tbuckley/cabot-search huggingface dataset:
Relationship between colorectal adenomatous polyps and thyroid function in middle-aged and elderly people
Authors: Changxi Chen, Yushan Mao, Zhongwei Zhu, Juan Du, Yimin Xu, Cheng Zhang
Journal: BMJ (2015)

Objective
To explore the relationship between thyroid hormone and colorectal adenomatous polyps (CAP) in middle-aged and elderly people.


Methods
We surveyed 3 042 middle-aged employees and retirees aged 45 years and over at a petrochemical enterprise of Ningbo. Their colonoscopic findings, body mass index, waist circumference and thyroid function were analyzed.


Results
Age and serum free triiodothyronine (FT3) of females with CAP were higher than those of the corresponding non-CAP group, so were age and waist circumference of males with CAP (P<0.05). Furthermore, these differences were statistically significant. The detection rate of CAP was significantly higher in males than in females (χ2=49.418, P<0.01). The detection rate of CAP was higher in females with higher levels of FT3. Multivariate unconditional logistic regression analyses showed the effects of thyroid hormone on the CAP differed by gender. Age and FT3 (OR=1.60, 95%CI: 1.12-2.28, P=0.01) were correlated with CAP in females. However, only age and waist circumference were correlated with CAP in males.


Conclusion
Elevated FT3 may be a risk factor of CAP in elderly females. The detection rate of CAP may not be affected by FT3 levels in males.


Key words: 
Colorectal neoplasms; Colorectal adenomatous Polyps; Thyroid function
Cabozantinib in combination with atezolizumab in non-small cell lung cancer (NSCLC) patients previously treated with an immune checkpoint inhibitor: Results from cohort 7 of the COSMIC-021 study.
Authors: Joel W. Neal, Farah Louise Lim, Enriqueta Felip, Ryan D. Gentzler, Shiven B. Patel, Joaquina Baranda, Bruno Fang, Christian Michael Squillante, Matteo Simonelli, Scott Werneke, Dominic Curran, Santiago Ponce Aix
Journal: Journal of Clinical Oncology (2020)

9610 Background: First-line immunotherapy with/without chemotherapy is standard of care for patients (pts) with advanced NSCLC; however, there is a need for effective treatment options after progression on a prior immune checkpoint inhibitor (ICI). Cabozantinib (C) may augment response to ICI by inhibiting kinases implicated in suppressing immune cell responses and has shown encouraging clinical activity in combination with ICI in other tumor types including RCC and HCC. COSMIC-021, a multicenter phase 1b study, is evaluating the combination of C with atezolizumab (A) in various solid tumors (NCT03170960). We report results from cohort 7 in NSCLC pts after prior ICI therapy. Methods: Eligible pts had ECOG performance status (PS) 0-1 and radiographic progression after one prior anti-PD-1/PD-L1 ICI given alone or in combination with chemotherapy for metastatic non-squamous NSCLC. Up to 2 lines of prior systemic anticancer therapies were permitted. Pts received C 40 mg PO QD and A 1200 mg IV Q3W. CT/MRI scans were performed Q6W for the first year and Q12W thereafter. Primary endpoint is ORR per RECIST 1.1 by investigator. Other endpoints include safety, duration of response (DOR), progression-free survival, and overall survival. Results: Thirty pts with advanced NSCLC were enrolled. Median age was 67 yrs (range 41, 81), 43% were male, 57% had ECOG PS 1, and 23% had liver metastases. Median duration of prior ICI therapy was 4.8 months (mo; range 0.8, 29), and 15 (50%) pts were refractory to prior ICI (progressive disease as best response). As of December 20, 2019, the median follow-up was 8.9 mo (range 5, 20) with 9 (30%) pts continuing study treatment. The most common treatment related adverse events (TRAEs) of any grade were diarrhea (53%), fatigue (37%), nausea (23%), decreased appetite (20%), palmar-plantar erythrodysesthesia (20%) and vomiting (20%). Grade 3/4 TRAEs occurred in 14 (47%) pts, and 1 (3.3%) had grade 5 TRAEs of myocarditis and pneumonitis. Confirmed ORR per RECIST 1.1 was 23% (7 of 30 pts; all partial responses including 3 pts refractory to prior ICI). Time to response was 1.4 mo (range 1, 3), and median DOR was 5.6 mo (range 2.6, 6.9). DCR (CR+PR+SD) was 83%. Conclusions: The combination of C and A had an acceptable safety profile and showed encouraging clinical activity in pts with advanced NSCLC who had progressed after prior ICI therapy. The response rate was greater than previously observed with C monotherapy. Due to the promising data, enrollment in this cohort has been expanded and is ongoing. Clinical trial information: NCT03170960 .
缺血性脑卒中和短暂性脑缺血发作的二级预防
Authors: 陈玉辉, 龚涛
Journal: BMJ (2012)

