tbuckley/cabot-search huggingface dataset:
国务院关于建立全科医生制度的指导意见
Authors: 国务院
Journal: BMJ (2011)

(国发[2011]23号) 各省、自治区、直辖市人民政府,国务院各部委、各直属机构: 为深入贯彻医药卫生体制改革精神,现就建立全科医生制度提出以下指导意见: 一、充分认识建立全科医生制度的重要性和必要性 (一)建立全科医生制度是保障和改善城乡居民健康的迫切需要.我国是一个有13亿多人口的发展中国家,随着经济发展和人民生活水平的提高,城乡居民对提高健康水平的要求越来越高;同时,工业化、城镇化和生态环境变化带来的影响健康因素越来越多,人口老龄化和疾病谱变化也对医疗卫生服务提出新要求。
NSCLC: Integrating the “Yale model shared decision-making solution” into the practice setting.
Authors: Kerin B. Adelson, Roy S. Herbst, Patricia Peterson, Michele Ingram, Brant J. Oliver, Tarjani Agrawal, Marianne Davies, Elaine Rudell
Journal: Journal of Clinical Oncology (2020)

7054 Background: Lung cancer patients are faced with treatment choices that involve complex decisions that can be preference-sensitive. In 2017 the National Quality Forum initiated a “Call to Action” to integrate shared decision-making (SDM) processes into practice in which clinicians and patients work together to make healthcare decisions that align with what matters most to patients. Projects In Knowledge, @Point of Care, Dartmouth and Yale collaborated to develop a pilot educational initiative to address and improve patient-centered care and SDM processes in the institutional cancer-care setting. Methods: Training materials co-developed for the Yale NSCLC team members (oncologists, nurses/NPs, social worker) address SDM, Checkpoint Inhibitor Therapy in NSCLC, and clinician-patient role play methods for implementing SDM in treatment discussions/decisions. Qualitative interview and observational methods were used to assess improved SDM performance by the multidisciplinary Yale NSCLC team by comparing baseline pre-intervention to post-intervention interviews and rating observed performance on case study role-play scenarios. Following the training and assessments, a focus group that included all team members was conducted to assess the acceptability, feasibility, and repeatability of the program and to inform future education. Results: Training empowered all Yale NSCLC team members to show pre- to post-education improvement in SDM (34% to 88%). Areas of greatest improvement: 1) providing reasonable treatment options to patients (+58%); 2) determining decision style preference – to what extent a patient wants to participate in the treatment decision process with their clinician (+76%); 3) determining patients’ risk tolerance regarding treatments that may be more efficacious but may have more side effects (+77); and 4) determining patients’ goals/preferences (+88%). Conclusions: Educational training improved SDM skills by all Yale NSCLC team members, which can lead to improved clinician-patient decision-making and patient-centric care. The training process also facilitated team building and encouraged ongoing participation in SDM.
Secukinumab shows high and sustained efficacy in nail psoriasis: 2.5‐year results from the randomized placebo‐controlled TRANSFIGURE study*
Authors: K. Reich, J. Sullivan, P. Arenberger, S. Jazayeri, U. Mrowietz, M. Augustin, B. Elewski, R. You, P. Regnault, J.A. Frueh
Journal: British Journal of Dermatology (2020)

Background Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A, a cornerstone cytokine in psoriasis, has shown long-lasting efficacy and safety in the complete spectrum of psoriasis manifestations. Objectives To report the long-term (2·5-year) efficacy and safety of secukinumab in nail psoriasis. Methods TRANSFIGURE, a double-blind, randomized, placebo-controlled, parallel-group, multicentre phase IIIb study in 198 patients, investigated secukinumab 150 mg and 300 mg in patients with moderate-to-severe nail psoriasis. Results At week 16, the primary endpoint Nail Psoriasis Severity Index (NAPSI) was met, demonstrating superiority of secukinumab to placebo. The effect was sustained over 2·5 years with a large benefit for nail clearance, with mean NAPSI improvement of −73·3% and −63·6% with secukinumab 300 mg and 150 mg, respectively. At 2·5 years, secukinumab demonstrated sustained clinically significant reductions in total mean Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) quality-of-life (QoL) scores of −52·4% and −18·1%, and 70% and 71% of patients achieved a weighted NAPPA Patient Benefit Index global score of ≥ 2 with secukinumab 300 mg and 150 mg, respectively. Patients showed considerable improvements in the EuroQol 5-Dimension health status questionnaire at 2·5 years, reporting a decrease in pain and discomfort. No new safety findings were observed. Conclusions Secukinumab demonstrated strong and clinically meaningful efficacy for up to 2·5 years in nail psoriasis, with significant sustained QoL improvements and a favourable safety profile.
2型糖尿病口服药物的联合应用
Authors: 翁建平, 黄知敏
Journal: BMJ (2004)

