Introduction:
Spleen Deficiency Syndrome (SDS) is recognized as one of the most common Traditional Chinse Medicine (TCM) syndromes in patients with colorectal cancer (CRC). However so far there is no ...existing patient-reported outcome (PRO) to evaluate SDS. Our study aimed to develop and validate a PRO TCM-SDS scale for CRC in China.
Methods:
We developed an initial 8-item TCM-SDS scale for CRC based on literature review and consultation with experts. We then pilot tested the scale (n = 40) and performed item revision. We conducted a survey study among CRC patients from oncology clinics at a TCM Hospital to further determine the reliability and validity of the scale.
Results:
Among 100 patients finally enrolled and analyzed in the survey study, 46% were female with median age of 60 years old, 77% had left side tumors and 23% had stage IV disease. Factor loading indicated that there were three domains within TCM-SDS scale. The final TCM-SDS scale involves 5 items including “I feel loss of appetite,” “I feel abdomen fullness,” “I feel my arms and legs lack strength,” “I feel short of breath when talking,” and “My stool is formless” (Cronbach’s alpha coefficient 0.76). We calculated the total score of the scale by summing the 5 individual items and normalizing them to a value maximum of 10, with higher scores indicating greater burden of spleen deficiency syndrome. The average spleen deficiency score for all patients was 3.55 ± 1.54. Among them, those who had stage IV disease had higher scores than stage I-III patients (4.30 vs 3.38, P = .015). Test-retest reliability after 2 weeks showed Pearson coefficient of 0.67 and all items were highly related (P < .001). Compared with healthy controls, CRC patients had significantly higher spleen deficiency scores (3.55 vs 3.23, P = .045).
Conclusion:
The patient-reported TCM-SDS scale for CRC showed adequate initial reliability and validity. The development of the scale provided an outcome measurement tool, which could facilitate future studies to better evaluate the role of TCM in treating CRC.
Abstract Background The measurement of quality-adjusted life-years (QALYs) forms a key component of cost–utility evaluation in cancer intervention; however, detailed data for utility weights by ...cancer type and health status are still scarce both in China and other regions. The aim of this study was to systematically evaluate utility scores in relation to the most common six cancers in China in 2012 (lung, breast, colorectal, oesophageal, liver, and stomach cancer). Methods As a part of a Screening Program in Urban China (CanSPUC) supported by the central government of China, we undertook a cross-sectional survey in 13 provinces across China from 2013 to 2014. Two generic instruments, EQ-5D (EuroQol 5-dimensions) and SF-12 (12-item Short Form Health Survey), and a cancer-specific instrument, FACTs (Function Assessment of Cancer Therapy) were applied. 46 394 participants were interviewed in five groups: general population (n=11 699, group A), individuals who had attended single cancer screening (n=11 805, group B), individuals who had attended multiple screenings (n=6838, group C), patients with precancerous lesions (n=1942, group D), and patients with cancer (n=14 110, group E). All participants had no psychosis and provided written consent to participate in the study. The survey was approved by the Institutional Review Board of the Cancer Hospital of Chinese Academy of Medical Sciences. Findings The EQ-5D utility scores were 0·96 (95% CI 0·96–0·96) for group A, 0·94 (0·94–0·94) for group B, 0·94 (0·94–0·94) for group C, 0·85 (0·84–0·86) for group D, and 0·77 (0·77–0·77) for group E. Cancer-specific analysis showed that EQ-5D utility scores were 0·77 (0·76–0·78) for lung cancer, 0·78 (0·77–0·79) for breast cancer, 0·75 (0·74–0·76) for colorectal cancer, 0·75 (0·74–0·76) for oesophageal cancer, 0·80 (0·79–0·81) for liver cancer, and 0·76 (0·75–0·77) for stomach cancer. The utility scores for cancer at different clinical stages also differed; for example, the scores for patients with breast cancer were estimated as 0·79 (0·77–0·80) at stage I, 0·79 (0·78–0·80) at stage II, 0·77 (0·76–0·79) at stage III, and 0·69 (0·65–0·72) at stage IV. Compared with data from EQ-5D, results from SF-12 on differences among subgroups seemed narrower; for example, the utility score among the six cancers ranged from 0·60 to 0·62. Interpretation These data will be applied to future cost–utility evaluation on various cancer screening strategies in China, and could contribute more precise evaluation of burden of disease related to disability-adjusted life-years globally. Funding The National Health and Family Plan Committee of China.
