Based on the principles and methods of systematic review of randomized controlled clinical trials, systematic review of economic analyses can integrate information from multiple economic studies which focus on the same clinical questions. It can also provide important insights by systematically examining how differences among studies lead to different results. Generally, there are seven steps to conduct such a review: 1) formulating questions; 2) establishing eligibility criteria; 3) searching and selecting eligible economic analyses; 4) assessing the validity of economic analyses; 5) acquiring data; 6) analyzing and synthesizing data; and 7) presenting results. Owing to the specificity of economic analyses, many methodological challenges exist, including the varieties of economic models, analytic perspectives, time horizons, and uncertainty and sensitivity analysis among different economic analyses. This may cause difficulties for critical assessment of the economic analyses.
CT texture analysis (CTTA) can objectively evaluate the heterogeneity of tissues and their lesions beyond the ability of subjective visual interpretation by extracting the texture features of CT images, then performing analysis and quantitative and objective evaluation, reflecting the tissue micro environmental information. This article reviews the recent studies on the applications of CTTA in gastric cancers, in the aspects of identification of gastric tumors, prediction of stage, correlation with Lauren classification, prediction of occult peritoneal carcinomatosis, evaluation of efficacy and prognosis, and prediction of biomarkers. It is regarded that CTTA has a good application prospect in gastric cancers.
Objective For potential patients with better prognosis of non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, a simpler and more effective model with easy-to-obtain histopathological parameters was established. MethodsThe computed tomography (CT) images of 158 patients with EGFR-mutant NSCLC who were first diagnosed in West China Hospital of Sichuan University were retrospectively analyzed, and the target areas of the lesions were described. Patients were randomly assigned to either a model training group or a test group.The radiomics features were extracted from the CT images, and the least absolute shrinkage and selection operator (LASSO) regression method was used to screen out the valuable radiomics features. The logistic regression method was used to establish a radiomic model, and the nomogram was used to evaluate the discrimination ability. Finally, the calibration curve, receiver characteristic curve (ROC), Kaplan-Meier curve and decision curve analysis (DCA) were employed to assess model efficacy. ResultsA nomogram combining three important clinical factors : gender, lesion location, treatment, and imaging risk score was established to predict the 3-year, 5-year, and 8-year survival rates of NSCLC patients with EGFR mutation. The calibration curve demonstrated highly consistent between model-predicted survival probabilities and observed overall survival (OS). The area under the curve (AUC) -ROC of the predicted 3-year, 5-year and 8-year OS was 0.70, 0.79 and 0.68, respectively. The Kaplan-Meier curve revealed significant OS disparities when comparing high- and low-risk patient subgroups. The DCA curve showed that the predicted 3-year and 5-year OS increased more clinical benefits than the treatment of all patients or no treatment.ConclusionThe nomogram for predicting the survival prognosis of NSCLC patients with EGFR mutation was constructed and verified, which can effectively predict the survival time range of NSCLC patients, and provide a reference for more individualized treatment decisions for such patients in clinical practice.
Abstract： Objective To study the molecular mechanism of pathologic states related to cardiopulmonary bypass (CPB) and screen the differential proteins from the serum before and after CPB in the open heart surgery patients. Methods By the twodimensional gel electrophoresis (2DE), we took the blood samples from each of the sixteen open heart surgery patients 30 minutes before CPB, 1 hour after CPB, and 24 hours after CPB. The protein spots were analyzed by the PDQuest image analysis software and the differential protein spots were identified by matrixassisted laser desorption/ionizationtime of flightmass spectrometry (MALDITOF-MS). Then, enzymelinked immunosorbent assay (ELISA) was used to determine the expression level of serum amyloid A protein (SAA) in the serum of healthy people and the enrolled patients before and after CPB. Results Through 2DE in combination with massspectrometry, 7 proteins altered in expression were identified, including SAA, haptoglobin (HPT), leucinerich alpha2-glycoprotein (A2GL), hemoglobin subunit beta (HBB), serine/threonineprotein phosphatase 2A -regulatory subunit B″ subunit gamma (P2R3C), transthyretin (TTHY), and T-complex protein 11-like protein2 (T11L2). ELISA analysis showed that SAA levels in healthy people and the open heart surgery patients 30 minutes before CPB were not statistically different (t=-1.955, P=0.056), while the SAA level rose from 54.47±48.32 μg/ml 30 min before CPB to 1 017.78±189.92 μg/ml 24 hours after CPB in the serum of open heart surgery patients． Conclusion The results of this pilot study illustrate that SAA, HPT, A2GL, HBB, P2R3C, TTHY and T11L2 may be the molecule markers of pathologic state related to CPB. Acute phase reaction happens intensively after CPB in human body.
