tbuckley/cabot-search huggingface dataset:
Quality of life and its related factors in patients of stable chronic obstructive pulmonary disease
Authors: Yuan-qiang He, Chuan-qin Xu, Yu-long Zheng, Li-yang Zhou, Yue Xu, Yu-feng Wan
Journal: BMJ (2012)

A total of 185 hospitalized patients with chronic obstructive pulmonary disease (COPD) were recruited.And the questionnaire of COPD Assessment Test (CAT) was used to evaluate the CAT scores and Hamihon Depression Scale to evaluate HAMD scores.Lung function,body mass index,smoking and medication were measured and recorded in details.According to the HAMD scores,65 cases had depression and 120 cases no depression.Comparing with the no-depression group,the results show that HAMD and CAT scores were higher significantly in the depression group and there was a lower proportion of long-term domiciliary oxygen therapy.According to the logistic regression analysis,the CAT scores were associated with global initiative for chronic obstructive lung disease (GOLD) stages Ⅳ and HAMD scores.These results suggest that poor lung function and depression affect greatly the quality of life for stable COPD patients.

Key words: 
Pulmonary disease,chronic obstructive;  Depression
Differentiation of prostate cancer from benign prostatic hyperplasia (BPH) in the transitional zone by magnetic resonance spectroscopic imaging
Authors: Sa-ying Li, Min Chen, Rui Wang, Wen-chao Wang, Wei-feng Zhao, Cheng Zhou
Journal: BMJ (2010)

Twenty patients with prostate cancer and 20 patients with benign prostate hyperplasia (BPH) in the transitional zone underwent magnetic resonance imaging (MRI) /magnetic resonance spectroscopic imaging ( MRSI ) examinations. The choline + creatine/citrate (CC/Ci) ratio and the choline/creatine (Cho/Cr) ratio were evaluated in each voxel with cancer or BPH confirmed by pathological results.Discriminant analysis was used to determine the power of the two ratios in differentiation between cancer and BPH. The CC/Ci ratio and Cho/Cr ratio for cancer voxels were significantly higher than those in the voxels with BPH in the transitional zone (CC/Ci: 2.26 ± 1.35 vs. 0.81 ±0.22, t =5.17, P ＜0. 01, Cho/Cr:4. 12 ± 1.65 vs. 1.25 ±0. 35, P＜0. 01 ). As for the discriminant function with the CC/Cr ratio and the Cho/Cr ratio, the specificity, sensitivity, and accuracy were 99%, 86%, 93% respectively for the differentiation between cancer and BPH.

Key words: 
Prostatic neoplasms;  Magnetic resonance spectroscopy
医院的人性化服务
Authors: 吴春容
Journal: BMJ (2004)

在核技术、纳米技术、基因技术、网络技术等高新科技突飞猛进的现代化社会,人类本身受到的威胁也越来越突出,重视人文理性的呼声越来越高.科学技术是为人类服务的,而不是威胁人类自身、甚至毁灭人类的,现代科技的高速发展急需人文理性、人文关怀、尊重人性的火车头的牵引,否则,会驶向人类美好愿望的相反方向.医学科学高新技术的快速发展、盲目的技术崇拜、技术滥用和经济利益的刺激所带来的也有医德滑坡、医疗腐败和人性缺失,对人性化服务的呼声也到了振聋发聩的地步,医疗服务也急需人性化火车头的牵引。
超常规浓度补钾抢救干燥综合征合并顽固低血钾性呼吸肌麻痹一例
Authors: 吴敏, 马英淳
Journal: BMJ (2007)

干燥综合征是一类系统性自身免疫性疾病,其肾脏损害以Ⅰ型肾小管酸中毒较为突出,常有低血钾.我科收治1例,但予常规浓度静脉补钾后,次日病情反而进行性加重,发生呼吸肌麻痹,经高浓度超常规补钾并呼吸机辅助呼吸抢救成功,报告如下。
对幽门螺杆菌若干问题的共识意见(2003·中国)
Authors: 中华医学会消化病学分会
Journal: BMJ (2005)

