tbuckley/cabot-search huggingface dataset:
点评:通过双向转诊建立专科和全科医师互动的医疗体系
Authors: 杜雪平
Journal: BMJ (2004)

世界家庭医生组织(WONCA)提出,一个效率高、成本效益好的卫生体系须由全科医师对患者进行筛选,在社区用较少的资源解决大多数患者的健康问题,而很少一部分患者(如疑难重症患者)转诊给专科医生,同时指出高效的卫生服务系统应该建立社区卫生服务机构与医院的双向转诊制度,这是国际会议对各国卫生事业发展经验的总结,也将是我国卫生事业改革和发展的方向.双向转诊主要可分为门诊转诊和住院转诊两种形式。
Plasma Biomarkers Associated With Chronic Bronchitis In The COPDgene Study
Authors: V. Kim, S. Jacobson, H. Zhao, A. P. Comellas, J. H. Lee, M. K. Han, C. H. Martinez, J. Crapo, G. J. Criner, B. J. Make, E. K. Silverman, R. P. Bowler, COPDgene Investigators
Journal: American Journal of Respiratory and Critical Care Medicine (2018)
慢性心力衰竭患者运动前后血浆B-型利钠肽的比较
Authors: 李文强, 范一帆, 杨河欣, 杨卫泽, 万曦
Journal: BMJ (2006)

对30例慢性心力衰竭患者及20例正常对照者进行运动试验,测定其运动前及运动后1 min、5 min的B-型利钠肽水平,并测定受检者的呼吸参数.结果示运动前后对照组的B-型利钠肽水平无显著性变化;慢性心力衰竭患者的B-型利钠肽水平在运动后1 min显著高于运动前和运动后5 min,并与氧摄取量、无氧代谢阈值时摄氧量及左室射血分数呈负相关.B-型利钠肽可作为评估慢性心力衰竭患者心功能及运动能力的一种参考指标。
Combination of kidney transplantation with hematopoietic stem cell infusion
Authors: Yong-chao Ge, Zhi-yu Wang, Li Zahng, Jin-shun Feng, Kun Duan, Shi-lin Chen, Quan-xi Guo, Tao Zheng, Bao-dong Chang, Zhi-hao Yuan, Fen Qin
Journal: BMJ (2012)

Ninety six female patients with chronic renal failure were randomly allocated into combination group (n =48) and control group (n =48).In combination group patients received both kidney transplantation and hematopoietic stem cell infusion,in control group patients underwent kidney transplantation only.The results showed that chronic rejection in the combination group was lower than that in the control group [2％(1/48)vs.17％ (8/48),P＜0.05)].The 1-,3-,5-and 10 y-survival rates of kidney in the combination group were 98％ (47/48),94％ (45/48),83％ (34/41) and 9/17,respectively,those in control group were 98％ (47/48),90％ (43/48),76％ (31/41) and 7/17,respectively.Infusion of donor hematopoietic stem cells can augment chimerism in early postoperative period and significantly reduce the rate of graft rejection,which is beneficial for the quality of life of the recipients.

Key words: 
Kidney transplantation; Transplantation tolerance
Statin treatment improves response to anti-PD1 agents in patients with malignant pleural mesothelioma and non-small cell lung cancer.
Authors: Luca Cantini, Federica Pecci, Daan Hurkmans, Cecilia Copparoni, Sophie Aerts, Robert A Belderbos, Robin Cornelissen, Daphne P Dumoulin, Ilaria Fiordoliva, Silvia Rinaldi, Joachim Aerts, Rossana Berardi
Journal: Journal of Clinical Oncology (2020)

