AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between ...AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.展开更多
Objective The objective of our study was to evaluate the vaccine effectiveness(VE)of the pentavalent rotavirus vaccine(RV5)among<5-year-old children in three provinces of China during 2020-2024 via a propensity sco...Objective The objective of our study was to evaluate the vaccine effectiveness(VE)of the pentavalent rotavirus vaccine(RV5)among<5-year-old children in three provinces of China during 2020-2024 via a propensity score-matched test-negative case-control study.Methods Electronic health records and immunization information systems were used to obtain data on acute gastroenteritis(AGE)cases tested for rotavirus(RV)infection.RV-positive cases were propensity score matched with RV-negative controls for age,visit month,and province.Results The study included 27,472 children with AGE aged 8 weeks to 4 years at the time of AGE diagnosis;7.98%(2,192)were RV-positive.The VE(95%confidence interval,CI)of 1-2 and 3 doses of RV5 against any medically attended RV infection(inpatient or outpatient)was 57.6%(39.8%,70.2%)and 67.2%(60.3%,72.9%),respectively.Among children who received the 3rd dose before turning 5 months of age,3-dose VE decreased from 70.4%(53.9%,81.1%)(<5 months since the 3rd dose)to 63.0%(49.1%,73.0%)(≥1 year since the 3rd dose).The three-dose VE rate was 69.4%(41.3%,84.0%)for RVGE hospitalization and 57.5%(38.9%,70.5%)for outpatient-only medically attended RVGE.Conclusion Three-dose RV5 VE against rotavirus gastroenteritis(RVGE)in children aged<5 years was higher than 1-2-dose VE.Three-dose VE decreased with time since the 3rd dose in children who received the 3rd dose before turning five months of age,but remained above 60%for at least one year.VE was higher for RVGE hospitalizations than for medically attended outpatient visits.展开更多
Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,e...Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,eligible women who underwent a COH were divided into acupuncture and non-acupuncture groups.The primary outcome was LBR,as determined by propensity score matching(PSM).LBR was defined as the delivery of one or more living infants that reached a gestational age over 28 weeks after embryo transfer.The propensity score model encompassed 16 confounding variables.To validate the results,sensitivity analyses were conducted using three additional propensity score methods:propensity score adjustment,inverse probability weighting(IPW),and IPW with a"doubly robust”estimator.Results:The primary cohort encompassed 9751 patients(1830[18.76%]in the acupuncture group and7921[81.23%]in the non-acupuncture group).Following 1:1 PSM,a higher LBR was found in the acupuncture cohort(41.4%[755/1824]vs 36.4%[664/1824],with an odds ratio of 1.23[95%confidence interval,1.08-1.41]).Three additional propensity score methods produced essentially similar results.The risk of serious adverse events did not significantly differ between the two groups.Conclusion:This retrospective study revealed an association between acupuncture and an increased LBR among patients undergoing COH,and that acupuncture is a safe and valuable treatment option.展开更多
Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to...Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.展开更多
OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in ...OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in this study.All patients were categorized into the traditional herbal medicine(THM) group(n = 115) or the non-THM treatment(nTHM) group(n = 239),with the Jiedu formula administered twice a day to the patients in the THM group.The primary outcome was recurrence-free survival(RFS).Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors associated with RFS.Then,the high risk of recurrence among patients was identified,and propensity score matching(PSM) and RFS analysis were performed to analyze the prognostic factors for the outcomes of patients at a high risk of recurrence in different groups.RESULTS:The one,two,three,and five-year RFS rates of the THM and nTHM groups were 76.4% vs 66.1%,65.5% vs 48.8%,57.9% vs 39.9%,and 43.9% vs 29.2%,respectively.The results of the Multivariate Cox analysis showed that giant tumors [hazard ratio(HR),1.54,P = 0.04],poor degree of differentiation,microsatellite,or microvascular invasion(HR,1.29,P = 0.09) increased the risk of recurrence.In the population with a high risk of recurrence,after PSM,the one,two,three,and five-year survival rates were 70.6% vs 68.0%,63.0% vs 43.1%,59.6% vs 33.3%,and 41.9% vs 26.4%,respectively.CONCLUSION:In this study,THM was found to be an effective agent for adjuvant therapy for HCC to prevent early recurrence of HCC after hepatic resection.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 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
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 Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic ...BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.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 Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,i...BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.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
BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marke...BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.展开更多
BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of...BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery;and(5)Physical status:One month after surgery,the Karnofsky performance score in the observation group was higher than that in the control group.CONCLUSION Laparoscopic radical resection of CRC has significant benefits,such as reducing postoperative pain and postoperative inflammatory response,avoiding excessive immune inhibition,and contributing to postoperative recovery.展开更多
BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria fo...BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria for their application.AIM To provide a reference for the development of standardized treatment strategies for gGISTs.METHODS Clinical baseline characteristics,histopathological results,and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed.Propensity score matching(PSM)was employed to achieve balance in baseline characteristics of the two groups.RESULTS Among 206 patients,135 were in the ER group and 71 in the LR group.The ER group had significantly smaller tumors[3.5 cm(3.0-4.0 cm)vs 4.2 cm(3.3-5.0 cm),P<0.001]and different tumor locations(P=0.048).After PSM,59 pairs of patients were balanced.After matching,the baseline characteristics of the ER and LR groups did not differ significantly from each other.Compared with LR,ER had faster recovery of diet(P=0.046)and fewer postoperative symptoms(P=0.040).LR achieved a higher complete resection rate(P<0.001)and shorter operation time(P<0.001).No significant differences were observed in postoperative hospital stay(P=0.478),hospital costs(P=0.469),complication rates(P>0.999),pathological features(mitosis,P=0.262;National Institutes of Health risk classification,P=0.145),recurrence rates(P=0.476),or mortality rates(P=0.611).CONCLUSION Both ER and LR are safe and effective treatments for gGISTs.ER has less postoperative pain and faster recovery,while LR has a higher rate of complete resection.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
BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients re...BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage II/III gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.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
BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS...BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.展开更多
文摘AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.
基金the Study on Vaccine Application Evaluation Strategies and Capacity Building (INV-006373)the National Key R&D Program of China(2024YFC2310604)
文摘Objective The objective of our study was to evaluate the vaccine effectiveness(VE)of the pentavalent rotavirus vaccine(RV5)among<5-year-old children in three provinces of China during 2020-2024 via a propensity score-matched test-negative case-control study.Methods Electronic health records and immunization information systems were used to obtain data on acute gastroenteritis(AGE)cases tested for rotavirus(RV)infection.RV-positive cases were propensity score matched with RV-negative controls for age,visit month,and province.Results The study included 27,472 children with AGE aged 8 weeks to 4 years at the time of AGE diagnosis;7.98%(2,192)were RV-positive.The VE(95%confidence interval,CI)of 1-2 and 3 doses of RV5 against any medically attended RV infection(inpatient or outpatient)was 57.6%(39.8%,70.2%)and 67.2%(60.3%,72.9%),respectively.Among children who received the 3rd dose before turning 5 months of age,3-dose VE decreased from 70.4%(53.9%,81.1%)(<5 months since the 3rd dose)to 63.0%(49.1%,73.0%)(≥1 year since the 3rd dose).The three-dose VE rate was 69.4%(41.3%,84.0%)for RVGE hospitalization and 57.5%(38.9%,70.5%)for outpatient-only medically attended RVGE.Conclusion Three-dose RV5 VE against rotavirus gastroenteritis(RVGE)in children aged<5 years was higher than 1-2-dose VE.Three-dose VE decreased with time since the 3rd dose in children who received the 3rd dose before turning five months of age,but remained above 60%for at least one year.VE was higher for RVGE hospitalizations than for medically attended outpatient visits.
基金funded by the National Natural Science Foundation of China(No.81973966)。
文摘Objective:To explore the association between acupuncture during controlled ovarian hyperstimulation(COH)and the live birth rate(LBR)using different propensity score methods.Methods:In this retrospective cohort study,eligible women who underwent a COH were divided into acupuncture and non-acupuncture groups.The primary outcome was LBR,as determined by propensity score matching(PSM).LBR was defined as the delivery of one or more living infants that reached a gestational age over 28 weeks after embryo transfer.The propensity score model encompassed 16 confounding variables.To validate the results,sensitivity analyses were conducted using three additional propensity score methods:propensity score adjustment,inverse probability weighting(IPW),and IPW with a"doubly robust”estimator.Results:The primary cohort encompassed 9751 patients(1830[18.76%]in the acupuncture group and7921[81.23%]in the non-acupuncture group).Following 1:1 PSM,a higher LBR was found in the acupuncture cohort(41.4%[755/1824]vs 36.4%[664/1824],with an odds ratio of 1.23[95%confidence interval,1.08-1.41]).Three additional propensity score methods produced essentially similar results.The risk of serious adverse events did not significantly differ between the two groups.Conclusion:This retrospective study revealed an association between acupuncture and an increased LBR among patients undergoing COH,and that acupuncture is a safe and valuable treatment option.
