tbuckley/cabot-search huggingface dataset:
社区实施冠心病双向转诊的作用和目前存在的问题
Authors: 杜雪平, 丁静
Journal: BMJ (2006)

一个效率高、成本效益好的卫生体系应该由全科医生先对患者进行筛选,在社区用较少的医疗资源解决大多数患者的健康问题,而只把很少一部分患者转诊给专科医生,使得专科医生与全科医生之间工作达成一种平衡.1993年世界医学教育高峰会议就明确提出,高效的卫生服务系统应该建立社区卫生服务机构与大医院之间的双向转诊制度。
The predictive value of alarm features for upper gastrointestinal malignancy: a single-center retrospective study
Authors: Bo Lu, Dong Wu, Aiming Yang
Journal: BMJ (2016)

Objective
To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.


Methods
A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted. Biopsy or surgical pathological findings served as the golden standard. The main outcome measure was the diagnostic accuracy of alarm features.


Results
Among 921 gastrointestinal outpatients, 39 patients (4.2%) with malignancy were detected, including 13 (33.3%) with esophageal cancer, 24 (61.5%) with gastric cancer and 2 (5.1%) with duodenal ampulla cancer. 36 patients (92.3%) were found with advanced cancer. In 137 patients who had alarm features, 21 (15.3%) were found to have malignancy and all were advanced. The sensitivity, specificity, positive predictive value and negative predictive value of alarm features were 53.8% (21/39), 86.8% (766/882), 15.3% (21/137) and 97.7% (766/784), respectively.


Conclusions
Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy. Non-invasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.


Key words: 
Esophageal neoplasms; Stomach neoplasms; Ampulla cancer; Gastroscopes; Alarm feature
Health seeking behavior of patients with chronic heart failure in community
Authors: Guilian Wang, Ruijie Li, Jian Yang
Journal: BMJ (2015)

Total 1 500 subjects aged over 60 years were selected from 10 community health service centers with cluster sampling method. A questionnaire survey and physical examination were performed in all subjects. Sixty five patients with chronic heart failure were detected. The questionnaire showed that 77.6% (38/49) patients were diagnosed in tertiary hospitals, and 12.2% (6/49) were diagnosed in community hospitals. When heart failure occurred, most patients (37.7%, 20/53) chose to take a taxi to the tertiary hospital directly, and less patients (17.0%, 9/53) contacted community doctors. When a heart attack happened, 68.8%(33/48) of the patients could reach the hospital within 30 min, and 55.3% (26/47) within 60 min. 45.7% (21/46) elderly patients were hospitalized for heart failure once a year; 31.1% (14/45) were in hospital for less than 10 d each time. 46.0% (23/50) heart failure patients had received health education and 40.0%(16/40) had taken drugs under supervision; the majority health educators were community doctors and majority supervisors were family members. The results suggest that the confirmed diagnosis and treatment of heart failure patients still rely on tertiary hospitals, community health institutions play an important role in health education and management of heart failure patients outside hospitals. But the utilization of community health services is still not enough in community health service centers.

Key words: 
Disease management; Heart failure
浙江省城市社区卫生服务机构运行现状的分析
Authors: 周爱珍, 石文军, 顾亚明, 叶真
Journal: BMJ (2007)

2006年2月,国务院下发了《关于发展城市社区卫生服务的指导意见》(简称《指导意见》),随后卫生部、财政部、国家发改委、人事部、民政部、劳动保障部、国家中医药局相继制订了9个配套文件.本研究对2005年浙江省城市社区卫生服务机构运行情况进行分析,为出台地方配套政策提供依据。
Evaluation of impact of a health education project on knowledge and behavior of prevention and treatment for hyperlipidemia and coronary heart disease in health-care workers in China
Authors: 王增武, 武阳丰, 高润霖
Journal: BMJ (2005)

目的 评价健康教育项目对医师有关血脂异常与冠心病防治知识及行为的干预效果.方法为实施健康教育项目,建立了一个包括20个分中心的教育网络,对项目对象(各级医院医师)进行相关的有针对性的心血管病健康教育培训.通过比较干预人群(两次独立抽样,干预前为1 502人,干预后有效调查1 512人)干预前后有关血脂异常与冠心病相关知识的认知率的变化来了解干预的效果.同时对非干预人群行抽样调查,设为对照组(1 164人),以便分析干预的净效应.结果干预后各级医院医师对血脂异常与冠心病相关知识的认知率均有增加,其中乡村医师增幅最明显,达8.7%～40.2%;对成人血脂正常范围的认知,各级医师增加了16.1%～48.0%;对于冠心病患者血脂控制目标水平的认知,各级医师增加了26.4%～42.4%;运用膳食治疗方法来降低血脂水平的医师增加了18.2%;对单纯高胆固醇血症的患者给予他汀类药物治疗的地市级医师增加了49.6%,乡村医师增加了47.4%;工作中对非心血管病患者测血脂的比例增幅不足15.0%.结论通过干预,各级医院医师有关血脂异常和冠心病的防治知识有了明显提高,但其医疗行为改善不理想,在今后的健康教育项目实施中应予重视。
Changes in indicators related to inflammatory cytokines, coagulation and fibrinolysis in patients with disseminated intravascular coagulation and multiple organ dysfunction syndrome caused by sepsis
Authors: Zhao-xia Duan
Journal: BMJ (2009)

