BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world ...BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.展开更多
BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To ex...BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.展开更多
Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment proces...Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.展开更多
AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to exa...AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques.Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF)and combinations.We identified patients at least 18 years of age,with≥1 inpatient or≥2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14.A 6 mo clean period prior to first treatment ensured patients were newly treated.Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients:mean(SD)age was 55.6 years(SD=9.7),47.2%of the patients were between 55 and 64 years,and 48.8%were female.All regions of the United States were represented.59.6%started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3%CC,3.6%TT,and 0.5%IF.The remainder received combinations.Mean follow up was 576 d.Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT).58.9%of patients had no pharmacological treatment beyond first line.The most common secondline was combination therapy with SSA.In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60%of patients initiated treatment with SSA alone or in combination.The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.展开更多
activities.Ex-periments on a synthetic log of the non-secondary hy-pertension MTP and empirical findings demonstrate the effectiveness of our approach.The results show that the process mining in our approach framework...activities.Ex-periments on a synthetic log of the non-secondary hy-pertension MTP and empirical findings demonstrate the effectiveness of our approach.The results show that the process mining in our approach framework can automatically generate more accurate MTP mod-els,and the subprocess models based on treatment pat-terns make the models easy to understand.展开更多
AIM:To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy(PDT)among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang ...AIM:To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy(PDT)among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014.METHODS:Study subjects were recruited retrospectively using the Electronic Medical Record(EMR)database software in Hospital Selayang.Demographic data,medical history,diagnostic procedure,treatments and diagnosis of patients were recorded.RESULTS:The five-year analysis included 821 patients with a mean age of 65.9±11.73 y.Overall,there were a highernumber of males(63.1%)and a higher number of Chinese(47.4%)patients.Among the 821 patients,62.9%received ranibizumab injection followed by 19.2%PDT therapy and 17.9%had ranibizumab combined with PDT therapy.Age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)were the most common retinal eye diseases reported,recording prevalence of 25.0%and 45.6%,respectively.The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014.In terms of treatment,following multiple logistic regression,AMD was associated with the subjects being more likely to have received ranibizumab monotherapy(P〈0.001)while PCV was associated with more likely to have received PDT(P〈0.001)and PDT combined with ranibizumab therapy(P〈0.001).CONCLUSION:The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD,while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.展开更多
As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable adva...As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1<sup>st</sup>-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.展开更多
Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer deaths in the United States. The goal of this study was to understand treatment patterns, biomark...Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer deaths in the United States. The goal of this study was to understand treatment patterns, biomarker testing practices, treatment adherence, and the clinical and economic outcomes associated with chemotherapy for metastatic disease. Methods and Materials: We retrospectively examined electronic health records of patients with metastatic CRC who initiated chemotherapy between 01 January 2007 and 30 June 2011, with follow-up to 30 June 2012. Parameters analyzed included demographics and clinical characteristics, treatment patterns, clinical outcomes, and health care resource utilization. Results: In the analysis, 756 patients were included;median age was 61 years (55% male) at start of first line therapy. The most commonly used regimens in the first, second, and third line were FOLFOX + bevacizumab (46%), FOLFIRI + bevacizumab (23%), and irinotecan + cetuximab (23%) respectively. Adherence to guidelines decreased with increasing line of therapy. When assessed by treatment backbone categories in the third line, outcome measures including overall survival (OS), and time to treatment discontinuation (TTD) were not statistically different between groups. In the multivariable model, body mass index (BMI), performance status, and KRAS were significant predictors of survival. Conclusions: This study provides insight into patterns of care and outcomes of mCRC patients for the aforementioned time period. As treatment options for mCRC evolve, it is valuable to understand the continuum of care to help inform future treatment among candidates for continued therapy.展开更多