3074 Background: After progression to standard chemotherapy, only a small proportion of malignant pleural mesothelioma (MPM) and non-small cell lung cancer (NSCLC) patients (pts) benefit from anti-programmed cell death (PD-1) treatment. Combination strategies might improve response. In pre-clinical models, statins showed vaccine adjuvant activities and synergized with anti-PD1 agents. In this multi-center study, we evaluated the impact of baseline statin treatment in MPM and NSCLC pts. Methods: We separately examined MPM and NSCLC pts treated with anti-PD1 monotherapy after progression to standard chemotherapy at two European academic institutions. As control cohort, MPM pts treated with first-line chemotherapy were also examined. Pts receiving statins at start of treatment were compared with those who did not. Objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) were analyzed. Results: A total of 287 patients were examined. Twenty-seven out of 80 (34%) MPM and 36 out of 130 (20%) NSCLC pts received statins at start of anti-PD1 treatment. The most common statins were simvastatin, atorvastatin and rosuvastatin. In MPM pts, statin use was associated with improved ORR (22% versus 5%, P = 0.05), longer PFS (median 6.7 versus 2.4 months, hazard ratio (HR) 0.42, 95% confidence interval (CI) 0.23–0.77, P &lt; 0.01), and longer OS (median not reached versus 6.0 months, HR 0.43, 95% CI 0.21–0.85, P = 0.01). In NSCLC pts, statin use was associated with improved ORR (40% versus 22%, P = 0.04), longer PFS (median 7.8 versus 3.6 months, HR 0.59, 95% CI 0.37–0.97.2, P = 0.03) but similar OS (median 13.1 versus 10.1 months, HR 0.79, 95% CI 0.49–1.28, P = 0.30). At multivariate analyses, after adjusting for ECOG performance status (PS) and histological subtype, the impact of statins remained significant for ORR, PFS and OS in MPM and for PFS in NSCLC. Conversely, no association between statin use and outcomes was found in 77 MPM pts treated with first-line chemotherapy. Conclusions: This study shows that statin use at start of anti-PD1 treatment improves response to anti-PD1 agents in MPM and NSCLC pts who progressed to standard chemotherapy in routine clinical practice. This association could not be found in MPM pts treated with first-line chemotherapy, thus suggesting a synergy between statins and anti-PD1 agents. Prospective studies are needed to confirm whether the combination of statin and anti-PD1 therapy could improve outcome in pts with poorly immunogenic thoracic malignancies.
Analysis of canonical and noncanonical splicing site mutation of MET that causes exon 14 skipping.
Authors: Yongfeng Yu, Rongrong Chen, Jun Zhao, Xin Yi, Shun Lu
Journal: Journal of Clinical Oncology (2020)

e21513 Background: The hepatocyte growth factor receptor gene ( MET) exon 14 skipping ( METex14) has been wildly accepted as a driver alteration in lung cancer targetable by tyrosine kinase inhibitors (TKIs) such as crizotinib. While it is easy to interpret canonical splicing site mutations, it is more controversial to interpret noncanonical splicing site mutations. Methods: Hybrid capture–based next generation sequencing of 59-1021 genes including MET was performed at the request of individual treating physicians. The mutation profiling of MET were retrospectively analyzed. Results: Of 3500 lung cancers profiled by comprehensive genomic profiling, 211 harbored MET single nucleotide mutation (SNV), or small insertion/deletion (InDel). Among which 66 cases were predicted to have METex14. Forty-two (62.1%) cases harbored mutations affecting the splicing donor site, while 24 harbored mutations affecting the splicing acceptor site. Thirty-four of the 42 cases affecting the splicing donor site had mutations in the canonical splicing site, including 3 cases harbored MET c.3028G &gt; A/T/C mutation, 14 cases harbored c.3028+1G &gt; A/T/C, 10 cases harbored c.3028+2T &gt; A/C/G, 8 cases harbored deletion of the whole canonical splicing site. Interestingly, all the seven cases affecting the noncanonical splicing donor site were c.3028+3A &gt; G/T mutation. On the contrary, all the 24 mutations affecting the splicing acceptor site were deletion with/without insertion, with 12 affecting the canonical site and 12 the noncanonical site. We speculated that the polypyrimidine tract around the splicing acceptor site making it more susceptible to deletion/insertion, and thus single nucleotide variant less common. Conclusions: At the 5’ end of the exon 14 of MET, most of the genome alterations are deletions with/without insertions affecting the canonical and noncanonical splicing acceptor site. At the 3’ end, they are mostly point mutations affecting the splice donor site. The noncanonical splicing donor site c.3028+3A plays crucial role in the splicing of exon 14 in MET.
Response to: ‘Case series of acute arthritis in COVID-19 admission’ by López-González <i>et al</i>
Authors: Elizabeth R Graef, Jean W Liew, Alfred Hj Kim, Jeffrey A Sparks
Journal: Annals of the Rheumatic Diseases (2020)