2型糖尿病患者大部分(70% ～85%)在就诊初期即需用口服降糖药物治疗[1],并且随着病程的逐步进展,胰岛素抵抗的加重及胰岛β细胞功能的减退,多数患者需要2种或以上口服降糖药才能使血糖获得满意控制.本文将简单介绍临床常用的几种口服降糖药,并重点阐述几种不同的联合用药方案。
社区卫生服务站使用抗生素不当分析
Authors: 张晓林, 李研
Journal: BMJ (2004)

β-内酰胺类抗生素是临床上包括社区卫生服务站用量比较大的抗生素.2002年本区25个社区卫生服务站共输液治疗98 663人次,其中使用抗生素9 502人次,使用β-内酰胺药物占其中的37.99%.而不正确使用占67.98%.作者将β-内酰胺类抗生素在社区使用中的问题进行浅析,最常见的问题表现在以下两方面。
An analysis of clinicopathological characteristics and prognosis on hepatoid adenocarcinoma of stomach.
Authors: Juan Shi, Yanping Chen, Lin Liu, Xiangyu Su
Journal: Journal of Clinical Oncology (2020)

e16558 Background: Hepatoid adenocarcinoma of the stomach(HAS) is a rare type of gastric adenocarcinoma(GAC). At present, histopathology is the gold standard for the diagnosis of HAS, however, HAS is easy to be missed diagnosis, and lack of a perfect diagnosis system and effective treatment strategy. In this research, clinical pathological features will be analyzed to improve the diagnostic system, judge prognosis and provide clues for exploration of pathogenesis and targeted therapy of HAS. Methods: 576 cases including 5 confirmed patients with HAS were enrolled onto this study from 1320 patients with GAC. 10 cases of HAS were diagnosed by the second histopathological examination from the other 571 enrolled cases. 30 cases from the remaining 561 enrolled patients were randomly selected as the control group. The information of the two group cases were completed by collecting the existing case data, detecting the missed immunohistochemical indicators and telephone follow-up. The clinicopathological features of the two group cases were compared, and the treatment and prognosis of 15 HAS cases were analyzed. Results: In this study, 15 cases of HAS were found in 576 patients with GAC, including 5 cases from the 1st pathological diagnosis and 10 cases from the 2nd pathological diagnosis. There was no significant difference in age, gender, HP positive rate, serum CEA or CA19-9 level, tumor size, TNM stage, tumor invasion depth, lymph node invasion, distant metastasis rate, differentiation degree, nerve/vascular invasion, and Ki-67 expression level between the two groups( P&gt; 0.05). Compared with the control group, the serum AFP level, and the expression level of GPC3, AFP, EGFR and VEGF protein of patients in HAS group were significantly high, as well as the patients in the HAS group were more likely to develop liver metastasis( P&lt; 0.05). The mOS was 12 mo vs 42 mo for HAS group vs control group( P&lt; 0.05). Multivariate analysis showed immunohistochemical AFP staining intensity was an independent risk factor for prognosis of HAS. Conclusions: As a special type of GAC, HAS is prone to developing liver metastasis with poor prognosis. Based on the higher missed diagnosis rate of HAS, it is suggested to make 2nd cancer histopathological diagnosis including immunohistochemical detection of AFP and GPC3 for GAC patients with significantly increased serum AFP level. The intensity of immunohistochemical AFP staining is an independent risk factor for the prognosis of patients with HAS. VEGF, EGFR and PD-1 / PDL-1 may be potential therapeutic targets of HAS, which is worth further study.
集思广益共谋发展
Authors: 刘岚, 邵隽一
Journal: BMJ (2007)

