), TP53 (15.5%), SETD2 (10.2%). PD-L1 was high (≥50% tumor cells positive) in 11.4% (n = 24), intermediate (1-49%) in 31.4% (n = 66), and negative ( &lt; 1%) in 57.1% (n = 120) pts. TMB was high (≥10 mutations/Mb) in 9.6% of tumors (n = 20). None of the tumors were dMMR/MSI-H. HR gene BAP1 and CR gene SETD2 mutations trended to be more prevalent in pts ≥70 yo (p = 0.02). CR trended to be more commonly mutated in females (p = 0.02). No other significant differences were found in specific gene/pathway alterations, PD-L1 expression, or TMB in the context of age and gender. Distribution of PD-L1 expression was not different among various pathways. No highly recurrent, targetable fusion isoforms were seen among the 85 identified (mean 1.1 fusions/tumor), which have not yet been characterized for pathogenicity. Conclusions: The majority of MPM tumors harbor alteration in one of the key cellular pathways. HR pathway mutations are the most common. The majority of tumors were PD-L1 negative and carry low TMB indicating low immunogenicity. No age and gender specific differences exist except for BAP1 and SETD2 mutations.
髂骨骨纤维结构不良一例
Authors: 孙骏, 张如明, 张琥, 史萌, 陈俭波
Journal: BMJ (2008)

患者女,57岁.因左侧腰部及臀部疼痛1年,加重2月余,于2006年6月7日入院.患者1年前开始出现左侧腰部及臀部疼痛,近2月余有加重,并伴有左下肢的放射痛.体检腰椎棘突及两侧压痛(±),双下肢感觉肌力正常,双侧直腿抬高试验阴性,双膝踝反射正常.腰椎平片示退变,骨盆平片未见异常,腰椎MRI示第5腰椎与第1骶椎间盘左后突出.给予卧床,腰椎牵引以及对症镇痛治疗。
Trastuzumab with trimodality treatment for esophageal adenocarcinoma with HER2 overexpression: NRG Oncology/RTOG 1010.
Authors: Howard Safran, Kathryn A. Winter, Dennis A. Wigle, Thomas A. DiPetrillo, Michael G. Haddock, Theodore S. Hong, Lawrence P. Leichman, Lakshmi Rajdev, Murray B. Resnick, Lisa A. Kachnic, Samantha A. Seaward, Harvey J. Mamon, Dayssy Alexandra Diaz Pardo, Carryn M. Anderson, Xinglei Shen, Anand K. Sharma, Alan W. Katz, Jonathan C. Salo, Kara Lynne Leonard, Christopher H. Crane
Journal: Journal of Clinical Oncology (2020)