基金supported by grants from Guangzhou Sci-ence and Technology Bureau City-University(College)Joint Fund-ing Project(2023A03J0224)2024 Guangzhou Basic and Applied Basic Research Scheme(Project for Maiden Voyage)(SL2023A04J00258)。
文摘Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.
基金Natural Science Foundation-funded Project:Mechanism of Action of Detoxification Formula to Inhibit Hypoxia-Inducible Factor 1 Alpha-Exosomal MicroRNA-130b-3p-Sterile Alpha Motif Domain-Containing Protein 90-mediated Macrophage M2-type Polarisation to Improve the Immunosuppressive Microenvironment in Hepatocellular Carcinoma (No.82374540)Medical Innovation Research Project of Shanghai Science and Technology Commission:a Multicenter Prospective Randomized Controlled Study of “Arsenic Target” Combination Therapy for Unresectable Hepatocellular Carcinoma (No.22Y11921200)。
文摘OBJECTIVE:To investigate the clinical efficacy of using a Jiedu formula(解毒方) as an adjunctive therapy in patients with hepatocellular carcinoma(HCC) after hepatectomy.METHODS:In total,354 patients were included in this study.All patients were categorized into the traditional herbal medicine(THM) group(n = 115) or the non-THM treatment(nTHM) group(n = 239),with the Jiedu formula administered twice a day to the patients in the THM group.The primary outcome was recurrence-free survival(RFS).Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors associated with RFS.Then,the high risk of recurrence among patients was identified,and propensity score matching(PSM) and RFS analysis were performed to analyze the prognostic factors for the outcomes of patients at a high risk of recurrence in different groups.RESULTS:The one,two,three,and five-year RFS rates of the THM and nTHM groups were 76.4% vs 66.1%,65.5% vs 48.8%,57.9% vs 39.9%,and 43.9% vs 29.2%,respectively.The results of the Multivariate Cox analysis showed that giant tumors [hazard ratio(HR),1.54,P = 0.04],poor degree of differentiation,microsatellite,or microvascular invasion(HR,1.29,P = 0.09) increased the risk of recurrence.In the population with a high risk of recurrence,after PSM,the one,two,three,and five-year survival rates were 70.6% vs 68.0%,63.0% vs 43.1%,59.6% vs 33.3%,and 41.9% vs 26.4%,respectively.CONCLUSION:In this study,THM was found to be an effective agent for adjuvant therapy for HCC to prevent early recurrence of HCC after hepatic resection.
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.
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 Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.
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 Interdisciplinary Guided Network for Investigation,Translation and Equity for the All of Us Research Program,No.OT2 OD031915.
文摘BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.
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supported by the National Key Research and Development Program of China(2021YFC2501800)Leader Project of Henan Province Health Young and Middle-aged Professor(HNSWJW2020013).
文摘BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality rate.We aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and CAP.METHODS:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April 2020.Patients were allocated to the DM or non-DM group and paired with propensity score matching.Baseline characteristics and clinical outcomes up to 90 days were evaluated.The primary outcome was the 10-day mortality.Receiver operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical analysis.RESULTS:Among 152 enrolled patients,60 pairs were successfully matched.There was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml vs.median 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of 0.747.The cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,respectively.Multivariate Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with DM.CONCLUSION:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.
基金Supported by Scientific Research Project of Hunan Provincial Health Commission,No.202204114103.
文摘BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery;and(5)Physical status:One month after surgery,the Karnofsky performance score in the observation group was higher than that in the control group.CONCLUSION Laparoscopic radical resection of CRC has significant benefits,such as reducing postoperative pain and postoperative inflammatory response,avoiding excessive immune inhibition,and contributing to postoperative recovery.