1999年我国幽门螺杆菌科研协作组召开的海南会议提出并经全国消化大会确认的 [1]于2000年发表至今已3年余.3年多来,对幽门螺杆菌(Helicobacter pylori, 简称H. pylori或简写为HP或Hp)的一些重要问题又有了新的认识.2000年欧洲Maastricht-2共识报告具有重要的指导意义[2].2002年第三届全国HP会议上广泛听取了大家对 的意见,又经2003年安徽桐城召开的全国HP共识会议(简称桐城会议)审核修订,现提出新的HP共识意见,以便在推广应用中充实和完善。
Real-world biomarker testing practices in cancer treatment in a lower-middle income country in Southeast Asia.
Authors: Lance Isidore Garcenila Catedral, Harold Nathan Tan, Alfredo Viray Chua, Danielle Benedict Leoncio Sacdalan, Dennis Sacdalan
Journal: Journal of Clinical Oncology (2020)

e19042 Background: Several factors affect how medical oncologists in the Philippines, a lower middle income country, incorporate biomarkers in real-world practice. This study described patterns of use of biomarker testing for the management of breast, colorectal, and lung cancers among medical oncologists in the Philippines, where treatment is largely out-of-pocket. Methods: A cross-sectional survey was performed among practicing medical oncologists in the Philippines from November to December 2019. Responses were compiled and summarized using descriptive statistics. Results: A total of 127 responses (about 40% of medical oncologists in the country) were collected. Respondents were both consultants and fellows-in-training who, on the average, had been in oncology practice for 6.64 years (SD 7.37). Majority of respondents were affiliated with private hospitals and/or clinics (62.20%), but 40.94% of medical oncologists worked in academic medical centers. If clinically indicated and if cost did not play a role, 96% of respondents would order ER, PR and HER2neu testing for breast cancer. A quarter of respondents would include Ki-67 testing. In actual practice, 97% of the respondents reported ordering for ER/PR and 93% for HER2neu testing. For lung cancer, respondents would use EGFR (97.76%), PD-L1 (88.19%), ALK (80.31%), ROS1 (58.27%), and BRAF (33.07%). In actual practice, EGFR was the most frequently ordered biomarker (67.72%). 44.80% of medical oncologists had never used ROS1. For colorectal cancer, the respondents would use KRAS (98.43%), NRAS (81.89%), MMR/MSI (82.25%), and BRAF (63.78%), but these were only sometimes used. 59.84% of medical oncologists had never used BRAF. The strongest factor that drove medical oncologists to test for biomarkers was adherence to clinical practice guidelines (96%), with most respondents using international guidelines from the United States and Europe (61.4%). The largest barrier to biomarker use in the Philippines was financial constraints (94.5%), followed by the patients’ unwillingness to be tested (59.1%), and unavailability of tests in the areas of practice (58.27%). Conclusions: Medical oncologists in the Philippines would use biomarkers in the management of breast, colorectal, and lung cancers if these were clinically indicated and if cost did not play a role. Biomarker use was largely driven by American and European clinical practice guidelines. Financial difficulties by patients, who often had to resort to out-of-pocket payments for their treatment, formed the largest barrier to biomarker use.
Intratumoral heterogeneity and tumor evolution of small cell lung cancer through multi-regional sequencing.
Authors: Yaxiong Zhang, Ningning Zhou, Huaqiang Zhou, Mengmeng Song, Pansong Li, Yan-Fang Guan, Xuefeng Xia
Journal: Journal of Clinical Oncology (2020)