4500 Background: Trastuzumab is a monoclonal antibody against human epidermal growth factor receptor 2 (HER2). The primary objective of RTOG 1010 was to determine if trastuzumab increases disease-free survival (DFS) when combined with trimodality treatment for patients with HER2 overexpressing esophageal adenocarcinoma. Methods: This open label, randomized phase III trial included patients with newly diagnosed stage T1N1-2, T2-3N0-2 adenocarcinoma of the esophagus involving the mid, distal, or esophagogastric junction and up to 5cm of the stomach. All patients received chemotherapy (C) of paclitaxel, 50mg/m 2 and carboplatin AUC = 2, weekly for 6 weeks, with radiation (XRT: 3D-CRT or IMRT, 50.4 Gy in 28 fractions) followed by surgery. Patients were randomized 1:1 to receive weekly trastuzumab 4mg/kg week 1 then 2mg/kg/weekly x 5 during CXRT then 6 mg/kg for 1 dose prior to surgery and 6mg/kg every 3 weeks for 13 treatments after surgery. HER2 status was determined by IHC and gene amplification by FISH. With a 2-sided alpha of 0.05, 162 DFS events provide 90% power to detect a signal for an increase in median DFS from 15 to 25 months. DFS and overall survival (OS) were estimated by the Kaplan-Meier method. and arms were compared using the log rank test. The Cox proportional hazards model was used to analyze treatment effect. Results: 571 patients were entered for assessment of HER2 expression, 203 HER2+ patients randomized. The median follow-up for alive patients is 5.0 years. The estimated 2, 3, and 4-year DFS (95% CI) for the CXRT +trastuzumab arm were 41.8% (31.8%, 51.7%), 34.3% (24.7%, 43.9%), and 33.1% (23.6%, 42.7%), respectively, and for the CXRT arm were 40.0% (30.0%, 49.9%), 33.4% (23.8%, 43.0%), and 30.1% (20.7%, 39.4%), respectively; log-rank p = 0.85. The median DFS time is 19.6 months (13.5-26.2) for the CXRT +trastuzumab arm compared to 14.2 months (10.5-23.0) for the CXRT arm. The hazard ratio (95% CI) comparing the DFS of CXRT+trastuzumab arm to the CXRT arm was 0.97 (0.69, 1.36). The median OS time was 38.5 months (26.2-70.4) for the CXRT+trastuzumab arm compared to 38.9 months (29.0-64.5) for the CXRT arm, hazard ratio (95% CI): 1.01 (0.69, 1.47). There was no statistically significant increase in treatment-related toxicities with the addition of trastuzumab including no increase in cardiac events. Conclusions: The addition of trastuzumab to trimodality treatment did not improve DFS for patients with HER2 overexpressing esophageal adenocarcinoma. Supported by NCI grants U10CA180868, UG1CA189867, U10CA180822 and Genentech. Clinical trial information: NCT01196390 .
大脑前动脉闭塞致胼胝体梗死二例
Authors: 朴明淑, 姜春莉, 刘春颖, 刘淑杰
Journal: BMJ (2005)

例1 女,60岁,因突发不能讲话、右侧肢体不能活动、尿失禁1 d入院.既往冠心病病史5年,无高血压、糖尿病病史.查体:神志清楚,情感淡漠,感觉性失语,不能按医生指令完成动作,如伸舌、系扣等,但自发能完成上述动作,右上肢肌力Ⅲ级,右下肢肌力Ⅰ级,右下肢精细、复杂及深感觉障碍明显,右下肢病理反射(+).头部核磁共振成像(MRI)平扫:左尾状核头、胼胝体嘴、膝部、体部大片状等T1WI长T2WI信号病区,边界清楚.头部增强核磁血管造影(MRA):左前交通动脉、左大脑前动脉未显示(图1).入院后予降纤、抗凝等治疗,住院第 3周表情较前明显丰富,问话能答,自发语言流利,语量减少,行走自如。
First-line pembrolizumab (pembro) monotherapy in advanced non-clear cell renal cell carcinoma (nccRCC): Updated follow-up for KEYNOTE-427 cohort B.
Authors: Jae-Lyun Lee, Marek Ziobro, Cristina Suarez, Przemyslaw Langiewitz, Vsevolod Borisovich Matveev, Pawel Wiechno, Rustem Gafanov, Piotr Tomczak, Frédéric Pouliot, Frede Donskov, Boris Alekseev, Sang Joon Shin, Georg A. Bjarnason, Daniel Castellano, Xiaoqi Du, Rodolfo F. Perini, Karla Rodriguez-Lopez, David F. McDermott, Michael B. Atkins
Journal: Journal of Clinical Oncology (2020)