Objective The method of metabonomics based on nuclear magnetic resonance (NMR) imaging was used to explore the difference in metabolites of serum and bile, and to analyze the metabolic variation related to the pathogenesis of gallbladder stones between normal people/liver transplantation donors and patients with gallbladder stones. Methods Prospectively collected the serum samples (17 cases) and bile samples (19 cases) in 19 patients with gallbladder stones who underwent surgery in West China Hospital form March 2016 to December 2016, as well as the serum samples of 10 healthy persons and the bile samples of 15 liver transplantation donors at the same time period. The differences of metabolites in the blood and bile in these 3 groups were compared by using 1H-NMR metabonomics technology and chemometric methods. Results The concentrations of valine, alanine, lysine, glutamine, glutamate, pyruvate, creatinine, choline, alpha-glucose, beta-glucose, tyrosine, histidine, and hypoxanthine in serum of patients with gallbladder stones decreased significantly, comparing with those of healthy people without gallbladder stones (P<0.05), while 1, 2-propanediol, acetoacetate, and lactate increased significantly in the serum of patients with gallbladder stones (P<0.05). The concentrations of taurine conjugated bile acids, glycine conjugated bile acids, choline, and phosphatidylcholine decreased significantly in the bile of patients with gallbladder stones when compared with those of liver transplantation donors (P<0.05), while cholesterol increased significantly in the bile of patients with gallbladder stones (P<0.05). Conclusions There are significant differences of the serum and bile metabolites between patients with gallbladder stones and healthy men without gallbladder stones/liver transplantation donors. 1H-NMR metabonomics is helpful to investigate the pathogenesis of gallbladder stones.
Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus causing severe visual impairment, and it is the main cause of blindness in adults. Metabolic abnormalities play an important role in the occurrence and development of DR, including the abnormal levels of glucose metabolism, lipid metabolism, amino acid metabolism and purine metabolism, which indicate that there are disorders of phosphopentose pathway, arginine metabolism pathway, polyol pathway and ascorbic acid pathway in the progression of DR. Metabolomics has great advantages in exploring the pathogenesis and diagnosis of DR, helping to identify the characteristic metabolic changes of DR And discover potential biomarkers. However, the existing metabolomics studies on DR have some limitations, such as the potential biomarkers found in some studies are difficult to verify in other studies due to differences in race, age, gender and sample size. There are few studies on biomarkers at different stages of DR. Therefore, in the future, multi-center and large-scale clinical studies are needed to screen out biomarkers with practical clinical diagnostic value.
Objective To analysis and explore the value of metagenomics next-generation sequencing (mNGS) and clinical characteristics of Chlamydia psittaci (C. psittaci) pneumonia. Methods Totally 5 patients who were diagnosed with C. psittaci pneumonia and were treated in the Department of Respiratory and Critical Care Medicine and the Department of Infectious Diseases of Huazhong University of Science and Technology Union Shenzhen Hospital from Febuary 2021 to March 2021 were enrolled in the study. The clinical data of the patients were analyzed, and the clinical characteristics of the disease and treatment experience were summarized. Results The main symptoms of the 5 patients were high fever and cough, 4 of them had a history of raising parrots. The white blood cell and the neutrophils were mostly normal or slightly increased, the C reactive protein and erythrocyte sedimentation rate were significantly increased. The chest CT showed exudation and consolidation of one or several lung lobes. The serious patients might develop respiratory failure, if they were not treated by effective antibiotics. The diagnosis was based on clinical manifestations, contact history and alveolar lavage fluid that were detected by mNGS technology of C. psittaci nucleic acid sequence. The accuracy of detecting pathogens in alveolar lavage fluid by mNGS was high. In addition, mNGS could also identify other bacteria or viruses. After the timely adjustment of treatment, the condition of the patients was improved relied on tetracycline drugs or quinolone drugs, which shortened the diagnosis time and course of C. psittaci pneumnonia and reduced the use of unnecessary antibacterial drugs. Conclusions mNGS is of great significance in diagnosing C. psittaci pneumonia. The timely use of appropriate antibacterial drugs can achieve favorable therapeutic effect.
