tbuckley/cabot-search huggingface dataset:
Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults
Authors: Hokyou Lee, Yuichiro Yano, So Mi Jemma Cho, Jong Heon Park, Sungha Park, Donald M. Lloyd-Jones, Hyeon Chang Kim
Journal: Circulation (2020)

Background: Little is known regarding health outcomes associated with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), or systolic and diastolic hypertension (SDH) among young adults with stage 1 hypertension, defined using the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline. Methods: From a nationwide health screening database, we included 6 424 090 participants, aged 20 to 39 years, who were not taking antihypertensive medication at the baseline examination in 2003 to 2007. Participants were categorized as having normal BP (untreated systolic BP [SBP] &lt;120/diastolic BP [DBP] &lt;80 mm Hg; n=2 665 310); elevated BP (SBP 120–129/DBP &lt;80 mm Hg; n=705 344); stage 1 IDH (SBP &lt;130/DBP 80–89 mm Hg; n=1 271 505); stage 1 ISH (SBP 130–139/DBP &lt;80 mm Hg; n=255 588); stage 1 SDH (SBP 130–139/DBP 80–89 mm Hg; n=711 503); and stage 2 hypertension (SBP ≥140, DBP ≥90 mm Hg; n=814 840). The primary outcome was composite cardiovascular disease (CVD) events, including myocardial infarction, stroke, heart failure, and CVD-related death. Results: The median age of the participants was 30 years and 60.9% were male. Over a median follow-up of 13.2 years, 44 070 new CVD events occurred. With normal BP as the reference, multivariable-adjusted hazard ratios (95% CIs) for CVD events were 1.14 (1.09–1.18) for elevated BP, 1.32 (1.28–1.36) for stage 1 IDH, 1.36 (1.29–1.43) for stage 1 ISH, 1.67 (1.61–1.72) for stage 1 SDH, and 2.40 (2.33–2.47) for stage 2 hypertension. Conclusions: Among young adults, stage 1 ISH, IDH, and SDH were all associated with higher CVD risks than normal BP. The CVD risks of stage 1 ISH and IDH were similar to each other but lower than the risk of stage 1 SDH. Categorizing young adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.
An investigation on current status of general practitioners-in-charge in three large cities of China
Authors: 全国全科医学专业技术队伍现状研究课题组
Journal: BMJ (2009)

Objective To study current status of health professionals before and after promotion to general practitioners (GPs)-in-charge to provide evidence for related policy decision-making. Methods From November 2007 to March 2008, 524 general practitioners-in-charge who passed national qualification examinations of medium-level health professionals were interviewed with questionnaire, as well as by focus group discussion, in cities of Tianjin, Nanjing and Wuhan during 2001 to 2007. Results One hundred and thirty-three of 524 respondents (25.4%) registered at local health bureaux as GPs to practise medicine, and 52 left their original clinical positions and 21 of 52 moved to administration positions. Forty of them left primary-care hospitals, township hospitals, community health-care service centers or hospitals and clinics affiliated to enterprises, where they originally worked with. Eleven of them left state-owned institutions. Conclusion At present, the number of GPs registered for permit to practice medicine decreased and workforce of GPs drained out seriously appearing in unstable status.

Key words: 
Questionnaires; Interviews; Data collection; General practitioner
内镜黏膜下剥离术治疗肠黏膜早癌及癌前病变37例分析
Authors: 赵江海, 李丽, 宋慧琴
Journal: BMJ (2012)

对37例发现肠黏膜早癌及癌前病变患者进行内镜黏膜下剥离术( ESD)治疗,成功率91.9％ (34/37),平均手术时间55 min;2例术中出血＞500 ml,经急诊外科手术切除后出血停止；1例(2.7％)十二指肠球部小穿孔,应用金属夹成功闭合裂孔.术后平均随访2年,37例患者全部生存,3例(8.1％)复发,均再次内镜下切除成功.提示ESD治疗肠黏膜早癌及癌前病变是安全有效的,可以完整切除消化道黏膜层病变,且创伤小恢复快。
Activin as a biomarker for platinum resistance in non-small cell lung cancer.
Authors: Jennifer Wen Ying Lim, Alexander David Murphy, Sandra O'Toole, Adnan Nagrial, Deme John Karikios, Dariush Daneshvar, Angela Murphy, Rachael McCloy, Neil Watkins, Venessa T. Chin
Journal: Journal of Clinical Oncology (2020)

