tbuckley/cabot-search huggingface dataset:
Serum heart-type fatty acid-binding protein and platelet activating factor levels in Kawasaki disease and their clinical significance
Authors: Ze Hong, Xing-zhen Sun
Journal: BMJ (2011)

Forty six children with Kawasaki disease (observer group) were classified as coronary artery lesions (CAL) subgroup (19 cases) and non-coronary artery lesions (NCAL) subgroup (27 cases)according to echocardiography; 50 healthy children served as control group.Serum heart-type fatty acidbinding protein (h-FABP), platelet activating factor (PAF), cardiac tropnin Ⅰ (cTnI) and creatine kinase isoenzyme MB (CK-MB) levels of all subjects were detected.The results showed that the h-FABP and cTnI levels and positive rate in observer group were higher those in control group (P ＜ 0.05 ), while there were no differences in CK-MB level and positive rate between two groups ( P ＞ 0.05 ).The h-FABP positive rate in observation group was higher than the positive rates of cTnI and CK-MB (P ＜0.05).The PAF level, PLT and polymorphonuclear neutrophil count in observer group were higher than those in control group ( P ＜0.05).The h-FABP and PAF levels in CAL subgroup were higher than those in NCAL subgroup (P ＜0.05).The results suggest that serum h-FABP and PAF can be used as diagnostic indicators for Kawasaki disease complicated with coronary artery lesions.

Key words: 
Mucocutaneous lymph node syndrome;  Fatty acid-binding proteins
Risk of hypocalcemia in cancer patients treated with cabozantinib: A meta-analysis.
Authors: Adam Khorasanchi, Shenhong Wu
Journal: Journal of Clinical Oncology (2020)

e17067 Background: Cabozantinib as a multiple tyrosine kinase inhibitor has been used extensively in cancer treatment and clinical trials, and is associated with the development of hypocalcemia. Its impact on calcium metabolism is not clear. We have performed a meta-analysis to determine the overall risk of hypocalcemia with cabozantinib in cancer patients. Methods: Databases including PubMed and Google Scholar until January 2020 were used to identify relevant studies. Studies of patients assigned to cabozantinib with available data on hypocalcemia were included. Incidence and relative risk (RR) of hypocalcemia were calculated using a random-effects or fixed effects model, depending on the heterogeneity of the included studies. Results: 88 articles were screened with a total of eight studies including 1,460 cancer patients were selected for analysis. For patients receiving cabozantinib, the overall incidences of all-grade and high-grade (grade 3 or 4) hypocalcemia were 15.5% (95% CI: 12.1-42.5%) and 3.5% (95% CI: 1.1-6.8%), respectively. The incidences of all-grade and high-grade hypocalcemia varied significantly with tumor types and cabozantinib dose. Cabozantinib was associated with a significantly increased risk of all-grade and high-grade hypocalcemia with RR of 6.2 (95% CI: 2.6-14.5, p &lt; 0.001) and 10.7 (95% CI: 2.0-56.2, p = 0.005) in comparison with controls including placebo or sunitinib. Conclusions: Cabozantinib was associated with a significantly increased risk of developing all-grade and high-grade hypocalcemia in cancer patients. Further studies are needed to understand the effect of cabozantinib on calcium metabolism and patient outcome.
Analysis of microsatellite instability differences in eight types of tumors.
Authors: Zhen Zhang, Xing Zhang, Minhui Ge, Huijuan Qin
Journal: Journal of Clinical Oncology (2020)