e21103 Background: Small cell lung cancer (SCLC) is a type of aggressive malignancy with poor prognosis, accounting for 15% of lung cancers. Intratumoral heterogeneity (ITH) has been investigated in lung adenocarcinoma or squamous cell carcinoma, but its role in SCLC still remains unclear. Exploring ITH and tumor evolution of SCLC is essential for its treatment and prognosis. Methods: 102 multi-regional tumor tissues were collected from 34 operative SCLC patients (pts) before systemic therapy during Sep. 2009 to Sep.2018 from Sun Yat-sen University Cancer Center. All of the enrolled cases were confirmed as SCLC by immunohistochemistry. We performed whole-exome sequencing (WES) of all the tumor tissues and assessed the ITH using clonal and subclonal somatic mutations or copy number variants. ITH was defined as the proportion of subclonal genetic alterations of all. The relationship between ITH and overall survival (OS) was also explored. Results: Among the enrolled 34 SCLC pts, the median age was 64 year. 28 pts had the smoking history. 23 pts received adjuvant therapy after surgery. Stage I-II and III-IV pts accounted for 50% respectively. The most frequent mutated genes were TP53 (88%), RB1 (70%), TTN (68%), TCEB3CL (65%), MUC16 (56%), and all of them were clonal. The median overall ITH was 0.36 (ranging from 0 to 1), while the mutational ITH and the CNV ITH were 0.50 (0.22 to 1) and 0.49 (0.22 to 1). Univariate analysis revealed that postoperative treatment (HR = 0.27, 0.07-0.97, p= 0.006) and higher CNV ITH (HR = 0.28, 0.08-0.99, p= 0.009) were significant positive predictors of OS, while higher mutational heterogeneity was not associated with OS (HR = 3.34, 0.91-12.25, p= 0.21) significantly. Conclusions: TP53, RB1, TTN, TCEB3CL and MUC16 were probably clonal mutations as early events in SCLC evolution. CNV ITH might be a prognostic predictor in SCLC, which should be verified in a large-sample cohort.
Phase II/III study of circulating tumor DNA as a predictive biomarker in adjuvant chemotherapy in patients with stage II colon cancer:NRG-GI005 (COBRA).
Authors: Van K. Morris, Greg Yothers, Scott Kopetz, Samuel A. Jacobs, Peter C. Lucas, Atif Iqbal, Patrick M Boland, Dustin A. Deming, Aaron James Scott, Howard John Lim, Norman Wolmark, Thomas J. George
Journal: Journal of Clinical Oncology (2021)

TPS148 Background: There are currently no validated predictive biomarkers for stage II resected colon cancer (CC) after adjuvant chemotherapy. However, circulating tumor DNA (ctDNA) that is shed into the bloodstream represents a highly specific and sensitive approach for identifying microscopic or residual tumor cells. For patients (pts) with CC, the detection of ctDNA is associated with persistent disease after resection and may outperform traditional clinical and pathological features as a prognostic factor to assess risk for recurrence. We hypothesize that for pts whose stage II colon cancer has been resected and who have no traditional high-risk features, a positive ctDNA status may identify those who will benefit from adjuvant chemotherapy. Methods: In this prospective phase II/III clinical trial, pts (N=1,408) with resected stage II CC without traditional high-risk features and whom the evaluating oncologist deems suitable for no adjuvant chemotherapy will be randomized 1:1 into 2 arms:standard-of-care/observation (Arm A), or prospective testing for ctDNA (Arm B). Postoperative blood will be analyzed for ctDNA with the GuardantHealth LUNAR panel, covering CC-relevant mutations and CC-specific methylation profiling. Pts in Arm B with ctDNA detected will be treated with 6 months of adjuvant (FOLFOX) chemotherapy. For all pts in Arm A, ctDNA status will be analyzed retrospectively at the time of endpoint analysis. The primary endpoints are clearance of ctDNA with adjuvant chemotherapy (phase II) and recurrence-free survival (RFS) for “ctDNA-detected” pts treated with or without adjuvant chemotherapy (phase III). Secondary endpoints will include time-to-event outcomes (OS, RFS, TTR) by ctDNA marker status and treatment, prevalence of detectable ctDNA in stage II CC, and rates of compliance with assigned intervention. Archived normal and matched tumor and blood samples will be collected for exploratory correlative research. The trial is actively accruing towards the phase II endpoint across all US and Canadian cooperative groups. Support:U10-CA-180868, -180822; UG1CA-189867; GuardantHealth. Clinical trial information: NCT04068103.
Role of T0 status in overall survival for unresectable stage III non-small cell lung cancer.
Authors: Takefumi Komiya, Emily Powell, Charles Vu, Achuta Kumar Guddati
Journal: Journal of Clinical Oncology (2020)