e21737 Background: Lung cancer is the leading cause of cancer death in Australia with 13,000 new cases per year. Although targeted therapy and immunotherapy have drastically changed the treatment landscape, the majority of patients will receive platinum-based chemotherapy for which the response rate is approximately 30% (Reck et al, 2016). An immunohistochemistry-based, predictive biomarker would be beneficial for patients and help avoid toxicity for patients unlikely to respond. Marini et al (2018) identified 3 biomarkers associated with in-vitro platinum resistance – activin A, growth differentiation factor-11 and transforming growth factor-b – which were investigated in a real-world retrospective cohort to determine their relation to objective radiological response and overall survival. Methods: We identified 101 patients with advanced non-small cell lung cancer who received platinum chemotherapy at 2 cancer centres between 2014-2015. Archival formalin-fixed paraffin embedded tissue samples were stained with activin A. Slides were manually scored by 2 independent clinicians using the multiplicative quickscore method (Detre et al, 1995). Kaplan Meier analysis for overall survival, a Cox-proportional hazards model for confounding variables and a chi-square analysis was performed to analyse the relationship between high immunohistochemistry scores (greater or less than 6) and radiological response. Results: We performed statistical analysis around the median cytoplasmic score (6). The overall median survival was 15.3 months. No significant difference in survival was detected between the two populations (p value = 0.97). The immunohistochemistry score was also not associated with rates of partial response (p value = 0.98) or progressive disease (p value 0.22). Conclusions: Despite an association with lower progression-free survival in a retrospective cohort in a previous study, high expression of activin does not appear to be a useful biomarker for platinum response in the setting of non-small cell lung cancer. Further research into associated antibodies including GDF-11 and TGF-b is in progress.
Reducing time to treatment and patient costs with breast cancer: The impact of patient visits.
Authors: Sarah Sittenfeld, Zachary Greenberg, Zahraa Alhilli, Jame Abraham, Halle C. F. Moore, Stephen R. Grobmyer, Emily Elizabeth Monteleone, Katherine Tullio, Chirag Shah
Journal: Journal of Clinical Oncology (2020)

e19407 Background: The purpose of this study was to evaluate the impact of a continuous improvement process aimed at reducing time to treatment on minimizing the number of days spent to complete pre-treatment visits and the associated costs for patients with non-metastatic breast cancer. Methods: System-wide initiatives were implemented in 2015 to minimize time to treatment initiation (TTI), by incorporating lean process strategies and enhanced coordination. Patient and treatment information was obtained through an IRB-approved registry for the years 2015 and 2018. Average number of days spent to complete visits, TTI, and associated patient costs including driving expenses, parking, food, childcare, and lost wages were calculated and compared between the years 2015 and 2018. Results: In 2015, the median TTI was 43.5 days and the average number of separate days spent to attend multidisciplinary visits prior to first treatment was 1.86. These were reduced to 29 days and 1.52 visits, respectively, in 2018 (p &lt; 0.0001 for both). When evaluating treatment visits by surgical procedure, the average number of visits was reduced regardless of surgical procedure. The average number of visits was highest for patients undergoing mastectomy with reconstruction (2.34 in 2015, reduced to 1.65 in 2018, p &lt; 0.0001). A single visit to complete treatment planning was associated with patient costs of $249 as compared with multiple trips costing $491 for 2 visits and up to $1,226 for 5 visits. Conclusions: In breast cancer patients, implementing a continuous improvement process to reduce time to treatment was associated with fewer visits required prior to treatment initiation, resulting in lower patient costs.
居民健康档案的编码方法
Authors: 皇甫建红, 王殿臣
Journal: BMJ (2008)