BACKGROUND Medications for inflammatory bowel disease(IBD)have changed dramatically over time.However,no study on long-term medication profiles has been conducted in the Chinese population.AIM To evaluate temporal cha...BACKGROUND Medications for inflammatory bowel disease(IBD)have changed dramatically over time.However,no study on long-term medication profiles has been conducted in the Chinese population.AIM To evaluate temporal changes in medication use and treatment patterns for Chinese patients with IBD.METHODS A multicenter retrospective cohort study was conducted among Chinese patients newly diagnosed with Crohn’s disease(CD)and ulcerative colitis(UC)between January 1999 and December 2019.Baseline characteristics and drug prescriptions were collected.Trends in medication use and therapeutic patterns were analyzed.RESULTS In total,3610 patients were analyzed.During follow-up,5-aminosalicylates(5-ASA)and corticosteroids(CS)prescriptions gradually decreased,accompanied by a notable increase in immunosuppressants(IMS)and infliximab(IFX)prescriptions in patients with CD.Prescription rates of 5-ASA and CS were stable,whereas IMS and IFX slightly increased since 2007 in patients with UC.Subgroup(n=957)analyses showed a switch from conventional medications to IFX in patients with CD,while 5-ASA and CS were still steadily prescribed in patients with UC.Logistic regression analyses revealed that surgical history,disease behavior,and disease location were associated with initial therapeutic strategies in patients with CD.However,medications before diagnosis,disease location,and diagnostic year might affect initial strategies in patients with UC.CONCLUSION Long-term treatment strategies analyses has provided unique insight into the switch from conventional drugs to IFX in Chinese patients with CD.展开更多
There is a lack of high-quality,large-scale,real-world evidence from patients with metastatic colorectal cancer(mCRC),especially in China.It remains unclear whether efforts to improve the quality of care for mCRC woul...There is a lack of high-quality,large-scale,real-world evidence from patients with metastatic colorectal cancer(mCRC),especially in China.It remains unclear whether efforts to improve the quality of care for mCRC would improve patient survival outcomes in real-world practice.On the basis of an intelligent bigdata platform,we established a large-scale retrospective cohort of mCRC patients.We investigated the temporal changes in the systemic and local treatment(resection,ablation,or radiation to liver,lung,or extrahepatic and/or extrapulmonary metastases)patterns of mCRC,and whether these changes were associated with improved overall survival(OS)over time.Between July 2012 and December 2018,3403 eligible patients were included in this research.The median OS was 42.8 months(95%confidence interval(CI),40.7–46.6)for the entire cohort,25.6 months(95%CI,24.7–26.9)for those treated with systemic therapy only,and not reached(95%CI,78.6 months–not reached)for those receiving local therapy.The utility rate of local therapy increased continuously from 37.9%in 2012–2014 to 46.9%in 2017–2018.A dramatic increase in the utility rate of either cetuximab or bevacizumab was observed since 2017(39.9%,43.2%,and 60.3%in 2012–2014,2015–2016,and 2017–2018,respectively).Compared with 2012–2014,the OS of the entire population significantly improved in 2015–2016(hazard ratio(HR)=0.87(95%CI,0.78–0.99);P=0.034),but not for patients receiving systemic therapy only(HR=0.99(95%CI,0.86–1.14);P=0.889),whereas an improved OS was found in 2015–2018 for both the entire population(HR=0.75(95%CI,0.70–0.81);P<0.001)and for patients receiving systemic therapy only(HR=0.83(95%CI,0.77–0.91);P<0.001).In summary,the quality of care for mCRC,as indicated by the utility rate of targeted and local therapies,has been continuously improving over time in this study cohort,which is associated with continuously improving survival outcomes for these patients.展开更多
To the Editor:Endometrial cancer(EC)ranks as the second most common gynecologic malignancy in China,with rising incidence rates.[1,2]In China,the 5-year survival rate for EC patients has improved from 55.1%in 2003–20...To the Editor:Endometrial cancer(EC)ranks as the second most common gynecologic malignancy in China,with rising incidence rates.[1,2]In China,the 5-year survival rate for EC patients has improved from 55.1%in 2003–2005 to 72.8%in 2012–2015.However,due to sociodemographic,clinicopathological,and treatment-related factors,this remains lower than the 81%in the United States.[3,4]EC is a complex disease with multiple risk factors,distinct histological subtypes,and a variety of available therapeutic options.However,we know very little about the real-world characteristics and treatment patterns of EC in China.[5]Therefore,this large-scale,multicenter study aimed to investigate the demographic,histopathological,and molecular features of newly diagnosed EC patients in China,as well as to provide insights into current treatment patterns.展开更多
Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, an...Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.展开更多
AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vi...AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.展开更多
Background:This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction(HFrEF)in Thail...Background:This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction(HFrEF)in Thailand.Methods:A retrospective cohort study of patients with HFrEF was conducted.Treatment with aβ-blocker and renin-angiotensin system inhibitors(RASIs)with or without mineralocorticoid receptor antagonists(MRAs)at discharge was regarded as guideline-directed medical therapy(GDMT).All others were considered non-GDMT.The primary endpoint was the composite of all-cause mortality or heart failure(HF)rehospitalization.Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects.Results:In total,653 patients with HFrEF(mean age 64.1±14.3 years;55.9%male)were included.GDMT withβ-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%.During a median of 1-year follow-up,167 patients(27.5%)had a composite event,81 patients(13.3%)had all-cause mortality,and 109 patients(18.0%)had HF rehospitalization.Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint(adjusted hazard ratio[HR]0.63;95%CI 0.44-0.89;p=0.009)compared with patients who did not receive GDMT.The use of GDMT was also associated with a significantly lower risk of all-cause mortality(adjusted HR 0.59;95%CI 0.36-0.98;p=0.045)and HF rehospitalization(adjusted HR 0.65;95%CI 0.43-0.96;p=0.031).Conclusions:For HFrEF treatment,GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization.Nevertheless,prescribing GDMT remains underused,and it could be encouraged to improve HF outcomes in real-world settings.展开更多