e15174 Background: Microsatellite instability-high (MSI-H) is the gain or loss of nucleotides from repetitive DNA caused by genomic hypermutability and a powerfully predictive phenotype for diagnosis, immunotherapy and prognosis in various types of cancer. Herein, we analyze the frequency of MSI-H for the understanding of epidemiology of MSI-H across major types of human cancer. Methods: MSI value was calculated by bioinformatics algorithm based on NGS from 539 genes panel in tumor tissue. Patients were divided into three classes as MSI-H, MSI-L and MSS based on MSI value. MSI-H was defined as above 10% positive of the 195 tested microsatellites sites, and this method was totally consistent with conventional MSI-PCR testing in research and development sample verification. We compared the differences of MSI-H ratio in eight types of human cancer including liver cancer, bile duct cancer, gastric cancer, colorectal cancer, pancreatic cancer, melanoma, glioma and lung cancer from 874 cancer cases via χ 2 test, adjusted standardized residual or Fisher's exact test. Results: The ratios of MSI-H in eight types of solid tumors were 0% in 32 patients with bile duct cancer or 27 patients with pancreatic cancer, 0.6% (1/174) in liver cancer, 1.9% (1/54) in gastric cancer, 6.7% (8/119) in colorectal cancer, 3.1% (1/32) in melanoma, 4% (1/25) in glioma, and 0.5% (2/411) in lung cancer, respectively. Significant correlations between the MSI-H and cancer types were found by χ 2 test (χ 2 = 26.571, Cramer’s V coefficient = 0.174, p = 3.980×10 −4 ). Only patients with colorectal cancer had absolute values of adjusted standardized residual above 3, its observed counts of MSI-H significantly higher than expected counts. Fisher’s exact test was performed to analyze the differences of MSI-H ratio across hepatobiliary (liver and bile duct) cancer, digestive tract (gastric and colorectal) cancer and lung cancer, and we found the MSI-H ratio of patients with digestive duct cancer was significantly higher than patients with hepatobiliary cancer ( p = 0.007) or lung cancer ( p = 4.599×10 −4 ). Conclusions: Our study provided new references to cancer-specific properties and clinical diagnosis of MSI especially in East Asian populations. As a retrospective study with a relatively small population, the conclusions of this study needed to be verified with a larger sample.
英国医疗服务体系简介及启示
Authors: 潘志刚
Journal: BMJ (2004)

英国采用以公共合同方式为主的卫生政策,医疗服务分为公立医疗体系及私营医疗服务两种.公立医疗服务又称为国家健康服务(national health service,NHS),由国家购买医疗服务,覆盖99%的英国人.私营医疗服务是公立医疗服务的补充,服务对象是收入较高,对医疗服务要求也较高的人群.下面主要介绍NHS医疗体系。
Pneumothorax in HIV/AIDS patients
Authors: Pan Xiang
Journal: BMJ (2017)

A total of 3 177 HIV/AIDS patients were admitted in Beijing Ditan Hospital, Capital Medical University from January 2009 to December 2015, among whom pneumothorax developed in 50 cases with a morbidity rate of 1.6%. Twenty six HIV/AIDS patients with pneumothorax died with a case fatality rate of 52.0% (26/50). Pneumocystis jirovecii pneumonia (PCP) was the dominant lung disease related to pneumothorax(37/50). Risk factors of pneumothorax were assessed among 40 HIV/AIDS patients with PCP undergoing mechanical ventilation in ICU, including 20 cases with pneumothorax and 20 cases without pneumothorac. Multivariate logistic regression analysis revealed that positive end-expiratory pressure (PEEP) was independent risk factor of pneumothorax in HIV/AIDS patients with PCP under mechanical ventilation(OR=2.490, 95%CI: 1.302-4.763, P=0.01).


Key words: 
HIV infections; Acquired immunodeficiency syndrome; Pneumothorax; Pneumonia, pneumocystis
神经性关节病误诊为类风湿关节炎一例
Authors: 赵金霞, 栗占国
Journal: BMJ (2009)

患者女,66岁,主因左上肢麻木40余年,左腕关节肿胀30年,加重1年就诊.患者40余年前无明显诱因出现左上肢麻木,对疼痛感觉迟钝.30年前开始出现左腕关节肿胀,伴活动受限,疼痛不明显.近1年来出现右腕关节轻微肿胀伴疼痛.曾长期在当地诊断为类风湿关节炎。
A follow-up study on 48 patients with chronic obstructive pulmonary disease by long-term management
Authors: 王英保, 何权瀛
Journal: BMJ (2004)

