BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who r...Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who required long-term central venous access device(LCVAD)substitution due to prior CLABSI with those who had never experienced CLABSI.Methods The study was conducted in hospitals across northern and central Italy using a multicenter,observational,cross-sectional design from March to September 2021.A total of 174 adults with cancer were included.Data were collected through electronic case report forms,including demographic,clinical,treatment-related,and catheter-related variables.Propensity score matching(PSM)was used to compare the characteristics of patients who underwent LCVAD substitution due to previous CLABSI with those who never experienced CLABSI.Multiple correspondence analysis(MCA)was conducted to explore the patterns within matched subgroups.Results The prevalence of CLABSI was 3%,and 5.2%of patients required LCVAD substitution due to prior CLABSI.After applying PSM,the groups were successfully balanced for sex,age,presence of metastases,comorbidities,BMI,received treatments,corticosteroid therapy,ongoing antibiotics,hormone therapy,type of LCVAD,lumens,and utilization frequency.Hematologic cancer was more frequent in the CLABSI group(44.4%)compared to the non-infective group(0),with a statistically significant difference(P=0.045).MCA revealed potential patterns among matched subgroups but did not identify statistically significant associations:patients with previous LCVAD substitution were more frequently associated with a history of prior infections,ongoing antibiotic therapy,and unspecified primary lesion locations;conversely,patients who never experienced CLABSI tended to cluster around characteristics such as hormone therapy and corticosteroid therapy.Conclusions These findings emphasize the importance of continuous monitoring,individualized infection prevention strategies in oncology nursing practice.Future research with larger datasets is needed to validate these findings and develop tailored interventions to reduce CLABSI risks.展开更多
BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,len...BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.展开更多
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impa...BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impairment in elderly T2DM patients.METHODS A retrospective analysis was conducted on 245 elderly T2DM patients treated at Xuanwu Hospital,Beijing,in 2023.Patients were categorized into low physical activity(n=126)and non-low physical activity(n=119)groups.After propensity score matching(PSM)of 100 pairs,univariate and binary logistic regression analyses identified risk factors for cognitive impairment.A predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS Before PSM,the percentage of cognitive impairment was higher in the low physical activity group(P<0.05),but after PSM,this difference was not signi-ficant(P>0.05).Additionally,on regression analyses after PSM,age,occupation type,history of stroke,malnutrition,and frailty remained independent factors associated with cognitive impairment,while low physical activity did not.The constructed risk prediction model for cognitive impairment in elderly T2DM patients exhibited an area under the curve of 0.77.CONCLUSION Low physical activity was not associated with cognitive impairment in our study population.Some results differed before and after PSM analysis,indicating that PSM supports objective assessment of risk factors by controlling for selection bias and confounding factors related to population characteristics.The constructed cognitive risk model insight for the development of a clinical tool for early prevention of cognitive impairment in elderly patients.展开更多
Randomized controlled trials(RCTs)have long been recognized as the gold standard for establishing causal relationships in clinical research.Despite that,various limitations of RCTs prevent its widespread implementatio...Randomized controlled trials(RCTs)have long been recognized as the gold standard for establishing causal relationships in clinical research.Despite that,various limitations of RCTs prevent its widespread implementation,ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria,amongst others.However,with the introduction of propensity score matching(PSM)as a retrospective statistical tool,new frontiers in establishing causation in clinical research were opened up.PSM predicts treatment effects using observational data from existing sources such as registries or electronic health records,to create a matched sample of participants who received or did not receive the intervention based on their propensity scores,which takes into account characteristics such as age,gender and comorbidities.Given its retrospective nature and its use of observational data from existing sources,PSM circumvents the aforementioned ethical issues faced by RCTs.Majority of RCTs exclude elderly,pregnant women and young children;thus,evidence of therapy efficacy is rarely proven by robust clinical research for this population.On the other hand,by matching study patient characteristics to that of the population of interest,including the elderly,pregnant women and young children,PSM allows for generalization of results to the wider population and hence greatly increases the external validity.Instead of replacing RCTs with PSM,the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each other.For example,in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial,the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization protocol.Therefore,PSM was incorporated in its analysis to create samples from the treatment and control arms that were matched in terms of these baseline characteristics,thus providing a fairer comparison for the impact of mannitol.This literature review reports the applications,advantages,and considerations of using PSM with RCTs,illustrating its utility in refining randomization,improving external validity,and accounting for non-compliance to protocol.Future research should consider integrating the use of PSM in RCTs to better generalize outcomes to target populations for clinical practice and thereby benefit a wider range of patients,while maintaining the robustness of randomization offered by RCTs.展开更多