5034 Background: KEYNOTE-427 (NCT02853344), a single-arm, open-label, phase 2 study, showed antitumor activity with first-line pembro monotherapy in nccRCC (cohort B). Studies of RCC and immune-oncology have shown that depth of tumor response may correlate with long-term benefit. We present the association between depth of response and OS plus updated efficacy and safety data in cohort B. Methods: Pts with histologically confirmed nccRCC, who did not receive prior systemic therapy, and who have measurable disease (RECIST v1.1) received pembro 200 mg IV Q3W for 2 y or until progressive disease, unacceptable toxicity, or withdrawal. End points were ORR (primary), DOR, and PFS (RECIST v1.1); OS; and safety. Association between depth of response, defined as maximum reduction from baseline in sum of target lesions, and OS was evaluated using a Cox proportional hazards model with target lesion reduction group as time-varying covariate. Results: Of 165 pts, 72% had papillary histology, 13% had chromophobe histology, and 16% were unclassified. Median time from enrollment to data cutoff was 18.7 mo (range, 9.9-26.0). ORR was 26.1% (95% CI, 19.5-33.5; 10 CRs, 33 PRs). Median (range) DOR was 15.3 mo (2.8-21.0+); 57.3% had DOR ≥12 mo. At 18-mo, PFS rate was 18.9% and OS rate was 67.0%. Most pts (58.8%) had some reduction in target lesions. Pts with a &gt; 30% reduction in target lesions had an increased probability of survival (Table). ORR (95% CI) was similar for papillary (28.0% [20.1-37.0]) and unclassified (30.8% [14.3-51.8]) histology but lower for chromophobe (9.5% [1.2-30.4]). OS rates at 18 mo were 70.8%, 66.7%, and 50.0 in the papillary, chromophobe, and unclassified groups, respectively. Treatment-related AEs (TRAEs) occurred in 67.9% of all pts, primarily pruritus (19%), hypothyroidism (14%), and fatigue (14%). Grade 3-5 TRAEs occurred in 14% of pts; 2 pts died of TRAEs (pneumonia and cardiac arrest). Conclusions: First-line pembro monotherapy continued to show antitumor activity in nccRCC with no new safety concerns. In general, for pts who had greater reductions in target lesions, the trend was toward improved OS; pts with reduction of tumor burden ≥80% had comparable long term outcomes to those who achieved a RECIST 1.1 defined CR. Clinical trial information: NCT02853344 . [Table: see text]
救治多发伤342例
Authors: 黄海波, 王成旭, 孙树杰
Journal: BMJ (2006)

自2001年1月至2005年6月我院急诊科抢救多发伤患者342例,疗效满意,现报告如下. 1.对象与方法:男254例(74.3%),女88例(25.7%).年龄10～71岁,平均32.6岁.致伤原因:交通事故伤236例(69%),坠落伤62例(18%),其他伤44例(13%).损伤部位:颅脑214例,胸部121例,腹部82例,四肢骨盆186例,脊柱及其他部位76例.其中≥2个脏器损伤236例(69%),≥3个脏器损伤172例(50%).损伤程度评分(injury severity score,ISS)为(32±9)分,格拉斯哥昏迷评分(GCS)为(8±5)分。
神经系统疾病诊断入门
Authors: 龚涛
Journal: BMJ (2010)

龚涛:神经病学是研究神经系统及骨骼肌疾病的一门学科.神经系统包括中枢神经系统与周围神经系统,中枢神经系统包括脑、脊髓;周围神经系统包括进出大脑的12对颅神经及进出脊髓的31对脊神经;其附属结构包括脑血管、脑膜与脑脊液。
Pilot study for the use of wearable devices for patients undergoing oral chemotherapy.
Authors: Monaliben Patel, Matthew M. Cooney, Paolo Fabrizio Caimi, Rory Eric Randall, Leland L. Metheny, Prateek Mendiratta, Debora S. Bruno, Paula Silverman
Journal: Journal of Clinical Oncology (2020)