2007年新年伊始, 顺利完成了4年一次的编委会换届工作.1月26日,第二届编委会第一次工作会议暨专家新春联谊会在北京圆满召开.来自全国各地的60多位编委及中华医学会、杂志社有关领导出席了会议。
Effects of health interventions for patients with hyperuricemia on knowledge-attitude-performance in community
Authors: Wei Yang
Journal: BMJ (2015)

A total of 446 hyperuricemic patients were divided randomly by community-based cluster sampling into study (n=228) and comparison (n=218) groups. After 12-month health interventions, the Knowledge-Attitude-Performance (KAP) questionnaire [(19.0±4.7) points], lifestyle (balanced diet, modest physical exercises & regular monitoring) self-report questionnaire [attitudes prevention awareness: (8.3±6.1) points, disease self-management behaviors: (13.2±9.8) points], uric acid index [(395±46) mmol/L] and body mass index (BMI) [(23.1±2.3) kg/m2] were better than those at pre-intervention in study group [(9.3±2.7), (4.6±3.9), (7.4±6.4)], [(420±44) mmol/L, (24.9±1.6) kg/m2] (P<0.05). Also the inter-group difference had statistical significance (P<0.05). It suggests that health intervention management is both feasible and effective in improving the KAP of patients, modulating lifestyles and lowering the levels of uric acid index and BMI.


Key words: 
Health education; Hyperuricemia
A phase II study of rh-endostatin combined with paclitaxel and nedaplatin in treating patients with recurrent or metastatic esophageal squamous cell carcinoma (ESCC).
Authors: Zhiqiang Wang, Yu-Hong Li, De-Shen Wang, Fenghua Wang, Chao Ren, Qiong Tan
Journal: Journal of Clinical Oncology (2020)

4522 Background: For patients (pts) with metastatic ESCC, the prognosis is poor. Rh-endostatin (endostar), a potent inhibitor of angiogenesis, has shown clinical activity when combined with chemoradiotherapy in treating locally advanced ESCC. This single-arm phase 2 study was designed to assess the efficacy and safety of endostar combined with paclitaxel and nedaplatin in treating pts with recurrent or metastatic ESCC. Methods: Eligible pts had recurrent or metastatic ESCC and Karnofsky score ≥70. Endostar (30 mg/day, continuous infusion, day 1-14) plus paclitaxel (150 mg/m 2 , day 4) and nedaplatin (80 mg/m 2 , day 4) were administered every 3 weeks for 6 cycles followed by maintenance therapy with endostar. Primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS) and adverse events (AEs). Results: From January 2015 to August 2019, 53 pts were enrolled. 44 (83%) pts were male. The median age was 59 years. 43 (81%) pts had pathology of poor or moderate differentiated ESCC. The middle and lower thirds of the esophagus (81%) were the most common primary tumor sites. 11 (21%) patients had undergone esophagectomy. At the time of treatment, 49 (93%) pts were diagnosed with clinical stage IVB. The most common metastatic sites were lymph node (91%), lung (32%) and liver (26%). 50 pts were assessable for response. No complete response was observed. 21 pts achieved a best response of partial response and 14 pts had stable disease. ORR was 42% and DCR was 70%. The median PFS and OS was 5.1 months (95% CI 3.7-6.6 months) and 13.2 months (95% CI 8.0-18.4 months) respectively. The most common AEs observed during this study were anemia (49.1%), neutropenia (34%), fatigue (28.3%) and anorexia (26.4%). The most common Grade 3/4 AE observed was neutropenia (17%). Conclusions: The combination of endostar plus paclitaxel and nedaplatin is a well tolerated treatment modality with promising activity in previously untreated recurrent or metastatic ESCC. Its efficacy and safety could be further studied in randomized trials. Clinical trial information: NCT02350517 .
Baseline skeletal muscle density and adverse outcomes during chemotherapy for early breast cancer.
Authors: Gabriel Aleixo, Allison Mary Deal, Kirsten A. Nyrop, Hyman B. Muss, Grant Richard Williams, Emily Damone, Hyeon Yu, Shlomit S. Shachar
Journal: Journal of Clinical Oncology (2020)

