AIM： To develop a critical pathway for primary open angle glaucoma （POAG） diagnosis intended to be efficient, to unify criteria, reduce resource use and minimize costs to the health system. METHODS： We performed ...AIM： To develop a critical pathway for primary open angle glaucoma （POAG） diagnosis intended to be efficient, to unify criteria, reduce resource use and minimize costs to the health system. METHODS： We performed a systematic search on PubMed, Cochrane, Embase and ClinicalTrials.org databases and classified the quality of evidence from level I through III. RESULTS： A critical pathway was designed by setting a key-decision step by step model on the basis of the best current evidence. CONCLUSION： A critical pathway, evidence-based guideline, may be a useful tool intended to reduce costs while maintaining or even improving the quality of care for diagnosing a highly prevalent pathology such as open angle glaucoma.展开更多
Background:Despite the existence of proposed prognostic features on computed tomography(CT)for patients with advanced-stage non-small cell lung cancer(NSCLC),including radiologists'handcrafted(RaH)features,radiomi...Background:Despite the existence of proposed prognostic features on computed tomography(CT)for patients with advanced-stage non-small cell lung cancer(NSCLC),including radiologists'handcrafted(RaH)features,radiomics features,and deep learning features,comprehensive studies that examine their reproducibility,stability,and biological interpretability remain limited.Methods:The Image Biomarker Standardization Initiative-reported tolerance,Kappa,interclass correlation coefficient,and coefficient of variance were employed to identify reproducible features among RaH,radiomics,and deep learning features derived from NSCLC phantoms.The reproducible features were then input into six artificial intelligence algorithms to develop prognostic models for targeted therapy and immunotherapy using real-world patients with advanced-stage NSCLC to assess their capability and stability.Pathway enrichment was also conducted to explore the underlying biological pathways associated with these reproducible features.Results:Reproducible features in advanced NSCLC included RaH features(9/9,100%),radiomics features(572/1835,31.17%),and deep learning features(3442/4096,84.03%).Among the six artificial intelligence-based prognostic methods,the RaH features exhibited least variability.We also observed that the optimal CT-based prognostic approach differed depending on treatment regimens for advanced NSCLC.In analysis using the Cancer Genome Atlas Program lung adenocarcinoma dataset,the identified reproducible prognostic features,specifically tumor size-derived radiomics and RaH features,showed significant associations with five key signaling pathways involved in NSCLC survival outcomes(false-discovery rate p<0.05).Conclusions:By elucidating the reproducibility,stability,and biological as-sociations of prognostic CT features,our study provides valuable evidence for future NSCLC studies and modeling approaches.展开更多
Background Current guidelines support primary percutaneous coronary intervention （primary PCI） as the first treatment of choice （as opposed to thrombolytic therapy） for patients with acute ST-segment elevation myo...Background Current guidelines support primary percutaneous coronary intervention （primary PCI） as the first treatment of choice （as opposed to thrombolytic therapy） for patients with acute ST-segment elevation myocardial infarction （STEMI） especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI. Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory （rapid group）, and 275 patients were admitted to the coronary care unit （CCU） or cardiac ward first, and then transferred to the catheterization laboratory （non-rapid group）. Primary endpoint was door-to-balloon （D2B） time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events （MACE） including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein lib/Ilia receptor inhibitors before angiography （84.0% and 77.1, P=0.042） and had TIMI 3 flow in the culprit vessel at initial angiogram （17.1% and 9.2%, P=0.007） in the non-rapid group. The D2B time was shortened （（108±44） minutes and （138±31） minutes, P 〈0.0001）, and number of patients with D2B time 〈90 minutes was greater （22.6% and 10.9%, P 〈0.0001） in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality （4.1% and 5.8%） and cumulative MACE rate （7.0% and 9.8%） did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group （94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively）.Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours.展开更多
文摘AIM： To develop a critical pathway for primary open angle glaucoma （POAG） diagnosis intended to be efficient, to unify criteria, reduce resource use and minimize costs to the health system. METHODS： We performed a systematic search on PubMed, Cochrane, Embase and ClinicalTrials.org databases and classified the quality of evidence from level I through III. RESULTS： A critical pathway was designed by setting a key-decision step by step model on the basis of the best current evidence. CONCLUSION： A critical pathway, evidence-based guideline, may be a useful tool intended to reduce costs while maintaining or even improving the quality of care for diagnosing a highly prevalent pathology such as open angle glaucoma.
基金National Natural Science Foundation of China,Grant/Award Numbers:92259104,82001904。
文摘Background:Despite the existence of proposed prognostic features on computed tomography(CT)for patients with advanced-stage non-small cell lung cancer(NSCLC),including radiologists'handcrafted(RaH)features,radiomics features,and deep learning features,comprehensive studies that examine their reproducibility,stability,and biological interpretability remain limited.Methods:The Image Biomarker Standardization Initiative-reported tolerance,Kappa,interclass correlation coefficient,and coefficient of variance were employed to identify reproducible features among RaH,radiomics,and deep learning features derived from NSCLC phantoms.The reproducible features were then input into six artificial intelligence algorithms to develop prognostic models for targeted therapy and immunotherapy using real-world patients with advanced-stage NSCLC to assess their capability and stability.Pathway enrichment was also conducted to explore the underlying biological pathways associated with these reproducible features.Results:Reproducible features in advanced NSCLC included RaH features(9/9,100%),radiomics features(572/1835,31.17%),and deep learning features(3442/4096,84.03%).Among the six artificial intelligence-based prognostic methods,the RaH features exhibited least variability.We also observed that the optimal CT-based prognostic approach differed depending on treatment regimens for advanced NSCLC.In analysis using the Cancer Genome Atlas Program lung adenocarcinoma dataset,the identified reproducible prognostic features,specifically tumor size-derived radiomics and RaH features,showed significant associations with five key signaling pathways involved in NSCLC survival outcomes(false-discovery rate p<0.05).Conclusions:By elucidating the reproducibility,stability,and biological as-sociations of prognostic CT features,our study provides valuable evidence for future NSCLC studies and modeling approaches.
文摘Background Current guidelines support primary percutaneous coronary intervention （primary PCI） as the first treatment of choice （as opposed to thrombolytic therapy） for patients with acute ST-segment elevation myocardial infarction （STEMI） especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI. Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory （rapid group）, and 275 patients were admitted to the coronary care unit （CCU） or cardiac ward first, and then transferred to the catheterization laboratory （non-rapid group）. Primary endpoint was door-to-balloon （D2B） time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events （MACE） including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein lib/Ilia receptor inhibitors before angiography （84.0% and 77.1, P=0.042） and had TIMI 3 flow in the culprit vessel at initial angiogram （17.1% and 9.2%, P=0.007） in the non-rapid group. The D2B time was shortened （（108±44） minutes and （138±31） minutes, P 〈0.0001）, and number of patients with D2B time 〈90 minutes was greater （22.6% and 10.9%, P 〈0.0001） in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality （4.1% and 5.8%） and cumulative MACE rate （7.0% and 9.8%） did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group （94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively）.Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours.