e14103 Background: The rapid development of digital technology holds enormous potential to transform the delivery of cancer care. Despite these digital innovations, we still face significant challenges in healthcare in using these emerging digital technologies in the clinical setting. Clinicians generally underestimate the severity and extent of chemotherapy toxicity of patients. This project seeks to conduct an exploratory field study to collect patient feedback on their experiences, and the design/functionality of the prototype of the digital health service platform designed to monitor their symptoms. Methods: Using the National Cancer Institute item library addressing the most common symptoms for chemotherapy toxicity, a digital health platform was designed by Samsung Research America (SRA) and University Hospitals. Patients age ≥ 18 years old, willingness to agree to the consent document, ability to understand use of wearable device and willingness to answer patient reported outcomes questions were included in this study. Patients who are not undergoing oral chemotherapy treatment for their cancer were excluded. Patients were given a phone that had our designed platform along with a watch. The watch had the capability of tracking blood pressure, heart rate, and pulse oximetry. Patients were set up with an electronic account that queried them on patient Reported Outcomes (PRO) regarding potential toxicity they may be experiencing. They were also able to track medication consumption and input their weight. Subjects were be asked to use the wearable device and phone for at least 28 days and no more than 90 days. At the end of the study, a phone survey was attempted. Results: Total patients enrolled: 21. 18/21 (85.7%) patients completed the 90 days of the study. Only 9 patients provided PRO with total number of side effects reported 28 times. Watch device was only utilized by 15/21 (71.4%) patients. On an average across 90 days, these patients wore the watch 430 minutes per day. At the end of the treatment, 5 patients agreed to participate in the phone survey. Three patients stated that they would do similar study in the future noting that the digital platform helped them stay on track and monitor symptoms accurately. Every patient questioned had a complaint regarding the watch functionality. Patients also found it difficult to carry a second phone in addition to their personal phone. Conclusions: Improving our digital health service platform will get us closer to achieving effective bi-lateral patient communication and ultimately improving patient care.
To improve clinical ability of general practitioners through two-way referral system
Authors: Zhaoxia Yin
Journal: BMJ (2016)

随着国务院《关于推进分级诊疗制度建设的指导意见》的发布，分级诊疗将成为医疗体制改革的重点。全科医生在分级诊疗推行、实施过程中的地位与作用举足轻重。文章从全科医生工作性质、特点等方面探讨全科医生在分级诊疗中的作用、应具备的能力，提出全科医生应以分级诊疗为契机，提升自我能力，实现自身价值。
A survey on anxiety status in patients over 60 years old from one community health service center in Shanghai
Authors: Si Li, Hongyang Gao, Liming Tang, Juan Shou, Lin Chen, Xiaoyi Che
Journal: BMJ (2018)

Objective
To investigate the prevalence and related risk factors of anxiety symptoms in elderly patients from one community health service center in Shanghai.


Methods
Patients aged 60 to 85 years visiting Kongjiang Community Health Service Center from August to December of 2016 were included in the survey. The patients were evaluated with Generalized Anxiety Disorder Scale-7 (GAD-7), Sociodemographic and Health-related Variables Questionnaire, Mental Health Knowledge Scale and Lubben Social Network Scale-6(LSNS-6).


Results
Total 2 006 questionnaires were distributed and 1 981 valid questionnaires were returned with a recovery rate of 98.75%. The overall GAD-7 score was 0(0, 2), and 13.5% (267/1 981) participants had positive anxiety symptoms. Multivariate logistic analysis showed that 6 variables were related to anxiety symptoms, including educational background, exercise frequency, percentage of medical costs over total household expenses, life satisfaction, the amount of chronic somatic disease, mental health knowledge awareness (P<0.05).


Conclusion
The prevalence of anxiety symptoms in the study population is relatively high. Anxiety symptoms are associated with multiple factors, to which the attentions should be paid.


Key words: 
Anxiety; Community health center; Aged
现场急救时危重症的正确判断与基本对策
Authors: 冯庚
Journal: BMJ (2004)

当危重症突然发生之后,患者性命攸关的时刻恰恰是在入院前.在此期间患者能否得到及时正确的现场急救至关重要.在发病现场抢救突发危重症患者与院内有很大不同.首先是环境条件较差,从场地到光线,到各种干扰因素等等现场条件都无法和医院同日而语;第二是医务人员数量少,急救常常是基层的全科医生单独工作,缺少上级医生和同行的配合、指导和商讨;第三是装备差,缺乏复杂的检查和治疗设备.在这种特殊的条件下怎样开展工作,怎样利用简陋的装备尽快做出正确的现场判断和治疗方针进而拯救患者的生命,是需要研究和探讨的课题。
Communicating cancer and its treatment to Australian Aboriginal patients with cancer: A qualitative study.
Authors: Ian N. Olver, Kate M Gunn, Vikki E Knott, Alwin Chong, Kristiaan Spronk, Joan Cunningham
Journal: Journal of Clinical Oncology (2020)