9026 Background: Occult (T0) primary non-small cell lung cancer (NSCLC) with mediastinal involvement is a known but rare clinical condition. Its prognosis has not been evaluated well in the literature. Methods: Using National Cancer Database (NCDB), cases diagnosed between 2004 and 2016 with unresectable clinical stage III NSCLC with N2 or N3 involvement were selected and assigned to T0 or T1-4 group according to AJCC staging version 6 th or 7th. Clinical demographics including use of chemotherapy/immunotherapy in first course of treatment were collected. As validation, independent data using Surveillance, Epidemiology, and End Results Program (SEER) was analyzed accordingly. Survival analyses were conducted using Kaplan-Meier and log-rank tests. Results: A total of 458 and 84,263 cases met criteria for unresectable, N2/N3 stage III NSCLC with T0 and T1-4 status, respectively. T0 status was associated with younger age, recent diagnosis, adenocarcinoma histology, N3, and use of chemotherapy. Overall survival (OS) was improved in T0 over T1-4 group (p &lt; 0.0001) with a five-year survival rate of 30.5% and 12.7%, respectively, with a validation with multivariate proportional hazard models. Propensity score matching analyses using all 458 patients in each group demonstrated a significant difference in OS (p &lt; 0.0001). The difference was also significant in a subset of those who have undergone chemoradiation (p &lt; 0.0001). Independent analysis using SEER data confirmed its superior survival of T0 over T1-4 with a five-year survival rate of 35.3% and 13.5%, respectively. Conclusions: Both NCDB and SEER analyses demonstrated better survival of T0 than T1-4 counterpart in the setting of unresectable stage III NSCLC, irrespective of chemotherapy status. This group may require a distinct assignment to new staging group after further investigation.
A randomized controlled clinical trial on the two-days course of oseltamivir in treatment of influenzalike diseases
Authors: Hong-bo Zhang, Qin-bing Yang, Yu-qing Zhu
Journal: BMJ (2009)

Eighty six patients with influenza-like diseases were randomly assigned to trial group (n=42,oseltamivir 75 mg,twice daily for 2 days)and control group(n=44,osehamivir 75 mg,twice daily for 5 days).The results showed that there Was no statistical difierence in the duration of fever between trial groups[(56±14)h]and control group[(54±13)h,P=0.623],the cost of the trial group[(193±38)yuan]Was 189 yuan less than that in the control group[(382±61)yuan,P=0.016].It is suggested that the efficacy of two-day course of oseltamivir is the same as that of five-day course in tlle treatment for influenza-like diseases,but with lower cost.

Key words: 
Enzyme inhibitirs; Influenza,human
控烟是预防肺癌最重要的措施
Authors: 翁心植
Journal: BMJ (2005)

支气管肺癌是当今世界发病率最高的恶性肿瘤,而且其发病率在多数国家仍在迅速增加.导致肺癌的病因很多,诸如吸烟、电离辐射、大气污染、取暖、烹调产生的煤烟尘、烹调用的油烟尘等所致的室内微小环境的污染、职业的危害、食物中的致癌物及遗传因素等等.但国内外大量研究包括肺癌归因分析发现吸烟是导致肺癌发生危险度最高的因素.吸烟与肺癌的发生有密切的因果关系、剂量发病相关性,而且开始吸烟年龄愈小,肺癌的发病率愈高.早在19世纪50年代,英国牛津Radeliffe医院的Doll医生等对34 434名男性医生进行了一项长达50年的前瞻性流行病学研究[1]。
Abnormalities of blood coagulation and fibrinolysis in patients with steroid induced osteonecrosis after severe acute respiratory syndrome
Authors: 孙伟, 李子荣, 史振才, 张念非, 韩呈武, 莱亚杰, 李志碧, 张远春
Journal: BMJ (2006)