目的 寻求一种能够减轻慢性阻塞性肺疾病(COPD)患者症状,尽可能减缓其肺功能下降速度,改善生命质量的方法.方法入选的48例患者先填写患者登记表,考核对COPD的认识水平和生命质量.然后举办简短的学习班,与入选患者共同制订基本药物治疗方案以及康复锻炼计划,帮助其中吸烟者制订戒烟计划,并要求每位患者记录防治疾病日记.此后每2个月随访复查1次,由患者汇报病情变化情况、治疗和康复锻炼情况,并根据病情变化调整用药方案.研究结束时对患者进行一次考核,内容方法与入选时相同.结果经过系统教育、规范治疗辅以康复锻炼,48例COPD患者咳嗽、咳痰、气短评分显著降低(均P<0.001),门诊就诊次数由入选前(6±5)次/年减少为(3±3)次/年(P<0.001),1秒钟用力呼气容积占预计值百分比显著改善,由入选时(62±27)%增加至(69±31)%(P<0.001),生命质量评分也由入选时113±12升高至118±12(P<0.05), 相关疾病知识由入选时(11±4)分提高至(15±5)分(P<0.001).两年中14名吸烟者中6人成功戒烟1年以上.同时显示COPD患者对本病认识水平也有显著提高.结论对COPD患者进行系统的教育、管理和规范治疗,辅以必要的康复锻炼,可以有效地减轻其症状、部分改善肺功能、减少门诊就诊次数和提高生命质量。
Real-world effectiveness of post-T-DM1 treatments in HER2-positive metastatic breast cancer: KBCSG-TR1917 observational study.
Authors: Norikazu Masuda, Tetsuhiro Yoshinami, Hiroyuki Yasojima, Nobuyoshi Kittaka, Masato Takahashi, Shoichiro Ohtani, Seung Jin Kim, Hiroyuki Kurakami, Naoko Yamamoto, Tomomi Yamada, Takehiko Takata, Takahiro Nakayama
Journal: Journal of Clinical Oncology (2020)

e13020 Background: For patients with HER2-positive, unresectable and/or metastatic breast cancer (HER2+ mBC), T-DM1 is now the standard of care after trastuzumab and/or pertuzumab-based therapy. On the other hand, there is limited evidence after T-DM1 treatment. To clarify the treatment options and the effectiveness of drug therapy just after T-DM1 (post–T-DM1 therapy), we performed a multicenter observational study in patients with HER2+ mBC. Methods: This study enrolled consecutive patients who met eligibility criteria; Japanese female patients with HER2+ mBC, 20 years of age or older, who received at least one subsequent drug treatment except for an investigational drug after discontinuing T-DM1 between Jan 2014 and Dec 2018. To investigate the effectiveness of post–T-DM1 therapy, the real-world progression-free survival (rwPFS), time to treatment failure (TTF), overall survival (OS), objective response rate (ORR) and clinical benefit rate (CBR) were evaluated. Tumor response was exactly assessed by investigators according to RECISTv1.1. Results: Of 205 patients who were treated with T-DM1 at five institutions, 138 patients were enrolled and 128 patients were included in the analysis (data-cut off: Jul 31 2019). The median age of the patients was 59 years (range 27–84), and the median duration of T-DM1 treatment was 5.1 months (range 0.0–41.4). Ninety-two patients (71.9%) had an ECOG PS score of 0 or 1. Of the 128 patients, 34 (26.6%) patients received lapatinib + capecitabine therapy, 35 (27.3%) trastuzumab-based therapy (excluding pertuzumab), 36 (28.1%) pertuzumab-containing therapy, and 23 (18.0%) other therapy except for anti-HER2 therapy. In the 111 patients with measurable lesions, ORR was 22.5% (95% CI: 15.1–31.4). The median rwPFS was 5.7 months (95% CI: 4.8–6.9), median TTF 5.6 months (95% CI: 4.6–6.4), median OS 22.8 months (95% CI: 18.2–32.4), and the CBR was 47.7% (95% CI: 38.8–56.7) in the 128 patients. Conclusions: We clarified that the effectiveness of post–T-DM1 therapy was limited among the current standard treatment options. Therefore, to improve the prognosis in the later settings of HER2+ mBC, novel treatment options are warranted in the future. Clinical trial information: UMIN000038296 .
Urinary diary in evaluation of nocturia in benign prostatic hyperplasia patients over 60 years old
Authors: Hua-lin Chao, Xin Li, Ming Liu, Dong Wei
Journal: BMJ (2009)