e12506 Background: Skeletal Muscle Density (SMD) is the amount of fat infiltration in the muscle, Low SMD (myosteatosis), is associated with chemotherapy toxicity in women with breast cancer (BC); however, cut points are not consistent across studies. We investigated the association of alternative cut-points for low SMD at BC diagnosis and adverse outcomes during chemotherapy in women with early BC. Methods: This is a retrospective chart review. Axial CT images were evaluated at the L3 level to calculate average SMD in Hounsfield Units (HU). Three cut points (Table) classified patients as low versus normal SMD. T-test was used to calculate the relative risk (RR) for adverse events. Results: In 340 patients, the mean age was 51. Table shows RR for three adverse events (dose reduction, early treatment discontinuation, hospitalization) for each of the three cut points. Conclusions: All three cut-points described in the literature are reliable for stratification of patients with EBC for myosteatosis and associated chemotherapy-related adverse events. [Table: see text]
NRG1 fusion-driven cancers: A systematic literature review and meta-analysis.
Authors: Viktoriya Stalbovskaya, Ernesto Wasserman, Jon Fryzek, Lauren C Bylsma, L. Andres Sirulnik
Journal: Journal of Clinical Oncology (2020)

e15605 Background: Neuregulin 1 (NRG1) fusion proteins have recently been identified as oncogenic drivers in diverse cancers with high unmet medical need. We recently reported promising responses in patients with cancers harboring NRG1 fusions treated with the bispecific antibody MCLA-128 (Schram 2019). The objective of this study was for the first time to quantitatively summarize the frequency of tumors harboring NRG1 fusions reported in the published literature. Methods: Neuregulin 1 (NRG1) fusion proteins have recently been identified as oncogenic drivers in diverse cancers with high unmet medical need. We recently reported promising responses in patients with cancers harboring NRG1 fusions treated with the bispecific antibody MCLA-128 (Schram 2019). The objective of this study was for the first time to quantitatively summarize the frequency of tumors harboring NRG1 fusions reported in the published literature. Results: Out of 212 articles identified in the literature as of 31-Jul-2019, 37 met the inclusion criteria and were abstracted. 13 different tumor types were identified as harboring NRG1 fusions including 5 tumor (sub)types which met the criteria for frequency meta-analysis (Table 1). NRG1 fusions were most frequent in pancreatic adenocarcinoma (3.3%, 95% confidence intervals (CI): 0.3-28.7%; apparent enrichment in KRAS WT) and NSCLC (0.8% 95% CI: 0.3-2.7%) with an enrichment in invasive mucinous adenocarcinoma (9.8%, 95% CI: 4.7-19.6%). Statistically significant heterogeneity was observed indicating substantial variation across studies in each analysis. For tumor types that did not meet the criteria for meta-analysis (uterine, renal cell, ovarian, colorectal, head and neck, bladder, prostate and sarcoma) the reported frequency of NRG1 fusions was typically less than 1%. Conclusions: NRG1 fusions are present across a wide range of different solid tumor types, most frequently in NSCLC and PDAC. NRG1 fusion-driven cancers represent a potential tumor-agnostic therapeutic target. The advent of new treatment options and increased genomic testing will allow a more precise estimation of the frequency of NRG1 fusions in cancer. [Table: see text]
A phase Ib/II study of niraparib plus temozolomide plus atezolizumab versus atezolizumab as maintenance therapy in extensive-stage small cell lung cancer (TRIO-US L-06).
Authors: Amy Lauren Cummings, David Dae-Young Kim, Lee S. Rosen, Edward B. Garon, Zev A. Wainberg, Dennis J. Slamon, Jonathan Wade Goldman
Journal: Journal of Clinical Oncology (2020)