The creation of a national unified textbook on acupuncture was a critical effort by China to standardize traditional Chinese medicine.In the early People’s Republic of China,the development of acupuncture textbooks f...The creation of a national unified textbook on acupuncture was a critical effort by China to standardize traditional Chinese medicine.In the early People’s Republic of China,the development of acupuncture textbooks followed a complex trajectory.It began with Zhu Lian’s(朱琏)Xin Zhen Jiu Xue(《新针灸学》New Acupuncture and Moxibustion),extending the Yan’an(延安)tradition,and moved to Zhen Jiu Xue(《针灸学》Acupuncture and Moxibustion,1957),a localized effort from the Jiangsu Provincial Chinese Medicine School.This culminated in the national Zhen Jiu Xue Jiang Yi(《针灸学讲义》Lectures on Acupuncture and Moxibustion).This process reflects a shift from regional teaching to a standardized national model,as well as a pedagogical transformation from a scientific approach to a return to classical sources.The textbook centers on Bian Zheng Lun Zhi(辨证论治treatment based on pattern differentiation),blending systematic,scientific,and practical elements,and represents the era’s fusion of Chinese and Western medicine,helping to shape a modern acupuncture framework.展开更多
Objective:To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome.Methods:The study will be conducted in the Hong Kong Feder...Objective:To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome.Methods:The study will be conducted in the Hong Kong Federation of Trade Unions Workers'Medical Clinics,Hong Kong Baptist University Chinese Medicine Clinic cum Training and Research Centre(Hong Kong,China).One hundred Chinese women,aged 45-55 years,will be recruited.The participants will be randomized into 2 groups.The intervention group will be administered medication,based on pattern differentiation,by qualified traditional Chinese medicine(TCM)practitioners.After each evaluation,TCM practitioners will evaluate and revise the prescription,based on the participants'patterns.The control group will be given the standard formula,i.e.,the Erxian decoction,which contains 6 herbs.The treatment period and the follow-up period will be 8 weeks each.The primary assessment outcome measure will be the Kupperman Index,and the secondary outcome measure will be the Menopause-specific Quality of Life Questionnaire score.Conclusion:Pattern-differentiated treatment is the basic principle of TCM to understand and treat diseases.The study will show the pattern-differentiated treatment is effectiveness than the fixed prescription.展开更多
A pseudoplastic metal nanoparticle fluid （PMNF） is used in nanoimprint to fabricate semiconductors and func- tional devices. The evaporation of the solvent and the sintering of the Au PMNF are investigated. The key ...A pseudoplastic metal nanoparticle fluid （PMNF） is used in nanoimprint to fabricate semiconductors and func- tional devices. The evaporation of the solvent and the sintering of the Au PMNF are investigated. The key parameters, which influence the morphology of patterning, such as the radius of metal particles, the concentra- tion of metal particles, the Hamaker constant of the solvent, viscosity of the fluids and the evaporation velocity, are analyzed. Based on a two-sphere sintering model, the equations are derived, which represent the relationships between the relative shrinkage and radius of the metal particles, sintering temperature and time. The optimal parameters for the heat treatment are provided in nanoimprint.展开更多
Cancer immunotherapy has led to a new era of cancer treatment strategies, and transforming healthcare for cancer patients. Meanwhile, reports of immune-related adverse events have been increasing, greatly hindering th...Cancer immunotherapy has led to a new era of cancer treatment strategies, and transforming healthcare for cancer patients. Meanwhile, reports of immune-related adverse events have been increasing, greatly hindering the use of cancer immunotherapy. Traditional Chinese medicine(TCM), which has been widely used in Asian countries for thousands of years, is known to play a complementary role in the treatment of cancer. Taken in combined with conventional modern therapies, such as resection, ablation and radiotherapy, TCM exerts its main anti-cancer effects in two ways: health-strengthening(Fu-Zheng) and pathogen-eliminating(Qu-Xie). Theoretically, pathogen-eliminating TCM can promote the release of tumor-related antigens and should be able to increase the effect of immunotherapy, while healthstrengthening TCM may have immune-enhancing mechanisms that overlap with immunotherapy. In the era of cancer immunotherapy, it is important to balance the use of TCM and immunotherapy, with the goal of enhancing immune efficacy and antagonizing immune toxicity. In this article, we discuss this issue by considering the mechanism of tumor immunotherapy, alongside the theoretical basis of TCM treatment of tumors, with the aim of bringing new insights to future research in this field.展开更多