Objective To evaluate the causes of nocturia in the elderly patients with benign prostatic hyperplasia (BPH) and significance of urinary diary on it. Methods Seventy-two patients with BPH aged over 60 years who keep urinary diaries were recruited in the study and undergone with international prostatic symptom score (IPSS) and quality of life score evaluation and measurements of prostate volume and peak urinary flow rate. Correlation between frequency of nocturia and the measurements mentioned-above was analyzed. Results Whole-day urinary volume amounted more than 2500 ml in four patients (7%), and nocturnal urinary volume accounted for more than 33% of their daytime urinary volume in 23 patients (40%). Nocturnal urinary volume and residual urinary volume were significantly more in 14 patients with increased urinary frequency than in 58 patients with normal frequency, but volume of each urination was significantly decreased in the formers than that in the latter, P < 0.01. There was no significant difference in age, prostate volume, peak urinary flow rate and IPSS score between those with increased and normal urinary frequencies. Urinary dynamic examinations showed that 35 (60%) of 58 patients with increased nocturnal urinary frequency had unstable urinary bladders, with an average nocturnal volume of each urination of less than 100 ml in 24 of them. Conclusions Nocturnal urinary volume and bladder function were determinant factors which affect their nocturnal urinary frequency. Three factors, i.e. , IPSS score, prostate volume and peak urinary flow rate, correlate with BPH, but not with nocturia. Keeping a detailed urinary diary for the patients is beneficial for elucidating their urinary function and in decision-making of their treatment regimen.

Key words: 
Urination;  Prostatic hyperplasia;  Frequent micturition
Pathologic sampling and pathological report interpretation of breast cancer
Authors: Huilin Geng, Lixue Xuan, Susheng Shi
Journal: BMJ (2017)

乳腺癌是女性最常见的肿瘤，严重威胁女性健康，外科手术治疗一直作为乳腺癌的首要治疗方式，病理的取材和诊断在乳腺癌的治疗中也起着至关重要的作用。本文介绍乳腺癌病理取材、病理报告及相关分子检测知识，以进一步指导临床诊断及治疗。
Effect of micronized fenofibrate on beta-cell function and insulin resistance in type 2 diabetic patients with hypertriglyceridemia
Authors: Wen Xu, Juan Liu, Wan-ping Deng, Yan-bing Li
Journal: BMJ (2010)

Thirty six patients with hypertriglyceridemia and impaired glucose regulation or newly diagnosed type 2 diabetes, whose fasting plasma glucose was ≤8.0 mmol/L, were treated by fenofibrate for 3 months. Lipid profile, insulin during intravenous glucose tolerance test and oral glucose tolerance test ( including glucose) were measured before and after treatment After treatment, lipid profile was significantly improved. Insulinogenic index (△I30/△G30) and acute insulin response were significantly increased (98. 9vs. 129. 2, 3558.9 vs. 4783. 3 pmol · L - 1 · min - 1, respectively, P ＜ 0. 05 ). Fasting insulin and insulin resistant index in homeostasis model assessment ( HOMA IR) decreased ( 128. 6 vs. 84. 8 pmol/L, 4. 8 vs.3.0, respectively, P ＜0. 05 ). The improvement of insulin secretory function was more significant in patients with higher triglyceride (TG ＞ 3. 3 mmol/L). These results indicate that short-term lipid-lowering treatment with fenofibrate can improve β-cell function and insulin resistance. Patients with higher triglyceride are likely to achieve more benefit from lipid-lowering treatment.