We read the comment on our article by López-González et al with great interest. 1 2The authors detail the presentation of four cases of acute arthritis in patients hospitalised with COVID-19 and underlying gout (three cases) or recurrent arthritis of unknown origin (one case).Although we await further reports, there have been anecdotes of newly diagnosed inflammatory arthritis in the context of COVID-19 infection, perhaps representing either a viral-associated arthritis or a reactive arthritis. 3 4However, as the authors note, common causes of acute inflammatory arthritis must continue to be considered in the differential diagnosisthese include crystal-associated arthritis, such as gout or pseudogout.Acute illnesses, including infection, are well-established risk factors for gout and pseudogout flares; inpatient gout flares are known to complicate admissions for heart failure, pneumonia and acute kidney injury. 5These comorbidities are either associated with or features of severe COVID-19 infection and so may explain the presentations of acute inflammatory arthritis detailed in their report. 6he thorough workup completed by the authors highlights some of the current gaps in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing methods.While reverse transcription (RT)-PCR testing was negative in all three of the synovial fluid samples in these patients with documented COVID-19 infection from nasopharyngeal swab, no molecular testing method has been validated yet to detect SARS-CoV-2 in synovial fluid.Thus, the clinical significance of the synovial fluid cultures and RT-PCR results is currently unknown.Despite these uncertainties, we commend the authors' efforts in providing the first report of SARS-CoV-2 nucleic acid testing in synovial fluid.
Abstract 15570: Differential Implications of Developing New Onset Heart Failure in Contrast to Pre-Existing Heart Failure on Sepsis Related Mortality
Authors: Balaram Krishna J Hanumanthu, Carla Rosenzvit, Fitsumberhan Medhane, Adam Gershon, Michael Park, Dov Rosenbaum, Simon Mendez, Aditya Goyal, Perminder Gulani
Journal: Circulation (2018)

Background: Sepsis induced cardiomyopathy (SIC) is defined as reversible dysfunction of the left and/or right ventricle and is a poorly characterized in literature. We want to determine patient/dis...
Genomic comparisons between different radiological features in ground glass nodules under 20 mm in diameter.
Authors: Muyun Peng, Bingyu Zhang, Guanlan Xing, Yaping Xu, Fenglei Yu
Journal: Journal of Clinical Oncology (2020)