减少缺血性脑卒中和短暂性脑缺血发作复发的措施主要包括危险因素控制及特殊治疗.危险因素的控制包括血压、血脂、血糖的控制及改变不良生活方式.特殊治疗指根据病因不同采取不同的抗血小板、抗凝或手术治疗。
长期服用阿司匹林和藻酸双酯钠对凝血检测值的影响
Authors: 徐斌, 张明英, 潘世杰, 魏孔明
Journal: BMJ (2005)

我们2000年初的研究工作显示,不论阿司匹林(ASA)与藻酸双酯(PSS)合用 ,还是单用ASA,均能明显降低缺血性心脑病的发病率,但发现其消化道出血及牙龈出血的发生率为0.9%～1.7%。
脓毒症患者血浆内毒素的动态变化及其临床意义
Authors: 吴彩军, 李春盛, 黄逸
Journal: BMJ (2011)

严重脓毒症和多脏器功能不全综合征(multiple organ dysfunction syndrome,MODS)仍是重症监护病房患者死亡的主要疾病[1].内毒素(lipopolysaccharide)血症导致MODS已被临床所证实[2],严重者在经有效抗牛素治疗并血培养细菌转阴后仍可死亡,此时检测患者血浆内毒素水平仍很高.有报道,脓毒症患者的血浆内毒索水平对疾病的发生进展起着关键作用,可以引起一系列病理生理改变[3-4].由于血浆内毒素含量相对稳定,能较为敏感地反映机体革兰阴性菌感染的动态变化过程,连续监测其动态变化可用于临床评估感染程度.本研究旨在观察脓毒症患者血内毒素水平的动态变化,并且探讨其在脓毒症发生发展中的意义。
BMK_PANC: Search for new predictive/prognosis biomarkers (BKs) in potentially resectable pancreatic adenocarcinoma (PDAC).
Authors: Antonio Viudez, Iranzu González-Borja, Saioa Goñi, Ismael Ghanem, Irene Amat, Virginia Arrazubi, Jairo Pérez-Sanz, Irene Hernandez, Jaime Feliu Batlle, Ruth Vera, Joaquin Fernández-Irigoyen
Journal: Journal of Clinical Oncology (2020)