Objective To investigate changes in indicators related to inflammatory cytokines, coagulation and fibrinolysis system in patients with disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) resulted from sepsis. Methods In total, 97 patients diagnosed as sepsis were divided into different groups and their plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), tissue factor (TF) and tissue factor pathway inhibitor (TFPI), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) were measured by ELISA and plasma activity of protein C (PC:A) was measured by chromogenic substrate assay. Results Plasma concentrations of TNF-α and I L-6 were (38 ± 12) ng/L and (77 ± 9) ng/L, respectively, in patients of sepsis complicated with DIC, much higher than those without DIC [ ( 17±6) ng/L and (45 ± 6), respectively], P <0.05;and (63±25) ng/L and (103±28) ng/L, respectively, in those complicated with MODS, significantly higher than in those without MODS [ (29 ± 7 ) ng/L and (48±9)ng/L, respectively], P < 0/05 and those without DIC [( 17 ± 6) ng/L and (45 ± 6) ng/L, respectively], P <0. 05;as well as significantly higher in the dead than in survivors (P <0. 05). Plasma activity of protein C was (32 ± 10) percent in those with DIC and (24 ± 12) percent in those with MODS, both significantly lower than in those without DIC [ (57±28) percent] and without MODS [ (55 ± 17) percent], respectively, P <0. 05, as well as significantly lower in the dead than in survivors, P <0. 05. Plasma concentrations of t-PA and PAI-1 were significantly higher in sepsis patients with DIC [(48±17)μg/L] than that in those without DIC [(103 ± 38)μg/L], P < 0.05. Conclusions Inflammatory cytokines play important roles in development of DIC as well as MODS in patients with sepsis. Decreased activity of protein C and increased plasma level of PAI-1 can result in deposition of fibrin on the vessel wall and thrombosis, which can be used as indicators of poor prognosis for patients with DIC.

Key words: 
Systemic inflammatory response syndrome; Disseminated intravascular coagulation; Multiple organ failure
Genomic origin and immune-related status of pulmonary sarcomatoid carcinoma.
Authors: Xuewen Liu, Fang Wang, Xinru Chen, Xue Hou, Lianpeng Chang, Zhi Xie, Yongdong Liu, Qian Li, Pansong Li, Yan-Fang Guan, Xuchao Zhang, Sha Wang, Chunwei Xu, Hui Wang, Xin Yi, Jianjun Zhang, Xuefeng Xia, Cesar Moran, Likun Chen
Journal: Journal of Clinical Oncology (2020)

e13500 Background: Pulmonary sarcomatoid carcinoma (PSC), composed of sarcomatous component (SaC) and carcinomatous component (CaC), is a rare and generally aggressive subtype of non-small-cell lung cancer (NSCLC). Little is known about the genetic origin, TMB, and PD-L1 status of PSC. Methods: 31 immunohistochemically (IHC) confirmed PSCs were enrolled and tumor samples were subjected to microdissection to obtain SaC and CaC. Different components were subjected to targeted sequencing with a 1021-gene-panel. Somatic mutations were used to assess TMB and construct phylogenetic tree. PD-L1 expression level was determined by IHC. Independent cohorts of 90 lung adenocarcinomas (LUAD) from the Geneplus database and 167 sarcomas from TCGA were used for genomic comparison. Results: 87% of patients (pts) were male, with a median age of 57.0 years. 52% were smokers. The most recurrently mutated genes were TP53 (80%), MET (24%), NF1 (21%), EGFR (21%), and KRAS (21%) in CaC, while TP53 (76%), MAP3K1 (21%), NF1 (21%), MET (21%), and KRAS (21%) in SaC. 55.4% of the variations (SNV, small indels, SV, and CNV) were shared within SaC and CaC. TP53, MET, NF1, and EGFR were mostly frequently found in shared mutations. Overwhelming majority of PSCs (29/30) had common mutations between SaC and CaC implying a monoclonal origin. EGFR were mutated significantly less in adenocarcinoma components (AdC) than LUAD (Fisher Exact test, 4/24 vs 52/90, p &lt; 0.001). High-frequency mutated driver genes in SaC, MET, EGFR, NF1, and ALK, were rarely detected in leiomyosarcomas and uterine sarcomas. The median of TMB in SaC and CaC were both 12.9 mutations/Mb (range, SaC 2.88-33.1, CaC 2.88-47.5), with high correlation between the two components (p &lt; 0.001). PD-L1 expression levels in the two components also had high correlation (p &lt; 0.001). More pts showed high PD-L1 expression ( &gt; = 50%) in SaC rather than CaC (8 versus 3). Conclusions: A majority of PSCs share a monoclonal origin. PSCs with AdC exhibited lower mutated frequency of EGFR than LUAD. SaC and CaC had similar higher TMB status than LUAD. SaC and CaC had similar level of PD-L1expression.
Evaluation of clinical capability of young general practitioners in communities of Shanghai
Authors: Hui Li, Minghui Peng, Xiangjie Zhang, Shijie Fu, Yao Liu
Journal: BMJ (2016)