This study aimed to investigate the effects of male hepatitis B virus(HBV)infection on male fertility,embryonic development,and in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)outcomes.We performed a ...This study aimed to investigate the effects of male hepatitis B virus(HBV)infection on male fertility,embryonic development,and in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)outcomes.We performed a retrospective cohort study that included 3965 infertile couples who received fresh embryo transfer cycles for the first time at the Fujian Maternity and Child Health Hospital(Fuzhou,China)from January 2018 to January 2021.Infertile couples were categorized based on their HBV infection status into the HBV group(HBV-positive men and HBV-negative women)and the control group(HBV-negative couples).A 1:1 propensity score matching was performed with relatively balanced covariates.Baseline characteristics,semen parameters,laboratory outcomes,clinical outcomes,and obstetric and neonatal outcomes were compared between groups.After propensity score matching,821 couples were included in each group.Both groups had similar semen parameters and obstetric and neonatal outcomes.The HBV group showed a significantly lower live birth rate than the control group(P<0.05).The HBV group had a significantly higher abortion rate than the control group(P<0.05).The rates of high-quality embryos and blastocyst formation were significantly lower in the HBV group than those in the control group(both P<0.05).In conclusion,in couples who undergo IVF/ICSI,male HBV infection reduces the live birth rate and increases the risk of miscarriage.However,the incidence of low birth weight in women with IVF/ICSI does not increase with male HBV infection.展开更多
This paper explores the significant impact of the Ukraine conflict on local food security,employing a robust methodological framework that integrates Propensity Score Matching(PSM)and Difference-in-Differences(DiD)est...This paper explores the significant impact of the Ukraine conflict on local food security,employing a robust methodological framework that integrates Propensity Score Matching(PSM)and Difference-in-Differences(DiD)estimation,supplemented by placebo tests and the synthetic control method.By examining panel data from 2014 to 2022,the study reveals a causal relationship between the conflict and a notable deterioration in Ukraine’s food security index.The conflict,characterized by direct damages to agricultural production and infrastructure,alongside indirect economic and social disruptions,has led to a substantial decline in food security.This research contributes to understanding the dynamics of how war affects food security and provides actionable insights for policy formulation and response strategies to mitigate such impacts in similar conflict scenarios.Through a comprehensive analysis,it highlights the urgent need for international cooperation and humanitarian aid to address the challenges posed to food security by the war,emphasizing the broader implications for global food markets and prices.展开更多
Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.T...Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.展开更多
Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a ...Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a retrospective cohort study based on propensity score matching(PSM)was conducted by analyzing the China Health and Retirement Longitudinal Study dataset.After data cleaning,a total of 5125 participants were enrolled and subjected to PSM;1351 pairs were matched and followed for 2 years.Further logistic regression and restricted cubic spline(RCS)were performed to evaluate,model and visualize the relationship between depression and LUTS/BPH.Moreover,subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions.Before PSM,depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates(P<0.001).After PSM,univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group(odds ratio[OR]=2.10,P<0.001).The RCS results indicated a nonlinear(P<0.05)and inverted U-shaped relationship between depression and LUTS/BPH.In the subgroup analyses,no increased risks were found among participants who were not married or cohabitating,received an education,had an abnormal body mass index(<18.5 kg m−2 and≥28 kg m−2),slept more than 6 h,did not smoke,and drank less than once a month(all P>0.05).The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models(all P<0.001).In conclusion,depression enhances the risks of LUTS/BPH in aging males.展开更多