e16782 Background: New BKs are urgently needed in order to improve PDAC patient’s outcome. In this sense, the main aim of this multicenter and prospective project is to find predictive and/or prognostic BKs based on many cytokines that are produced in cancer microenvironment and can nowadays be accurately analyzed. Methods: Patients diagnosed of potentially resectable PDAC with poor prognostic factors and treated with neoadjuvant treatment are being included. Serial analyses (basal, with TC, with surgery and time of relapse/or after 1y of follow-up) of serum levels of 80 cytokines are being done. Results: With a median follow-up of 11,25 months (m) (4,67-38,28) 22 patients (pt) with median of age of 62,5 y-0, most of them men (63.6%) have been included, with radical surgery performed in 14 of them (2 pts with bypass). Seven operated pt received adjuvant treatment and 12 operated pt developed progression of disease. 18 pt have received nab-paclitaxel and gemcitabine as perioperative treatment and 4 received Folfirinox. Perineural and vascular invasion were confirmed after surgery in 45,5% and 27,3% of cases, respectively. Positive nodes were found in 40,9% of them, being the median of positive and resected nodes of 1 (0-14) and 26 respectively. Surgical margins were negative (R0) in 64,3% of cases (35,7% R1). Pathological response was described as partial in 13,6%, with no changes in 31,8% and progression in 13,6%. Globally, PFS and OS were 13,50 m (CI95%: 6,44-20,55) and 17,31 m (CI 95% 8,86-25,76). Significant differences (p = 0,002) were observed in cases in which radical surgery had been performed with PFS of 13,5 m (9,34-17,66) and 3.97 m (0-8,23) for unresectable patients. Regarding the cytokine array, we observed different PFS outcome based on basal MCP3 levels (low: 16,32 m CI 95%: 5,02-27,63; high: 7,52 m CI95%: 6,23-8.81, p = 0,023), basal Oncostatin (high: 7,12 m CI95%: 3,09-11,15, low: not reached; p = 0,007) or basal Eotaxin (low: 7,12 m CI 95%: 5,75-8,50; high: not reached, p = 0,029). A cytokine score was created based on these results, maintained significant differences for PFS (16,32 m CI95%: 5,07-27,57 vs 6,53 m CI95%: 2,75-10,32, p = 0.003). Our cytokine score showed a significant role as independent prognosis factor in multivariate analysis (HR: 0,196 CI95%: 0,042-0,918; p = 0.039). Conclusions: In potentially resectable/borderline PDAC our basal cytokine score seems to be able to discriminate as independent prognosis factor between those patients that will get significant benefit from neoadjuvant treatment from those that will not
儿童中耳炎诊断和治疗指南(草案)
Authors: 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会小儿学组
Journal: BMJ (2012)

儿童中耳炎的分型一、急性中耳炎分为急性非化脓性中耳炎和急性化脓性中耳炎.二、分泌性中耳炎三、慢性化脓性中耳炎分为伴胆脂瘤型中耳炎和不伴胆脂瘤型中耳炎(不含先天性中耳胆脂瘤).儿童中耳炎通用检查一、耳镜及鼓气耳镜检查二、听力学评估听力评估检查项目包括各个年龄段行为测听和客观听功能检查,其中客观听功能检查至少包括听觉诱发电位(骨气导阈值)和中耳声导抗(6个月以内患儿用1000 Hz探测音,大于6个月患儿用226 Hz或1000 Hz探测音).不同年龄患儿检查项目:①6个月以内:行为听觉反应测听+客观听功能检查;②7个月～2岁5个月:视觉强化测听+客观听功能检查;③2岁6个月～5岁:游戏测听+客观听功能检查;④5岁以上:纯音测听+客观听功能检查。
CodeBreak 100: Phase I study of AMG 510, a novel KRAS<sup>G12C</sup> inhibitor, in patients (pts) with advanced solid tumors other than non-small cell lung cancer (NSCLC) and colorectal cancer (CRC).
Authors: David S. Hong, James Kuo, Adrian G. Sacher, Fabrice Barlesi, Benjamin Besse, Yasutoshi Kuboki, Grace K. Dy, Vikas Dembla, John C. Krauss, Timothy F. Burns, June Kim, Haby Henary, Gataree Ngarmchamnanrith, Bob T. Li
Journal: Journal of Clinical Oncology (2020)

