tbuckley/cabot-search huggingface dataset:
Beyond patient-level barriers: Evaluation of rural residency and area-level deprivation and clinical trial (CT) participation.
Authors: Joseph M. Unger, Anna Moseley, Raymond U. Osarogiagbon, Gary C. Doolittle, Dawn L. Hershman
Journal: Journal of Clinical Oncology (2020)

e19068 Background: Residents of rural and socioeconomically deprived areas have worse cancer outcomes and are less likely to participate in CTs. It is unknown whether these area-level attributes predict CT participation after accounting for individual sociodemographic variables. Methods: We combined data from two SWOG national survey studies. S0316, a multi-center prospective survey, was combined with data from a large web-based survey. Both studies examined CT treatment decision making from diagnosis in patients with common cancers. Zip codes of residences were classified as rural or urban using Rural-Urban Continuum Codes (urban, 1-3, vs. rural, 4-9) and a 3-level ordinal variable (urban, 1-3, vs. rural, 4-7, vs. very rural, 8-9). We identified socioeconomically deprived areas (SDAs) as those with an Area Deprivation Index (ADI) in the upper quartile. We also examined areas by ADI quartile. Multivariable logistic regression was used to evaluate the association of rural residency and area-level socioeconomic deprivation with CT participation after adjusting for important individual-level factors (age, sex, race/ethnicity, income, and education), stratified by study and cancer type. Results: Among 7080 patients, 1299 (18.5%) were from rural areas, 653 (9.4%) were from SDAs; and 715 (10.1%) participated in a CT. Patients had breast (56.1%), prostate (21.8%), lung (13.6%), and colorectal (8.4%) cancer. In univariate analysis, rural patients were 23% less likely to participate in a CT (OR=0.77, 95% CI: 0.62-0.95, p=.016); in multivariate analysis, results were similar (OR=0.80, 95% CI: 0.64-0.99, p=.037). Very rural residents were 34% less likely to participate than urban patients (OR=0.66, 95% CI, 0.55-0.80, ordinal p=.031). There was no statistically significant association between residence in SDAs and CT participation (p&gt;.30). Rural patients were more likely to have &gt;1 comorbid conditions (45.4% vs. 39.5%, p=.001), to be concerned about how to pay for their care (40.6% vs. 32.4%, p&lt;.0001), and to travel farther for care (median 50.0 vs. 12.0 miles, p&lt;.0001). Conclusions: Our findings are the first to show that rural residents are less likely to participate in CTs even after accounting for confounding individual factors. These results agree with prior observations that rural patients must travel longer distances for care, including for CT care. Reducing the travel burden for rural cancer patients could improve their CT participation and the generalizability of CT results to all patients.
Problems and countermeasures in clinical practice of general practice residency training in Hebei province
Authors: Xiao Zhi, Hongchao Liu, Feng Li, Rongying Wang, Rui Jiang
Journal: BMJ (2016)

随着我国全科医师规范化培训的逐渐开展，全科医师培训工作已经初具规模，培训相关问题也逐渐展现。通过分析河北省全科医师规范化培训临床实践阶段的情况、存在的问题，提出完善管理制度、培养合格的师资及加强技能训练等可行措施，以提升全科医师临床实践阶段的培训质量，为我国全科医师规范化培训工作提供可借鉴的经验。
Dual TGF-β and AURKA targeting enhances chemosensitivity in triple-negative breast cancer.
Authors: Fahad Ahmed Faruqi, Mohammad Jalalirad, Antonino Bonaventura D'Assoro, Tufia C. Haddad, Jodi M Carter, Judy Caroline Boughey, Leiwei Wang, Matthew P. Goetz, James N. Ingle
Journal: Journal of Clinical Oncology (2020)

