BACKGROUND The diagnostic and economic value of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and CA72-4 for gastrointestinal malignant tumors lacked evaluation in a larger scale.AIM To reassess the d...BACKGROUND The diagnostic and economic value of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and CA72-4 for gastrointestinal malignant tumors lacked evaluation in a larger scale.AIM To reassess the diagnostic and economic value of the three tumor biomarkers.METHODS A retrospective analysis of all 32857 subjects who underwent CEA,CA19-9,CA72-4,gastroscopy and colonoscopy from October 2006 to May 2018 was conducted.Then,we assessed the discrimination and clinical usefulness.Total cost,cost per capita and cost-effectiveness ratios were used to evaluate the economic value of two schemes(gastrointestinal endoscopy for all people without blood tests vs both gastroscopy and colonoscopy when blood tests were positive).RESULTS The analysis of 32857 subjects showed that CEA was a qualified biomarker for colorectal cancer(CRC),while the diagnostic efficiencies of CA72-4 were catastrophic for all gastrointestinal cancers(GICs).Regarding early diagnosis,only CEA could be used for early CRC.The combination of biomarkers didn’t greatly increase the area under the curve.The economic indicators of CEA were superior to those of CA19-9,CA72-4 and any combination.At the threshold of 1.8μg/L to 10.4μg/L,all four indicators of CEA were lower than those in the scheme that conducted gastrointestinal endoscopy only.Subgroup analysis implied that the health checkup of CEA for people above 65 years old was economically valuable.CONCLUSION CEA had qualified diagnostic value for CRC and superior economic value for GICs,especially for elderly health checkup subjects.CA72-4 was not suitable as a diagnostic biomarker.展开更多
Background Antibiotics,a common strategy used for neonatal infection,show consistent effect on the gut microbiota of neonates.Supplementation with probiotics has become increasingly popular in mitigating the loss of t...Background Antibiotics,a common strategy used for neonatal infection,show consistent effect on the gut microbiota of neonates.Supplementation with probiotics has become increasingly popular in mitigating the loss of the gut microbiota.However,no clear consensus recommending the use of probiotics in the infection of neonates currently exists.This study examined the effects of probiotics on the gut microbiota of infectious neonates when used concurrently with or during the recovery period following antibiotic therapy.Methods Fifty-five full-term neonates diagnosed with neonatal infections were divided into the following groups:NI(no intervention,antibiotic therapy only),PCA(probiotics used concurrently with antibiotics),and PAA(probiotics used after antibiotics).The NI group received antibiotic treatment(piperacillin–tazobactam)for 1 week and the PCA group received antibiotic treatment together with probiotics(Bifidobacterium longum,Lactobacillus acidophilus,and Enterococcus faecalis)for 1 week.The PAA group received antibiotic treatment for 1 week followed by probiotics for 1 week.Fecal samples were collected at four time nodes:newborn,1 week,2 weeks,and 42 days after birth.The composition of the gut microbiota was determined by the high-throughput sequencing of 16S rRNA amplicons.Results Antibiotic exposure was found to dramatically alter gut microbiota,with a significant decrease of Bifidobacterium and Lactobacillus.The use of probiotics did not restore the overall diversity of the gut microbiota.However,using probiotics simultaneously with the antibiotics was found to be beneficial for the gut microbiota as compared to delaying the use of probiotics to follow treatment with antibiotics,particularly in promoting the abundance of Bifidobacterium.Conclusions These results suggest that the early use of probiotics may have a potential ability to remodel the gut microbiota during recovery from antibiotic treatment.However,further study is required to fully understand the long-term effects including the clinical benefits.展开更多
基金The study was reviewed and approved by the Zhongshan Hospital of Fudan University Institutional Review Board(Approval No.B2018-234).
文摘BACKGROUND The diagnostic and economic value of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and CA72-4 for gastrointestinal malignant tumors lacked evaluation in a larger scale.AIM To reassess the diagnostic and economic value of the three tumor biomarkers.METHODS A retrospective analysis of all 32857 subjects who underwent CEA,CA19-9,CA72-4,gastroscopy and colonoscopy from October 2006 to May 2018 was conducted.Then,we assessed the discrimination and clinical usefulness.Total cost,cost per capita and cost-effectiveness ratios were used to evaluate the economic value of two schemes(gastrointestinal endoscopy for all people without blood tests vs both gastroscopy and colonoscopy when blood tests were positive).RESULTS The analysis of 32857 subjects showed that CEA was a qualified biomarker for colorectal cancer(CRC),while the diagnostic efficiencies of CA72-4 were catastrophic for all gastrointestinal cancers(GICs).Regarding early diagnosis,only CEA could be used for early CRC.The combination of biomarkers didn’t greatly increase the area under the curve.The economic indicators of CEA were superior to those of CA19-9,CA72-4 and any combination.At the threshold of 1.8μg/L to 10.4μg/L,all four indicators of CEA were lower than those in the scheme that conducted gastrointestinal endoscopy only.Subgroup analysis implied that the health checkup of CEA for people above 65 years old was economically valuable.CONCLUSION CEA had qualified diagnostic value for CRC and superior economic value for GICs,especially for elderly health checkup subjects.CA72-4 was not suitable as a diagnostic biomarker.
基金This work was supported by grants from the National Natural Science Foundation of China(Nos.81230057,81200264,81372615,and 81472262)the Emerging Cutting-Edge Technology Joint Research Projects of Shanghai(No.SHDC12012106)the Tongji University Subject Pilot Program(No.162385).
文摘Background Antibiotics,a common strategy used for neonatal infection,show consistent effect on the gut microbiota of neonates.Supplementation with probiotics has become increasingly popular in mitigating the loss of the gut microbiota.However,no clear consensus recommending the use of probiotics in the infection of neonates currently exists.This study examined the effects of probiotics on the gut microbiota of infectious neonates when used concurrently with or during the recovery period following antibiotic therapy.Methods Fifty-five full-term neonates diagnosed with neonatal infections were divided into the following groups:NI(no intervention,antibiotic therapy only),PCA(probiotics used concurrently with antibiotics),and PAA(probiotics used after antibiotics).The NI group received antibiotic treatment(piperacillin–tazobactam)for 1 week and the PCA group received antibiotic treatment together with probiotics(Bifidobacterium longum,Lactobacillus acidophilus,and Enterococcus faecalis)for 1 week.The PAA group received antibiotic treatment for 1 week followed by probiotics for 1 week.Fecal samples were collected at four time nodes:newborn,1 week,2 weeks,and 42 days after birth.The composition of the gut microbiota was determined by the high-throughput sequencing of 16S rRNA amplicons.Results Antibiotic exposure was found to dramatically alter gut microbiota,with a significant decrease of Bifidobacterium and Lactobacillus.The use of probiotics did not restore the overall diversity of the gut microbiota.However,using probiotics simultaneously with the antibiotics was found to be beneficial for the gut microbiota as compared to delaying the use of probiotics to follow treatment with antibiotics,particularly in promoting the abundance of Bifidobacterium.Conclusions These results suggest that the early use of probiotics may have a potential ability to remodel the gut microbiota during recovery from antibiotic treatment.However,further study is required to fully understand the long-term effects including the clinical benefits.
