tbuckley/cabot-search huggingface dataset:
Family aggregation of pulmonary ground-glass nodules: Identification of multiple candidate risk loci.
Authors: Rui Fu, Jia-Tao Zhang, Rongrong Chen, Zai-Xian Tai, Hao-Xiang Lin, Jian Su, Xiang-Peng Chu, Chao Zhang, Wen-Fang Tang, Jun-Tao Lin, Qiang Nie, Xue-Ning Yang, Yi-Long Wu, Wenzhao Zhong
Journal: Journal of Clinical Oncology (2020)

e13512 Background: Lung cancer with family history have been emerging gradually of late years in East Asian, especially those presenting as pulmonary ground-glass nodules (GGNs). The predisposition of GGNs with lung cancer family history remains baffling. Methods: This prospective study was registered at clinicaltrials.gov (number NCT04220268) and enrolled patients with pulmonary pre-invasive or invasive adenocarcinoma, especially presenting as GGNs. We collected blood and tumor samples from 29 GGNs patients with family history to investigated germline and somatic mutations by whole exome sequencing (WES). As the first part of our study, we focused on 107 nonoverlapping susceptibility loci for lung carcinogenesis identified by recent genome-wide association studies (GWAS) to identify novel rare causal variants. Potential causal variants were further verified in other patients from the families when possible. Results: A total of 461267 single neocleotide variants (SNVs) and 132268 insertion-deletions (InDels) were detected from the 29 index patients. By focusing on exome profiles of the 107 target loci, we identified three key rare mutations, namely MSH5 p.Ala702Thr, ADGRG6 p.Asn338Ile and CCDC147 p.Arg619Trp in two index patients respectively. The minor allele frequency (MAF) of these three variants was extremely low in the general population, which is 1/5008, 2/5008 and 6/5008 respectively in the 1000 Genomes database, and 2/31406, 5/31346, and 5/31394 respectively in the GnomAD database. There three mutations were predicted as probably damaging or disease-causing variations by SIFT or Polyphen. Mutations of MSH5 and CCDC147 were also detected in other patients from the two families. Conclusions: With the identification of highly disruptive risk-conferring MSH5, ADGRG6 and CCDC147 mutations, we confirmed the probably heritable and risk loci exists in the GGNs patients with lung cancer family history in East Asians. Exome sequencing has great potential to identify novel rare causal variants, and more analyses on more patients are still ongoing.
自体心包环在双孔形二尖瓣成形术中的应用
Authors: 马松峰, 乔峻, 木拉提, 安勇
Journal: BMJ (2007)

二尖瓣关闭不全是临床上常见的心脏疾病.寻求简便易行、效果稳定的二尖瓣成形技术对其治疗有重要意义.1.对象与方法:2005年1月至10月我院行二尖瓣双孔成形手术治疗二尖瓣关闭不全患者9例(男7例,女2例).年龄11～59(36±20)岁,体重32～68(55±15)kg.心功能(NYHA分级)Ⅲ级6例、Ⅱ级3例。
短暂性脑缺血发作对后继脑梗死缺血耐受的研究
Authors: 闵汇刚, 陈杭英, 游娜
Journal: BMJ (2007)

回顾分析2000年至2005年我院神经内科收治的68例1周内有短暂性脑缺血发作(TIA)脑梗死患者的临床资料,并以236例无TIA脑梗死病例为对照.有TIA脑梗死患者的治愈率(75%)高于对照者(53%,χ2=10.5137,P＜0.01),神经功能缺损评分、脑梗死体积均低于对照者(P均＜0.01).TIA使大脑通过脑缺血预处理机制对抗脑梗死所产生的神经损害,从而对脑神经起保护作用。
Treatment of frequently relapsing idiopathic nephrotic syndrome in children: cyclophosphamide vs mycophenolate mofetil
Authors: Haiyun Geng, Li Cao
Journal: BMJ (2014)

The clinical data of 43 children diagnosed as idiopathic nephrotic syndrome (INS) with frequent relapse and treated with cyclophosphamide (CTX) or mycophenolate mofetil (MMF) were retrospectively analyzed. In this series of patients 18 were treated with CTX and 25 were treated with MMF. After CTX therapy the relapse-free period was round 6.0 months, the relapse rate decreased from 4.8 episodes/y to 1.1 episodes/y(P 0.05)between MMF and CTX groups. This retrospective study shows that both MMF and CTX are effective immunosuppressive agents for children with frequently relapsing INS, however, MMF is more convenient and safe to administrate, it may be proposed before CTX.


