Research on Retrospective Studies of Real-World Study and Its Selection Bias

Objective To provide references for improving the authenticity and reliability of the retrospective study results,thus improving the quality of evidence in the real world and strengthening drug supervision and decision-making.Methods Literature review was used to study the data sources,the characteristics of retrospective research,the sources and the corrections of selective bias in the real world.Results and Conclusion The biases in retrospective study mainly come from admission rate bias,patient rate bias,survivors bias,health user bias and symptom bias.

Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Comparison of QT Correction Methods in the Pediatric Population of a Community Hospital: A Retrospective Study

Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia:A multicenter retrospective study

BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.

Deliberate self-harm among pediatric psychiatric inpatients in China:A single-center retrospective study

BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.

Quantifying the natural growth rate of hepatocellular carcinoma:A real-world retrospective study in southwestern China

BACKGROUND In recent years,approximately half of the newly diagnosed cases and mortalities attributed to hepatocellular carcinoma(HCC)have been reported in China.Despite the high incidence of HCC,there remains a paucity of data regarding the natural growth pattern and the determination of optimal surveillance intervals specific to the Chinese population.AIM To quantify the natural tumor growth pattern of HCC in regional China.METHODS A retrospective analysis was performed on patients from a single institution in Southwest China who had undergone two or more serial dynamic computed tomography or magnetic resonance imaging scans between 2014 and 2020,without having received any anti-cancer therapy.Tumor growth was assessed using tumor volume doubling time(TVDT)and tumor growth rate(TGR),with volumes measured manually by experienced radiologists.Simple univariate linear regression and descriptive analysis were applied to explore associations between growth rates and clinical factors.RESULTS This study identifies the median TVDT for HCC as 163.4 d,interquartile range(IQR)72.1 to 302.3 d,with a daily TGR of 0.42%(IQR 0.206%-0.97%).HCC growth patterns reveal that about one-third of tumors grow indolently with TVDT exceeding 270 d,another one-third of tumors exhibit rapid growth with TVDT under 90 d,and the remaining tumors show intermediate growth rates,with TVDT ranging between 3 to 9 months.CONCLUSION The identified TGRs support biannual surveillance and follow-up for HCC patients in certain regions of China.Given the observed heterogeneity in HCC growth,further investigation is warranted.

Correlation between immune-related adverse events and long-term outcomes in pembrolizumab-treated patients with unresectable hepatocellular carcinoma:A retrospective study

BACKGROUND Although immune checkpoint inhibitor(ICI)therapy has improved the prognosis of unresectable hepatocellular carcinoma(HCC),it has also resulted in unique immune-related adverse events(irAEs).The relationship between irAE and treatment outcomes in ICI-treated unresectable HCC patients remains unknown.AIM To elucidate the correlation between immune-related toxic effects and prognosis in patients with unresectable HCC treated with pembrolizumab.METHODS From March 2019 to February 2021,a total of 190 unresectable HCC(Barcelona Clinic Liver Cancer C)patients receiving pembrolizumab treatment were retrospectively reviewed.Overall survival(OS)was the primary endpoint,while objective response rate(ORR),disease control rate(DCR),and time to progression(TTP)were secondary evaluation indexes.We assessed demographics,irAEs,and outcomes by retrospective review.RESULTS One hundred and forty-three males and 47 females were included in the study.The ORR and DCR were 12.1%(23/190)and 52.1%(99/190),respectively.The median OS was 376 d[95%confidence interval(CI):340-411 d]and the median TTP was 98 d(95%CI:75-124 d).The overall incidence of treatment-related adverse events was 72.6%(138/190)and 10.0%of them were severe irAEs(grade≥3).Child-Pugh B class,portal vein tumor thrombus,extrahepatic metastasis,and hypothyroidism were the independent risk factors for survival.Patients with hypothyroidism showed a longer OS[517 d(95%CI:423-562)vs 431 d(95%CI:412-485),P=0.011]and TTP[125 d(95%CI:89-154)vs 87 d(95%CI:61-98),P=0.004]than those without irAEs.CONCLUSION Pembrolizumab-treated patients with unresectable HCC who experienced hypothyroidism have promising ORR and durable response.Hypothyroidism,an irAE,may be used as a clinical evaluation parameter of response to ICIs in unresectable HCC.