Objective： Although superior clinical benefits of epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） in the treatment of advanced non-small-cell lung cancer （NSCLC） had been reported, the...Objective： Although superior clinical benefits of epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） in the treatment of advanced non-small-cell lung cancer （NSCLC） had been reported, the survival difference between exon 19 deletion （Dell9） and exon 21 Leu858Arg substitution （L858R） remains controversial. The purpose of this study is to investigate the differences in progression-free survival （PFS） and overall survival （OS） between different EGFR mutant subtypes among advanced NSCLC patients receiving gefitinib. Methods： There were 204 advanced NSCLC patients with EGFR mutations treated with gefitinib were enrolled in this retrospective cohort study. Patients were divided into the EGFR Dell9 group and the L858R mutated group according to their mutant subtype. Propensity score matching （PSM） was conducted by using a nearest-neighbor algorithm （1：1） to adjust for demographical and clinical covariates. Survival curves were constructed with the Kaplan-Meier method and compared by using the log-rank test. Results： The PFS in Dell9 group was similar to that in the L858R group [before PSM 8.6 vs. 7.2 months, P=0.072; after PSM 7.3 vs. 7.2 months, P=0.155]. No differences were detected in OS between the L858R and the Dell9 group （before PSM 17.8 vs. 13.1 months, P=0.253; after PSM 16.9 vs. 13.1 months, P=0.339）. The Dell9 group was significantly younger compared with the L858R mutation group in age （P=0.015）. Conclusions： No significant difference was found in the PFS or OS between the Dell9 and L858R mutant NSCLC patients receiving gefitinib. The age gap might contribute to the survival differences between Dell9 and L858R groups. PSM is of important value to the elimination of potential bias.展开更多
BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)...BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.展开更多
Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who un...Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.展开更多
BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and th...BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.展开更多
AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with anot...AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P < 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.展开更多
BACKGROUND Laparoscopic total gastrectomy(LTG)has drawn increasing attention over the years.Although LTG has shown surgical benefits compared to open TG(OTG)in early stage gastric cancer(GC),little is known about the ...BACKGROUND Laparoscopic total gastrectomy(LTG)has drawn increasing attention over the years.Although LTG has shown surgical benefits compared to open TG(OTG)in early stage gastric cancer(GC),little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy(NAT).AIM To compare the long-and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.METHODS Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups:LTG and OTG.Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.RESULTS In total,185 patients were enrolled(LTG:78;OTG:109).Of these,138 were paired after propensity score matching.After adjustment for propensity score matching,baseline parameters were similar between the two groups.Compared to OTG,LTG was associated with a significantly shorter length of hospital stay(P=0.012).The rates of R0 resection,lymph node harvest,and postoperative morbidity did not significantly differ between the two groups.Overall survival(OS)outcomes were comparable between the two groups.Pathological T and N stages were found to be independent risk factors for OS.CONCLUSION LTG can be a feasible method for advanced GC patients following NAT,as it appears to be associated with better short-and comparable long-term outcomes compared to OTG.展开更多
BACKGROUND Multiple gastrointestinal stromal tumors(MGISTs)are specific and rare.Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors(GIST).The diagnosis,treatmen...BACKGROUND Multiple gastrointestinal stromal tumors(MGISTs)are specific and rare.Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors(GIST).The diagnosis,treatment and follow-up strategies of MGISTs is not specifically described in guidelines.AIM To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs(SGISTs)METHODS Patients diagnosed with primary GISTs from March 2010 to January 2020 were included.Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes,propensity score matching was performed according to comorbidities,body mass index,tumor location,mitotic index,sex,age and American Society of Anesthesiologists score.Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.RESULTS Among the entire cohort of 983 patients,the incidence of MGISTs was 4.17%.Before matching,patients with MGISTs and those with SGISTs had disparities in body mass index,surgical approach,tumor size and mitotic index.After 1:4 ratio matching,the clinical baseline data were comparable.The 5-year progression-free survival rate was 52.17%in the MGIST group and 75.00%in the SGIST group(P=0.031).On multivariate analysis,tumor location,tumor size,mitotic index,imatinib treatment and MGISTs(hazard ratio=2.431,95%confidence interval=1.097-5.386,P=0.029)were identified as independent prognostic factors of progression-free survival.However,overall survival was similar between the SGIST and MGIST groups.CONCLUSION Patients with MGISTs had poorer progression-free survival than patients with SGISTs.Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.展开更多
BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do...BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms.However,accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA(M1a diseases)and stage IVB(M1b diseases)colorectal adenocarcinoma(CRA).METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results(SEER)database.To minimize potential selection bias,the data were adjusted by propensity score matching(PSM).Baseline characteristics,including gender,year of diagnosis,age,marital status,primary site,surgical information,race,grade,chemotherapy,and radiotherapy,were recorded and analyzed.Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database,including 10399 cases of M1a diseases and 9281 cases of M1b diseases.Common independent prognostic factors for both M1a and M1b patients included year of diagnosis,age,race,marital status,primary site,grade,surgery,and chemotherapy.After PSM adjustment,3732 and 3568 matched patients in the M1a and M1b groups were included,respectively.Patients receiving palliative primary tumor resection had longer survival time than those without surgery(P<0.001).For patients with M1a diseases,palliative resection could increase the median survival time by 9 mo;for patients with M1b diseases,palliative resection could prolong the median survival time by 7 mo.For M1a diseases,patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis(15 mo for lung metastasis vs 8 mo for liver metastasis,P<0.001).CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases.Those patients with M1a(lung metastasis)have superior long-term outcomes after palliative primary tumor resection.展开更多
Health status is widely regarded as a correlate of depressive symptoms.However,health assessments based on clinical diagnosis in rural areas with poor medical conditions are very limited.Self-rated health(SRH)serves a...Health status is widely regarded as a correlate of depressive symptoms.However,health assessments based on clinical diagnosis in rural areas with poor medical conditions are very limited.Self-rated health(SRH)serves as a simple and convenient evaluation indicator,which may be used as an independent predictor of depressive symptoms.To confirm the relationship between SRH and depressive symptoms in rural adults,a longitudinal survey of rural households in China was conducted using the China Family Panel Studies(CFPS)from 2012 to 2016.Propensity score matching and logistic regression analysis were used to explore the association.After data cleansing,3,127 pairs(6,254 participants)aged 16 and older followed for 4 years were enrolled,of which the average age was(50.02±14.19)years old,and the proportions of male and female were 48.64%and 51.36%,respectively.The incidence rate of depressive symptoms within 4 years was 30.86%(95%CI:29.24–32.48)in the group with fair or poor SRH,and 21.59%(95%CI:20.14–23.03)in the group with good SRH.The difference between the two groups was statistically significant(χ^(2)=69.51,P<0.001).The results of univariate unconditional logistic regression analysis showed that there was a correlation between SRH and depressive symptoms in rural adults aged 30 and above(OR=1.65,95%CI:1.46–1.85,P<0.001).Thus,a simple and practical assessment tool based on SRH and other indicators should be established for early prevention and intervention in rural primary mental health care.展开更多
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
文摘BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
基金part of a project that has received funding from the 5x1000 Humanitas funds。
文摘Objectives This study aimed to analyze the prevalence of long-term central line-associated bloodstream infections(CLABSI)among hospitalized adults with cancer in Italy and compare the characteristics of patients who required long-term central venous access device(LCVAD)substitution due to prior CLABSI with those who had never experienced CLABSI.Methods The study was conducted in hospitals across northern and central Italy using a multicenter,observational,cross-sectional design from March to September 2021.A total of 174 adults with cancer were included.Data were collected through electronic case report forms,including demographic,clinical,treatment-related,and catheter-related variables.Propensity score matching(PSM)was used to compare the characteristics of patients who underwent LCVAD substitution due to previous CLABSI with those who never experienced CLABSI.Multiple correspondence analysis(MCA)was conducted to explore the patterns within matched subgroups.Results The prevalence of CLABSI was 3%,and 5.2%of patients required LCVAD substitution due to prior CLABSI.After applying PSM,the groups were successfully balanced for sex,age,presence of metastases,comorbidities,BMI,received treatments,corticosteroid therapy,ongoing antibiotics,hormone therapy,type of LCVAD,lumens,and utilization frequency.Hematologic cancer was more frequent in the CLABSI group(44.4%)compared to the non-infective group(0),with a statistically significant difference(P=0.045).MCA revealed potential patterns among matched subgroups but did not identify statistically significant associations:patients with previous LCVAD substitution were more frequently associated with a history of prior infections,ongoing antibiotic therapy,and unspecified primary lesion locations;conversely,patients who never experienced CLABSI tended to cluster around characteristics such as hormone therapy and corticosteroid therapy.Conclusions These findings emphasize the importance of continuous monitoring,individualized infection prevention strategies in oncology nursing practice.Future research with larger datasets is needed to validate these findings and develop tailored interventions to reduce CLABSI risks.