AIM To compare features of hepatocellular carcinoma(HCC)in Hispanics to those of African Americans and Whites.METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from...AIM To compare features of hepatocellular carcinoma(HCC)in Hispanics to those of African Americans and Whites.METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry.Data were collected retrospectively,including demographics,comorbidities,liver disease characteristics,tumor parameters,treatment,and survival(OS)outcomes.OS analyses were performed using Kaplan-Meier method.RESULTS One hundred and ninety-five patients with HCC were identified:80.5%were male,and 22%were age 65 or older.Mean age at HCC diagnosis was 59.7±9.8 years.Sixty-one point five percent of patients had Medicare or Medicaid;4.1%were uninsured.Compared to African American(31.2%)and White(46.2%)patients,Hispanic patients(22.6%)were more likely to have diabetes(P=0.0019),hyperlipidemia(P=0.0001),nonalcoholic steatohepatitis(NASH)(P=0.0021),end stage renal disease(P=0.0057),and less likely to have hepatitis C virus(P<0.0001)or a smoking history(P<0.0001).Compared to African Americans,Hispanics were more likely to meet criteria for metabolic syndrome(P=0.0491),had higher median MELD scores(P=0.0159),ascites(P=0.008),and encephalopathy(P=0.0087).Hispanic patients with HCC had shorter OS than the other racial groups(P=0.020),despite similarities in HCC parameters and treatment.CONCLUSION In conclusion,Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH,and shorter OS than African American and White patients.展开更多
Objective To describe the treatment patterns and survival status of advanced gastric cancer(AGC)in China in the past two decades,and objectively evaluate the impact of standardized Chinese medicine(CM)treatment on the...Objective To describe the treatment patterns and survival status of advanced gastric cancer(AGC)in China in the past two decades,and objectively evaluate the impact of standardized Chinese medicine(CM)treatment on the survival of AGC patients.Methods This multicenter registry designed and propensity score analysis study described the diagnosis characteristics,treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1,2000 and July 31,2021.Overall survival(OS)was evaluated between non-CM cohort(standard medical treatment)and CM cohort(integrated standard CM treatment≥3 months).Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were performed to adjust any difference in average outcomes for bias.Results A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled.Among them,1,607 received systemic chemotherapy,215(10.74%)accepted molecular targeted therapy,44(2.2%)received checkpoint inhibitor therapy,and 769(38.43%)received CM.Two-drug regimen was the main choice for first-line treatment,with fluoropyrimidine plus platinum as the most common regimen(530 cases,60.09%).While 45.71%(16 cases)of patients with HER2 amplification received trastuzumab in first-line.The application of apatinib increased(33.33%)in third-line.The application of checkpoint inhibitors has increased since 2020.COX analysis showed that Lauren mixed type(P=0.017),cycles of first-line treatment>6(P=0.000),CM(P=0.000),palliative gastrectomy(P=0.000),trastuzumab(P=0.011),and apatinib(P=0.008)were independent prognostic factors for the OS of AGC.After PSM and IPTW,the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months,respectively(P<0.001).Conclusions In real-world practice for AGC in China,therapy choices consisted with guidelines.Two-drug regimen was the main first-line choice.Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC.(Registration No.NCT02781285)展开更多
基金Supported by Takeda Pharmaceuticals USA,Inc.Medical writing support was provided by Luke Humphreys,PhD,of Oxford PharmaGenesis,Oxford,UK and was funded by Takeda Development Center Americas,Inc.
文摘BACKGROUND Data regarding complex Crohn’s perianal fistulas(CPF)epidemiology are limited,and optimal treatment strategies are elusive.An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development,treatment failure,and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies,reduce treatment burden,and improve outcomes in patients with CPF.AIM To describe the epidemiology,treatments,outcomes,and associated risk/protective factors for complex CPF.METHODS Electronic databases(MEDLINE,EMBASE,EBM Reviews,EconLit)were searched.Two reviewers independently used populations,interventions,comparators,outcomes,study designs,and time criteria to identify relevant studies.Observational studies published in English from January 1,2015 to February 17,2022 with>50 patients were included,even if complex CPF was not defined.Items of interest included complex CPF definitions,epidemiology,treatment patterns,morbidity,mortality,and risk factors associated with complex CPF development,treatment failure,and undergoing multiple surgeries.Data were reported using descriptive statistics.RESULTS Overall,140 studies were included.Complex CPF definitions were heterogeneous and rarely reported(24 studies).Hence,data mostly related to CPF in general.CPF prevalence was variable(range:1.5%-81.0%).Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn’s disease diagnosis(range:3.5%-50.1%).Overall healing and failure rates after treatment were in the range of 10.5%-80.2%and 3.6%-83.0%,respectively.Abscesses were the most frequently reported morbidity(n=18).No CPF-related deaths were reported.No consistent risk or protective factors were identified.CONCLUSION Epidemiology,treatment patterns,and risk factors for CPF vary,likely due to inconsistent CPF and clinical outcome definitions.Standardization would facilitate comparability,which may inform optimal complex CPF treatment strategies.
基金the National Key Clinical Specialty Construction Project,No.ZK108000CAMS Innovation Fund for Medical Sciences,No.2021-I2M-C&T-A-001 and No.2022-I2M-C&T-B-012.
文摘BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.
基金supported by Chinese National Key Research and Development Program(No.2017YFB1400604).