e13664 Background: Radiological features still matters in the management of ground glass nodules (GGNs). The 20 mm in maximum diameter and consolidation tumor ratio (CTR) under 0.5 are pivotal indexes from the lobectomy to segmentectomy decision. However, the feasibility of limited resection remains controversial. Understanding the relationship between genomic characteristics and radiological features of GGNs will provide critical insights to theoretical basis of surgical method decision and expand a novel perspective to risk-stratify patients. Methods: In total, 297 surgically resected GGNs (≤ 20 mm in maximum diameter) were consecutively collected in the study. The summarized radiological features are shown (Table). In order to obtain their comprehensive genomic profiling, these tumor samples were performed using customized panels of 1021 genes. Fisher's exact test, Mann Whitney test and Kruskal-Wallis test were used for statistical analysis. Results: Higher TMB was found in subgroups with the maximum diameter &gt; 10 mm, the volume &gt; 0.40 mL, the CT value &gt; -500 HU, and the mass &gt; 200 mg ( p &lt; 0.05). However, TMB was not associated with the increase of CTR. These data suggested that enlarged nodules occurred with increased mutation events. EGFR, RET, TP53 and RBM10 mutations were significantly enriched in groups with maximum diameter &gt; 10 mm, volume &gt; 0.40 mL, and mass &gt; 0.200 g ( p &lt; 0.05), and significant enrichment in p53-pathway and Myc-pathway were also found ( q &lt; 0.05). ERBB2 and BRAF mutations were significantly enriched in the subgroups with maximum diameter ≤ 10 mm, volume ≤ 0.40 mL, or mass ≤ 0.200 g ( p &lt; 0.05). As compared to the cohort of CTR ≤ 0.5 in all nodules, mutation frequencies of EGFR, RBM10 were similar, those of RET, ALK and TP53 were relatively higher ( p &lt; 0.05), and that of ERBB2 was lower ( p = 1.7×10 −5 ) in the cohort of CTR &gt; 0.5. Conclusions: Our study provides the comprehensive description of the mutational landscape and radio-genomic features of GGNs under 20 mm in diameter. [Table: see text]
Evaluation of glioblastoma tumor microenvironment after treatment with pembrolizumab.
Authors: Nazanin Majd, Heather Y. Lin, Ying Yuan, Kristin Alfaro-Munoz, Kathy Hunter, Amy B. Heimberger, John Frederick De Groot
Journal: Journal of Clinical Oncology (2020)

2559 Background: Neoadjuvant pembrolizumab improved outcome of patients with recurrent Glioblastoma (GBM) in two early phase clinical trials. However, several large phase II/III studies in patients with newly diagnosed and recurrent GBM failed to demonstrate a therapeutic benefit of anti-PD-1 therapy. Therefore, identification of biomarkers of response is crucial for appropriate patient selection and further clinical development of anti-PD-1 therapy. We reported the outcome of our window-of-opportunity clinical trial of neoadjuvant pembrolizumab in 15 patients with recurrent GBM, demonstrating rare CD8+ T cells and abundant of CD68+ macrophages in GBM tissue after 3 weeks of anti-PD-1 treatment (NCT02337686). In the current study, we compared tumor infiltrating lymphocyte (TIL) and PD-L1 scores, known biomarkers of response to anti-PD-1 therapy in other cancers, in pre-trial vs. on-trial tumor tissue and associated these markers with survival. Methods: We determined TIL score (morphological assessment of the presence or absence of TILs, 0-3) and PD-L1 H score (defined as [1*1+ %]+[2*2+ %]+[3*3+ %], 0-200) and correlated these with survival. The Wilcoxon signed rank test was used to compare levels of PD-L1 H or TIL scores between pre-trial and on-trial specimens. The Cox proportional hazards models were used to assess associations between correlative markers and progression free survival or overall survival (OS). Results: The on-trial TIL level (median: 3) was significantly higher than the pre-trial TIL level (median: 1) (p = 0.031). However the difference between pre-trial and on-trial PD-L1 levels was not statistically significant (p &gt; 0.9). Patients whose on-trial PD-L1 H score was ≥ 3 trended toward a longer OS than those with a PD-L1 H score &lt; 3 (HR [95% CI] = 0.225 [0.043, 1.183]) (p = 0.0782). Conclusions: Although GBM tissue lacks abundant T cells, treatment with pembrolizumab increases trafficking of T cells to the tumor microenvironment, which is necessary but not sufficient to induce an effector T-cell response. Elevated PD-L1 expression may be a biomarker of response to anti-PD1 therapy in GBM, which needs confirmation in larger studies. Further genomic, transcriptomic, and methylation profiling of the pre-trial and on-trial tissues is ongoing. Clinical trial information: NCT02337686 .
Hypoxia-induced tumor biological behavior changes and application of radiotracers for PET imaging of tumor hypoxia
Authors: Mingyu Zhang, Hao Jiang, Hailong Xu
Journal: BMJ (2017)