Key words: 
Nephrotic syndrome; Immunosuppressive agents
Treating Patients With Opioid Use Disorder in Their Homes
Authors: Lori Uscher-Pines, Haiden A. Huskamp, Ateev Mehrotra
Journal: JAMA (2020)

This Viewpoint discusses the emergence of telehealth as a model for providing medication-assisted treatment (MAT) for opioid use disorder (OUD), and the advantages and disadvantages of the approach for underserved patient populations.
Neuroimmune interactions in cardiovascular diseases
Authors: Daniela Carnevale, Giuseppe Lembo
Journal: Cardiovascular Research (2020)

Our body is continuously in contact with external stimuli that need a fine integration with the internal milieu in order to maintain the homoeostasis. Similarly, perturbations of the internal environment are responsible for the alterations of the physiological mechanisms regulating our main functions. The nervous system and the immune system represent the main interfaces between the internal and the external environment. In carrying out these functions, they share many similarities, being able to recognize, integrate, and organize responses to a wide variety of stimuli, with the final aim to re-establish the homoeostasis. The autonomic nervous system, which collectively refers to the ensemble of afferent and efferent neurons that wire the central nervous system with visceral effectors throughout the body, is the prototype system controlling the homoeostasis through reflex arches. On the other hand, immune cells continuously patrol our body against external enemies and internal perturbations, organizing acute responses and forming memory for future encounters. Interesting to notice, the integration of the two systems provides a further unique opportunity for fine tuning of our body's homoeostasis. In fact, the autonomic nervous system guides the development of lymphoid and myeloid organs, as well as the deployment of immune cells towards peripheral tissues where they can affect and control several physiological functions. In turn, every specific immune cell type can contribute to regulate neural circuits involved in cardiovascular function, metabolism, and inflammation. Here, we review current understanding of the cross-regulation between these systems in cardiovascular diseases.
Transparent Reporting of Multivariable Prediction Models in Journal and Conference Abstracts: TRIPOD for Abstracts
Authors: Pauline Heus, Johannes B. Reitsma, Gary S. Collins, Johanna A.A.G. Damen, Rob J.P.M. Scholten, Douglas G. Altman, Karel G.M. Moons, Lotty Hooft
Journal: Annals of Internal Medicine (2020)

Clear and informative reporting in titles and abstracts is essential to help readers and reviewers identify potentially relevant studies and decide whether to read the full text. Although the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) statement provides general recommendations for reporting titles and abstracts, more detailed guidance seems to be desirable. The authors present TRIPOD for Abstracts, a checklist and corresponding guidance for reporting prediction model studies in abstracts. A list of 32 potentially relevant items was the starting point for a modified Delphi procedure involving 110 experts, of whom 71 (65%) participated in the web-based survey. After 2 Delphi rounds, the experts agreed on 21 items as being essential to report in abstracts of prediction model studies. This number was reduced by merging some of the items. In a third round, participants provided feedback on a draft version of TRIPOD for Abstracts. The final checklist contains 12 items and applies to journal and conference abstracts that describe the development or external validation of a diagnostic or prognostic prediction model, or the added value of predictors to an existing model, regardless of the clinical domain or statistical approach used.
Cost savings of biosimilar pegfilgrastim in a Medicare OCM population.
Authors: Jennifer Webster, Robert E. Smith, Danielle Wieland, John Verniero, Jeffrey A. Scott
Journal: Journal of Clinical Oncology (2020)