3511 Background: Kirsten rat sarcoma viral oncogene homolog ( KRAS) p.G12C mutation occurs in approximately 13% of NSCLC and 1%–3% of CRC and other solid tumors. AMG 510 is a first-in-class small molecule that specifically and irreversibly inhibits KRAS G12C . Previously, AMG 510 showed preliminary antitumor activity and favorable tolerability in pts with KRAS p.G12C mutant NSCLC or CRC in the phase 1, first-in-human trial. Here, we report results in pts with other tumor types from the same trial. Methods: This study evaluates AMG 510 in pts with locally-advanced or metastatic KRAS p.G12C mutant solid tumors. Key inclusion criteria: KRAS p.G12C mutation via local testing and prior systemic anticancer treatment (tx). Oral daily doses of 180, 360, 720, and 960 mg were tested in the dose escalation, and 960 mg was selected for expansion. Primary endpoint is safety; key secondary endpoints include pharmacokinetics and objective response rate as assessed per RECIST 1.1. Response is assessed every 6 weeks (wks) for 24 wks then every 12 wks thereafter. Results: As of January 8, 2020, 25 pts (9 female, median age 60 years [range: 40–75]) with tumor types categorized by investigators as histology other than NSCLC and CRC were enrolled and dosed (10 pancreatic cancer, 4 appendiceal cancer, 2 endometrial cancer, 2 unknown primary cancer, 1 bile duct cancer, 1 sinonasal cancer, 1 ampullary cancer, 1 small bowel cancer, 1 melanoma, 1 small cell lung cancer, and 1 esophageal cancer). 23 pts received 960 mg dose. 20 pts (80.0%) had ≥2 prior lines of tx. At data cutoff, 13 pts (52.0%) remained on tx; 9 (36.0%) and 3 (12.0%) pts remained on tx for ≥3 and ≥6 months, respectively. Median follow up was 4.3 months (range: 0.1–12.6). Tx-related adverse events (TRAEs) occurred in 9 pts (36.0%). 2 pts (8.0%) had grade 3 TRAEs, including diarrhea (1/25) and pneumonia (1/25, serious AE). No dose-limiting toxicities, grade ≥4, or fatal TRAEs were reported. No TRAEs led to tx discontinuation. 3 pts had not been followed up for ≥7 wks by the data cutoff. 22 pts were followed up for ≥7 wks, and their best overall responses were: 3 confirmed partial response (1 appendiceal, 1 melanoma, and 1 endometrial), 13 stable disease (6 pancreatic, 2 appendiceal, 1 ampullary, 1 bile duct, 1 endometrial, 1 sinonasal, and 1 unknown primary), and 6 progressive disease. Conclusions: AMG 510 was well tolerated and demonstrated clinical activity in pts with advanced KRAS p.G12C mutant solid tumors other than NSCLC and CRC. Clinical trial information: NCT03600883 .
Effects of social support on depression and anxiety among standardized training residents
Authors: Lei Huang, Xiangyun Long, Haisong Cui, Xiaofeng Guan, Zheng Lu
Journal: BMJ (2017)

Objective
To investigate the influence of social support on the depression and anxiety of standardized training residents.


Methods
Three hundred and eighteen standardized training residents selected by random sampling method from 4 training bases in Shanghai participated in this survey.


Results
The average score of PHQ-9 was(7.24±5.20), and 67.30%(n=214)of participants had different degrees of depression; the average score of GAD-7 was(5.57±4.55), and 55.03%(n=175)of participants had different degrees of anxiety. One-way analysis of variances showed that standardized training residents who had work experience, longer training years and less salary satisfaction got higher scores in PHQ-9 and GAD-7. Male physicians had higher scores in GAD-7 than female ones. The scores of PHQ-9 (r=-0.390, P<0.01) and GAD-7 (r=-0.376, P<0.01) were both negatively correlated with social support. Regression analysis showed that training years, salary satisfaction, objective social support and the availability of support were significant for predicting the scores of PHQ-9(adjusted R2=0.242, F=17.893), work experience, salary satisfaction, objective social support and the availability of support were significant for predicting the scores of GAD-7(adjusted R2=0.228, F=14.390). After controlled the demographic variables, social support explained the variation rate of 0.119 to the score of PHQ-9 and 0.126 to the score of GAD-7.