目的 观察严重急性呼吸综合征(SARS)使用激素的骨坏死患者血液血栓形成和低纤溶倾向的指标变化,探讨SARS后骨坏死的病因学,以便用于非创伤性骨坏死的早期诊断和易感人群的筛选.方法 选取88例SARS后激素性骨坏死患者抽取空腹肘静脉血.另取健康人群52名为对照,应用凝血仪和酶标仪的酶联免疫吸附法等方法测定凝血和纤溶指标.结果 SARS后激素性骨坏死患者血液学因素改变明显,骨坏死组蛋白C(PC)(89±32)%,抗凝血酶Ⅲ(AT-Ⅲ)(87±27)%,纤溶酶原激活物抑制剂(PAI)(18±15) U/ml,纤溶酶原(PLG)(73±24)%,而对照组分别是PC(109±20)%,AT-Ⅲ (104±15)%,PAI (8±4) U/ml,PLG (95±15)%,两组比较差异有统计学意义(P<0.01).在各指标出现异常的人数上,骨坏死组PC 25例(占28.41%),活化蛋白C抵抗(APCR)11例(12.6%),AT-Ⅲ 39例(44.82%),PAI 46例(52.27%),PLG 52例(59.09%);而对照组PC 2例(3.85%),APCR 1例(1.92%),AT-Ⅲ 2例(3.85%),PAI 5例(9.62%),PLG 3例(5.77%),差异有统计学意义(P<0.05).结论 SARS后骨坏死患者的凝血、纤溶指标异常,对骨坏死易感人群可以进行高凝和低纤溶的筛选,PC、AT-Ⅲ、PAI、APC-R、PLG可作为骨坏死易感因素的筛选指标。
Evaluation of the efficacy and safety of deferiprone compared with deferasirox in paediatric patients with transfusion-dependent haemoglobinopathies (DEEP-2): a multicentre, randomised, open-label, non-inferiority, phase 3 trial
Authors: Aurelio Maggio, Antonis Kattamis, Mariagrazia Felisi, Giorgio Reggiardo, Amal El-Beshlawy, Mohamed Bejaoui, Laila Sherief, Soteroula Christou, Carlo Cosmi, Oscar Della Pasqua, Giovanni Carlo Del Vecchio, Aldo Filosa, Liana Cuccia, Hoda Hassab, Manika Kreka, Raffaella Origa, Maria Caterina Putti, Michael Spino, Paul Telfer, Bianca Tempesta, Angela Vitrano, Yu Chung Tsang, Ariana Zaka, Fernando Tricta, Donato Bonifazi, Adriana Ceci
Journal: The Lancet Haematology (2020)
Doppler ultrasound screening for deep vein thrombosis in patients with lower limb fracture
Authors: You-qing Yan, Hua Ren, Kun Feng, Chao-hui Du, Zhi-yu Wei
Journal: BMJ (2011)

One hundred and sixteen patients with lower limb fracture were screened by Doppler ultrasound for deep vein thrombosis(DVT) of bilateral lower extremities within the first 72 h, d7 and d21 after fracture. Results showed that DVT was detected in 31 (26. 7% ) out of 116 cases within 72 h; at d7 and d21 DVT was detected in 3 and 1 patient respectively with a cumulated DVT rate of 30. 2% in 3 weeks.Serial Doppler ultrasonography is of value in screening for DVT of the lower extremities in patients with lower limb fracture at early stage.

Key words: 
Deep vein thrombosis;  Fracture,lower limb
Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study
Authors: Bennett-Britton Ian, Teyhan Alison, Macleod John, Sattar Naveed, Smith George Davey, Ben-Shlomo Yoav, 曹勤, 范竹萍
Journal: BMJ (2018)

背景
婚姻关系的质量被认为是对心血管健康结果的独立影响因子。这项研究调查了婚姻关系质量的变化与男性心血管疾病（CVD）危险因素之间的关系。


方法
我们使用了埃文父母和儿童纵向研究的数据，这是一项前瞻性出生队列研究（布里斯托尔，英国）。基线样本仅限于研究已婚的父亲，有基线关系和协方差数据(n=2 496)。我们将最终的分析限制在那些有完整结果、暴露和协方差数据的人身上(n=620)，他们是已婚并在基线后6.4年和18.8年确认了研究儿童的父亲。在基线时间和6.4年之间测量婚姻关系质量，并将其确定为持续良好、改善、恶化或持续恶化的关系。我们还测量了基线后18.8年时的血压、静息心率、体质指数、血脂和空腹血糖等这些与CVD有关的危险因素。


结果
相对于持续良好的关系，调整混杂因素后，发现改善人际关系与低密度脂蛋白的低水平相关[-0.25 mmol/L，95%可信区间（CI）：-0.46~-0.03]，同时相对降低体质指数（-1.07 kg/m2，95%CI：-1.73~-0.42）。而改善关系与总胆固醇水平（-0.24 mmol/L，95%CI：-0.48~0）和舒张压（-2.24 mmHg，95%CI：-4.59~0.11）的关系较弱。关系恶化则与舒张压相关（2.74 mmHg，95%CI：0.50~4.98）。