Key words: 
Hypertriglyceridemia;  Procetofen
Patterns and determinants of chemotherapy-associated Clostridium difficile infection among cancer patients in the United States: A population-based study.
Authors: Pramit Nadpara
Journal: Journal of Clinical Oncology (2020)

e19111 Background: Elderly cancer patients comprise a population that is vulnerable for Clostridium difficile infection (CDI). In addition to the frequent hospitalizations, the administration of chemotherapeutic agents has been associated with the development of CDI. The objective of this study was to identify the patterns and determinants of chemotherapy-associated CDI (Chemo-CDI), in a nationwide sample of elderly patients. Methods: We used NCI’s Surveillance, Epidemiology, and End Results registry linked Medicare (SEER-Medicare) 2007-2012 files. We included patients’ aged ≥65 year, with diagnosis of lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia during 2008-2011. We excluded those not receiving chemotherapy, with non-continuous Medicare enrollment, or HMO enrollment. Chemotherapy receipt was identified using appropriate ICD-9/HCPCS/CPT codes. Incidence of CDI following chemotherapy were determined by identifying any claim with primary/secondary diagnosis of CDI during the two-month follow-up period. Recurrent Chemo-CDI was identified by presence of any claim that was &gt; 2 weeks and ≤8 weeks from the index CDI diagnosis date. Covariates including antibodies/proton pump inhibitors usage were captured and included in the analysis. Chi-square tests, and hierarchical generalized logistic models were conducted to identify determinants of Chemo-CDI. Results: We identified 41,470 elderly patients with lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia diagnosis during the study years. While few (266) patients developed Chemo-CDI within one year of diagnosis, more than 50% (136) of those patients developed recurrent Chemo-CDI. Patient characteristics were not associated with risk of developing Chemo-CDI, however, significant differences were observed in antibiotics/proton pump inhibitors exposure across all cancer types (p &lt; 0.001). Treatment for Chemo-CDI mostly comprised of Metronidazole and oral Vancomycin. Conclusions: While the incidence of Chemo-CDI is lower among patients receiving chemotherapy, the rate of recurrent Chemo-CDI was significantly higher. Strategies to prevent CDI recurrence in this population are therefore warranted. Future studies should also explore the association between increased disease burden and comorbidity, and the risk of developing Chemo-CDI.
社区卫生服务中心全科病房的现状分析及建议
Authors: 张少虹, 韩建新
Journal: BMJ (2010)

医疗制度的改革、医学模式的改变、地段医院改制成为社区卫生服务中心,担负着社区人群的医疗、预防、保健、康复、健康教育和计划生育指导六位一体的基本医疗服务任务[1],为了解决老年人住院难的问题,上海市由地段医院改制为社区卫生服务中心仍保留病房,但由于在性质、功能上与综合性医疗机构不同,病房工作也由原来专科病房改变为全科病房,在服务功能上有其特殊性.本研究通过对上海市徐汇区长桥街道社区卫生服务中心(简称长桥中心)全科病房的管理现状进行分析,探讨社区卫生服务中心全科病房存在的问题和今后的发展建议。
Pembrolizumab versus paclitaxel for previously treated patients with PD-L1–positive advanced gastric or gastroesophageal junction cancer (GC): Update from the phase III KEYNOTE-061 trial.
Authors: Charles S. Fuchs, Mustafa Özgüroğlu, Yung-Jue Bang, Maria Di Bartolomeo, Mario Mandalà, Min-hee Ryu, Lorenzo Fornaro, Tomasz Olesinski, Christian Caglevic, Hyun Cheol Chung, Kei Muro, Eric Van Cutsem, Anneli Elme, Peter C. Thuss-Patience, Ian Chau, Atsushi Ohtsu, Pooja Bhagia, Anran Wang, Chie-Schin Shih, Kohei Shitara
Journal: Journal of Clinical Oncology (2020)