Conclusion
The depression and anxiety of standardized training residents in this study is in a serious situation. Providing the objective social support and the availability of support as well as improving the salary satisfaction of standardized training residents may relieve the depression and anxiety and enhance their mental health.


Key words: 
Physicians; Depression; Anxiety; Standardized training residents
Studies of Plasma Quinidine Content
Authors: RICHARD W. KALMANSOHN, JOHN J. SAMPSON
Journal: Circulation (1950)

The gastrointestinal symptoms of quinidine toxicity occurred without relation to plasma concentration, suggesting that most examples are due to individual local gastrointestinal sensitivity and some, associated with giddiness, occur only at higher levels and may be due to nervous system effects. Tinnitus, visual disturbances and marked hypotension generally occurred at relatively high plasma quinidine concentrations. It is suggested that hypotension is due to a nervous system effect rather than to myocardial incompetence, but nonetheless warrants cessation of administration.
Use of artificial intelligence to improve access to initial leukemia diagnosis in low- and middle-income countries.
Authors: Tania Raquel Cerrato
Journal: Journal of Clinical Oncology (2020)

e14117 Background: Disparities in access to cancer diagnostic methods affect especially low and middle-income countries (LMIC). Honduras, a country with limited resources of laboratory, and trained personnel to diagnose leukemia have an estimated incidence of leukemia of 5.8 per 100,000 person-years and the mortality is 4.8 per 100,000 person-years. This country has a single immunophenotyping center and similar to many other LMICs, the preliminary diagnosis of leukemia is performed by a morphological study of blood. Machine learning (ML) is a form of artificial intelligence (AI) that has the potential to improve medical attention in several medical fields. The purpose of this study is to evaluate the impact of ML use, as a method to reduce the time interval and the access to a diagnosis of leukemia in Honduras, where the current average time to perform an initial diagnosis of leukemia is from 2 weeks to 3 months. Methods: A quantitative correlational study was designed. With the help of local informatic developers, an automated image processing algorithm was designed, which was fed with a total of 1009, digital images of bone marrow aspirates and peripheral blood of patients with proven leukemia through immunophenotyping. The images were captured using a microscope Carl Zeiss lens with a 100x objective, the process included the segmentation of leukemia cells for its analysis. Bivariate outcomes were assessed using the Pearson chi-squared test. Results: From 2016 to 2018, a total of 341 samples of patients with any symptom of leukemia were included. After anonymization of patient identification, the samples were analyzed using our algorithm by comparing the cells with its database. Posteriorly, an expert hematologist performed an analysis of the sample. A total of 20 samples (5.8%), were diagnosed with a preliminary diagnosis of leukemia. Of the 20 samples, a total of 10(50%) were acute myeloid leukemia, 6 samples (30%) lymphoblastic leukemia and the remaining 4 samples (20%) were compatible with chronic myeloid leukemia. The average time to make an initial diagnosis of leukemia was 75% and 24% in 24 and 48 hours respectively. Local hematologists managed to make treatment decisions earlier with benefit to the patients. In 19 of the samples (95%), there was correspondence between the morphology diagnosis obtained by our algorithm and the immunophenotyping diagnosis. Conclusions: This preliminary study demonstrates that the use of artificial intelligence constitutes an important element to improve access and shortening of the time required to obtain a diagnosis of leukemia in LMCIs, and represents a method to reduce disparities in access to diagnosis of hematological cancers.
Impact of CD38 knockout in NK cells on daratumumab-mediated cytotoxicity and cellular metabolism.
Authors: Yuya Nagai, Meisam Naeimi Kararoudi, Syed Abbas Ali, Philip H. Imus, Marcelo Pereira, Ezgi Elmas, Ivan Borrello, Dean Anthony Lee, Gabriel Ghiaur
Journal: Journal of Clinical Oncology (2020)