e13106 Background: Chemotherapy resistance remains a significant barrier in the effective treatment of patients with triple negative breast cancer (TNBC). TGF-β signaling is a well characterized oncogenic pathway in TNBC that promotes chemoresistance by inducing epithelial to mesenchymal transition (EMT) and tumor stemness. Aurora-A kinase (AURKA) is a serine/threonine kinase responsible for chromosomal stability during mitosis. Significantly, aberrant expression of AURKA induces breast cancer progression. We hypothesized that aberrant activation of TGF-β and AURKA signaling pathways contributes to chemoresistance in TNBC by promoting EMT and tumor stemness and that dual-targeting of these oncoproteins will enhance chemosensitivity. Methods: RNA-Seq data were analyzed from patient derived xenografts (PDx) established from patients with Stage I-III TNBC who received pre-operative taxane and anthracycline based chemotherapy. Chemoresistance was defined as an RCB score of 1-3, and chemosensitivity was defined as an RCB score of 0. Unique TNBC cell lines developed from brain metastasis PDxs (TNBC M14, TNBC M25) were treated in vitro with 10nM docetaxel (DTX), 50nM LY2157299 (TGF-β inhibitor) and 50nM MLN8237 (AURKA inhibitor). EMT reprogramming was determined by measuring the expression of vimentin, ALDH activity and mammosphere growth. Apoptotic cells following drug treatment were labeled with Red Annexin-V marker and monitored in real time using the IncuCyte instrument. Results: RNA-Seq revealed that there was no baseline difference in expression of AURKA between chemoresistant and chemosensitive TNBC PDxs. However, there was a 2.7-fold increase in AURKA expression in the post-treatment PDx models compared to pre-treatment PDx models. In vitro treatment of the M14 and M25 cell lines with DTX demonstrated no significant increase in apoptotic cells compared to control, whereas treatment with the combination of DTX, LY2157299 and MLN8237 resulted in a two-fold increase in apoptosis compared to treatment with DTX alone (p = 0.0068 M14, p = 0.003 M25). Dual-targeting with LY2157299 and MLN8237 reduced the expression of vimentin and ALDH activity. Conclusions: TGF-β and AURKA play a central role inducing EMT and a stem-cell-like phenotype in TNBC that confers chemoresistance. AURKA is up-regulated after exposure to chemotherapy in chemoresistant TNBC PDx models. LY2157299 and MLN8237 reduce TNBC stemness in M14 and M25 cell lines and enhance DTX chemosensitivity. Dual-targeting of TGF-β and AURKA is a potentially promising approach in chemoresistant TNBC.
冠心病
Authors: 吴东, 刘永太, 陈嘉林
Journal: BMJ (2011)

一、典型症状对稳定性心绞痛诊断价值很高 冠心病的正确诊断有赖于详尽的病史和及时的辅助检查. 最常用于稳定性心绞痛评估的辅助检查是心电图.目前,很多社区卫生机构已配备心电图机,但是对心电图的解读能力尚有不足.很多患者仅因为心电图出现一些非特异性改变,即被扣上冠心病的帽子并开始服药。
Trial in progress: A phase III, randomized, open-label study comparing zanubrutinib plus rituximab versus bendamustine plus rituximab in patients with previously untreated mantle cell lymphoma (MCL).
Authors: Martin H. Dreyling, Constantine Si Lun Tam, Michael Wang, Stephen Douglas Smith, Marco Ladetto, Huiqiang Huang, Rebecca L. Elstrom, Melannie Co, Eric Holmgren, Jane Huang, Steven Le Gouill
Journal: Journal of Clinical Oncology (2020)