文摘Clinical practice guidelines(CPGs)contain evidence-based and economically reasonable medical treatment processes.Executable medical treatment processes in healthcare information systems can assist the treatment processes.To this end,business process modeling technologies have been exploited to model medical treatment processes.However,medical treatment processes are usually flexible and knowledge-intensive.To reduce the effort in modeling,we summarize several treatment patterns(i.e.,frequent behaviors in medical treatment processes in CPGs),and represent them by three process modeling languages(i.e.,BPMN,DMN,and CMMN).Based on the summarized treatment patterns,we propose a pattern-based integrated framework for modeling medical treatment processes.A modeling platform is implemented to support the use of treatment patterns,by which the feasibility of our approach is validated.An empirical analysis is discussed based on the coverage rates of treatment patterns.Feedback from interviewed physicians in a Chinese hospital shows that executable medical treatment processes of CPGs provide a convenient way to obtain guidance,thus assisting daily work for medical workers.
基金Supported by Novartis Pharmaceuticals,One Health Plaza,East Hanover,No.NJ 07936-1080,United State
文摘AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques.Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF)and combinations.We identified patients at least 18 years of age,with≥1 inpatient or≥2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14.A 6 mo clean period prior to first treatment ensured patients were newly treated.Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients:mean(SD)age was 55.6 years(SD=9.7),47.2%of the patients were between 55 and 64 years,and 48.8%were female.All regions of the United States were represented.59.6%started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3%CC,3.6%TT,and 0.5%IF.The remainder received combinations.Mean follow up was 576 d.Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT).58.9%of patients had no pharmacological treatment beyond first line.The most common secondline was combination therapy with SSA.In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60%of patients initiated treatment with SSA alone or in combination.The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
基金Chinese National Key Research and Development Program(No.2017YFB1400604).
文摘activities.Ex-periments on a synthetic log of the non-secondary hy-pertension MTP and empirical findings demonstrate the effectiveness of our approach.The results show that the process mining in our approach framework can automatically generate more accurate MTP mod-els,and the subprocess models based on treatment pat-terns make the models easy to understand.
基金Supported by Putra Grant from Universiti Putra Malaysia(No.9409800,No.9432700)
文摘AIM:To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy(PDT)among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014.METHODS:Study subjects were recruited retrospectively using the Electronic Medical Record(EMR)database software in Hospital Selayang.Demographic data,medical history,diagnostic procedure,treatments and diagnosis of patients were recorded.RESULTS:The five-year analysis included 821 patients with a mean age of 65.9±11.73 y.Overall,there were a highernumber of males(63.1%)and a higher number of Chinese(47.4%)patients.Among the 821 patients,62.9%received ranibizumab injection followed by 19.2%PDT therapy and 17.9%had ranibizumab combined with PDT therapy.Age-related macular degeneration(AMD)and polypoidal choroidal vasculopathy(PCV)were the most common retinal eye diseases reported,recording prevalence of 25.0%and 45.6%,respectively.The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014.In terms of treatment,following multiple logistic regression,AMD was associated with the subjects being more likely to have received ranibizumab monotherapy(P〈0.001)while PCV was associated with more likely to have received PDT(P〈0.001)and PDT combined with ranibizumab therapy(P〈0.001).CONCLUSION:The tertiary care setting in Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD,while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.
文摘As the treatment landscape for advanced melanoma continues to evolve, it is critical to focus on unmet needs and understand the cost of therapy. While Ipilimumab (IPI), an immunotherapy indicated for unresectable advanced melanoma, has been a mainstay of 1<sup>st</sup>-line treatment, there was no standard of care following progression until recently. The objective of this study was to examine real-world treatment patterns and healthcare costs following IPI use in advanced melanoma patients prior to the anti-PD-1 class approval. Adult stage III or IV melanoma patients treated with IPI were selected between April 1, 2011, and September 30, 2013, from a large U.S. commercial and Medicare claims database. Patients were evaluated for therapy after IPI, with an index date set as the first systemic therapy after IPI. Per-Patient Per-Month (PPPM) healthcare costs while on active treatment were evaluated from index until treatment discontinuation, inpatient death, end of insurance enrollment, or September 30, 2013. Of 361 eligible patients, 111 (30.7%) initiated subsequent systemic therapy (mean age, 57 years;64.9% male). The most common therapies, single-agent or combination, included vemurafenib (32.4%), paclitaxel (28.8%), temozolomide (20.7%), and carboplatin (17.1%). During a median follow-up of 130 days, mean [standard deviation] PPPM all-cause total healthcare costs were $20,383 [$18,988], of which $4800 (23.6%), $5899 (28.9%), and $9684 (47.5%) were related to melanoma drug costs, medical claims with a diagnosis of melanoma, and other (non-specified) utilization, respectively. When considering total care, the costs of U.S. patients with advanced melanoma post-IPI were substantial across all commonly used agents.