文摘BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
基金Supported by The Capital Funds for Health Improvement and Research,No.2024-2-1033The Beijing Municipal Administration of Hospitals Incubating Program,No.PX2022032+1 种基金Post-subsidy Fund from the National Clinical Research Center,the Ministry of Science and Technology of China,No.303-01-001-0272-08The Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes,No.JYY2023-13.
文摘BACKGROUND The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus(T2DM)patients remains unclear.AIM To explore this association and identify risk factors for cognitive impairment in elderly T2DM patients.METHODS A retrospective analysis was conducted on 245 elderly T2DM patients treated at Xuanwu Hospital,Beijing,in 2023.Patients were categorized into low physical activity(n=126)and non-low physical activity(n=119)groups.After propensity score matching(PSM)of 100 pairs,univariate and binary logistic regression analyses identified risk factors for cognitive impairment.A predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS Before PSM,the percentage of cognitive impairment was higher in the low physical activity group(P<0.05),but after PSM,this difference was not signi-ficant(P>0.05).Additionally,on regression analyses after PSM,age,occupation type,history of stroke,malnutrition,and frailty remained independent factors associated with cognitive impairment,while low physical activity did not.The constructed risk prediction model for cognitive impairment in elderly T2DM patients exhibited an area under the curve of 0.77.CONCLUSION Low physical activity was not associated with cognitive impairment in our study population.Some results differed before and after PSM analysis,indicating that PSM supports objective assessment of risk factors by controlling for selection bias and confounding factors related to population characteristics.The constructed cognitive risk model insight for the development of a clinical tool for early prevention of cognitive impairment in elderly patients.
文摘Randomized controlled trials(RCTs)have long been recognized as the gold standard for establishing causal relationships in clinical research.Despite that,various limitations of RCTs prevent its widespread implementation,ranging from the ethicality of withholding potentially-lifesaving treatment from a group to relatively poor external validity due to stringent inclusion criteria,amongst others.However,with the introduction of propensity score matching(PSM)as a retrospective statistical tool,new frontiers in establishing causation in clinical research were opened up.PSM predicts treatment effects using observational data from existing sources such as registries or electronic health records,to create a matched sample of participants who received or did not receive the intervention based on their propensity scores,which takes into account characteristics such as age,gender and comorbidities.Given its retrospective nature and its use of observational data from existing sources,PSM circumvents the aforementioned ethical issues faced by RCTs.Majority of RCTs exclude elderly,pregnant women and young children;thus,evidence of therapy efficacy is rarely proven by robust clinical research for this population.On the other hand,by matching study patient characteristics to that of the population of interest,including the elderly,pregnant women and young children,PSM allows for generalization of results to the wider population and hence greatly increases the external validity.Instead of replacing RCTs with PSM,the synergistic integration of PSM into RCTs stands to provide better research outcomes with both methods complementing each other.For example,in an RCT investigating the impact of mannitol on outcomes among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial,the baseline characteristics of comorbidities and current medications between treatment and control arms were significantly different despite the randomization protocol.Therefore,PSM was incorporated in its analysis to create samples from the treatment and control arms that were matched in terms of these baseline characteristics,thus providing a fairer comparison for the impact of mannitol.This literature review reports the applications,advantages,and considerations of using PSM with RCTs,illustrating its utility in refining randomization,improving external validity,and accounting for non-compliance to protocol.Future research should consider integrating the use of PSM in RCTs to better generalize outcomes to target populations for clinical practice and thereby benefit a wider range of patients,while maintaining the robustness of randomization offered by RCTs.
基金the innovation Platform Project of Science and Technology,Fujian Province(2021Y2012)the Key Project on the Integration of Industry,Education and Research Collaborative Innovation of Fujian Province(No.2021YZ034011)+2 种基金the Key Project on Science and Technology Program of Fujian Health Commission(No.2021ZD01002)the Fujian Provincial Health and Young and Middle-aged Key Personnel Training Program(No.2022GGA035)the Natural Science Foundation of Fujian Province(No.2023J011221).