e15018 Background: Multiple myeloma (MM) is a neoplasm of plasma cells. These cells express high levels of CD38 and are sensitive to daratumumab (DARA), a CD38-targeting monoclonal antibody. DARA kills MM cells via several mechanisms including antibody dependent cellular cytotoxicity (ADCC). Although DARA has improved the outcome of patients, CR is not achieved in all the cases. Besides, most patients that achieve CR will experience relapse. A potential explanation for blunted efficacy of DARA is downregulation of CD38 levels on MM cells and impaired ADCC due to depletion of CD38 high NK cells during therapy. ATRA upregulates CD38 levels on target cells and was proposed to improve the efficacy of DARA. NK cell supplementation was tested in a preclinical model, but that had only a modest effect on DARA efficacy, likely due to their short life via DARA-mediated elimination. Methods: We generated CD38 knockout (CD38 KO ) NK cells from healthy donors via Cas9 RNPs and investigate if these cells boost DARA activity against MM. RNA-seq and cellular metabolic analysis were performed to examine the effect of CD38 deletion on NK cell function. Results: Knockout efficiency was 81.9 ± 6.9% (mean ± SD, N = 5). Very low off-target effects were seen by whole genome sequencing. When compared to paired CD38 wild type (CD38 WT ) NK cells, CD38 KO NK cells showed lower conjugation (2.57% vs. 11.85%, N = 3, p = 0.04), less fratricide (97.3% vs. 54.2%, mean viability, N = 3, p = 0.01), and superior persistence in mice (18.16% vs. 0.42%, mean frequency in blood, N = 5, p &lt; 0.01) in the presence of DARA. Additionally, CD38 KO NK cells exhibited enhanced ADCC against all tested MM cell lines and primary samples including CD38 low cell lines and primary MM cells from a patient with disease relapse on DARA. Transcriptomic and cellular metabolic analysis revealed that CD38 KO NK cells have favorable metabolic shift with higher mitochondrial respiratory capacity (N = 3, p &lt; 0.01). Although ATRA upregulates CD38 levels on MM cell lines, we observed that ATRA treatment upregulates CD38 levels on circulating NK cells in patients. ATRA upregulated CD38 levels on CD38 WT NK cells, but not on CD38 KO NK cells, and increased their fratricide. Thus, CD38 WT NK cells showed impaired overall DARA-mediated cytotoxicity against MM cells in the presence of ATRA, even though those MM cells were sensitized to DARA. Conclusions: We present proof of concept that adoptive CD38 KO NK cell therapy has the potential to maximize the efficacy of DARA against MM. Further investigation into the role of metabolic reprogramming of CD38 KO NK cells is warranted.
Online Access to MEDLINE in Clinical Settings
Authors: R. Brian Haynes, K. Ann McKibbon, Cynthia J. Walker, Nancy Ryan, Dorothy Fitzgerald, Michael F. Ramsden
Journal: Annals of Internal Medicine (2020)

Abstract Study Objective:We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. Desig...
The prevalence of BRCA1/2 germline mutation in Chinese pan-cancer.
Authors: Fei Ma, Lixi Li, Zongbi Yi, Jianming Shi, Hua Jiang, Chen Chen, Pingping Dai, Weipei Zhu, Chunhui Jin, Qin Tan, Xuefeng Xia, Yan-Fang Guan, Ling Yang, Xin Yi
Journal: Journal of Clinical Oncology (2020)