文摘Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer deaths in the United States. The goal of this study was to understand treatment patterns, biomarker testing practices, treatment adherence, and the clinical and economic outcomes associated with chemotherapy for metastatic disease. Methods and Materials: We retrospectively examined electronic health records of patients with metastatic CRC who initiated chemotherapy between 01 January 2007 and 30 June 2011, with follow-up to 30 June 2012. Parameters analyzed included demographics and clinical characteristics, treatment patterns, clinical outcomes, and health care resource utilization. Results: In the analysis, 756 patients were included;median age was 61 years (55% male) at start of first line therapy. The most commonly used regimens in the first, second, and third line were FOLFOX + bevacizumab (46%), FOLFIRI + bevacizumab (23%), and irinotecan + cetuximab (23%) respectively. Adherence to guidelines decreased with increasing line of therapy. When assessed by treatment backbone categories in the third line, outcome measures including overall survival (OS), and time to treatment discontinuation (TTD) were not statistically different between groups. In the multivariable model, body mass index (BMI), performance status, and KRAS were significant predictors of survival. Conclusions: This study provides insight into patterns of care and outcomes of mCRC patients for the aforementioned time period. As treatment options for mCRC evolve, it is valuable to understand the continuum of care to help inform future treatment among candidates for continued therapy.
文摘BACKGROUND Medications for inflammatory bowel disease(IBD)have changed dramatically over time.However,no study on long-term medication profiles has been conducted in the Chinese population.AIM To evaluate temporal changes in medication use and treatment patterns for Chinese patients with IBD.METHODS A multicenter retrospective cohort study was conducted among Chinese patients newly diagnosed with Crohn’s disease(CD)and ulcerative colitis(UC)between January 1999 and December 2019.Baseline characteristics and drug prescriptions were collected.Trends in medication use and therapeutic patterns were analyzed.RESULTS In total,3610 patients were analyzed.During follow-up,5-aminosalicylates(5-ASA)and corticosteroids(CS)prescriptions gradually decreased,accompanied by a notable increase in immunosuppressants(IMS)and infliximab(IFX)prescriptions in patients with CD.Prescription rates of 5-ASA and CS were stable,whereas IMS and IFX slightly increased since 2007 in patients with UC.Subgroup(n=957)analyses showed a switch from conventional medications to IFX in patients with CD,while 5-ASA and CS were still steadily prescribed in patients with UC.Logistic regression analyses revealed that surgical history,disease behavior,and disease location were associated with initial therapeutic strategies in patients with CD.However,medications before diagnosis,disease location,and diagnostic year might affect initial strategies in patients with UC.CONCLUSION Long-term treatment strategies analyses has provided unique insight into the switch from conventional drugs to IFX in Chinese patients with CD.
基金This study was supported by the grants from the National Natural Science Foundation of China(81930065)the Natural Science Foundation of Guangdong Province(2014A030312015)+1 种基金the Science and Technology Program of Guangdong(2019B020227002)the Science and Technology Program of Guangzhou(201904020046,201803040019,and 201704020228).
文摘There is a lack of high-quality,large-scale,real-world evidence from patients with metastatic colorectal cancer(mCRC),especially in China.It remains unclear whether efforts to improve the quality of care for mCRC would improve patient survival outcomes in real-world practice.On the basis of an intelligent bigdata platform,we established a large-scale retrospective cohort of mCRC patients.We investigated the temporal changes in the systemic and local treatment(resection,ablation,or radiation to liver,lung,or extrahepatic and/or extrapulmonary metastases)patterns of mCRC,and whether these changes were associated with improved overall survival(OS)over time.Between July 2012 and December 2018,3403 eligible patients were included in this research.The median OS was 42.8 months(95%confidence interval(CI),40.7–46.6)for the entire cohort,25.6 months(95%CI,24.7–26.9)for those treated with systemic therapy only,and not reached(95%CI,78.6 months–not reached)for those receiving local therapy.The utility rate of local therapy increased continuously from 37.9%in 2012–2014 to 46.9%in 2017–2018.A dramatic increase in the utility rate of either cetuximab or bevacizumab was observed since 2017(39.9%,43.2%,and 60.3%in 2012–2014,2015–2016,and 2017–2018,respectively).Compared with 2012–2014,the OS of the entire population significantly improved in 2015–2016(hazard ratio(HR)=0.87(95%CI,0.78–0.99);P=0.034),but not for patients receiving systemic therapy only(HR=0.99(95%CI,0.86–1.14);P=0.889),whereas an improved OS was found in 2015–2018 for both the entire population(HR=0.75(95%CI,0.70–0.81);P<0.001)and for patients receiving systemic therapy only(HR=0.83(95%CI,0.77–0.91);P<0.001).In summary,the quality of care for mCRC,as indicated by the utility rate of targeted and local therapies,has been continuously improving over time in this study cohort,which is associated with continuously improving survival outcomes for these patients.
文摘To the Editor:Endometrial cancer(EC)ranks as the second most common gynecologic malignancy in China,with rising incidence rates.[1,2]In China,the 5-year survival rate for EC patients has improved from 55.1%in 2003–2005 to 72.8%in 2012–2015.However,due to sociodemographic,clinicopathological,and treatment-related factors,this remains lower than the 81%in the United States.[3,4]EC is a complex disease with multiple risk factors,distinct histological subtypes,and a variety of available therapeutic options.However,we know very little about the real-world characteristics and treatment patterns of EC in China.[5]Therefore,this large-scale,multicenter study aimed to investigate the demographic,histopathological,and molecular features of newly diagnosed EC patients in China,as well as to provide insights into current treatment patterns.