基金Supported by The Medical Science and Technology Project of Zhejiang Province,China,No.2024KY1792The Health Science and Technology Program of Zhejiang Province,China,No.22PY101+2 种基金The Program of Taizhou Science and Technology Grant,China,No.22ywb08 and No.22ywb09The Scientific Research Fund Program of Enze Medical Center,China,No.22EZB12 and No.22EZC17The Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province,China,No.21SZDSYS15.
文摘BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria for their application.AIM To provide a reference for the development of standardized treatment strategies for gGISTs.METHODS Clinical baseline characteristics,histopathological results,and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed.Propensity score matching(PSM)was employed to achieve balance in baseline characteristics of the two groups.RESULTS Among 206 patients,135 were in the ER group and 71 in the LR group.The ER group had significantly smaller tumors[3.5 cm(3.0-4.0 cm)vs 4.2 cm(3.3-5.0 cm),P<0.001]and different tumor locations(P=0.048).After PSM,59 pairs of patients were balanced.After matching,the baseline characteristics of the ER and LR groups did not differ significantly from each other.Compared with LR,ER had faster recovery of diet(P=0.046)and fewer postoperative symptoms(P=0.040).LR achieved a higher complete resection rate(P<0.001)and shorter operation time(P<0.001).No significant differences were observed in postoperative hospital stay(P=0.478),hospital costs(P=0.469),complication rates(P>0.999),pathological features(mitosis,P=0.262;National Institutes of Health risk classification,P=0.145),recurrence rates(P=0.476),or mortality rates(P=0.611).CONCLUSION Both ER and LR are safe and effective treatments for gGISTs.ER has less postoperative pain and faster recovery,while LR has a higher rate of complete resection.
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Supported by Xiamen Natural Science Foundation of China,No.3502Z20227347.
文摘BACKGROUND Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy(AC)initiation,the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.AIM To evaluate the feasibility,safety,and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.METHODS In this retrospective cohort study,219 stage II/III gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed.Patients were stratified by AC initiation timing:Early(10-13 days,n=21)vs conventional(4-6 weeks,n=198).Propensity score matching(1:2)was performed,with balance assessed via standardized mean differences.Recurrence-free sur-vival,overall survival,and safety were compared between the two groups.Sensi-tivity analyses were conducted to assess the robustness of the findings.RESULTS After 1:2 matching(21 patients vs 42 patients),early AC demonstrated comparable 3-year recurrence-free survival(53.7%vs 61.6%,hazard ratio=0.89,P=0.562)and overall survival(69.1%vs 66.3%,P=0.874)rates to conventional timing.Peritoneal recurrence was significantly lower in the early group(4.8%vs 26.2%,P=0.048),although Cox regression did not confirm a significant difference(hazard ratio=0.418,P=0.257).Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions(57.1%vs 26.2%,P=0.026)but similar grade 3/4 toxicity(42.9%vs 57.1%,P=0.285).CONCLUSION Early AC initiation appears feasible in selected patients but necessitates individualized dose management.Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.
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BACKGROUND Robotic surgery(RS)is gaining popularity;however,evidence for abdominoperineal resection(APR)of rectal cancer(RC)is scarce.AIM To compare the efficacy of RS and laparoscopic surgery(LS)in APR for RC.METHODS We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022.Data regarding short-term surgical outcomes were compared between the two groups.To reduce the effect of potential confounding factors,propensity score matching was used,with a 1:1 ratio between the RS and LS groups.A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.RESULTS Of 133 patients,after propensity score matching,there were 42 patients in each group.The postoperative complication rate was significantly lower in the RS group(17/42,40.5%)than in the LS group(27/42,64.3%)(P=0.029).There wasno significant difference in operative time(P=0.564),intraoperative transfusion(P=0.314),reoperation rate(P=0.314),lymph nodes harvested(P=0.309),or circumferential resection margin(CRM)positive rate(P=0.314)between the two groups.The meta-analysis showed patients in the RS group had fewer positive CRMs(P=0.04),lesser estimated blood loss(P<0.00001),shorter postoperative hospital stays(P=0.02),and fewer postoperative complications(P=0.002)than patients in the LS group.CONCLUSION Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.