文摘This study aimed to investigate the effects of male hepatitis B virus(HBV)infection on male fertility,embryonic development,and in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)outcomes.We performed a retrospective cohort study that included 3965 infertile couples who received fresh embryo transfer cycles for the first time at the Fujian Maternity and Child Health Hospital(Fuzhou,China)from January 2018 to January 2021.Infertile couples were categorized based on their HBV infection status into the HBV group(HBV-positive men and HBV-negative women)and the control group(HBV-negative couples).A 1:1 propensity score matching was performed with relatively balanced covariates.Baseline characteristics,semen parameters,laboratory outcomes,clinical outcomes,and obstetric and neonatal outcomes were compared between groups.After propensity score matching,821 couples were included in each group.Both groups had similar semen parameters and obstetric and neonatal outcomes.The HBV group showed a significantly lower live birth rate than the control group(P<0.05).The HBV group had a significantly higher abortion rate than the control group(P<0.05).The rates of high-quality embryos and blastocyst formation were significantly lower in the HBV group than those in the control group(both P<0.05).In conclusion,in couples who undergo IVF/ICSI,male HBV infection reduces the live birth rate and increases the risk of miscarriage.However,the incidence of low birth weight in women with IVF/ICSI does not increase with male HBV infection.
文摘This paper explores the significant impact of the Ukraine conflict on local food security,employing a robust methodological framework that integrates Propensity Score Matching(PSM)and Difference-in-Differences(DiD)estimation,supplemented by placebo tests and the synthetic control method.By examining panel data from 2014 to 2022,the study reveals a causal relationship between the conflict and a notable deterioration in Ukraine’s food security index.The conflict,characterized by direct damages to agricultural production and infrastructure,alongside indirect economic and social disruptions,has led to a substantial decline in food security.This research contributes to understanding the dynamics of how war affects food security and provides actionable insights for policy formulation and response strategies to mitigate such impacts in similar conflict scenarios.Through a comprehensive analysis,it highlights the urgent need for international cooperation and humanitarian aid to address the challenges posed to food security by the war,emphasizing the broader implications for global food markets and prices.
基金supported by grants from the Science&Technology Key Program of Zhejiang China(2017C03051)the National Science&Technology Major Project of China(2017ZX10203201)。
文摘Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.
基金This work was supported by the Natural Science Foundation of China(No.81871147 and No.81671453)Sichuan Science and Technology Program(2018TJPT0018)Chengdu Science and Technology Program(No.2019-YFYF-00087-SN).
文摘Lower urinary tract symptoms suggestive of benign prostate hyperplasia(LUTS/BPH)and depression are both increasing in Chinese aging males.However,the relationship still remains unknown.To explore their relationship,a retrospective cohort study based on propensity score matching(PSM)was conducted by analyzing the China Health and Retirement Longitudinal Study dataset.After data cleaning,a total of 5125 participants were enrolled and subjected to PSM;1351 pairs were matched and followed for 2 years.Further logistic regression and restricted cubic spline(RCS)were performed to evaluate,model and visualize the relationship between depression and LUTS/BPH.Moreover,subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions.Before PSM,depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates(P<0.001).After PSM,univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group(odds ratio[OR]=2.10,P<0.001).The RCS results indicated a nonlinear(P<0.05)and inverted U-shaped relationship between depression and LUTS/BPH.In the subgroup analyses,no increased risks were found among participants who were not married or cohabitating,received an education,had an abnormal body mass index(<18.5 kg m−2 and≥28 kg m−2),slept more than 6 h,did not smoke,and drank less than once a month(all P>0.05).The results of sensitivity analyses indicated identical increased risks of LUTS/BPH in all four models(all P<0.001).In conclusion,depression enhances the risks of LUTS/BPH in aging males.