文摘Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.
文摘AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.
基金Thailand Science Research and Innovation Fund,Unit of Excellence on Pharmacogenomic Pharmacokinetic and Pharmacotherapeutic Research,Grant/Award Numbers:FF65-RIM100,FF65-UoE012。
文摘Background:This study aimed to assess the prescribing patterns of evidencebased pharmacotherapy and their association with clinical outcomes in patients with heart failure with reduced ejection fraction(HFrEF)in Thailand.Methods:A retrospective cohort study of patients with HFrEF was conducted.Treatment with aβ-blocker and renin-angiotensin system inhibitors(RASIs)with or without mineralocorticoid receptor antagonists(MRAs)at discharge was regarded as guideline-directed medical therapy(GDMT).All others were considered non-GDMT.The primary endpoint was the composite of all-cause mortality or heart failure(HF)rehospitalization.Inverse-probabilitytreatment-weighted adjusted Cox proportional hazard models were used to examine the treatment effects.Results:In total,653 patients with HFrEF(mean age 64.1±14.3 years;55.9%male)were included.GDMT withβ-blockers and RASIs with or without MRAs was prescribed at a rate of 35.4%.During a median of 1-year follow-up,167 patients(27.5%)had a composite event,81 patients(13.3%)had all-cause mortality,and 109 patients(18.0%)had HF rehospitalization.Patients treated with GDMT at discharge showed significantly lower rates of the primary endpoint(adjusted hazard ratio[HR]0.63;95%CI 0.44-0.89;p=0.009)compared with patients who did not receive GDMT.The use of GDMT was also associated with a significantly lower risk of all-cause mortality(adjusted HR 0.59;95%CI 0.36-0.98;p=0.045)and HF rehospitalization(adjusted HR 0.65;95%CI 0.43-0.96;p=0.031).Conclusions:For HFrEF treatment,GDMT initiation at hospital discharge was associated with a significantly reduced risk of all-cause mortality and HF rehospitalization.Nevertheless,prescribing GDMT remains underused,and it could be encouraged to improve HF outcomes in real-world settings.
基金financed by the grant from major bidding project of National Social Science Foundation of China Major Historical Issues Research Project of Chinese Academy of History in 2024(No.24VLS013).
文摘The creation of a national unified textbook on acupuncture was a critical effort by China to standardize traditional Chinese medicine.In the early People’s Republic of China,the development of acupuncture textbooks followed a complex trajectory.It began with Zhu Lian’s(朱琏)Xin Zhen Jiu Xue(《新针灸学》New Acupuncture and Moxibustion),extending the Yan’an(延安)tradition,and moved to Zhen Jiu Xue(《针灸学》Acupuncture and Moxibustion,1957),a localized effort from the Jiangsu Provincial Chinese Medicine School.This culminated in the national Zhen Jiu Xue Jiang Yi(《针灸学讲义》Lectures on Acupuncture and Moxibustion).This process reflects a shift from regional teaching to a standardized national model,as well as a pedagogical transformation from a scientific approach to a return to classical sources.The textbook centers on Bian Zheng Lun Zhi(辨证论治treatment based on pattern differentiation),blending systematic,scientific,and practical elements,and represents the era’s fusion of Chinese and Western medicine,helping to shape a modern acupuncture framework.
基金funded by Chinese Medicine Research Practical Training Program of Hong Kong Hospital Authority Chinese Medicine Department(Hong Kong,China)。
文摘Objective:To further understand and compare the effectiveness of pattern differentiation treatment and fixed prescription treatment in perimenopausal syndrome.Methods:The study will be conducted in the Hong Kong Federation of Trade Unions Workers'Medical Clinics,Hong Kong Baptist University Chinese Medicine Clinic cum Training and Research Centre(Hong Kong,China).One hundred Chinese women,aged 45-55 years,will be recruited.The participants will be randomized into 2 groups.The intervention group will be administered medication,based on pattern differentiation,by qualified traditional Chinese medicine(TCM)practitioners.After each evaluation,TCM practitioners will evaluate and revise the prescription,based on the participants'patterns.The control group will be given the standard formula,i.e.,the Erxian decoction,which contains 6 herbs.The treatment period and the follow-up period will be 8 weeks each.The primary assessment outcome measure will be the Kupperman Index,and the secondary outcome measure will be the Menopause-specific Quality of Life Questionnaire score.Conclusion:Pattern-differentiated treatment is the basic principle of TCM to understand and treat diseases.The study will show the pattern-differentiated treatment is effectiveness than the fixed prescription.