TPS8071 Background: Bruton tyrosine kinase (BTK) mediates B-cell proliferation, migration, and adhesion. BTK inhibition has emerged as a strategy for targeting B-cell malignancies, including MCL. Zanubrutinib is a next-generation BTK inhibitor that was designed to maximize BTK occupancy and minimize off-target inhibition of TEC- and EGFR-family kinases, with favorable pharmacokinetic and pharmacodynamic properties. Zanubrutinib monotherapy has been evaluated in 118 patients (pts) with relapsed/refractory MCL in 2 single-arm studies: BGB-3111-206 [NCT03206970] and BGB-3111-AU-003 [NCT02343120]. The overall response rate (ORR) by independent review committee (IRC) in both trials was 84% with median durations of response of 19.5 and 18.5 months, respectively. First-line treatment for MCL has failed to cure most pts, particularly elderly or transplant-ineligible groups, and chemotherapy-based approaches result in cumulative, long-term risks. The study described herein is designed to evaluate the safety and efficacy of zanubrutinib plus rituximab versus bendamustine plus rituximab in elderly pts and pts with comorbidities with previously untreated MCL who are ineligible for stem cell transplant. Methods: This ongoing phase 3, open-label study will enroll ≈500 pts to be randomized 1:1, stratified by MCL International Prognostic Index score (low vs intermediate/high), age ( &lt; 70 vs ≥70 years), and geographic region (North America/Europe vs Asia-Pacific). In arm A, pts will receive up to six 28-day cycles of oral zanubrutinib 160 mg twice daily in combination with intravenous (IV) rituximab 375 mg/m 2 on day 1 of each cycle. After 6 cycles, zanubrutinib will continue as a monotherapy until progressive disease, unacceptable toxicity, or withdrawal of consent. In arm B, pts will receive up to six 28-day cycles of IV bendamustine 90 mg/m 2 on days 1 and 2 of each cycle and rituximab 375 mg/m 2 on day 1 of each cycle, followed by observation. Eligible pts must have histologically confirmed MCL and be aged ≥70 years, or 65-69 years with defined comorbidities. Disease response will be assessed per the 2014 Lugano Classification for non-Hodgkin lymphoma. The primary endpoint is progression-free survival (PFS) determined by IRC. Key secondary end points include PFS by investigator assessment, ORR, time to and duration of response, overall survival, and safety. Recruitment is ongoing. Clinical trial information: NCT04002297 .
Clinical analysis for 173 cases of Behcet's disease
Authors: 彭劲民, 张卓莉, 董怡
Journal: BMJ (2006)

目的 总结白塞病患者的临床特点,提高对白塞病的认识.方法收集北京协和医院1983年1月至2004年6月确诊白塞病的173例患者的临床资料,回顾性分析其临床表现、系统受累及在不同性别的发生率和发生时间差异.结果平均发病年龄为(28±12)岁,病程为5(2～10)年.173例患者中,口腔溃疡是最常见的临床表现(173例,100%),其后依次为外阴溃疡(128例,74.0%)和眼部受累(91例,52.6%).HLA-B51阳性率为41%(16/39),针刺反应阳性率为60.0%(102/173).口腔溃疡为最常见的首发表现(119例,68.2%),其后依次为生殖器溃疡(47例,27.2%)、结节红斑(28例,16.2%).白塞病可以导致重要脏器的病变,眼部症状发生在首发症状后平均1(0～7)年,中枢神经系统症状在4(2～6)年,消化系统症状在4(1～7)年,大血管症状在3(0.6～4)年.临床表现存在显著性别差异的有男性大血管受累较多(OR=10.6,P<0.01)、女性血液系统受累较多(OR=0.094,P<0.05).结论白塞病的临床表现多种多样,可累及多个系统,存在性别差异。
Evaluation on training effect of "The Guidelines for Prevention and Treatment of Hypertension in China" training in Shanghai General practitioners
Authors: Xiangjie Zhang, Tianhao Wang, Yuan Zhang, Jie Gu, Qian Chen, Dean Liu, Xiaoyan Ou, Ning Zhong, Liping Xu
Journal: BMJ (2014)

Objective
To evaluate the effect of  Guidelines for Prevention and Treatment of Hypertension in China (the Guidelines) training in Shanghai General practitioners(GPs).


Methods
One hundred and forty seven GPs from 5 community health centers in Xuhui District of Shanghai were assigned into intervention group(n=78) and control group(n=69). GPs in intervention group received regular trainings of the Guideline for 8 months, the control group did not receive the training.A questionnaire survey was conducted in both groups before and after the training.