居民健康档案的管理是社区卫生服务中信息管理的基本内容.目前,各社区卫生服务机构对档案进行编码各具特色,全国未有统一的要求.如何对居民健康档案进行编码,能够达到科学管理、利用和开发每一位居民的健康档案,是一个值得探讨的问题.根据工作中所积累的编码方案,本研究参考身份证号编制原理,设计了以住户为单位进行编码的方法,介绍如下。
Development and evaluation of a disease-specific health-related quality of life instrument for obstructive sleep apnea hypopnea syndrome
Authors: 金晓燕, 蔡映云, 严瑾, 曾健, 姚媛
Journal: BMJ (2006)

目的 制定适合我国阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的生命质量评估表并做初步检验.方法通过与OSAHS相关人员访谈并参考国外OSAHS生命质量量表确立反映OSAHS生命质量的条目库.由20例OSAHS患者对条目库进行筛选,计算频度、重要性评分和影响分,将影响分大于1.5分的条目纳入量表.对52例OSAHS患者根据呼吸紊乱指数(AHI)分为AHI<40与AHI≥40两组,比较两组生命质量评分,其中20例在第1次生命质量测评后的1周内进行了重测,计算两次测评的相关性.结果条目库共有72个条目,从中筛选出影响分大于1.5分的条目37条,其中症状12条、日常工作生活6条、社会关系5条、警觉6条、情感8条,加上一个对自我总体生命质量评价的条目,最终形成含5个维度,37+1个条目的正式量表.AHI<40与AHI≥40两组生命质量评分比较,无论是总分还是各维度分,AHI<40组明显高于AHI≥40组(P<0.01).1周内的重测结果显示,量表总分和上述5个维度的重测相关系数分别为0.885、0.840、0.798、0.928和0.842.结论本量表具有较好的信度和效度,可作为我国OSAHS成人患者生命质量的测评工具。
Application of concept and mode of family medicine in health checkup and heath management in comprehensive hospital
Authors: Guanqun Chao
Journal: BMJ (2017)

随着我国人口老龄化，健康问题成为最为突出的问题，人们希望并且要求定期进行健康体检，以能够及时了解和掌握自身的健康状况，并在体检后能够获得如何防止疾病发生的健康指导以及发现疾病后的及时治疗。浙江大学医学院附属邵逸夫医院基于全科理念设立健康促进中心，以体检者为中心，设置检前咨询和检后咨询服务，使体检中心与全科门诊、慢病管理有效衔接，同时强调团队服务，以全人照顾以及个性化的原则，给予体检者慢性病体检服务。
糖尿病肾脏病终末肾衰竭时的肾脏替代治疗
Authors: 程叙扬, 左力
Journal: BMJ (2010)

我国糖尿病肾脏病(DKD)导致的终末肾衰竭(ESRD)比例逐年上升.据北京市血液透析登记年度报告,北京市新进入血液透析的ESRD患者中DKD者所占比例逐年增高,2007年为26.1%,2008年升高到27.3%,已经接近并有超过肾脏替代治疗的首位病因慢性肾小球肾炎的趋势。
Correction of Three Prominent Mutations in Mouse and Human Models of Duchenne Muscular Dystrophy by Single-Cut Genome Editing
Authors: Yi-Li Min, Francesco Chemello, Hui Li, Cristina Rodriguez-Caycedo, Efrain Sanchez-Ortiz, Alex A. Mireault, John R. McAnally, John M. Shelton, Yu Zhang, Rhonda Bassel-Duby, Eric N. Olson
Journal: Molecular Therapy (2020)

Duchenne muscular dystrophy (DMD), one of the most common neuromuscular disorders of children, is caused by the absence of dystrophin protein in striated muscle. Deletions of exons 43, 45, and 52 represent mutational "hotspot" regions in the dystrophin gene. We created three new DMD mouse models harboring deletions of exons 43, 45, and 52 to represent common DMD mutations. To optimize CRISPR-Cas9 genome editing using the single-cut strategy, we identified single guide RNAs (sgRNAs) capable of restoring dystrophin expression by inducing exon skipping and reframing. Intramuscular delivery of AAV9 encoding SpCas9 and selected sgRNAs efficiently restored dystrophin expression in these new mouse models, offering a platform for future studies of dystrophin gene correction therapies. To validate the therapeutic potential of this approach, we identified sgRNAs capable of restoring dystrophin expression by the single-cut strategy in cardiomyocytes derived from human induced pluripotent stem cells (iPSCs) with each of these hotspot deletion mutations. We found that the potential effectiveness of individual sgRNAs in correction of DMD mutations cannot be predicted a priori, highlighting the importance of sgRNA design and testing as a prelude for applying gene editing as a therapeutic strategy for DMD.
How reliable are stroke patients' reports of their numbersof general practice consultations over 12 months?
Authors: 陈丽英, 方力争
Journal: BMJ (2013)