基金Supported by the National Natural Science Foundation of China under Grant Nos 51175479 and 51475436the Education Department of Henan Province under Grant Nos 13A460725 and 2013GGJS-001
文摘A pseudoplastic metal nanoparticle fluid （PMNF） is used in nanoimprint to fabricate semiconductors and func- tional devices. The evaporation of the solvent and the sintering of the Au PMNF are investigated. The key parameters, which influence the morphology of patterning, such as the radius of metal particles, the concentra- tion of metal particles, the Hamaker constant of the solvent, viscosity of the fluids and the evaporation velocity, are analyzed. Based on a two-sphere sintering model, the equations are derived, which represent the relationships between the relative shrinkage and radius of the metal particles, sintering temperature and time. The optimal parameters for the heat treatment are provided in nanoimprint.
基金supported by Capital’s Funds for Health Improvement and Research (No. Z181100001718075)。
文摘Cancer immunotherapy has led to a new era of cancer treatment strategies, and transforming healthcare for cancer patients. Meanwhile, reports of immune-related adverse events have been increasing, greatly hindering the use of cancer immunotherapy. Traditional Chinese medicine(TCM), which has been widely used in Asian countries for thousands of years, is known to play a complementary role in the treatment of cancer. Taken in combined with conventional modern therapies, such as resection, ablation and radiotherapy, TCM exerts its main anti-cancer effects in two ways: health-strengthening(Fu-Zheng) and pathogen-eliminating(Qu-Xie). Theoretically, pathogen-eliminating TCM can promote the release of tumor-related antigens and should be able to increase the effect of immunotherapy, while healthstrengthening TCM may have immune-enhancing mechanisms that overlap with immunotherapy. In the era of cancer immunotherapy, it is important to balance the use of TCM and immunotherapy, with the goal of enhancing immune efficacy and antagonizing immune toxicity. In this article, we discuss this issue by considering the mechanism of tumor immunotherapy, alongside the theoretical basis of TCM treatment of tumors, with the aim of bringing new insights to future research in this field.
文摘AIM To compare features of hepatocellular carcinoma(HCC)in Hispanics to those of African Americans and Whites.METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry.Data were collected retrospectively,including demographics,comorbidities,liver disease characteristics,tumor parameters,treatment,and survival(OS)outcomes.OS analyses were performed using Kaplan-Meier method.RESULTS One hundred and ninety-five patients with HCC were identified:80.5%were male,and 22%were age 65 or older.Mean age at HCC diagnosis was 59.7±9.8 years.Sixty-one point five percent of patients had Medicare or Medicaid;4.1%were uninsured.Compared to African American(31.2%)and White(46.2%)patients,Hispanic patients(22.6%)were more likely to have diabetes(P=0.0019),hyperlipidemia(P=0.0001),nonalcoholic steatohepatitis(NASH)(P=0.0021),end stage renal disease(P=0.0057),and less likely to have hepatitis C virus(P<0.0001)or a smoking history(P<0.0001).Compared to African Americans,Hispanics were more likely to meet criteria for metabolic syndrome(P=0.0491),had higher median MELD scores(P=0.0159),ascites(P=0.008),and encephalopathy(P=0.0087).Hispanic patients with HCC had shorter OS than the other racial groups(P=0.020),despite similarities in HCC parameters and treatment.CONCLUSION In conclusion,Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH,and shorter OS than African American and White patients.
基金Supported by National Natural Science Foundation of China(No.82004133)"Three-Year Action Plan"of Shanghai Traditional Chinese Medicine Development Office of Shanghai Health Commission(No.ZY3-CCCX-3-2003)Shanghai"Science and Technology Innovation Action Plan"Medical Innovation Research Project,Shanghai Clinical Research Center of Traditional Chinese Medicine Oncology(No.21MC1930500)。
文摘Objective To describe the treatment patterns and survival status of advanced gastric cancer(AGC)in China in the past two decades,and objectively evaluate the impact of standardized Chinese medicine(CM)treatment on the survival of AGC patients.Methods This multicenter registry designed and propensity score analysis study described the diagnosis characteristics,treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1,2000 and July 31,2021.Overall survival(OS)was evaluated between non-CM cohort(standard medical treatment)and CM cohort(integrated standard CM treatment≥3 months).Propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)were performed to adjust any difference in average outcomes for bias.Results A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled.Among them,1,607 received systemic chemotherapy,215(10.74%)accepted molecular targeted therapy,44(2.2%)received checkpoint inhibitor therapy,and 769(38.43%)received CM.Two-drug regimen was the main choice for first-line treatment,with fluoropyrimidine plus platinum as the most common regimen(530 cases,60.09%).While 45.71%(16 cases)of patients with HER2 amplification received trastuzumab in first-line.The application of apatinib increased(33.33%)in third-line.The application of checkpoint inhibitors has increased since 2020.COX analysis showed that Lauren mixed type(P=0.017),cycles of first-line treatment>6(P=0.000),CM(P=0.000),palliative gastrectomy(P=0.000),trastuzumab(P=0.011),and apatinib(P=0.008)were independent prognostic factors for the OS of AGC.After PSM and IPTW,the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months,respectively(P<0.001).Conclusions In real-world practice for AGC in China,therapy choices consisted with guidelines.Two-drug regimen was the main first-line choice.Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC.(Registration No.NCT02781285)