Objective
To evaluate the clinical capability of young general practitioners (GPs) in communities in Shanghai.


Methods
A cross-sectional survey on clinical ability of young GPs was adopted from October to December 2014. Total 211 GPs aged (31±2) years (25-35) from 17 districts of Shanghai participated in the study. Written examination and objective structured clinical examination (OSCE) was applied in the evaluation.


Results
All 211 GPs (63 male and 148 females) completed the assessment. The overall score of the assessment was (602±83) and the pass rate was 62.6% (132/211). In written examination the average score was (64±7) and the pass rate was 72.1% (152/211). In OSCE, the highest score (80 ±15) and pass rate (92.9%, 196/211) was in CPR skill, followed by communication skill [average score: (76±15) and pass rate: 85.8% (181/211)]. The lowest average score was physical examination (47±15) with a pass rate of 26.1% (55/211), followed by electrocardiogram reading [average score: (84±31) and pass rate: 39.8% (84/211)]. In basic operation station, the lowest score was using funduscope and gynecologial examination (29.8% and 45.4%, respectively).


Conclusion
Young GPs in Shanghai communities basically master clinical skills, but also have some deficiencies, the training in certain skills need to be strengthened.


Key words: 
Clinical competence; General practitioners; Objective structured clinical examination
PD-1 inhibitor combined with radiotherapy and GM-CSF as salvage therapy in patients with chemotherapy-refractory metastatic solid tumors.
Authors: Yuehong Kong, Xiangrong Zhao, Li Zou, Pengfei Xing, Yifu Ma, Ye Tian, Liyuan Zhang
Journal: Journal of Clinical Oncology (2020)

e15173 Background: Patients with refractory metastatic solid tumors have poor prognoses and few therapeutic options. The application of PD-1 inhibitor has led to a paradigm shift in the treatment of advanced cancer, but its efficacy as a monotherapy is limited. Previous evidence has shown that the anti-tumor effects might be reinforced when PD-1 inhibitor combines with radiotherapy or granulocyte macrophage-colony stimulating factor (GM-CSF). An exploratory study was conducted to assess the clinical efficacy and safety of PD-1 inhibitor combined with radiotherapy and GM-CSF (PRaG regimen) for the treatment of refractory patients. Methods: Participants had multimetastatic solid tumors progressing beyond at least first-line chemotherapy.They were treated with hyperfractionated radiotherapy (3 doses of 8Gy or 5 doses of 5Gy) for each metastatic site. On the second day after radiotherapy, PD-1 inhibitor 200 mg once was intravenously administered and GM-CSF 200 µg daily was subcutaneously injected for 2 weeks. This course was repeated every 3 weeks, targeting a second metastatic site. Triple-combination therapy. (PRaG regimen) was given for at least 2 cycles. After combination therapy, maintenance with PD-1 inhibitor was administered until disease progression or unacceptable toxicity. The main outcome measures included safety, toxicity, progression-free survival (PFS) and objective response rate (ORR) after three cycles of treatment. Results: A total of 16 patients were enrolled.The median number of metastatic lesions was 7.5(95%CI, 5.3 to 19.5) and the median sum of the longest diameter of all measurable lesions was 161.7mm (95%CI, 104.1 to 279.3mm).All patients completed two cycles or more of triple-combination therapy. The ORR was 20% and the median PFS was 3.3 months (95%CI, 2.3to 7.2months) at the time of evaluation. Treatment-related adverse events of any grade occurred in 13 (81%) patients, and grade 3 and higher adverse event like pneumonitis occurred in 2 (11.0%) patients. Conclusions: The PRaG regimen is well tolerated with acceptable toxicity. For patients with resistant metastatic solid tumors, low efficacy and high cytotoxicity are commonly observed in conventional therapy. With the new chemo-free PRaG regimen, myelosuppression was not observed and gastrointestinal side effects remained low. So, PRaG regimen is considered as a promising salvage treatment for patients with chemotherapy-refractory metastatic solid tumor. The suggested mechanism might involve radiosensitization of immunotherapy. Clinical trial information: ChiCTR1900020175 .
Implications of a Swollen Optic Nerve
Authors: Shira Simon, Nicholas J Volpe
Journal: JAMA Network Open (2020)