Results
Most of GPs in the study (92.5%) had received hypertension training courses before, and majority of them (87.7%) wished to receive the further training.The scores of knowledge about hypertension in intervention group increased significantly(P=0.025) after training, but there were no changes in the control group(P=0.078) before and after training. The correct rate of hypertension treatment in intervention group was lower than that of control group before training (50.1% vs. 59.3%, P=0.001); however, the correct rate in intervention group was significantly higher than that of control group (65.5% vs. 55.4%, P=0.000) after training.


Conclusions
Providing GPs with regular training course on the Guidelines would improve their clinical ability for treatment of hypertension in the community.


Key words: 
Hypertension; General practitioner; Train
J波改变33例心电图分析
Authors: 李玲, 王一欣, 孙宗林, 李颖
Journal: BMJ (2009)

现回顾分析33例心电图J波的临床资料,报告如下. 一、临床资料 1.一般资料:33例均为我院1990年1月至2007年12月住院、资料较完整、诊断明确的患者.男性30例,女性3例,年龄37～73岁,平均55岁。
COVID-19: in the footsteps of Ernest Shackleton
Authors: Alvin J Ing, Christine Cocks, Jeffery Peter Green
Journal: Thorax (2020)

We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription-PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.
预混人胰岛素类似物的临床应用
Authors: 赵文惠, 邢小燕
Journal: BMJ (2012)

预混人胰岛素类似物是指将速效人胰岛素类似物和精蛋白结晶的人胰岛素类似物按一定比例预混的制剂.当2型糖尿病患者口服降糖药治疗血糖仍不能达标时,就需要启动胰岛素治疗,可采用每日1～2次预混人胰岛素类似物的起始治疗方案；当患者需要强化血糖控制时,可采用每日3次预混人胰岛素类似物的强化治疗方案。
慢性鼻窦炎与鼻窦相邻结构解剖学异常分析
Authors: 董金叶, 乔伟昌, 何海燕
Journal: BMJ (2011)

引起慢性鼻窦炎的因素包括感染因素、变应因素和解剖结构异常.随着鼻窦CT和鼻内镜的广泛使用,发现鼻窦相邻结构异常可能是发病原因之一.本研究以解剖结构异常为入点,对慢性鼻窦炎与解剖结构的关系进行探讨。
双八面体蒙脱石预防阿奇霉素的胃肠道反应28例
Authors: 褚建东, 周涛, 牛豫
Journal: BMJ (2004)

阿奇霉素属大环内酯类抗生素,抗菌方式和抗菌谱与红霉素相似,但作用较红霉素强,并具有持续的抗生素后效应,疗程短且稳定性更好,不良反应少,近些年在临床上较红霉素更广泛的用于支原体、衣原体所致的呼吸及泌尿系统感染.该药最常见的不良反应--胃肠道反应也给患者带来了不少痛苦.2002年4月～2003年1月在我院应用双八面体蒙脱石防治阿奇霉素的胃肠道反应,疗效显著。
Hyperuricemia increases risk of metabolic syndrome in women
Authors: Qiang Jia, Zhao-wei Meng, Jian Tan
Journal: BMJ (2011)

Hyperuricemia and metabolic syndrome were studied in 17 762 subjects of Tianjin Municipality from July 2007 to July 2009. The overall prevalence rate of hyperuricemia was 12. 16% (2160cases) , the rate in males was significantly higher than that in females (15. 71% vs. 6. 51% , P <0. 01).The overall prevalence rate of metabolic syndrome was 25. 56% (4540 cases) , the rate in males was also higher than that in females (28. 17% vs. 21. 40% , P <0. 01). Binary logistic regression analysis disclosed that females with high uric acid were twice likely to suffer from metabolic syndrome than males; and female ≤ 44 years with hyperuricemia had the highest odd ratio for metabolic syndrome.