Abstract Background Comprehensive health economic evaluation, a key component of the Cancer Screening Program in Urban China (CanSPUC), was expected to support government policy-making on screening ...initiatives for common cancers (lung, breast, colorectal, oesophageal, liver, and stomach cancer) in urban China. Estimation of expenditure for cancer diagnosis and treatment from a societal perspective was an essential component. The aim of this study was to estimate direct medical and non-medical expenditure and to discern the resultant financial burden. Methods A multicentre cross-sectional survey of patients with target cancers or precancerous lesions was conducted in 37 tertiary hospitals in 13 provinces across China, from 2012 to 2014. Each patient was interviewed with a structured questionnaire for sociodemographic, clinical, and expenditure information. Expenditure data was converted to 2014 values and presented as US$. Expenditure and financial burden were quantified as a whole and by subgroups. Findings Of the included 14 594 patients with cancer (mean age 56·7 years, 58% male), annual household income was $8607. Mean expenditure per patient was $9739 (95% CI 9612–9866), and non-medical expenditure accounted for 9·3%. Expenditure per patient with colorectal, oesophageal, lung, stomach, liver or breast cancer was $10 978 (10 636–11 321), $10 506 (10 199–10 813), $9970 (9664–10 276), $9891 (9606–10 176), $8668 (8358–8977) and $8532 (8234–8831), respectively. Expenditure increased from stage I to stage IV for colorectal, stomach, and breast cancer (p<0·0001). Out-of-pocket expenditure of newly diagnosed cancer (2 months before and 10 months after diagnosis) per cancer patient was $4947 (4875–5020), accounting for 57·5% of annual household income, presenting 77·6% of families with an unmanageable financial burden. Apart from cancer site and stage, hospital type, education, occupation, insurance type, and previous years' household income were also significant predictors of expenditure (F=247·9, 56·3, 29·7, 12·8, and 28·7, respectively; all p<0·0001) as well as self-reported financial burden (χ2 =130·4, 495·1, 1112·2, 1009·4, and 1848·2, respectively; all p<0·0001). In addition, for the included 1532 precancerous patients, mean expenditure was $3221 (3055–3387), a third of expenditure for patients with cancer. Interpretation Expenditure for diagnosis and treatment seemed catastrophic for patients with cancer in China, and non-medical expenditure was substantial. Expenditure and financial burden varied within subgroups, especially between patients with different degrees of lesions, suggesting that cancer screening might be cost-effective in China. Funding National Health and Family Plan Committee of China.
Abstract Background Pathogenesis and diagnostic biomarkers for diseases can be discovered by metabolomic profiling of human fluids. If the various types of coronary artery disease (CAD) can be ...accurately characterized by metabolomics, effective treatment may be targeted without using unnecessary therapies and resources. Objectives The authors studied disturbed metabolic pathways to assess the diagnostic value of metabolomics-based biomarkers in different types of CAD. Methods A cohort of 2,324 patients from 4 independent centers was studied. Patients underwent coronary angiography for suspected CAD. Groups were divided as follows: normal coronary artery (NCA), nonobstructive coronary atherosclerosis (NOCA), stable angina (SA), unstable angina (UA), and acute myocardial infarction (AMI). Plasma metabolomic profiles were determined by liquid chromatography–quadrupole time-of-flight mass spectrometry and were analyzed by multivariate statistics. Results We made 12 cross-comparisons to and within CAD to characterize metabolic disturbances. We focused on comparisons of NOCA versus NCA, SA versus NOCA, UA versus SA, and AMI versus UA. Other comparisons were made, including SA versus NCA, UA versus NCA, AMI versus NCA, UA versus NOCA, AMI versus NOCA, AMI versus SA, significant CAD (SA/UA/AMI) versus nonsignificant CAD (NCA/NOCA), and acute coronary syndrome (UA/AMI) versus SA. A total of 89 differential metabolites were identified. The altered metabolic pathways included reduced phospholipid catabolism, increased amino acid metabolism, increased short-chain acylcarnitines, decrease in tricarboxylic acid cycle, and less biosynthesis of primary bile acid. For differential diagnosis, 12 panels of specific metabolomics-based biomarkers provided areas under the curve of 0.938 to 0.996 in the discovery phase (n = 1,086), predictive values of 89.2% to 96.0% in the test phase (n = 933), and 85.3% to 96.4% in the 3-center external sets (n = 305). Conclusions Plasma metabolomics are powerful for characterizing metabolic disturbances. Differences in small-molecule metabolites may reflect underlying CAD and serve as biomarkers for CAD progression.