e24188 Background: To enable clinicians to effectively communicate about cancer and its treatment to Aboriginal and Torres Strait (Aboriginal) people with cancer who need to make informed choices about the Western medicine offered, we sought strategies from health professionals with experience in that field. Methods: Semi-structured interviews were conducted face-to face or via telephone with the experienced health professionals and audio-recorded. Thematic analysis using a bottom up, essentialist/realist approach was employed to analyse the data, when data saturation was reached. Results: The 23 health professionals interviewed were medical and radiation oncologists, oncology nurses and Aboriginal health workers. Twelve were female, 11 were male with 5 identifying as Aboriginal. Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves avoiding assumptions, allowing time, considering the physical environment, asking about home and family, being aware of gender issues and noting non-verbals. (2) Employ specific strategies to explain cancer, treatment and its side effects by using simple language, employing visual aids such as drawings, metaphors and relatable analogies such as trees with roots, weeds, abandoned rusty cars and blocked pipes. Use repetition and ensure alignment with patient needs. Warning about upcoming sensitive issues minimised the chance of disengagement. (3) Obtain support from those who can assist in communication. This includes interpreters, aboriginal liaison officers and health workers, and patient escorts. (4) Consider the culture which involves collective decision-making, strong connection to country and community, with cultural obligations and unique understanding of cancer which can involve curses, shame and utilise bush medicine. (5) Develop personal qualities of good communicators, including showing respect, patience, empathy, honesty, being person centred and embracing personal reflection. (6) Understand the contextual complexity of multiple languages, possible disengagement with treatment, difficulty maintaining contact with patients, conflicts between Western medicine and Aboriginal culture and late stage presentations. Be aware of practitioner bias. Conclusions: These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal people with cancer and enable the creation of educational modules for inexperienced clinicians.
急性肺栓塞溶栓和抗凝治疗中的几个问题
Authors: 梁瑛
Journal: BMJ (2006)

临床最常见的急性肺栓塞类型是形成于下肢或盆腔静脉的血栓突然堵塞肺动脉而引起相应肺实质血液供应受阻的一组病症,我们称其为肺血栓栓塞症(pulmonary thromboembolism,PTE),简称肺栓塞(PE),其致死、致残率很高.目前对PE的治疗已经取得了长足进展,特别是溶栓、抗凝治疗.实践证明PE是可以治疗的,如果诊治及时,方法正确,92%以上的患者可以生存或治愈.下面就有关PE的溶栓、抗凝治疗浅谈几个问题。
The impact of complications after diagnostic biopsy on repeat biopsy in men: Results from the Prostate Cancer Research International: Active surveillance (PRIAS-JAPAN) study.
Authors: Yoichiro Tohi, Takuma Kato, Ryuji Matsumoto, Nobuo Shinohara, Akira Yokomizo, Koji Mitsuzuka, Masaki Nakamura, Haruki Kume, Mikio Sugimoto
Journal: Journal of Clinical Oncology (2020)