背景
初级保健的数据常被用于经济评估。然而，患者自我报告他们向全科医师咨询的次数与电子病历中确切的咨询次数一致性如何并不清楚。如果患者自我报告的数据用于经济评估，两者的吻合情况就显得至关重要。


目的
评估中风患者自我报告的12个月内全科医师咨询次数与医院电子病历记录相比较的准确性。同时记录从医疗实践中收集数据所需要的联系人数量。


方法
我们调查了65名联系人，共有115名参与家庭自测血压试验项目的中风患者参与研究。我们把中风后12个月电子病历中记录的咨询次数与通过问卷调查得到的患者自我报告的同期咨询次数相比较。


结果
51名(78%)联系人给予回应。患者(83例)的问卷调查表显示平均每年向全科医师咨询5.7次，而电子病历显示7.2次(相差1.6, 95%CI：0.5～2.7, P<0.01)。从联系人处得到数据的平均时间为6周。


结论
患者自我报告的全科医师咨询次数相对较少。从联系人处获取患者数据比问卷调查表的形式从患者处获取信息相对困难。若要将患者自我报告的健康保健数据用于经济评估，研究者需要考虑所选择的样本相对于电子病历的有效性。
Integrated single-cell spatial multi-omics of intratumor heterogeneity in renal cell carcinoma.
Authors: James J Hsieh, Natalia Miheecheva, Akshaya Ramachandran, Yang Lyu, Ilia Galkin, Viktor Svekolkin, Ekaterina Postovalova, Alexander Bagaev, Yaroslav Lozinsky, Vladimir Zyrin, Aleksandr Zaitsev, Katerina Nuzhdina, Krystle Nomie, Anna Ogloblina, Felix Frenkel, Ravshan Ataullakhanov
Journal: Journal of Clinical Oncology (2020)

e17106 Background: Clear cell renal cell carcinoma (ccRCC) exhibits conspicuous intratumor heterogeneity (ITH) - a driver of tumor evolution and metastasis. ITH in RCC has been studied extensively with bulk tumor DNA sequencing, which lacks the ability to integrate single cell resolution data, spatial architecture, and microenvironment composition. Therefore, we analyzed primary ccRCC tumors at multiple biopsy sites with CyTOF, multiplex immunofluorescence (MxIF), whole exome sequencing (WES), RNA sequencing (RNA-seq), single nuclei RNA-seq (snRNA-seq), and whole genome bisulfite sequencing (WGBS). Methods: Primary ccRCC tumors collected from 6 patients (pts) were biopsied at multiple locations and subjected to CyTOF (n = 21 sites, 6 pts), MxIF (20 markers, n = 8 sites, 3 pts), WES (n = 8 sites, 3 pts), RNA-seq (n = 8 sites, 3 pts), snRNA-seq (n = 8 sites, 3 pts), and WGBS (n = 8 sites, 3 pts), enabling integrated multi-omics analysis. MxIF, CyTOF, and genomic/transcriptomic analyses were performed by BostonGene. Results: Genomic intratumor (IT) evolution of ccRCC cells was tracked with WES, and subclonal distribution of SETD2, STAG2, TSC2 and PBRM1 mutations was observed in different IT regions. Different regions of the same tumor were similar, whereas individual patient tumors were distinct according to tumor microenvironment cellular composition measured by CyTOF or deconvoluted from RNA-seq. The cellular deconvolution of the ccRCC tumors reconstructed from RNA-seq correlated with CyTOF, snRNA-seq and WGBS, showing high concordance among the methods. The promoter CpG island methylation levels, averaged across all genes, positively correlated with ccRCC grade. MxIF revealed spatial IT heterogeneity in the distribution of immune infiltrate components. Macrophages and T cells dispersed among malignant cells; whereas, T cells formed clusters at unique tumor margins. Conclusions: The utilization of multi-omics methods produced a high-resolution portrait of the ccRCC tumor composition and identified differential ITH among regions within the primary tumors or among individual primary tumors. This study demonstrated strong concordance among the different technologies, suggesting that tumor deconvolution by bulk RNA-seq might be clinically applicable for ccRCC tumors. MxIF analysis enabled a fine elucidation of the spatial relationships among the tumor and the immune and stromal cells, missed by common omic platforms. Integrated single cell multi-omics could render specific pathobiological and therapeutic insights that impact treatment decisions.
Consideration and suggestion of establishing general practice in general hospital
Authors: Miaorong Xie, Jianjun Chen, Yu Zheng, Lizheng Fang
Journal: BMJ (2016)