结论
纵向研究表明婚姻关系质量的改善和恶化与心血管疾病危险因素分别呈正相关与负相关。
COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection
Authors: Hanny Al-Samkari, Rebecca S. Karp Leaf, Walter H. Dzik, Jonathan C. T. Carlson, Annemarie E. Fogerty, Anem Waheed, Katayoon Goodarzi, Pavan K. Bendapudi, Larissa Bornikova, Shruti Gupta, David E. Leaf, David J. Kuter, Rachel P. Rosovsky
Journal: Blood (2020)
Identification and expression distribution of esophageal carcinoma autoantigens.
Authors: Fuchun Si
Journal: Journal of Clinical Oncology (2020)

e16520 Background: To identify the autoantigen protein molecules with autoserum in the tissues from the esophageal carcinoma (EC) patients, analyze autoantigen expression distribution in EC tissues, so as to provide basis for the molecular pathogenesis and clinical medication of EC. Methods: 69 cases of EC patients tissues and serum and 81 cases of healthy people serum were collected, serological proteome analysis (SERPA) was modified with sequential extraction of subcellular protein fractions to identify esophageal oncopathgensis stages autoantigen with autoserum in the tissues from the EC patients. Another 93 cases of EC patients tissue were collected, immunohistochemical and western blot method were used to detect expression distribution of EC autoantigens in esophageal carcinoma tissue, para-carcinoma tissue and normal tissue. Results: Autoantigens CK13, CK16, CaD, ACTG2, tumor rejection antigen (gp96) 1 variant, heat shock protein gp96 precursor were identified, among wihich, CK16, CaD, ACTG2, tumor rejection antigen (gp96)1 variant, heat shock protein gp96 precursor were firstly reported as EC autoantigens. Expression of autoantigens CK16, CaD, ACTG2 were increased in EC carcinoma tissue than para-carcinoma tissue and normal tissue, while CK13 were decreased. Positive expression level of CK16 in normal tissue, para-carcinoma tissue and cancer tissue of EC patients was 0.0076±0.0033, 0.0158±0.0065, 0.0356±0.0165 respectively, CaD was 0.0085±0.0048, 0.0107±0.0056, 0.0177±0.0103 respectively, ACTG2 was 0.0091±0.0039, 0.0136±0.0043, 0.0214±0.0110 respectively, and CK13 was 0.2053±0.0311, 0.1633±0.0280, 0.0412±0.0239 respectively. Conclusions: 6 EC autoantigens were identified, and 5 were first reported. Autoantigens CK13, CK16, CaD and ACTG2 were expressed in EC patients carcinoma tissue, which can be the potential biomarkers of esophageal carcinoma. This study provides new basis for the EC molecular mechanism and development of molecular drugs.
Novel Methods for Quantification of Vasodepression and Cardioinhibition During Tilt-Induced Vasovagal Syncope
Authors: J. Gert van Dijk, Maryam Ghariq, Fabian I. Kerkhof, Robert Reijntjes, Marc J. van Houwelingen, Ineke A. van Rossum, Dirk P. Saal, Erik W. van Zwet, Johannes J. van Lieshout, Roland D. Thijs, David G. Benditt
Journal: Circulation Research (2020)