基金supported by the Beijing Natural Science Foundation(Commission No.7162038)the Beijing Municipal Administration of Hospitals’Youth Program(Commission No.QML20161101)
文摘Objective： Although superior clinical benefits of epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） in the treatment of advanced non-small-cell lung cancer （NSCLC） had been reported, the survival difference between exon 19 deletion （Dell9） and exon 21 Leu858Arg substitution （L858R） remains controversial. The purpose of this study is to investigate the differences in progression-free survival （PFS） and overall survival （OS） between different EGFR mutant subtypes among advanced NSCLC patients receiving gefitinib. Methods： There were 204 advanced NSCLC patients with EGFR mutations treated with gefitinib were enrolled in this retrospective cohort study. Patients were divided into the EGFR Dell9 group and the L858R mutated group according to their mutant subtype. Propensity score matching （PSM） was conducted by using a nearest-neighbor algorithm （1：1） to adjust for demographical and clinical covariates. Survival curves were constructed with the Kaplan-Meier method and compared by using the log-rank test. Results： The PFS in Dell9 group was similar to that in the L858R group [before PSM 8.6 vs. 7.2 months, P=0.072; after PSM 7.3 vs. 7.2 months, P=0.155]. No differences were detected in OS between the L858R and the Dell9 group （before PSM 17.8 vs. 13.1 months, P=0.253; after PSM 16.9 vs. 13.1 months, P=0.339）. The Dell9 group was significantly younger compared with the L858R mutation group in age （P=0.015）. Conclusions： No significant difference was found in the PFS or OS between the Dell9 and L858R mutant NSCLC patients receiving gefitinib. The age gap might contribute to the survival differences between Dell9 and L858R groups. PSM is of important value to the elimination of potential bias.
基金the Excellent Talents Fund Project of Xuzhou Medical University,No.XYFY2021019.
文摘BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
基金the National Key R&D Program of China(Grant No.2017 YFC0112000)the National Natural Science Foundation of China(Grant Nos.81627803 and 91859201).
文摘Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.
基金the Ethical Review Board of the Nagoya University Hospital(2015-0449).
文摘BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.
文摘AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P < 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.
基金National Natural Science Foundation of China,No.81772642.
文摘BACKGROUND Laparoscopic total gastrectomy(LTG)has drawn increasing attention over the years.Although LTG has shown surgical benefits compared to open TG(OTG)in early stage gastric cancer(GC),little is known about the surgical and oncological outcomes of LTG for advanced GC following neoadjuvant therapy(NAT).AIM To compare the long-and short-term outcomes of advanced GC patients who underwent LTG vs OTG following NAT.METHODS Advanced GC patients who underwent TG following NAT between April 2011 and May 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences were enrolled and stratified into two groups:LTG and OTG.Propensity score matching analysis was performed at a 1:1 ratio to overcome possible bias.RESULTS In total,185 patients were enrolled(LTG:78;OTG:109).Of these,138 were paired after propensity score matching.After adjustment for propensity score matching,baseline parameters were similar between the two groups.Compared to OTG,LTG was associated with a significantly shorter length of hospital stay(P=0.012).The rates of R0 resection,lymph node harvest,and postoperative morbidity did not significantly differ between the two groups.Overall survival(OS)outcomes were comparable between the two groups.Pathological T and N stages were found to be independent risk factors for OS.CONCLUSION LTG can be a feasible method for advanced GC patients following NAT,as it appears to be associated with better short-and comparable long-term outcomes compared to OTG.
基金Supported by Key Research and Development Program of Shandong Province,No.2019JZZY010104 and No.2019GSF108146Special Foundation for Taishan Scholars Program of Shandong Province,No.ts20190978and Academic Promotion Programme of Shandong First Medical University,No.2019QL021.
文摘BACKGROUND Multiple gastrointestinal stromal tumors(MGISTs)are specific and rare.Little is known about the impact of MGISTs on the survival of patients with gastrointestinal stromal tumors(GIST).The diagnosis,treatment and follow-up strategies of MGISTs is not specifically described in guidelines.AIM To compare the clinicopathological characteristics and prognosis of MGISTs and solitary GISTs(SGISTs)METHODS Patients diagnosed with primary GISTs from March 2010 to January 2020 were included.Due to the inhomogeneous distribution of several baseline characteristics and uneven MGIST and SGIST group sizes,propensity score matching was performed according to comorbidities,body mass index,tumor location,mitotic index,sex,age and American Society of Anesthesiologists score.Differences in clinicopathological characteristics and prognosis between patients with MGISTs and patients with SGISTs were compared.RESULTS Among the entire cohort of 983 patients,the incidence of MGISTs was 4.17%.Before matching,patients with MGISTs and those with SGISTs had disparities in body mass index,surgical approach,tumor size and mitotic index.After 1:4 ratio matching,the clinical baseline data were comparable.The 5-year progression-free survival rate was 52.17%in the MGIST group and 75.00%in the SGIST group(P=0.031).On multivariate analysis,tumor location,tumor size,mitotic index,imatinib treatment and MGISTs(hazard ratio=2.431,95%confidence interval=1.097-5.386,P=0.029)were identified as independent prognostic factors of progression-free survival.However,overall survival was similar between the SGIST and MGIST groups.CONCLUSION Patients with MGISTs had poorer progression-free survival than patients with SGISTs.Risk criteria and diagnostic and treatment strategies should be developed to achieve personalized precision therapy and maximize the survival benefit.