Role of pre-existing incomplete intestinal metaplasia in gastric adenocarcinoma:A retrospective case series analysis

BACKGROUND Risk stratification for patients with gastric precancerous lesions for endoscopic surveillance remains controversial.AIM To analysis of patients having developed gastric adenocarcinoma during the period of follow-up.METHODS We conducted a retrospective study on patients having undergone upper endoscopy prior to the development of gastric adenocarcinoma. The presence and stage of precancerous lesions as well as subtype of intestinal metaplasia at the baseline endoscopy got evaluated. Literature mini-review was performed.RESULTS Out of 1681 subjects in the Biobank, gastric adenocarcinoma was detected in five cases in whom previous endoscopy data with biopsies either from the corpus or antral part were available. All of the patients had incomplete intestinal metaplasia during the baseline endoscopy;all three subjects in whom intestinal metaplasia subtyping was performed according to Filipe et al, had Type Ⅲ intestinal metaplasia. Two of the five cases had low Operative Link on Gastritis Assessment(OLGA) and Operative Link on Gastritis Intestinal Metaplasia Assessment(OLGIM) stages(Ⅰ-Ⅱ) at the baseline.CONCLUSION The presence of incomplete intestinal metaplasia, in particular, that of Type Ⅲ is a better predictor for gastric adenocarcinoma development than OLGA/OLGIM staging system. Subtyping of intestinal metaplasia have an important role in the risk stratification for surveillance decisions.

Liver disease epidemiology and burden in patients with alterations in plasma protein metabolism:German retrospective insurance claims analysis

BACKGROUND Alpha-1 antitrypsin deficiency is a rare genetic disease and a leading cause of inherited alterations in plasma protein metabolism(APPM).AIM To understand the prevalence,burden and progression of liver disease in patients with APPM including alpha-1 antitrypsin deficiency.METHODS We conducted a retrospective analysis of anonymized patient-level claims data from a German health insurance provider(AOK PLUS).The APPM cohort comprised patients with APPM(identified using the German Modification of the International Classification of Diseases-10th Revision[ICD-10-GM]code E88.0 between 01/01/2010-30/09/2020)and incident liver disease(ICD-10-GM codes K74,K70.2-3 and K71.7 between 01/01/2012-30/09/2020).The control cohort comprised patients without APPM but with incident liver disease.Outcomes were incidence/prevalence of liver disease in patients with APPM,demographics/baseline characteristics,diagnostic procedures,progression-free survival(PFS),disease progression and mortality.RESULTS Overall,2680 and 26299 patients were included in the APPM(fibrosis,96;cirrhosis,2584)and control(fibrosis,1444;cirrhosis,24855)cohorts,respectively.Per 100000 individuals,annual incidence and prevalence of APPM and liver disease was 10-15 and 36-51,respectively.In the APPM cohort,median survival was 4.7 years[95%confidence interval(CI):3.5-7.0]and 2.5 years(95%CI:2.3-2.8)in patients with fibrosis and cirrhosis,respectively.A higher proportion of patients in the APPM cohort experienced disease progression(92.0%)compared with the control cohort(67.2%).Median PFS was shorter in the APPM cohort(0.9 years,95%CI:0.7-1.1)compared with the control cohort(3.7 years,95%CI:3.6-3.8;P<0.001).Patients with cirrhosis in the control cohort had longer event-free survival for ascites,hepatic encephalopathy,hepatic failure and esophageal/gastric varices than patients with cirrhosis in the APPM cohort(P<0.001).Patients with fibrosis in the control cohort had longer event-free survival for ascites,cirrhosis,hepatic failure and esophageal/gastric varices than patients with fibrosis in the APPM cohort(P<0.001).In the APPM cohort,the most common diagnostic procedures within 12 mo after the first diagnosis of liver disease were imaging procedures(66.3%)and laboratory tests(51.0%).CONCLUSION Among patients with liver disease,those with APPM experience substantial burden and earlier liver disease progression than patients without APPM.