Key words: 
Hyperuricemia;  Metabolic syndrome X
Investigation of <i>Leptin</i> and its receptor (<i>LEPR</i>) for single nucleotide polymorphisms in colorectal cancer: A case-control study involving 2,306 subjects.
Authors: Jing Lin, Yu Chen, Bin Lan, Zeng-qing Guo, Wei-feng Tang, Gang Chen, Xuefeng Xia
Journal: Journal of Clinical Oncology (2020)

e16100 Background: Colorectal cancer is a leading cause of cancer deaths, with poor prognosis. Some studies have reported that obesity and overweight are risk factor for the development of CRC. Leptin ( LEP) and its receptor ( LEPR) single nucleotide polymorphisms (SNPs) might regulate energy balance and be implicated in the development of CRC. The aim of this case-control study was to assess the association of LEP rs2167270 G &gt; A, rs7799039 A &gt; G, LEPR rs6588147 G &gt; A, rs1137100 G &gt; A and rs1137101 G &gt; A SNPs with susceptibility to CRC in Eastern Chinese Han population. Methods: 1,003 CRC cases and 1,303 matched controls was compared. Five functional SNPs in LEP and LEPR genes were chosen to evaluate the correlation of these chosen SNPs with CRC susceptibility. We used the SNPscan genotyping assay to genotype LEP and LEPR SNPs. Results: A significantly decreased risk of CRC was found to be associated with the LEPR rs6588147 polymorphism (GA vs. GG: crude P= 0.007 and GA/AA vs. GG: crude P= 0.018). With adjustments for risk factors (e.g. age, gender, drinking, BMI and smoking), these associations were not changed. In subgroup analyses, the association of LEP rs2167270 with a decreased risk of CRC was found in the ≥61 years old subgroup. For LEPR rs1137100, the association of this SNP with an increased susceptibility of CRC was found in the BMI &lt; 24 kg/m 2 subgroup. In subgroup analyses for LEPR rs6588147, we identified that this locus also decreased the susceptibility of CRC in the male subgroup, &lt; 61 years old subgroup, never smoking subgroup and never drinking subgroup. For LEPR rs1137101, the relationship of this polymorphism with a decreased susceptibility to CRC was found in the never drinking subgroup. Conclusions: The present study highlights that LEPR rs6588147, rs1137101 and LEP rs2167270 may decrease the risk of CRC. However, LEPR rs1137100 is associated with susceptibility to CRC. Further case-control studies with larger sample sizes should be conducted to validate our findings.
Association of postoperative serum carcinoembryonic antigen (CEA) with disease-free survival in patients with stage III colon cancer: ACHIEVE phase III randomized clinical trial.
Authors: Masahito Kotaka, Dai Manaka, Tetsuya Eto, Junichi Hasegawa, Akinori Takagane, Masato Nakamura, Takeshi Kato, Yoshinori Munemoto, Fumitaka Nakamura, Hiroyuki Bando, Hiroki Taniguchi, Makio Gamoh, Manabu Shiozawa, Masayasu Nishi, Tetsuya Horiuchi, Tsunekazu Mizushima, Takeharu Yamanaka, Takayuki Yoshino, Atsushi Ohtsu, Masaki Mori
Journal: Journal of Clinical Oncology (2020)