文摘BACKGROUND Surgical resection is regarded as the only potentially curative treatment option for patients with metastatic colorectal cancer(CRC).The National Comprehensive Cancer Network clinical practice guidelines do not recommend palliative surgery unless there is a risk of severe symptoms.However,accumulating evidence has shown that palliative surgery is associated with more favorable outcomes for patients with metastatic CRC.AIM To investigate the separate role of palliative primary tumor resection for patients with stage IVA(M1a diseases)and stage IVB(M1b diseases)colorectal adenocarcinoma(CRA).METHODS CRA patients diagnosed from 2010 to 2015 with definite M1a and M1b categories according to the 8th edition of American Joint Committee on Cancer staging system were selected from the Surveillance Epidemiology and End Results(SEER)database.To minimize potential selection bias,the data were adjusted by propensity score matching(PSM).Baseline characteristics,including gender,year of diagnosis,age,marital status,primary site,surgical information,race,grade,chemotherapy,and radiotherapy,were recorded and analyzed.Univariate and multivariate analyses were performed to explore the separate role of palliative surgery for patients with M1a and M1b diseases.RESULTS A total of 19680 patients with metastatic CRA were collected from the SEER database,including 10399 cases of M1a diseases and 9281 cases of M1b diseases.Common independent prognostic factors for both M1a and M1b patients included year of diagnosis,age,race,marital status,primary site,grade,surgery,and chemotherapy.After PSM adjustment,3732 and 3568 matched patients in the M1a and M1b groups were included,respectively.Patients receiving palliative primary tumor resection had longer survival time than those without surgery(P<0.001).For patients with M1a diseases,palliative resection could increase the median survival time by 9 mo;for patients with M1b diseases,palliative resection could prolong the median survival time by 7 mo.For M1a diseases,patients with lung metastasis had more clinical benefit from palliative resection than those with liver metastasis(15 mo for lung metastasis vs 8 mo for liver metastasis,P<0.001).CONCLUSION CRA patients with M1a diseases gain more clinical benefits from palliative primary tumor resection than those with M1b diseases.Those patients with M1a(lung metastasis)have superior long-term outcomes after palliative primary tumor resection.
文摘Health status is widely regarded as a correlate of depressive symptoms.However,health assessments based on clinical diagnosis in rural areas with poor medical conditions are very limited.Self-rated health(SRH)serves as a simple and convenient evaluation indicator,which may be used as an independent predictor of depressive symptoms.To confirm the relationship between SRH and depressive symptoms in rural adults,a longitudinal survey of rural households in China was conducted using the China Family Panel Studies(CFPS)from 2012 to 2016.Propensity score matching and logistic regression analysis were used to explore the association.After data cleansing,3,127 pairs(6,254 participants)aged 16 and older followed for 4 years were enrolled,of which the average age was(50.02±14.19)years old,and the proportions of male and female were 48.64%and 51.36%,respectively.The incidence rate of depressive symptoms within 4 years was 30.86%(95%CI:29.24–32.48)in the group with fair or poor SRH,and 21.59%(95%CI:20.14–23.03)in the group with good SRH.The difference between the two groups was statistically significant(χ^(2)=69.51,P<0.001).The results of univariate unconditional logistic regression analysis showed that there was a correlation between SRH and depressive symptoms in rural adults aged 30 and above(OR=1.65,95%CI:1.46–1.85,P<0.001).Thus,a simple and practical assessment tool based on SRH and other indicators should be established for early prevention and intervention in rural primary mental health care.