Objective To find a new specific marker that can be used to early diagnose hepatic fibrosis by detecting the change of serum protein in patients with hepatic fibrosis. Methods This research adopted 50 SD rats (25 males and 25 females), and from which 6 rats were selected randomly (3 males and 3 females) as control group, last 44 rates were divided into four groups according to four pathological stages as hepatic fibrosis model group (experimental group). Distinct proteins in serum were detected by surface-enhanced laser desorption/ionization-time of flight-mass spectra (SELDI-TOF-MS). Radioimmunoassay was used to measure four parameters of hepatic fibrosis which were hyaluronidase (HA), precollagen Ⅲ (PCⅢ), laminin (LN) and collagen Ⅳ (Ⅳ-C). Results Distinct proteins in serum were detected in 8 cases of stage Ⅰ of hapatic fibrosis, 5 cases of stage Ⅱ, 5 cases of stage Ⅲ, 6 cases of stage Ⅳ, and 5 cases of control by SELDI-TOF-MS. Three protein peaks were found (M/Z: 4 203, 4 658, and 7 400). The peaks of M/Z 4 658 and 4 700 proteins were obviously increased in the stage Ⅰ of hepatic fibrosis （Plt;0.05）, while the changes of hepatic fibrosis four parameters appeared in stage Ⅳ of hepatic fibrosis. Conclusion This method shows great potential for early diagnosing of hepatic fibrosis and finding better biomarkers to hepatic fibrosis.
Biliary tract cancer is characterized by occult onset, highly malignancy and poor prognosis. Traditional medical imaging is an important tool for surgical strategies and prognostic assessment, but it can no longer meet the urgent need for accurate and individualized treatment in patients with biliary tract cancer. With the advent of the digital imaging era, the advancement of artificial intelligence technology has given a new vitality to digital imaging, and provided more possibilities for the development of medical imaging in clinical applications. The application of radiomics in the diagnosis and differential diagnosis of benign and malignant tumors of biliary tract, assessment of lymph node status, early recurrence and prognosis assessment provides new means for the diagnosis and treatment of patients with biliary tract cancer.
ObjectiveTo analyze the cost and performance of five methods for detection of carbapenemase-producing Enterobacteriaceae (CPE), including PCR (method A), Carba NP test (method B), ultraviolet spectrophotometry (method C), modified carbapenem inactivation method (mCIM, method D), and loop-mediated isothermal amplification (LAMP, method E).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were searched using the computer regarding literature on detection of CPE with the same or similar designs, same objectives, and independent results. The search was limited between May 2009 and May 2019. Data on the cost and detection performance of all five methods were extracted, and the four special indexes for laboratory tests, such as sensitivity, specificity, simplicity, and rapidity in the utility were quantified as specific values; subsequently, the cost-effective analysis (CEA), cost-utility analysis (CUA), and multi-attribute utility theory (MAUT) in the detection economic analysis were used to conduct health economics evaluation of five detection methods for CPE.ResultsThe cost of methods A, B, C, D and E were 210.00 yuan, 22.00 yuan, 10.50 yuan, 6.00 yuan, and 60.00 yuan, respectively. The C/E of CEA for the above five methods were 210.00, 22.96, 10.66, 6.14, and 60.00, respectively. The C/U of CUA for the above five methods were 302.16, 32.13, 19.30, 11.13, and 80.00, respectively. The MAUT value of the above five methods were 42.56, 5.00, 2.54, 1.63, and 12.56, respectively.ConclusionIn terms of CEA, CUA, and MAUT, the method D was the highest in economic value, which usually can be used as a routine method for detecting CPE, but it needs a long procedure time; thus, the method E can be used for rapid detection when clinical severe infection occurred, which is superior in both cost-effectiveness and rapidity.