Summary Background On the basis of the results of the randomised clinical trial HPTN 052 and observational studies, WHO has recommended that antiretroviral therapy be offered to all HIV-infected ...individuals with uninfected partners of the opposite sex (serodiscordant couples) to reduce the risk of transmission. Whether or not such a public health approach is feasible and the outcomes are sustainable at a large scale and in a developing country setting has not previously been assessed. Methods In this retrospective observational cohort study, we included treated and treatment-naive HIV-positive individuals with HIV-negative partners of the opposite sex who had been added to the national HIV epidemiology and treatment databases between Jan 1, 2003 and Dec 31, 2011. We analysed the annual rate of HIV infection in HIV-negative partners during follow-up, stratified by treatment status of the index partner. Cox proportional hazards analyses were done to examine factors related to HIV transmission. Findings Based on data from 38 862 serodiscordant couples, with 101 295·1 person-years of follow-up for the seronegative partners, rates of HIV infection were 2·6 per 100 person-years (95% CI 2·4–2·8) among the 14 805 couples in the treatment-naive cohort (median baseline CD4 count for HIV-positive partners 441 cells per μl IQR 314–590) and 1·3 per 100 person-years (1·2–1·3) among the 24 057 couples in the treated cohort (median baseline CD4 count for HIV-positive partners 168 cells per μl 62–269). We calculated a 26% relative reduction in HIV transmission (adjusted hazard ratio 0·74, 95% CI 0·65–0·84) in the treated cohort. The reduction in transmission was seen across almost all demographic subgroups and was significant in the first year (0·64, 0·54–0·76), and among couples in which the HIV-positive partner had been infected by blood or plasma transfusion (0·76, 0·59–0·99) or heterosexual intercourse (0·69, 0·56–0·84), but not among couples in which the HIV-positive partner was infected by injecting drugs (0·98, 0·71–1·36). Interpretation Antiretroviral therapy for HIV-positive individuals in serodiscordant couples reduced HIV transmission across China, which suggests that the treatment-as-prevention approach is a feasible public health prevention strategy on a national scale in a developing country context. The durability and generalisability of such protection, however, needs to be further studied. Funding Chinese Government's 12th Five-Year Plan, the National Natural Science Foundation of China, and the Canadian International Development Research Centre.
This paper presents the three market principles and the electricity value equivalent (EVE) pricing method. The developed electricity market pricing methodology have solved the three great difficult ...market problems in the world. We have also researched the market character of EVE pricing methods using analysis method and the intelligent agent-based method, taking into account the bidding action (Bertrand game) and the withholding capacity action (Cournot game) of participants and comparing with the uniform cleaning pricing (UCP) and pay as bid (PAB) pricing. Besides the market efficiency and the capacity adequate return, the results show that the EVE pricing method can induce the power suppliers bidding according to their true operation cost and without capacity withholding. This is an invaluable, market character. We call it market 'inductivity' which is different from reliability, stability and robustness etc. As we know that there are no such properties for any other pricing methods.
Ultrasound is a critical non-invasive test for preoperative diagnosis of ovarian cancer. Deep learning is making advances in image-recognition tasks; therefore, we aimed to develop a deep ...convolutional neural network (DCNN) model that automates evaluation of ultrasound images and to facilitate a more accurate diagnosis of ovarian cancer than existing methods.
In this retrospective, multicentre, diagnostic study, we collected pelvic ultrasound images from ten hospitals across China between September 2003, and May 2019. We included consecutive adult patients (aged ≥18 years) with adnexal lesions in ultrasonography and healthy controls and excluded duplicated cases and patients without adnexa or pathological diagnosis. For DCNN model development, patients were assigned to the training dataset (34 488 images of 3755 patients with ovarian cancer, 541 442 images of 101 777 controls). For model validation, patients were assigned to the internal validation dataset (3031 images of 266 patients with ovarian cancer, 5385 images of 602 with benign adnexal lesions), external validation datasets 1 (486 images of 67 with ovarian cancer, 933 images of 268 with benign adnexal lesions), and 2 (1253 images of 166 with ovarian cancer, 5257 images of 723 benign adnexal lesions). Using these datasets, we assessed the diagnostic value of DCNN, compared DCNN with 35 radiologists, and explored whether DCNN could augment the diagnostic accuracy of six radiologists. Pathological diagnosis was the reference standard.
For DCNN to detect ovarian cancer, AUC was 0·911 (95% CI 0·886–0·936) in the internal dataset, 0·870 (95% CI 0·822–0·918) in external validation dataset 1, and 0·831 (95% CI 0·793–0·869) in external validation dataset 2. The DCNN model was more accurate than radiologists at detecting ovarian cancer in the internal dataset (88·8% vs 85·7%) and external validation dataset 1 (86·9% vs 81·1%). Accuracy and sensitivity of diagnosis increased more after DCNN-assisted diagnosis than assessment by radiologists alone (87·6% 85·0–90·2 vs 78·3% 72·1–84·5, p<0·0001; 82·7% 78·5–86·9 vs 70·4% 59·1–81·7, p<0·0001). The average accuracy of DCNN-assisted evaluations for six radiologists reached 0·876 and were significantly augmented when they were DCNN-assisted (p<0·05).
The performance of DCNN-enabled ultrasound exceeded the average diagnostic level of radiologists matched the level of expert ultrasound image readers, and augmented radiologists’ accuracy. However, these observations warrant further investigations in prospective studies or randomised clinical trials.