Olivia M. Crum, BBmE; Khin P. Kilgore, MD, JD; Rishi Sharma; Michael S. Lee, MD; Matthew R. Spiegel, BS; Collin M. McClelland, MD; M. Tariq Bhatti, MD; John J. Chen, MD, PhD
Current status in epidemiological and therapeutical study on viral hepatitis in China
Authors: 成军
Journal: BMJ (2006)

从病原学角度,病毒性肝炎可分为甲型、乙型、丙型、丁型和戊型.其中甲型和戊型病毒性肝炎患者的临床病程绝大部分呈急性经过,鲜有慢性患者;丁型肝炎的病原体丁型肝炎病毒是一种缺陷性病毒,只能存在于乙型肝炎表面抗原(HBsAg)阳性的患者中。
Comprehensive investigation of mutational features of various lung adenocarcinoma histological subtypes among Chinese patients.
Authors: Yuchen Han, Chan Xiang, Haohua Teng, Lei Zhu, Jinchen Shao, Jikai Zhao, Shengji Ma, Jing Lin, Jingjing Zheng, Analyn Lizaso
Journal: Journal of Clinical Oncology (2020)

e21090 Background: Lung adenocarcinoma (LUAD) is further classified into several histological subtypes according to the World Health Organization classification; however, data on the molecular profile of these histological subtypes are limited. In this study, we aimed to investigate the mutational features of various LUAD histological subtypes among Chinese patients. Methods: We retrospectively analyzed clinical, histopathologic, and sequencing data from 3,425 consecutive patients diagnosed with stage IA-IVB LUAD between January 2017 to December 2019 at the Department of Pathology. Results: Based on histologic subtype, the cohort comprised of 0.2% atypical adenomatous hyperplasia (AAH, n = 6), 7.2% adenocarcinoma in situ (AIS, n = 246), 14.0% minimally invasive adenocarcinoma (MIA, n = 479), and 78.6% invasive adenocarcinoma (INV, n = 2,694), including 42.0% acinar (n = 1,438), 12.7% papillary (n = 435), 8.8% lepidic (n = 302), 8.5% solid (n = 290), 3.2% micropapillary (n = 109), 2.8% invasive mucinous (n = 95), 0.6% enteric (n = 21), 0.1% fetal (n = 3), and 0.1% colloid (n = 1). Analysis of mutation profiles revealed significantly higher mutation detection rates of ERBB2 ( P&lt; 0.01), BRAF ( P&lt; 0.01), and MAP2K1 ( P= &lt; 0.01) among patients with AIS, AAH and MIA as compared to patients with INV. Meanwhile, TP53 ( P&lt; 0.01) and EGFR ( P&lt; 0.01) mutations were significantly higher among patients with INV as compared to patients with AIS and MIA. Among the invasive subtypes, patients with invasive mucinous adenocarcinoma had significantly higher KRAS mutation rate (75%, P&lt; 0.01). Lepidic (81%), acinar (80%), papillary (77%), and micropapillary (66%) were the subtypes with the highest EGFR mutation rates. Conclusions: By analyzing the genomic data of a large cohort of patients, our study provides a more comprehensive outlook of gene mutations according to LUAD histological subtypes. Enrichement of actionable mutation in particular histological subtype contributes to more treatment option and better clinical outcomes as compared to other histological subtype, indicating the clinical relevance of performing comprehensive mutation profiling in addition to histopathologic analysis in all LUAD patients.
Genomic analysis of myeloproliferative neoplasm (MPN) patients from a single institution in South Korea to reveal novel pathogenic mutations and perturbed pathways.
Authors: Dilhan Weeraratne, Hu Huang, David Brotman, Shang Xue, Young Kyung Lee, Dae Young Zang, Hyo Jung Kim, Ho Young Kim, Boram Han, Jane Snowdon, Miyoung Kim
Journal: Journal of Clinical Oncology (2020)