4503 Background: KEYNOTE-061 ( NCT02370498) is a global phase 3 study of pembrolizumab vs paclitaxel as second-line therapy for GC. At the time of primary analysis (data cutoff: Oct 26, 2017), in patients with PD-L1–positive status (combined positive score [CPS] ≥1), pembrolizumab did not significantly prolong overall survival (OS) vs paclitaxel (9.1 months vs 8.3 months) but did elicit a longer duration of response (DOR) and a favorable safety profile vs paclitaxel. We present results of KEYNOTE-061 in patients with CPS ≥1, ≥5, and ≥10 after 2 additional years of follow-up (cutoff: Oct 7, 2019). Methods: Adult patients with GC that progressed after platinum + fluoropyrimidine chemotherapy were randomly assigned 1:1 to pembrolizumab 200 mg Q3W for up to 35 cycles (~2 y) or standard-dose paclitaxel. OS and progression-free survival (PFS) in the CPS ≥1 population were the primary end points. Comparisons were made using stratified log-rank tests. Results: At the time of this analysis, 366/395 patients with CPS ≥1 had died (92.6%). Pembrolizumab prolonged OS vs paclitaxel in PD-L1–positive patients (Table). No significant differences appeared between groups in PFS (Table). Objective response rate (ORR) was higher for pembrolizumab in the CPS ≥10 group, and DOR was longer with pembrolizumab using all CPS cutoffs (Table). There were fewer drug-related adverse events (AEs) with pembrolizumab than paclitaxel in the overall population (53% vs 84%). Conclusions: This long-term analysis found that second-line pembrolizumab prolonged OS among patients with PD-L1–positive GC and led to fewer drug-related AEs vs paclitaxel. Clinical trial information: NCT02370498 . [Table: see text]
HBV-human DNA integration in non-hepatic tumors.
Authors: Lei Liu, Ming Liu, Tanxiao Huang, Wenting Liao, Mimi Fu, Jingxian Duan, Shifu Chen
Journal: Journal of Clinical Oncology (2020)

e13544 Background: Hepatitis B virus (HBV) infection in hepatocytes may induce chronic liver damage, which further leads to hepatocellular carcinoma. HBV infection was also reported in other cell types including peripheral blood mononuclear cells (PBMCs). Moreover, epidemiological evidence suggested that HBV infection was associated with various types of cancers. In this study, we investigated whether HBV DNA integration was observed in extrahepatic tumor cells. Methods: The study enrolled thousands of Chinese patients with different types of cancers. Peripheral blood and tumor tissue samples were collected, plasma cfDNA, PBMC gDNA and tumor tissue DNA were extracted. By targeted capture and next-generation sequencing, we sequenced the cancer-related genes and identified HBV DNA integration events in these samples. Moreover, the subtype of HBV captured in the host genome was verified, and the ratio of reads mapped to the HBV genome was calculated. Results: Samples with more than 0.1% of the sequencing reads mapped to the HBV genome were identified as HBV positive cases. Thirty-two liver cancer patients were subtype-b HBV positive, among which 8 tumor samples exhibited HBV genome integration. Three colorectal cancer patients were infected by subtype-c HBV, only one tumor sample carried HBV DNA integration. Two lung cancer patients were shown to be HBV positive; one was infected by subtype-b HBV and the other carried subtype-c HBV. Subtype-b and-c HBV genome was observed in the tumor sample of two cholangiocarcinoma patients, whereas subtype-b HBV DNA was identified in the PBMC of one gastrointestinal stromal cancer patient. Conclusions: HBV genome integration was identified in the tumor cells of lung, colorectal, biliary ducts, and gastrointestinal stromal cancer. The mechanisms by which the HBV genome integrates into these tissues requires further investigation.
Formation of deep vein thrombosis and its prevention
Authors: Jianyun Long, Changpin Huang, Yongchang Liu, Dong Xu
Journal: BMJ (2019)

下肢深静脉血栓是静脉血栓栓塞症的一种，发病率高，是目前公认的院内可预防性死亡的最大疾病。研究表明，血栓的预防是安全、有效的。下肢深静脉血栓有基础预防、机械预防和药物预防三类，提前采取预防措施可明显降低血栓事件的发生率，改善患者生存期和生命质量。因此，早期识别高风险血栓患者、早期诊断对预防深静脉血栓至关重要。
Importance of standardized diagnosis and treatment of acute pancreatitis by primary care doctors
Authors: Wenhua He
Journal: BMJ (2019)

急性胰腺炎（AP）目前已是消化系统的常见疾病，其发病率逐年升高，早期规范诊治对改善患者预后至关重要。多数AP患者首诊于社区卫生服务中心、卫生院等基层医疗机构，而当前基层医生在诊治AP过程中存在一些不规范之处甚至误区。为此，中华医学会组织编制了《急性胰腺炎基层诊疗指南》，以进一步规范基层医疗卫生机构医务人员对AP的诊治。