Hypoxia exists in a wide range of advanced solid tumors and is often associated with poor prognosis. Hypoxia can enhance tumor invasion, promote tumor angiogenesis, impact genomic stability and change the tumor microenvironment by activating expression of relevant genes through hypoxia-induced factors (HIFs). Hypoxia provides favorable conditions for tumor metastasis and relapse, and it is involved in all aspects of tumor development. The study of hypoxia in tumors may provide useful information for pre-clinical evaluation, individualized treatment and clinical prognosis. Positron emission tomography (PET) is a non-invasive imaging method, which can be used for assessing and quantifying tumor hypoxic microenvironment. This article reviews the mechanisms of hypoxia-induced tumor biological behavior changes and the research progress of the application of radiotracers for PET imaging of tumor hypoxia.


Key words: 
Cell hypoxia, neoplasms; Hypoxia-inducible factor 1, alpha subunit; Radioactive tracers
Mobile health applications in oncology.
Authors: Vivek Upadhyay, Adam Landman, Michael J. Hassett
Journal: Journal of Clinical Oncology (2020)

e14115 Background: Over 325,000 mobile health (mhealth) applications (apps) have been developed. There has been a substantial increase in mhealth investment, with over $8.1 billion invested in digital health startups in 2018. While apps have been studied within clinical oncology, we are aware of no comprehensive evaluation of the commercial footprint of oncology-specific apps. We sought to describe the state of oncology-specific apps and highlight notable areas of development. Methods: We conducted a systemic search for oncology apps in the Apple iOS and Google Play app stores in January 2020. Search terms included “cancer,” “oncology,” “radiotherapy,” and “chemotherapy.” All apps were manually reviewed and classified by English language support, date of last update, downloads, intended audience, intended purpose, and developer type. We also compared commercially available apps with those described in a recently conducted meta-analysis of oncology-app studies. We performed descriptive statistics using RStudio V1.2.335. Results: We identified 794 oncology-specific, English-language applications, but only 257 (32%) met basic quality standards and were considered evaluable. The primary reason for exclusion was lack of a recent update. Of included apps, almost half (47%) were found in the “Medical” Store Category and the majority were free (88%). The most common intended audience was healthcare professionals (45%), with 28% being geared towards the general public and 27% being intended for patients. The intended function was education for 37%, clinical decision support (CDS) for 19%, and patient support for 18%. Only 22% of education apps and 40% of CDS apps reported any formal app content review process. Web developers created 61% of apps, scientific societies created 10%, and hospitals/healthcare organizations created just 6% (Table). The most frequently downloaded apps tended to be geared toward educating/supporting the public. Of 54 studies that utilized mobile apps in oncology identified by a recent meta-analysis, only 2 could be matched to commercially available apps from our study, suggesting a substantial divide between investigation and product dissemination. Conclusions: Our analysis of oncology-related apps in the commercial marketplace found few high-quality, up-to-date apps, and a notable absence of key oncology stakeholders in app development. Future studies should explore barriers to developing and disseminating apps designed to advance oncology care delivery. [Table: see text]
Survey on smoking related knowledge and intention of quitting among smokers with diabetes mellitus
Authors: Ruixia Lu, Yanling Fan, Hao Wu
Journal: BMJ (2017)

Objective
To survey on smoking related knowledge and intention of quitting among smoking patients with diabetes mellitus.


Methods
A questionnaire survey on smoking related knowledge and intention of quitting was conducted among 146 smoking patients with type 2 diabetes mellitus (T2DM) in Beijing Yangfangdian Community Health Service Center from September 2016 to October.The questionnaire included general information (6 items), smoking status (3 items), awareness of smoking hazards (11 items), smoking cessation (5 items). Of the 146 patients, 82 were face-to-face surveyed, and 64 were telephone surveyed.Among 141 respondents who completed the questionnaire, there were 135 males (95.7%) and 6 females (4.3%) aged 32-74 (58.9±7.9) years, 4 cases (2.8%) with primary school education, 46 cases (32.6%) with junior high school, 63 cases (44.7%) with secondary school or high school education, 28 cases (19.9%) with college degree or above.The duration of diabetes ranged from 1 to 35 years with an average of (7.7±5.9) years. There was 2 cases (1.4%) with 1-5 years of smoking, 2 cases (1.4%) with 6-10 years of smoking, 25 cases (17.8%) with 11-20 years of smoking, 112 cases (79.4%) with more than 20 years of smoking.