e19362 Background: Pegfilgrastim is a key supportive care agent in oncology patients, providing significant febrile neutropenia prophylaxis for patients on chemotherapy. However, pegfilgrastim also accounts for 5.3% of the total cost of cancer care for all patients in the Oncology Care Model (OCM). Fluctuations in the cost or quantity of pegfilgrastim can have significant impact on a practice’s performance under OCM. One such cost fluctuation is the introduction of biosimilars to the marketplace. This study seeks to understand how CMS reimbursement for pegfilgrastim has been impacted by the introduction of two pegfilgrastim biosimilars into the market. Methods: We tracked average CMS reimbursement for pegfilgrastim (Neulasta, Udenyca and Fulphila) from 7/1/2016 through 6/30/2019. We compared the average reimbursement and the average change in reimbursement before and after the introduction of biosimilars. Results: Prior to the introduction of biosimilars, the Medicare Part B reimbursement (80% of ASP +6%) of pegfilgrastim increased at a steady rate of $292 per year through the first 30 months of the OCM program, resulting in an average reimbursement of $3636 per administration in Q3 2018. However, since the introduction of biosimilars, average pegfilgrastim reimbursement has held steady, averaging $3543 for the time period from 7/1/2018 through 6/30/2019. The change in reimbursement has decreased from $292/year to -$93/year. Conclusions: In 2018, 88,847 Medicare patients received pegfilgrastim, resulting in $1.39 billion in Medicare reimbursement. Assuming that the patterns we’ve detected in our OCM data sample can be applied to the general Medicare population, we have estimated that the introduction of biosimilars resulted in a $4.8 million in savings (1.39%) compared with what the total reimbursement would have been without biosimilars in the market in Q4 2018. This bending of the cost curve is projected to result in savings of $79.1M (5.7%) in 2019 and $157.9M (11.5%) in 2020. Importantly, most of this cost containment is not due to patients utilizing biosimilars. 90.6% of patients in Q2 2019 are still receiving branded pegfilgrastim. However, the introduction of biosimilars has caused even the branded agent to stabilize and possibly even drop net acquisition cost prices. Introduction of biosimilars has created enough pressure on the market to result in significant cost savings, increasing the overall value proposition of pegfilgrastim. This results in significant cost saving to CMS, and also makes it easier for practices participating in OCM to have successful financial outcomes.
Real-world examination of remission patterns in patients (pts) with acute myeloid leukemia (AML).
Authors: Ashley Tabah, David Huggar, Brenna L. Brady, Krutika Jariwala-Parikh, Ronda Copher, Thomas William LeBlanc
Journal: Journal of Clinical Oncology (2020)

e19336 Background: For pts with AML, prognosis is poor as long-term remission is elusive and ≥ 60% of pts relapse. The effect of remission status on healthcare resource utilization (HCRU) and costs is unclear. This study assessed administrative claims data from pts with AML to understand the potential benefit of novel, remission-prolonging therapies on HCRU and costs. Methods: Pts with newly diagnosed AML who received frontline therapy and did not undergo hematopoietic stem cell transplantation were identified in the MarketScan Commercial and Medicare Supplemental database from Jan 1, 2012–June 6, 2018. Pts were followed over a fixed 6-month (mos) pre- and variable post-diagnosis period; remission and relapse events were identified by diagnosis codes. Pts were analyzed by duration of remission ( &lt; 3, 3– &lt; 6, 6– &lt; 9, and ≥ 9 mos), based on time from first remission claim to first relapse claim or end of follow up, whichever occurred first. Pt characteristics, relapse, HCRU, and costs were assessed. Results: 459/1003 eligible pts (45.8%) had evidence of remission. Most pts were in remission for &lt; 3 mos (n = 161; 35.1%) or ≥ 9 mos (n = 165; 35.9%); 81 (17.6%) and 52 (11.3%) pts were in remission for 3– &lt; 6 and 6– &lt; 9 mos, respectively. Median follow-up for all pts was 236 days. Across remission cohorts, mean age at diagnosis was 55–59 years and median time to remission (from first AML diagnosis to first remission claim) was 82–90 days. Median time from AML diagnosis to relapse was 265.5 days. Of pts in remission, 30.5% relapsed (41.0%, 28.4%, 40.4%, and 18.2% for &lt; 3, 3– &lt; 6, 6– &lt; 9, and ≥ 9 mos, respectively). From AML diagnosis to the end of follow-up, mean all-cause per pt per mos (PPPM) healthcare costs for all pts were $44,588. Longer durations of remission were associated with reduced mean PPPM costs ($64,188, $53,260, $30,219, and $16,654 for &lt; 3, 3– &lt; 6, 6– &lt; 9, and ≥ 9 mos, respectively); similar trends were observed for AML-related costs. Mean all-cause PPPM costs were also reduced during remission, measured from the first remission claim to the first relapse claim or end of follow-up. A significant decrease was observed for pts in remission for ≥ 6 mos ($35,229, $36,193, $17,486, and $8,933 for &lt; 3, 3– &lt; 6, 6– &lt; 9, and ≥ 9 mos, respectively). Conclusions: In this real-world study, 46% of pts with AML achieved remission after frontline therapy, although durations of remission varied. A longer duration of remission was associated with reduced PPPM costs over the study period indicating a potential economic benefit of remission-prolonging therapies in AML, including maintenance treatments.
昏迷的现场判断和院前急救原则
Authors: 冯庚
Journal: BMJ (2005)