TPS9084 Background: Maintenance therapy is a promising therapeutic approach for extensive-stage small cell lung cancer (ES-SCLC), especially in light of IMpower 133 (Horn NEJM 2018). SCLC models of poly (ADP-ribose) polymerase (PARP) protein 1 and 2 inhibition suggested synergy with temozolomide (TMZ) (Wainberg AACR 2016). Combining PARP inhibition and TMZ with atezolizumab after first-line therapy for ES-SCLC may improve disease control. Methods: This is a phase 1b/2, randomized, open-label study of TMZ plus niraparib, a PARP inhibitor, with atezolizumab versus atezolizumab as maintenance therapy in adult patients with ES-SCLC after completion of platinum-based first-line chemotherapy. The primary outcome for phase 1b is the RP2D of TMZ in combination with niraparib, and for phase 2, progression-free survival (PFS). Secondary endpoints include safety, objective response rate, and overall survival. Exploratory endpoints include adverse events and patient-reported outcomes, including health-related quality of life. Phase 1b participants are required to have an advanced and incurable solid malignancy. Part one of phase 1b includes an accelerated lead-in of 12 participants treated in cohorts of 6 with an initial dose level of niraparib 200 mg po daily in 28-day cycles and low-dose TMZ 40 mg po daily on days 1-5 of each cycle. Part two includes a safety lead-in of 6 patients receiving standard-of-care atezolizumab, to which R2PD niraparib and TMZ will be added. For phase 2, participants are required to have ES-SCLC with a complete response or partial response per RECIST 1.1 following 4 to 6 cycles of platinum-based chemotherapy and ability to proceed to randomization within 7 weeks after day 1 of the last cycle of prior chemotherapy. Prophylactic WBRT is allowed prior to study. 52 participants will be stratified by a history of brain metastases and randomized 1:1 to atezolizumab with or without RP2D niraparib plus TMZ. There will be no cross-over between arms. To date, cohort 1 had two DLTs. Enrollment to dose level -1 and an intermediate dose have been completed without a DLT. The atezolizumab safety lead-in begins enrollment in March 2020. Clinical trial information: NCT03830918.
有无典型胸痛症状的2型糖尿病患者冠状动脉造影分析
Authors: 任京媛, 余振球
Journal: BMJ (2007)

对428例2型糖尿病患者的冠状动脉造影(冠造)结果进行分析,表明糖尿病病程越长冠状动脉病变越重(P＜0.01);冠造阳性者占胸痛组人数的85.2%,高于无胸痛组的78.0%;无典型胸痛症状的糖尿病患者中,≥1支冠状动脉管腔狭窄≥75%的51例占24.9%.建议对无典型胸痛、病程短的2型糖尿病患者行冠造检查,尤其是糖尿病病史较长者。
Preliminary results of the organ preservation of rectal adenocarcinoma (OPRA) trial.
Authors: Julio Garcia-Aguilar, Sujata Patil, Jin K. Kim, Jonathan B. Yuval, Hannah Thompson, Floris Verheij, Meghan Lee, Leonard B. Saltz
Journal: Journal of Clinical Oncology (2020)