This paper revealed the necessity of establishing general medicine in large general hospital.It also argued that establishing general medicine in large general hospital were the need of leading discipline construction in general medicine, leading construction in general medical talent team, strengthening the cooperation of the regional medical, and constructing the general hospital. Furthermore, the specipic suggestions for settings, responsibilities, working contents and working methods of general medicine in large general hospital were put forward.


Key words: 
Hospital, general; General practice
Uterine artery embolisation to treat uterine fibroids
Authors: Watkinson A, Nicholson A, 单莹, 潘凌亚
Journal: BMJ (2007)

be transported directly to a facility with the necessary resources to resuscitate, investigate, and initially manage multiple injuries. It is expected that all acute hospitals and all neuroscience units accepting patients directly from the incident will have these resources, and that these resources will be appropriate for the patient's age.* Local guidelines on the interhospital transfer of patients with head injuries should be drawn up between the refer ring hospital trusts, the neuroscience unit, and the local ambulance service. These should recognise the merit of transferring all patients with serious head injuries (GCS <8), irrespective of their need for neurosurgery. However, if transfer of those who do not require neurosur gery is not possible, ongoing liaison with the neuroscience unit regarding clinical management is essential.*
Risedronate sodium in prevention and treatment for postmenopausal osteoporosis
Authors: 姚斌, 许雯, 李建娟, 胡国亮, 翁建平, 梁奕铨, 胡少眉
Journal: BMJ (2004)

目的 观察利塞膦酸钠防治绝经后骨质疏松症的疗效.方法绝经后骨质疏松症共48例,随机分为2组,对照组24例,服安慰剂;试验组24例,服利塞膦酸钠5 mg/d.另外,两组患者每日均服钙维生素D3合剂(凯思立) 1片,两组共服药12个月,试验后0、1、3、6、9、12个月进行随访.结果利塞膦酸钠组腰椎、股骨颈及大粗隆的骨密度均明显升高(P<0.05),其中腰椎骨密度治疗前为0.80±0.09,治疗后6个月及12个月均达到0.82±0.09,增加率为2.93%及2.85%,均明显高于对照组(P<0.05).6个月及12个月治疗总有效率试验组为80.95%及71.43%,显著高于对照组的45.45%及31.82%(P<0.05).两组患者均无严重副作用.结论利塞膦酸钠能明显提高绝经后骨质疏松症患者的骨密度,副作用轻。
Job satisfaction and influencing factors for community health service practitioners in Futian District of Shenzhen
Authors: Guang-qiang Lai, Qiao Li, Ying-zi Huang, Xiao-hui Zhang
Journal: BMJ (2010)

Three hundred and nine community health service (CHS) practitioners were selected with randomized cluster sampling for survey with the job satisfaction questionnaire-occupational stress indicator (OSI).Degree of the job satisfaction was (68 ± 12)%.Position, work experience, income,feeling of recognition, degree of motivation, the scope for career development, the space for personal ambition and the relationship between salary and work load were potential influencing factors of job satisfaction to CHS practitioners.The authors suggest to establish the dynamic mechanisms of satisfaction study and to formulate comprehensive and effective incentive measures for CHS practitioners.