e17616 Background: Active surveillance(AS) is the strategy to avoid the overtreatment for favorable prostate cancer. For safer AS protocol execution, repeat protocol biopsy is essential in evaluating cancer aggressiveness accurately. However, some men on AS refuse repeat protocol biopsy because of burdens on biopsy. We aimed to assess the complications of prostate biopsy and the impact of complications after diagnostic biopsy on repeat protocol biopsy from the analysis Japanese cohort forming part of the Prostate cancer Research International: Active surveillance (PRIAS) study. Methods: PRIAS-JAPAN started in January 2010, 39 institutions are participating in this study. Men are prospectively followed and repeat protocol biopsy are planned at 1 year and 4 years thereafter, or if prostate specific antigen-doubling time is &lt; 10 years. Data was collected on the complications such as infection, hematuria, hematospermia, pain, and antibiotics, and approach of biopsy, retrospectively. We compared the complications in diagnostic biopsy between repeat biopsy acceptance group and repeat biopsy non-acceptance group at 1 year. Results: From 2010 to 2018, 862 men with low-risk prostate cancer were prospectively enrolled in PRIAS-JAPAN. 794 men (92%) actually proceeded to protocol at 1 year. Of the 794 men, repeat protocol biopsy non-acceptance rate at 1 year was 18.4%(146 men). According to differences in the complications of diagnostic biopsy, hematuria(p = 0.003) and pain(p &lt; 0.001) rate were significantly higher in repeat biopsy non-acceptance group, but infection(p = 0.105) and hematospermia(p = 0.224). Approach of biopsy(p = 0.651) was not different in two groups. Conclusions: Hematuria and pain in diagnostic biopsy were significantly more frequent in repeat biopsy non-acceptance group. Our study supports the importance of adequate explanation and management of the complications at biopsy to improve the rate of protocol biopsy acceptance. [Table: see text]
高血压性视网膜病变误诊误治一例
Authors: 马路生, 高磊, 徐雁冰
Journal: BMJ (2006)

患者女,15岁,因头痛头晕3年,加重1个月,近期发生晕厥后双眼视物不清,于2005年11月14日就诊于当地市级医院眼科,并以双眼视乳头网膜炎收住院.患者当时最佳矫正视力双眼均为1.0.入院后以静脉滴注或口服大剂量糖皮质激素治疗为主,辅以改善眼底循环及代谢的药物共15 d,期间患者头痛加重,恶心、呕吐剧烈,转我院就诊。
Analysis of clinical competence test results of general practitioners in Shanghai Pudong New Area
Authors: Yaling Li, Dongmei Luo, Fang Zhang, Yao Li, Juan Shou, Zhaohui Du
Journal: BMJ (2017)

Objective
To analyze the clinical competency test results of general practitioners (GPs) in Shanghai Pudong New Area.


Methods
Total 1 160 GPs from Pudong New Area attended the clinical ability tests, all participated in theory test and 327 GPs attended practice skill tests.The results were reviewed by computer and the scores were automatically generated.


Results
The average score and pass rate of theory test were (64.24±12.23) points and 64.2% (745/1 155), respectively.The average scores of GPs with master or above degree were the highest (67.09±13.38 points), however, the pass rate of GPs with undergraduate degree was the highest (69.7%, 349/501). GPs with senior professional title got the highest average score and pass rate [68.26±9.92 points and 82.7% (43/52), respectively]. Introduction to General Practice (69.7%), Internal Medicine (68.6%) and Cancer (66.9%) were the top 3 subjects with the highest correct rate.The pass rate of clinical skills was 39.1% (128/327), GPs with master degree or above (192.87) and those with junior professional titles (171.08) had the highest scores.GPs with master degree or above (50.0%, 8/16) and those with intermediate professional title (40.1%, 97/242) had the highest pass rate.


Conclusions
The analysis shows that the average score and pass rate of both theory test and clinic practice skills test are not satisfactory among GPs in Shanghai Pudong New Area.The clinical ability of GPs need to be further improved, and the study of some specific disciplines need to be further strengthened.


Key words: 
Clinical competence; General practitioners
进食烤肉串致急性亚硝酸盐中毒一例
Authors: 张林, 徐迎明, 修旭日
Journal: BMJ (2007)

患儿男,9岁,因周身皮肤青紫1 h,抽搐、昏迷、呼吸困难30 min急诊来院.发病前2天在烧烤摊点进食烤肉串约20串.食后1 h出现脐周疼痛,排黄色稀便2次,口唇、指甲及全身皮肤青紫.30 min后出现呼吸困难,四肢抽搐,意识逐渐丧失.查体:脉搏140次/min,呼吸34次/min,血压60/10 mm Hg(8/1.33 kPa).深昏迷,口唇、指甲及全身皮肤呈紫黑色,双侧瞳孔等大等圆,光反射正常。