4008 Background: Organ preservation (OP) with a watch and wait strategy (WW) and total neoadjuvant therapy (TNT) are new treatment paradigms for patients with locally advanced rectal cancer. The safety and efficacy of WW and of TNT have not been studied prospectively. Methods: Patients with MRI stage II and III rectal adenocarcinoma were randomized to 4 months of FOLFOX or CAPEOX before (Induction) or after (Consolidation) fluorouracil or capecitabine based chemoradiotherapy (CRT). Patients were re-staged 8-12 weeks after finishing TNT with digital rectal exam, flexible sigmoidoscopy and MRI. Patients with complete or near-complete clinical response were offered WW. Those with incomplete response had total mesorectal excision. The trial was designed so that each arm served as its own single-stage study that discriminates between 3-year disease-free survival (DFS) rates of 75% (historical null) and 85%, with 86% power, and a two-sided type I error of 5%. Secondary objectives included comparing DFS, OP, and distant metastasis-free survival (DMFS) rates between the two arms using the log-rank test. Results: Of 324 patients enrolled, 307 (152 I, 155 C) are currently evaluable for the time-to-event analysis as of 2/1/2020. Median follow-up is 2.1 years; 52 DFS events were observed. Patient demographics and tumor characteristics were generally balanced across the two arms. Full compliance with systemic chemotherapy was 82% and 81% for the I- and C-arms, respectively. The median radiation dose was 5400 cGy for both arms. Table shows 3-y DFS, DMFS, and OP rates. Conclusions: A WW strategy for patients with locally advanced rectal cancer that achieve a clinical complete response to TNT results in organ preservation for a high proportion of patients without compromising survival. Up-front CRT followed by consolidation chemotherapy resulted in a numerically higher WW rate compared to induction chemotherapy followed by CRT. Clinical trial information: NCT02008656 . [Table: see text]
The dark age of single organ screening is over: CD24 is a novel universal simple blood test for early detection of cancer.
Authors: Shiran Shapira, Dina Kazanov, Marina Ben Shimon, Mori Hay Levy, Fatin Mdah, Shir Asido, Narin Carmel, Ofer Yossepowitch, Dan Grisaru, Dan Fliss, Ofer Isakov, Guy Lahat, Ido Nachmany, Nathan Gluck, Michael Peer, Ido Wolf, Nadir Arber
Journal: Journal of Clinical Oncology (2020)

e15591 Background: More than 1.8 million new cancer cases are expected to be diagnosed in 2020. Only in the U.S, about 606,520 Americans are expected to die this year, which translates to about 1,660 deaths per day. However, when found early, in the asymptomatic phase, cancer is often effectively treated or even cured. The few cancer screens available today, including mammograms and colonoscopies, each look for a single type of cancer. CD24 is hardly expressed in normal cells (but to B-lymphocytes, differentiating neuroblasts and neutrophils) but is overexpressed in numerous human cancers. Aim: To establish a universal cancer screening blood test. Methods: Blood samples were obtained from consecutive patients and healthy volunteers. 1x10 6 leukocytes were stained using anti-CD11b-PerCp-Cy5.5 and anti-CD24-FITC and analyzed by flow cytometry (CyFlow Cube 6, Sysmex, Germany). Percentage of positive cells was determined by subtracting the percentage of CD24 and CD11b-positive cells (dual stain) from CD24-positive cells (single stain). The cut off for cancer detection was 25. Healthy subjects underwent a thorough evaluation at the health promotion center and integrated cancer prevention center. All cancers were verified histologically. Results: CD24/CD11b expression in the healthy population was evaluated in 337 women and 408 men, ages 20-85. There were 222 cancer patients. After excluding thyroid and bladder cancers, the assay detected 146 out of 196 (75%) cancers at all stages and even in 31 out of colonic adenomas (table). The levels of CD24 drop back to near normal level following successful surgery/chemotherapy. The test score was not affected by age, gender, fasting and the time of the day that the blood sample is taken. In 55 cases the test was performed twice, with similar results, as well as when the test was performed in another flow cytometry, after 1d, 1w, 1m after freezing . Conclusions: 1. CD24 is a universal cancer screening. 2. It can detect pre malignant lesions like adenomas in the colon. 3. Preliminary results suggest that it can serve as a predictive marker. [Table: see text]
Survey on utilization intent of community health services in Beijing Fangzhuang community
Authors: Hao Wu, Cai-ying Ge, Hong-yan Jia, Xin-ying Liu, Xiu-mei Liu
Journal: BMJ (2011)

By stratified random sampling method, 10 000 residents were investigated with the questionnaire in Fangzhuang community of Beijing, 9497 valid questionnaires were collected with a return rate of 94. 97%. The results showed that two main purposes for patients to use the community health services were to seek consultation (29. 8% ) and to get prescription (28. 2% ). The three main reasons for residents to choose community health services were the convenience, less medical expenses and more clear explanation from doctors, followed by the personal trust in the doctors.

Key words: 
Community health services;  Questionnaires