昏迷(coma)是意识障碍的最严重类型,主要临床表现为持续意识丧失的同时心跳存在.心搏骤停导致的意识丧失也属于昏迷,但一般不与心搏骤停同时提出.昏迷是院前急救的危重症,死亡率20%～42%,文献报道约占全部急诊患者的3%,内科危重病患者的15%.昏迷病因复杂,多数人认为导致昏迷的最常见疾病依次为急性脑血管病、外伤和中毒;亦有报道在内科急诊的昏迷病因中,依次为急性中毒(34.9%)、脑血管病(29.2%)、脑膜炎和脑炎(10.8%)、癫痫(6%).昏迷患者脑功能能否恢复,取决于其原发疾病是否得到正确、及时治疗,因此,如何迅速对昏迷患者做出判断、提供生命支持并及时转诊十分重要。
A patient with bilateral epididymal leiomyoma: a case report
Authors: Fang Xie, Meng Tian, Jun Wang, Xinjie Wang, Shengjun Ma
Journal: BMJ (2018)

回顾性分析威海市立医院泌尿外科2017年诊治的1例附睾平滑肌瘤患者的临床资料。患者男性，45岁，发现双侧阴囊内包块20余年，进行性增大。查体右侧附睾尾可触及直径3 cm、左侧附睾尾可触及直径2 cm的结节样肿物，均质硬，无触痛，与阴囊皮肤无粘连。超声示右、左侧附睾尾部分别见27 mm×16 mm和23 mm×16 mm的低回声结节，回声不均，边界欠清，内可见条状血流信号。行双侧附睾肿物切除术，切除组织病理检查示双侧附睾平滑肌瘤。术后患者恢复良好，切口愈合良好出院。
Relation betweenobstructive sleep apnea and bradyarrhythmia
Authors: Li Li, Yu-shen Xu
Journal: BMJ (2009)

：Objective To analyze therelations between obstructive sleep apnea and bradyarrhythmia.Methods From 1999 to2005,203 patients who came from Bering Tongren Hospital and Fuwai Hospital were found tohave sleep apnea in an ambulatory study. A Hoher electrecardiogram was recorded for 24hours within 2 weeks after patients were diagnosed as obstructive sleep apnem ResultsNocturnal episodes of bradyarrhythmia were identified in 12(5.9%)of 203 patients.Body massindex and respiratory disturbance index in patients with bradyarrhythmia(n=12)were higherthan those in patientswithour bradyarrhymia(n=191)(34±5 735.24±6 and 63±15 vs.25±5,respectively,bothP<0.01).There was a significant difference in end-apneic oxygen saturation inapnea/hypopnea episodes with and without bradyarrhythmia(63%±15% vs.75%±11%,P<0.05).Alinear relation between end-apneic oxygen saturation and number of sinus arrests and heartblocks was not found.Conclusions Patients with apnea-associated bradyarrhythmia havehigher body mflgB index and higher respiratory disturbance index than patients withoutbradyarrhythmi&Bradyarrhythmia occurres independently from decrease in oxygensaturation.
A phase Ib study of TAK-079, an investigational anti-CD38 monoclonal antibody (mAb) in patients with relapsed/ refractory multiple myeloma (RRMM): Preliminary results.
Authors: Amrita Y. Krishnan, Krina K. Patel, Parameswaran Hari, Sundar Jagannath, Ruben Niesvizky, Rebecca Wang Silbermann, Deborah T. Berg, Qing Li, Kristina Allikmets, Keith Stockerl-Goldstein
Journal: Journal of Clinical Oncology (2020)