e13684 Background: Pathogenic variants in cancer predisposition genes BRCA1/2 confer susceptibility to breast and ovarian cancer and well-studied. But the characteristics of BRCA in other cancers is unknown, we identified and characterized BRCA germline variants in a large pan-cancer in China. Methods: NGS was performed on genomic DNA from 29,676 pan-cancer patients. Large fragment deletions were all verified by QPCR. We integrated guidelines of ACMG/AMP, ENIGMA and China expert consensus. Based on the in-house system, variants were interpreted one-by-one and classified into 5 grades: Benign (B), Likely Benign(LB), Variant of Uncertain significance(VUS), Likely pathogenic (LP), Pathogenic (P). Results: Among 29,676 patients, 300 BRCA1 mutations and 440 BRCA2 mutations were detected in our study. The proportion among P/LP/VUS/LB/B were 36.1%, 11.6%, 36.6%, 11.1% and 4.6%. Consistent with previous reports, the mutations spread around the whole genes. Missense and frameshift were most common types in BRCA1 (40%, 25.3%) and BRCA2 (42.3%, 29.3%). 192(25.9%) mutations were not reported in any of the databases. Among these newly reported mutations, 32 (16.7%) were classified as P, 62 (32.3%) LP and 98 (51%) VUS. Totally, 522 (1.8%) patients were identified with P/LP BRCA1/2 mutations. No founder mutations in Chinese population were defined, but BRCA1 5470_5477delATTGGGCA (I1824Dfs*3) and BRCA2 3109C &gt; T (Q1037*) had the highest prevalence indicating the common P/LP mutations in Chinese. On the whole, BRCA-associated hereditary cancer harbored higher P/LP percent than other cancer types (11.1% vs 0.7%). Different distribution and percent were observed in BRCA1 and BRCA2, the P/LP mutations were found in double primary cancers of breast and ovary (76.9% vs 38.5%), followed by ovarian cancer (15.5% vs 6.3%), breast cancer(3.8% vs 4.0%), endometrial cancer(1.6% vs 2.4%), prostatic cancer(1.3% vs 1.9%), pancreatic cancer (0.3% vs 1.8%), biliary tract tumor (0% vs 1%), thyroid cancer (0% vs 0.9%), NSCLC(0.2% vs 0.5%) and colorectal cancer(0.08% vs 0.4%). Except for SNV/Indels, large range heterozygous deletions were found in 9 patients, including 4 (0.6%) OC, 4 (0.2%) BC and 1 NSCLC, almost all interfering with BRCA1. Conclusions: This analysis depicted a comprehensive landscape of germline BRCA1/2 variants in Chinese pan-cancer. Besides breast and ovarian cancer, lots of other cancers also harbor BRCA germline mutation, retrospective family history and hereditary cancer risk assessment needs further study.
血压值尾数偏好的临床意义
Authors: 顾杰, 黄俏雯, 祝墡珠
Journal: BMJ (2012)

尾数偏好是血压测量中易被忽视的误差来源之一,其中以0偏好最常见.尾数0偏好的存在不仅影响高血压患病率和诊断分级,还会误导高血压患者的治疗决策和疗效判断.测量者的职业、被测量者的疾病和人口学特征、血压计类型都可能影响尾数0偏好的发生.对测量人员进行培训或增加电子血压计的使用是避免其发生的有效方法。
临床思维的陷阱
Authors: 吴东, 黄晓明, 陈嘉林
Journal: BMJ (2011)

很多前辈医家形容临床医学既是科学,又像艺术,反映出这门专业具有一定程度的模糊性和不确定性.如何处理这种不确定性体现了医生的专业水平.在工作中医生每天都要做出诊疗决定,有时甚至需要在信息不充分的情况下,做出事关生死的重大决策.例如:一位重症肺炎的患者呼吸窘迫,病情危重,在没有病原学资料的情况下,经治医生需要市即做出诊断,并开始经验性抗生素治疗,而抗生素的选择是否正确直接关系到病情转归.由此可见,临床决策是医疗行为的中心环节,直接关系到医疗质量.正确的决策能使病情转危为安,而错误的决策却可能造成误诊误治,轻者增加患者不必要的痛苦和负担,重者甚至引起伤残和死亡.临床决策的重要性,实在是不言而喻的。