4069 Background: ACHIEVE, as part of the IDEA collaboration, was a multicenter trial randomizing patients with stage 3 resected colon cancer to either 3 versus 6 months of adjuvant FOLFOX/CAPOX. We previously reported that the hazard ratios (HRs) in disease-free survival (DFS) of 3 versus 6 months duration according to risk stage (low-risk [T1-3 and N1] or high-risk [T4 or N2]) and regimen (FOLFOX or CAPOX) as well as in overall population were consistent with those observed in the whole IDEA. This study aimed to clarify the significance of post-operative serum carcinoembryonic antigen (CEA) on DFS in stage 3 colon cancer. Methods: Eligibility included post-operative serum CEA value of ≤10 ng/ml at registration in the ACHIEVE trial, which enrolled 1313 patients between 2012 and 2014, out of whom 1291 pts were the modified ITT (mITT) population and used in this study. The cutoff values of CEA analyzed for prognostic analyses were the median value (1.8 ng/ml) in the mITT, the upper limit of normal (ULN) level (5.0 ng/ml), and the half of ULN (2.5 ng/ml). The association of post-operative CEA with DFS were measured by Cox regression analyses. Results: Of the 3 cutoff values, the ULN (5.0 ng/ml) was associated with DFS more strongly than the median (1.8 ng/ml) or half of ULN (2.5 ng/ml), with a HR of 1.75 (95%CI, 1.24-2.46) (Table). The 99 patients (7.7%) were identified as the CEA &gt; ULN and 1192 (92.3%) as &lt; ULN. In univariate analysis, regimen (CAPOX or FOLFOX), ECOG PS (0 or 1), T factor (T1-3 or T4), N factor (N1 or N2-3) and CEA ( &lt; ULN or &gt; ULN) were significantly associated with DFS. Multivariate Cox regression identified CEA &gt; ULN as an independent poor risk factor (HR = 1.45; 95%CI, 1.03-2.05). Shorter DFS in patients with CEA &gt; ULN than in those with CEA &lt; ULN was consistently observed in each subgroup of baseline factors, including treatment duration, regimen, age, gender, PS, T-stage, N-stage, no of lymph nodes examined, and tumor location; no interaction was observed between CEA and these factors. Conclusions: Post-operative serum CEA is also a strong prognostic factor for DFS in stage 3 colon cancer. Clinical trial information: 000008543 . [Table: see text]
治疗关节痛中成药的合理应用
Authors: 郝伟欣
Journal: BMJ (2011)

关节痛是一种常见病和多发病,属于中医痹病的范畴,痹有闭塞不通的意思.关节痛的发生主要与正虚、邪侵及痰浊瘀血有关,会出现肌肉和关节疼痛、麻木、展伸不利,甚至灼热、畸形.病久不愈,可关节肿大、变形,疼痛加剧.中成药具有经济、省时、服用方便而不良反应小的特点,适用于需要较长时期服药的慢性关节痛患者.面对市场上数十种乃至近百种治疗关节痛的中成药,如何选择,需要医生进行正确的指导,只有坚持中医辨证论治的原则,掌握适应证,才能取得满意疗效.下面介绍几种常用中成药。
Attach importance to prevention and treatment of osteoporosis at the grassroots level
Authors: Juxiang Liu, Jing Liu
Journal: BMJ (2020)

骨质疏松症是最常见的骨骼疾病，患病率高，危害大，知晓率低，诊治率低，但可防、可治。在分级诊疗背景下，尤其需加强基层全科医生对骨质疏松症的防治能力。《原发性骨质疏松症基层诊疗指南（2019年）》主要针对原发性骨质疏松症，内容包括识别高危人群、准确诊断、强调鉴别诊断，合理用药、规范疗程、疗效评估及预防、分级诊疗及转诊。相信本指南对基层医生在骨质疏松症的规范化防治方面能够发挥积极作用。
Identifying an Optimal Liver Frailty Index Cutoff to Predict Waitlist Mortality in Liver Transplant Candidates
Authors: Ani Kardashian, Jin Ge, Charles E. McCulloch, Matthew R. Kappus, Michael A. Dunn, Andres Duarte‐Rojo, Michael L. Volk, Robert S. Rahimi, Elizabeth C. Verna, Daniel R. Ganger, Daniela Ladner, Jennifer L. Dodge, Brian Boyarsky, Mara McAdams‐DeMarco, Dorry L. Segev, Jennifer C. Lai
Journal: Hepatology (2020)