8539 Background: TAK-079 is a subcutaneously (SC) administered mAb with multiple modes of action for killing target cells. Here we report data from an ongoing dose finding study of TAK-079 monotherapy in patients with RRMM (NCT03439280). Methods: Pt were eligible after ≥ 3 lines of therapy and previous exposure to immunomodulatory drug (IMiD), proteasome inhibitor (PI), alkylating agent, and corticosteroid; prior anti-CD38 therapy allowed. Patients were refractory or intolerant to at least 1 PI and 1 IMiD. TAK-079 given as a SC injection weekly for 8 doses, every other week for 8 doses, then monthly until disease progression (PD) or unacceptable toxicity. SC injection was 2 mL administered in ≤ 1 minute. Results: 34 patients were enrolled across 5 fixed dose cohorts (TAK-079 45-135-300-600-1200 mg SC) as of 09 December 2019. Median age was 65 (50–81) years. At study entry, 65% were refractory to both an IMiD and PI; 82% refractory to last line of therapy, 21% of patients were previously exposed to at least 1 anti-CD38 monoclonal antibody. Median number of prior therapies was 4 (2,12). No ≥ Grade 1 early or late systemic infusion reactions (IRR) reported. Three ( &lt; 1%) injection site reactions described in &gt; 1200 injections administered; 2 mild pruritis and 1 moderate swelling. Drug related adverse events (AEs), any grade, occurring in at least 10% of patients were: fatigue (21%), anemia (18%), neutropenia (18%), leukopenia (15%). Neutropenia was the only drug related grade 3 AEs in 2 or more patients (n = 2); only drug related SAE was 1 Grade 3 diverticulitis. No drug-related grade 4 AEs, AEs leading to study discontinuation, or on-study deaths reported. Recommended phase 2 dose (RP2) is to be 600 mg based on no reported DLTs, no MTD identified, and preliminary efficacy (PFS and response [ORR]). At the RP2 dose, 9 patients received at least 6 cycles of therapy by the data cutoff; their ORR was 33%, median duration of response was not estimable. The clinical benefit rate (minimal response or better) in all 12 patients enrolled at the RP2 dose was 67%. At a median follow-up of 7.5 months, PFS not estimable at the RP2 dose. Conclusions: TAK-079 monotherapy is safe, generally well tolerated, and active in patients with RRMM through tested doses. Clinical activity occurred early and was durable. With no MTD identified, no IRRs, no significant hematologic toxicity, the RP2 dose is 600 mg. PFS, with a median FU of 7.5 months at the data-cut off, is not estimable at the RP2 dose. Updated safety and efficacy data will be presented. Clinical trial information: NCT03439280 .
Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study
Authors: Kunyu Yang, Yuhan Sheng, Chaolin Huang, Yang Jin, Nian Xiong, Ke Jiang, Hongda Lu, Jing Liu, Jiyuan Yang, Youhong Dong, Dongfeng Pan, Chengrong Shu, Jun Li, Jielin Wei, Yu Huang, Ling Peng, Mengjiao Wu, Ruiguang Zhang, Bian Wu, Yuhui Li, Liqiong Cai, Guiling Li, Tao Zhang, Gang Wu
Journal: The Lancet Oncology (2020)
Abstract 13881: The Utility of Strain Echocardiography in Follow up for Esophageal Cancer Patients Treated With Mediastinal Radiation Therapy
Authors: Sarah Hale, Nadia El Hangouche, Anjan Tibrewala, John P Hayes, Victoria Villaflor, Arushi Singh, Lua Jafari, Katherine McGee, Juan Lopez-Mattei, Nausheen Akhter
Journal: Circulation (2019)

Introduction: Mediastinal radiotherapy (RT) is a common and beneficial treatment modality in the management of esophageal cancer. Therefore, the effect of high dose RT on cardiac function in the on...
原发性系统性淀粉样变病研究进展
Authors: 张蕊娜, 赵俊英
Journal: BMJ (2011)