National Key Basic Research Program of China, National Sci-Tech Support Projects, and National Natural Science Foundation of China.
Aims/Introduction
The cardiovascular (CV) outcomes of vildagliptin – a dipeptidyl peptidase‐4 inhibitor – in patients with type 2 diabetes mellitus after acute coronary syndrome or acute ischemic ...stroke are unclear.
Materials and Methods
We analyzed data from the Taiwan National Health Insurance Research Database on 3,750 type 2 diabetes mellitus patients with acute coronary syndrome or acute ischemic stroke within 3 months between 1 August 2011 and 31 December 2013. Clinical outcomes were evaluated by comparing 1,250 participants receiving vildagliptin with 2,500 propensity score‐matched participants. The primary composite outcome included CV death, non‐fatal myocardial infarction and non‐fatal stroke.
Results
The primary composite outcome occurred in 122 patients (9.8%) in the vildagliptin group and 263 patients (10.5%) in the control group (hazard ratio HR 0.90, 95% confidence interval CI 0.72–1.11) with a mean follow‐up period of 9.9 months. No significant between‐group differences were observed for CV death (HR 0.93, 95% CI 0.56–1.52), non‐fatal myocardial infarction (HR 0.79, 95% CI 0.46–1.36) and non‐fatal stroke (HR 0.96, 95% CI 0.74–1.24). The vildagliptin group was at similar risks of hospitalization for heart failure (HF) or coronary intervention to the control group (P = 0.312 and 0.430, respectively). For patients with HF at baseline, the risk of hospitalization for HF was similar between the vildagliptin and control groups (HR 1.04, 95% CI 0.57–1.88).
Conclusions
Among patients with type 2 diabetes mellitus after a recent acute coronary syndrome or acute ischemic stroke, treatment with vildagliptin was not associated with increased risks of CV death, non‐fatal myocardial infarction, non‐fatal stroke and hospitalization for HF.
Among patients with type 2 diabetes mellitus after a recent acute coronary syndrome or acute ischemic stroke, treatment with vildagliptin was not associated with increased risks of cardiovascular death, non‐fatal myocardial infarction, non‐fatal stroke and hospitalization for heart failure.
Evidence regarding the safety and feasibility of transcatheter aortic valve implantation without balloon predilation (BP) is scarce. A literature search of PubMed, EMBASE, CENTRAL, and major ...conference proceedings was performed from January 2002 to July 2015. There were 18 studies incorporating 2,443 patients included in the present study. No differences were observed in the baseline characteristics between patients without BP (no-BP) and with BP. Compared with BP, no-BP had a shorter procedure time (no-BP vs BP, 124.2 vs 138.8 minutes, p = 0.008), used less-contrast medium (no-BP vs BP, 126.3 vs 156.3 ml, p = 0.0005) and had a higher success rate (odds ratio OR 2.24, 95% CI 1.40 to −3.58). In addition, no-BP was associated with lower incidences of permanent pacemaker implantation (OR 0.45, 95% CI 0.3 to 0.67), grade 2 or greater paravalvular leakage (OR 0.55, 95% CI 0.37 to 0.83), and stroke (OR 0.57, 95% CI 0.32 to 1.0). Furthermore, no-BP was associated with a 0.6-fold decreased risk for 30-day all-cause mortality (OR 0.60, 95% CI 0.39 to 0.92). However, the difference in the risk for permanent pacemaker implantation, grade 2, or higher aortic regurgitation, stroke was noted to be significant only in the subgroup of the CoreValve-dominating studies. In conclusion, no-BP before transcatheter aortic valve implantation was not only safe and feasible but was also associated with fewer complications and short-term mortality in selected patients especially using self-expandable valve.
Background: Currently, the prevalence of nontuberculous mycobacteria (NTM) strains isolated from mycobacterial cultures has been well characterized. However, the data on the prevalence of ...tuberculosis (TB) in patients with NTM disease remain unclear. Methods: Between January 2012 and August 2020, consecutive patients with positive mycobacterial cultures were included for analysis. The identification of Mycobacteria spp. was performed using the DNA array method or sequencing of 16S rDNA. NTM disease is diagnosed when the same infectious agent is identified in at least two sputum or is identified in sterile samples. Results: A total of 997 strains were isolated from 828 inpatients. Of them, 261 inpatients (31.5%) were diagnosed as NTM disease. The mean age of the 261 patients was 55.7 + or -15.5 years old and 64.0% (n = 167) of them were male. The prevalence of culture-confirmed TB patients among patients with NTM disease was estimated as 8.0% (21/261). Conclusion: TB is common in NTM disease and caution should be taken when initiating the treatment of NTM disease. Keywords: prevalence, tuberculosis, culture, nontuberculous mycobacteria, diagnosis
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