Five-year outcomes of immediate implant placement for mandibular molars with and without chronic apical periodontitis:A retrospective study

BACKGROUND Most physicians consider molars with chronic apical periodontitis(CAP)lesions as contraindications for immediate implant placement.At the patient’s request,we perform immediate implant placement of the mandibular molars with CAP in clinical practice.AIM To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.METHODS The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery,the Affiliated Hospital of Qingdao University,from June 2015 to June 2017 were collected.The patients were divided into CAP(n=52)and no-CAP(n=45)groups.Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.RESULTS At 5 years after implantation,the peri-implant bone mineral density was 528.2±78.8 Hounsfield unit(HU)in the CAP group and 562.6±82.9 HU in the no-CAP group(P=0.126).Marginal bone resorption around implants did not differ significantly between the two groups,including buccal(P=0.268)or lingual(P=0.526)resorption in the vertical direction or buccal(P=0.428)or lingual(P=0.560)resorption in the horizontal direction.Changes in the peri-implant jump space did not differ significantly between the two groups,including the buccal(P=0.247)or lingual(P=0.604)space in the vertical direction or buccal(P=0.527)or lingual(P=0.707)space in the horizontal direction.The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density.In the CAP area,the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue(P<0.01).CONCLUSION The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results,without significant differences in the complications,survival rate,or bone tissue condition from the no-CAP mandibular molars.

A retrospective study on professor Gui-Qi Xuan’s experience in traditional Chinese medicine treatment on attention-deficit hyperactivity disorder: based on data mining and network pharmacology

Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core herbal prescription.Methods:Following medical record information pretreatment,the Traditional Chinese Medicine(TCM)inheritance computing platform system V3.0 was utilized to analyze the standardized data.The associate rules were summarized to identify the core prescription for treating ADHD.The extracted core herbal prescription’s active compounds and potential targets were used to establish a protein-protein interaction network of active ingredient-disease targets.Cytoscape 3.9.1 software was used to analyze the network’s topological parameters to obtain the key active ingredients and their targets.The Bioconductor data package of R4.0.2 was used to analyze the gene ontology biological functions and Kyoto Encyclopedia of Genes and Genomes pathways of key targets.Results:Two hundred and twenty-seven entries derived from TCM record information were selected.Through data mining,it was found that 62.5%of pediatric patients had short-tempered behavior,nearly half had sleep problems,and 30%-40%had picky eating and polyphagia issues.The highest-frequency syndrome type was kidney deficiency and liver hyperactivity.Deficiency,fire,phlegm,and dyspeptic food were the main pathological factors for ADHD.Prof.Xuan’s treatment of ADHD mainly focused on replenishing kidney essence and subduing Yang(active,external,ascending,warm,bright,functional and excited pertain to Yang).The core herbal prescription for ADHD included Yuan-zhi,Yi-zhi,Gui-jia,Bai-shao,Long-chi,Ci-shi,Shi-chang-pu,Yu-jin,Fu-shen,and Huang-jing.The protein-protein interaction network showed that MAOA,ADRB2,FOS,MAOB,and SLC6A3 were the five key targets essential in treating ADHD with core herbal prescriptions.The gene ontology biological function of crucial targets mainly involved G protein-coupled amine receptor activity,catecholamine binding,and neurotransmitter transmembrane transporter activity.Analysis of Kyoto Encyclopedia of Genes and Genomes pathways showed that the dopaminergic synapse signaling and neuroactive ligand-receptor interaction pathways were significantly enriched and may be the primary routes for the main treatment of ADHD.Conclusion:Prof.Xuan’s treatment of ADHD has achieved satisfactory clinical effects by supplementing the kidney,replenishing the essence,opening the orifices,nourishing the Yin(static,internal,descending,cold,dim,organic,depressed and pertain to Yin),and subduing the Yang.The major prescription predominantly affects catecholamine binding,neuroactive ligand-receptor interaction,G protein-coupled amine receptor function,and signaling pathways for dopaminergic synapses.Our findings showed that the methodology and software used in this research could explore and analyze the mechanism behind Prof.Xuan’s clinical medication rule for treating ADHD in children.