淀粉样变病好发于50岁以上中老年人,男∶女为3∶1[1].根据病变累及部位分为局限性和系统性淀粉样变,系统性淀粉样变病又可进一步分为原发性、继发性、家族遗传性以及多发性骨髓瘤相关性.原发性系统性淀粉样变病(PSA)又称Lubarsch-Pick病,全身各系统组织都可有淀粉样物质沉积以致影响各器官的功能,最常受累的为肾脏(74％)、心脏(60％)、肝脏(27％)及外周(22％)、自主神经系统(18％),在确诊的PSA患者中约有69％患者有2个及2个以上器官受累[2],临床表现复杂多样,淀粉样蛋白物质在病变组织沉积为其病理共同特点.目前尚无特异性治疗方法,主要是对症支持和替代治疗。
An analysis of correlation between post-stroke depression and relevant factors
Authors: 田亚莉, 蔺承艳, 龚玲, 庞成, 于萍
Journal: BMJ (2004)

目的 探讨急性脑卒中后抑郁状态(PSD)与急性脑卒中发病时多种因素的相关性.方法对58例急性脑卒中患者使用汉密顿抑郁量表对抑郁程度评分,根据脑卒中脑神经功能缺损评分(NFD)标准对神经功能进行评分,计算IgG指数,测定脑脊液内一氧化氮(NO)含量,进行卒中定位、定性,对所得结果进行单因素t检验和χ2检验,各因素之间做直线回归分析.结果 PSD发生率为29%;脑卒中患者PSD发生率高于脑出血患者(χ2=4.86,P<0.05); PSD组IgG指数(t=3.16, P<0.05)、NO含量(t=6.20,P<0.01)及NFD(t=2.35,P<0.05)均高于非抑郁组;PSD组其他合并症较非抑郁组多(t=2.74,P<0.05); IgG与NO呈正相关(r=0.415,P＜0.01).结论 PSD是一种病态心理性改变,但它有确定的免疫病理生理性改变,检测这些因素对预测PSD有一定参考作用。
Determination of granulocyte colony-stimulating factor and interlukin-8 in acute surgical bacterial infection
Authors: Xue-jun Shuai, Yan Fu
Journal: BMJ (2008)

Objective To evaluate the value of serum granulocyte colony-stimulating factor(G-CSF),interlukin-8(IL-8)and white blood cell count(WBC)in detecting acute surgical bacterial infections.Methods A total of 36 patients with infections and 32 with traumatic diseases admitted in Beijing Tongren Hospital without use of antibiotics before admission were recruited,as well as 30 normal healthy controls.Three milliliters of peripheral blood were collected from each of them.Serum G-CSF and IL-8 were measured by enzyme-linked immunosorbent assay(ELISA).Results Of all the 68 patients,serum G-CSF Was(82±71)ng/L in average in those with infections,significantly higher than that in those with trauma(15±7)ng/L(P＜0.01)and controls(7±4)ng/L(P＜0.01).Conclusions Serum G-CSF may be used as a sensitive indicator for acute surgical bacterial infections.

Key words: 
Granulocyte colony-stimulating factor; Interleukin-8; Bacterial infections; Wounds and injuries
Clinical significance of serum B7-H4 protein levels in epithelial ovarian cancer
Authors: Ping Zhao, Xing-jian Cao, Xiu-lin Zhang, Chao Yu
Journal: BMJ (2011)

Serum B7-H4 protein levels were measured by enzyme-link immunosorbent assay (ELISA) in 62 patients with epithelial ovarian cancer, 20 patients with benign ovarian diseases, and 30healthy subjects.Serum B7-H4 protein levels in epithelial ovarian cancer, benign ovarian diseases and normal controls were 0.72(0.32,1.88 )μg/L, (0.45±0.21)μg/L,(0.38 ± 0.19 ) μg/L respectively (P＜0.01).The serum level of B7-H4 protein in epithelial ovarian carcinoma was correlated with FIGO stages, lymph node metastasis, histological grade and histological types ( all P ＜ 0.01 ), but not with menopause and ascites (P＞0.05).The receiver operating characteristics curve analysis revealed that B7-H4protein had a sensitivity and specificity of 69% (43/62)and 86%(43/50) for diagnosis of epithelial ovarian cancer.

Key words: 
Proteins;  Ovarian neoplasms
对心力衰竭的再认识
Authors: 曾昭耆
Journal: BMJ (2004)

心力衰竭(简称心衰)不是一种独立的疾病,是指在血管功能正常和循环血容量正常的条件下,心脏不能将从静脉流回心脏的血液充分排出,由于心排出量绝对或相对减少,不能满足全身组织的需要,而引起一系列循环障碍的临床综合征.是各种原因所致心脏疾病发展到晚期时难以避免的结局。