Results
99.3% (140/141) of the participants knew that smoking could lead to chronic bronchitis and emphysema, 46.8% (66/141) thought that smoking could lead to diabetes, 51.1% (72/141) thought that smoking affected blood glucose control, 65.2% (92/141) knew that smoking increased the incidence of cardiovascular and cerebrovascular diseases. The intention of quitting smoking was significantly correlated with the awareness of above knowledge in smoking diabetic patients.


Conclusion
The awareness rate of smoking causing diabetes, blood glucose control and diabetic chronic complications is relatively low.The awareness of smoking related knowledge can significantly facilitate patients to quit smoking.


Key words: 
Diabetes, 2 type; Smoking cessation; Health knowledge; Attitudes; Practice
Development of evaluation index system for community general practice teaching base
Authors: Huiling Xia, Sunfang Jiang, Juan Shou, Shanzhu Zhu
Journal: BMJ (2017)

Objective
To develop an index system for evaluation index system for community general practice teaching base.


Methods
A draft of evaluation index system for community general practice teaching base was preliminarily developed on the basis of literature research. Two rounds Delphi consultations with 32 experts of general practice were conducted between July 2014 and May 2015. The results of consultation were analyzed and the evaluation index system for community teaching base was established.


Results
In two rounds of Delphi consultation, the positive coefficients were both 100%, the authority coefficient of experts were 0.879 and 0.897, respectively, and the coordination coefficient were 0.165 and 0.204 (P<0.01). The established evaluation index system consisted of 4 first-class indexes, 8 second-class indexes and 27 third-class indexes. Four first-class indexes were basic conditions, teaching conditions, teaching staff and teaching practice.


Conclusion
The established evaluation index system may be used to accredit community general practice teaching base and to improve the quality of general practitioner training.


Key words: 
Delphi technique; Teaching; Community health centers; General practitioners
Clinical follow-up studies on frequent ventricular premature contractions in adolescents
Authors: 聂晓敏, 周玉杰, 李艳芳, 谢英
Journal: BMJ (2006)

目的 对无器质性心脏病的频发室性早搏(FPVC)青少年患者进行随访,观察FPVC对其左心室大小的影响和预后,探讨对其进行抗心律失常治疗的价值.方法无器质性心脏病的FPVC青少年患者随机分为对照组(58例)和治疗组(63例),对照组未行抗心律失常治疗,治疗组接受了抗心律失常药物或射频消融治疗.随访2～7年,平均(4±2)年.每半年复查1次24 h动态心电图和超声心动图,观察室性早搏情况,记录左心室舒张末期直径(LVEDd)和左心室收缩末期直径(LVESd).结果随访末期,所有患者的室性早搏均未发展为恶性心律失常,对照组室性早搏消失率为64.9%,治疗组为66.7%,两组间差异无统计学意义.随访第1年末,对照组室性早搏的消失率显著低于治疗组(37.8%比60.0%,P＜0.001),LVEDd和LVESd均大于治疗组[分别为(52±4)mm比(45±3)mm、(39±2)mm比(31±2)mm,均P=0.03],EF值与治疗组无明显差异;随访末期,两组的LVEDd、LVESd和EF差异无显著性.治疗组在用药期间有5例出现了与抗心律失常药物相关的不良反应.结论FPVC可能致左心室扩张;无器质性心脏病的FPVC青少年患者预后良好;进行抗心律失常治疗可在近期逆转左心室扩张的倾向,但远期疗效未得到证实,且具有一定的风险,提示积极的治疗对这些患者可能是不必要的。