Background and Aims Frailty, as measured by the Liver Frailty Index (LFI), is associated with liver transplant (LT) waitlist mortality. We sought to identify an optimal LFI cutoff that predicts waitlist mortality. Approach and Results Adults with cirrhosis awaiting LT without hepatocellular carcinoma at nine LT centers in the United States with LFI assessments were included. Multivariable competing risk analysis assessed the relationship between LFI and waitlist mortality. We identified a single LFI cutoff by evaluating the fit of the competing risk models, searching for the cutoff that gave the best model fit (as judged by the pseudo‐log‐likelihood). We ascertained the area under the curve (AUC) in an analysis of waitlist mortality to find optimal cutoffs at 3, 6, or 12 months. We used the AUC to compare the discriminative ability of LFI+Model for End Stage Liver Disease‐sodium (MELDNa) versus MELDNa alone in 3‐month waitlist mortality prediction. Of 1,405 patients, 37 (3%), 82 (6%), and 135 (10%) experienced waitlist mortality at 3, 6, and 12 months, respectively. LFI was predictive of waitlist mortality across a broad LFI range: 3.7‐5.2. We identified an optimal LFI cutoff of 4.4 (95% confidence interval [CI], 4.0‐4.8) for 3‐month mortality, 4.2 (95% CI, 4.1‐4.4) for 6‐month mortality, and 4.2 (95% CI, 4.1‐4.4) for 12‐month mortality. The AUC for prediction of 3‐month mortality for MELDNa was 0.73; the addition of LFI to MELDNa improved the AUC to 0.79. Conclusions LFI is predictive of waitlist mortality across a wide spectrum of LFI values. The optimal LFI cutoff for waitlist mortality was 4.4 at 3 months and 4.2 at 6 and 12 months. The discriminative performance of LFI+MELDNa was greater than MELDNa alone. Our data suggest that incorporating LFI with MELDNa can more accurately represent waitlist mortality in LT candidates.
关于急性缺血性脑卒中诊治指南中有关分型、分期治疗问题的答复
Authors: 刘鸣
Journal: BMJ (2011)

首先应该解释的是,指南不是专著而是面向全国多数医院医生临床实践的指导性学术和技术参考文件.指南推荐的不是进展或某些观点,而是世界和国内普遍公认和较成熟的基本方法,因此不可能包罗万象.有可能不是最高最精细的要求,但一定代表了国内外学界的成熟共识.指南未涉及的内容,不一定不能做,只是没有要求一定要做。
Transplantation of bone marrow mesenchymal stem cells improves cognitive deficits and alleviates neuropathology in animal models of Alzheimer’s disease: a meta-analytic review on potential mechanisms
Authors: Chuan Qin, Yalan Lu, Kewei Wang, Lin Bai, Guiying Shi, Yiying Huang, Yongning Li
Journal: Translational Neurodegeneration (2020)

Abstract Background Alzheimer’s disease is a neurodegenerative disorder. Therapeutically, a transplantation of bone marrow mesenchymal stem cells (BMMSCs) can play a beneficial role in animal models of Alzheimer’s disease. However, the relevant mechanism remains to be fully elucidated. Main body Subsequent to the transplantation of BMMSCs, memory loss and cognitive impairment were significantly improved in animal models with Alzheimer’s disease (AD). Potential mechanisms involved neurogenesis, apoptosis, angiogenesis, inflammation, immunomodulation, etc. The above mechanisms might play different roles at certain stages. It was revealed that the transplantation of BMMSCs could alter some gene levels. Moreover, the differential expression of representative genes was responsible for neuropathological phenotypes in Alzheimer’s disease, which could be used to construct gene-specific patterns. Conclusions Multiple signal pathways involve therapeutic mechanisms by which the transplantation of BMMSCs improves cognitive and behavioral deficits in AD models. Gene expression profile can be utilized to establish statistical regression model for the evaluation of therapeutic effect. The transplantation of autologous BMMSCs maybe a prospective therapy for patients with Alzheimer’s disease.
肺炎的影像诊断
Authors: 马大庆
Journal: BMJ (2011)

肺炎的病原体为细菌、病毒、支原体、衣原体和霉菌等.影像检查的目的是发现病变、鉴别诊断、判断严重程度,推测可能的病原和观察治疗效果.临床和X线表现典型的病例X线胸片即可诊断,CT用于难以吸收肺炎的鉴别诊断。