Assessing the relative contributions of cardioinhibition and vasodepression to the blood pressure (BP) decrease in tilt-induced vasovagal syncope requires methods that reflect BP physiology accurately.To assess the relative contributions of cardioinhibition and vasodepression to tilt-induced vasovagal syncope using novel methods.We studied the parameters determining BP, that is, stroke volume (SV), heart rate (HR), and total peripheral resistance (TPR), in 163 patients with tilt-induced vasovagal syncope documented by continuous ECG and video EEG monitoring. We defined the beginning of cardioinhibition as the start of an HR decrease (HR) before syncope and used logarithms of SV, HR, and TPR ratios to quantify the multiplicative relation BP=SV·HR·TPR. We defined 3 stages before syncope and 2 after it based on direction changes of these parameters. The earliest BP decrease occurred 9 minutes before syncope. Cardioinhibition was observed in 91% of patients at a median time of 58 seconds before syncope. At that time, SV had a strong negative effect on BP, TPR a lesser negative effect, while HR had increased (all P<0.001). At the onset of cardioinhibition, the median HR was at 98 bpm higher than baseline. Cardioinhibition thus initially only represented a reduction of the corrective HR increase but was nonetheless accompanied by an immediate acceleration of the ongoing BP decrease. At syncope, SV and HR contributed similarly to the BP decrease (P<0.001), while TPR did not affect BP.The novel methods allowed the relative effects of SV, HR, and TPR on BP to be assessed separately, although all act together. The 2 major factors lowering BP in tilt-induced vasovagal syncope were reduced SV and cardioinhibition. We suggest that the term vasodepression in reflex syncope should not be limited to reduced arterial vasoconstriction, reflected in TPR, but should also encompass venous pooling, reflected in SV.
地佐辛与芬太尼在无痛胃镜检查术中应用效果的比较
Authors: 李建
Journal: BMJ (2012)

240例行择期胃镜检查患者分别行地佐辛+异丙酚麻醉、芬太尼+异丙酚麻醉,两组的镇痛效果差异无统计学意义(P＞0.05);应用地佐辛者的恶心、呕吐等并发症发生率分别为4.2％(5/120)和0.8％(1/120),低于应用芬太尼者的19.2％(23/120)和10.0％ (12/120)。
Screening of risk factors for type 2 diabetes in general population
Authors: Li Liu, Qing Zhang, Kun Song, Hong-lin Zhao, Xiao-yan Gong, Wei Li
Journal: BMJ (2012)

Total 10 450 people received health check-up in our hospital from March 2009 to December 2010.The subjects were classified as high-risk for type 2 diabetes mellitus ( DM ) group ( n =9016) and non-high-risk group (n =1434).The rate of new DM was 3.36％ (303/9016) and the rate of impaired glucose regulation (IGR) was 12.38％ (1117/9016) in high-risk group; while in non-high-risk group there was no new DM cases,and IGR rate was 2.58％ (37/1434).The detection rate of IGR and DM significantly increased with the increasing rate of risk factor and numbers (P ＜ 0.01 ).Logistic regression analysis revealed that the abnormal glucose metabolism was associated with age,male,positive family history,heart rate,hypertension,abnormal lipid metabolism and hyperuricacidemia.The results suggest that subjects with multiple risk factors should be the key population for prevention and screening of type 2 diabetes.

Key words: 
Prediabetic state; Risk factors
Clinical analysis of 48 cases with pulmonary lymphangioleiomyomatosis:a report of three cases and review of domestic literatures published in the past ten years
Authors: 卢冰冰, 高占成, 王俊, 廖晓耘, 何权瀛
Journal: BMJ (2005)

目的 提高对肺淋巴管平滑肌瘤病(PLAM)的认识和诊断水平.方法报道确诊为PLAM的新病例3例,结合1994年至2004年国内报道的PLAM病例共48例,对该病的临床特点进行汇总分析.结果 3例患者均为育龄女性患者,首发症状为活动后呼吸困难,其中2例合并肺外淋巴管平滑肌瘤,3例均无乳糜胸水.文献报道的48例PLAM患者中,47例有病理学诊断依据;发病年龄为5～69(平均34±10)岁,常见临床表现依次为呼吸困难(95.8%)、咯血(52.1%)、气胸(45.8%)、乳糜胸(33.3%)、咳嗽咳痰(31.3%)和胸痛(12.5%);16例发现腹部异常,包括肾内肿物、腹膜后肿物和腹膜后淋巴结肿大.39例行胸部高分辨CT检查,38例可见双肺弥漫分布的薄壁小囊影.30例有肺功能测定数据或结论的患者中,23例为阻塞性通气功能障碍,7例为混合性通气功能障碍.28例患者有动脉血气分析数据,其中17例合并呼吸衰竭.结论胸部高分辨CT对PLAM具诊断价值.对育龄妇女发生的渐进性呼吸困难、咯血、自发性气胸应及时进行胸部高分辨CT检查.并应常规进行腹部和盆腔影像学检查以了解患者是否合并肺外淋巴管平滑肌瘤。