e19533 Background: Therapeutic, prognostic, and diagnostic insights gained from next generation sequencing (NGS) are a key premise of genomics-informed cancer care in hematological diseases. Particularly in BCR-ABL negative myeloproliferative neoplasms (MPN), insights gained from NGS is integral for risk stratification and prognostication. In this study, MPN patients of South Korean descent were sequenced, interpreted, and compared with a published validation cohort to identify variations in mutational profiles specific to demographics. Methods: 31 South Korean MPN patients including 12 essential thrombocythemia, 6 polycythemia vera, 6 primary myelofibrosis, and 7 chronic myelogenous leukemia were sequenced in 2018 and 2019 using the 54 gene Illumina TruSight Myeloid Panel at Hallym University College of Medicine. Orthogonal testing for CALR mutations was done by Sanger sequencing. Watson for Genomics (WfG), an artificial intelligence offering was used for variant interpretation and annotation. A cohort of 151 MPN patients previously published in the New England Journal of Medicine (NEJM) was used for comparison (PMID:24325359). Results: The table shows identified actionable mutations. Conclusions: Two novel pathogenic mutations in CALR (c.1162delG and c.1100_1145del)) were identified in Korean MPN patients. NOTCH1 pathogenic mutations were exclusive while TP53 mutations were significantly enriched in the Korean cohort suggesting that these pathways may play a role in MPN. TP53 mutations in MPN are clinically significant as they have been associated with increased risk for leukemic transformation. Of note, MPL mutations were not detected in the Korean cohort. In conclusion, race and ethnicity may contribute to some mutational signatures in cancer. [Table: see text]
Use of alpelisib in the treatment of hormone receptor positive metastatic breast cancer: An institutional experience.
Authors: Tsering G. Lama Tamang, Daniel Kyung, Lauren Eisenbud, Tianyi Tang, Ritesh Parajuli, Rita S. Mehta
Journal: Journal of Clinical Oncology (2020)

e15216 Background: Mutations in PI3K pathway is a known mechanism of resistance to endocrine therapy in breast cancer. Alpelisib is an alpha-specific PI3K inhibitor. Alpelisib with Fulvestrant is approved for treatment (Tx) of PIK3CA mutated HR+ metastatic breast cancer (MBC) that progress on hormonal therapy. Despite its approval by the FDA, real world data on the use of Alpelisib for the management of MBC is lacking. This abstract reviews the safety and efficacy of Alpelisib in the management of patients with MBC. Methods: A retrospective review of the tumor registry database at a single institution was conducted to identify patients with HR+ MBC. Detailed clinical and pathologic data of PIK3CA mutated patients treated with Alpelisib were obtained. Genomic profiling was done with Foundation One. Results: Table highlights the characteristics of the four patients. All were treated with Alpelisib and Fulvestrant after PIK3CA mutation was demonstrated. 3 patients were heavily pretreated with systemic Tx including CDK 4/6 inhibitors. All patients responded to Alpelisib and Fulvestrant despite treatment history. Mucositis, rash, hyperglycemia and pancytopenia were the observed adverse events (A/E). All A/E were adequately managed except in one patient that required discontinuation of Tx. None has clinically progressed. Conclusions: Our data suggests that Alpelisib and Fulvestrant is tolerated and improves outcomes in patients with HR+ MBC. Alpelisib and Fulvestrant could be an effective therapy in patients who have also progressed on systemic chemotherapy including CDK 4/6 inhibitors. Although our sample size is small, we hope that our experience could guide clinicians in the management of patients with HR+ MBC who harbor the PIK3CA mutation and are being treated with Alpelisib. [Table: see text]
Absence of images of skin of colour in publications of COVID‐19 skin manifestations
Authors: J.C. Lester, J.L. Jia, L. Zhang, G.A. Okoye, E. Linos
Journal: British Journal of Dermatology (2020)

coma-associated bulla. 7 However, in our case, thrombi and even fibrinoid necrosis were observed not only in the upperdermis vessels but also in all the other vessels in the biopsy, even in the dermo-hypodermal junction.This unexpected finding could be related to more extensive endothelial damage secondary to COVID-19 infection, as this has recently been reported after observation of viral inclusion bodies in electron microscopy of the kidney, small bowel and lung of severely affected patients. 8 To our knowledge, this is the first report of a patient with COVID-19 where the presence of an occlusive vasculopathy at the cutaneous level has been demonstrated.In our case, we also observed a striking sweat gland necrosis, a finding previously reported as being associated with ketoacidosis coma but not with COVID-19 infection.Additional studies are needed to characterize completely the tissue damage associated with the virus, including within the gamut of lesions observed in the skin.