Key words: 
Community health service;  Occupation satisfaction
Effects of hydromorphone in prevention of shivering after spinal anesthesia
Authors: Tianwei Zhang, Qumin Chen, Min Zhou, Yingwei Dong
Journal: BMJ (2017)

Eighty patients(American Society of AnesthesiologistsⅠ-Ⅱ)scheduled for elective unilateral inguinal hernia surgery with spinal anesthesia between January and June 2016 were randomized into two groups with 40 in each group. Patients were intravenously injected with normal saline (5 ml) in control group or hydromorphone 5 μg/kg (diluted to 5 ml) in intervention group after spinal anesthesia. Tympanic temperature and the incidence of shrivering were measured before and after spinal anesthesia at predetermined intervals. Side effects during surgery and the first 48 h after surgery were recorded. Rescue drug tramadol 0.5 mg/kg was given intravenously to patients with grade ≥2 shivering for more than 5 min duration. Tympanic temperature decreased significantly compared to the baseline from 20 min in control group and from 10 min in intervention group after spinal blocking(P 0.05). The incidence of shivering was significantly lower in intervention group [17.5%(7/40) ] than that in control group [47.5%(19/40), χ2=8.205, P=0.004]. The incidence of nausea and vomiting was 5.0%(2/40)in intervention group and 0.0% (0/40) in control group (χ2=2.051, P=0.494). The incidence of sedation was not significantly different between control group [0.0%(0/40)] and intervention group[10.0%(4/10) , χ2=4.211, P=0.116]. The use of rescue tramadol was more frequently in control group [32.5%(13/40)] than that in intervention group [7.5%(3/40), χ2=7.812, P=0.01]. The results indicate that intravenous hydromorphone can significantly attenuate the incidence of shivering after spinal anesthesia for inguinal herniorrhaphy repair surgery with minimum side effects.


Key words: 
Hydromorphone; Shivering; Anesthesia, spinal; Hernia, inguinal
Incidence of breast pain in breast cancer patients in a multi-ethnic cohort.
Authors: Jami Aya Fukui, Madison Meister, Ian Pagano, Erin Bantum
Journal: Journal of Clinical Oncology (2020)

e24085 Background: Breast cancer is the most common cancer in women. Prevalence rates for persistent pain following breast cancer surgery are reported to be up to 60%. Younger age, radiation, more invasive surgery, and acute post-operative pain have been identified as predictors of chronic pain after surgery. Several studies have looked at factors predicting breast pain, but to our knowledge none of these studies have reported on perceived pain among ethnic groups beyond white and non-white comparisons. Methods: Participants were asked to complete an anonymous breast pain questionnaire based on the McGill pain questionnaire, either online or face-to-face in a clinical setting. Incidence and type of breast pain, common risk factors (age, type of surgery, treatment: chemotherapy, radiation and endocrine therapy), and race/ethnicity was collected and analyzed through descriptive and multivariate analysis. Results: 238 responses were collected and analyzed. About 36% of participants reported breast pain, where 82% reported these symptoms for more than a year. More than 71% identified as non-white, with the majority identifying as Asian (50%) followed by White (11%), Multi-ethnic (9%) and Native Hawaiian (8%). The majority of participants were older than 60 years of age (57%), with 30% being older than 70. Japanese, Filipino and Native Hawaiian participants reported significantly more pain compared to White participants (p &lt; .0001). The majority of participants reported a 3/10 pain level on a pain scale and described overall breast pain as mild. The most common descriptor of mild pain was aching and represents the dullness pain characteristic. The most common descriptor of moderate pain was sharp characterizing an incisive pressure, and the most common descriptors of severe pain were heavy, tender, shooting and throbbing, representing various pain characteristics. Participants who were undergoing radiation (p &lt; .0001) or chemotherapy (p &lt; .05) reported statistically higher breast pain, although there were no differences in breast pain according to the type of surgery (mastectomy vs lumpectomy). Participants who completed the survey online also reported more pain (p &lt; .0001) than participants who completed the survey face-to-face. Conclusions: Breast pain is a significant problem in our breast cancer community. This questionnaire has informed our understanding of the type of pain our multi-ethnic breast cancer patients are experiencing and in turn we are developing culturally appropriate pain management strategies to treat this challenging symptom for breast cancer survivors.