Population-based X-ray gastric cancer screening in Hiroshima prefecture, Japan

BACKGROUND X-ray gastric cancer(GC)screening has been shown to decrease mortality.Population-based X-ray GC screening has been performed in Hiroshima Prefe-cture,Japan,since 1983 but time trends and the efficacy of the method over 39 years have not been assessed.METHODS This was a population-based retrospective study.The data were derived from aggregated data of the Hiroshima Regional Health Medical Promotion Organization,including the number and rate of participants and those requiring esophagogastroduodenoscopies(EGDs),the number and rate of participants diagnosed as having GC,and the positive predictive value of the abnormal findings detected by X-ray and confirmed by EGDs.The number and rate of esophageal cancers were also collected.Further,the cost of detecting one GC was evaluated.RESULTS The number of participants has decreased during the last four decades,from 39925 in 1983 to 12923 in 2021.The rate of those requiring EGDs decreased significantly in recent years(P<0.001).The number of participants diagnosed as having GC has also declined,from 76 to 10 cases.However,the rate of cases diagnosed as GC among the participants remained around 0.1%.The positive predictive value increased significantly in recent years except during 1983-1991.The number and rate of accidentally detected esophageal cancers have risen recently,from 0%in 2008 to 0.02%in 2021,one-fifth of the diagnosis rate of GC.One GC diagnosis costs approximately 4200000 Japanese Yen(30000 United States Dollars)for the X-ray screenings and EGDs.CONCLUSION X-ray GC screening in Hiroshima has been efficient,but one challenge is the cost.Esophageal cancers may also need to be considered because they have gradually increased in recent years.

Relationship between different sources of drinking water,water quality improvement and gastric cancer mortality in Changle County--A retrospectivecohort study in high incidence area

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Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma:A retrospective,propensity score-matched study

BACKGROUND The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIM To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.METHODS This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach(cT3/4 and cN any)diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis(cTNM)staging system.We performed 1:1 propensity score matching(PSM)to reduce bias in patient selection.The histologic and prognostic effects of neoadjuvant chemotherapy were assessed.The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.RESULTS Of the 144 patients eligible for this study,36 received neoadjuvant chemotherapy,and 108 received initial surgery after diagnosis.After adjustment by PSM,36 pairs of patients were generated,and baseline characteristics,including age,sex,American Society of Anesthesiologists score,tumor location,and cTNM stage,were similar between the two groups.The R0 resection rates were 88.9%and 86.1%in the surgery-first and neoadjuvant chemotherapy groups after PSM,respectively(P=1.000).The median follow-up period was 46.4 mo.The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0%and 65.0%(P=0.235),respectively,before PSM and 50%and 64.7%(P=0.192),respectively,after PSM.Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.CONCLUSION Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma.For resectable gastric signet-ring cell carcinoma,upfront surgery should be the primary therapy.

Stereotactic surgery for refractory epilepsy complicated by mental disorders A retrospective case analysis

BACKGROUND： Anti-epilepsy and anti-psychosis drugs have traditionally been used in the clinic to treat epilepsy complicated by mental disorders. However, there is still no effective therapy for refractory epilepsy patients suffering from persistent mental disorders. OBJECTIVE： To explore the therapeutic effects of stereotactic multi-element localization and multi-target radiofrequency ablation on patients with refractory primary epilepsy and mental disorders. DESIGN： A retrospective case analysis. SETTING： Department of Neurosurgery, the 454 Hospital of Chinese PLA. PARTICIPANTS： Between June and November 2004, 13 patients with refractory primary epilepsy complicated by persistent mental disorders were admitted to the Department of Neurosurgery, the 454 Hospital of Chinese PLA. The patient group consisted of nine males and four females, with an average age of 25 years （range 18-39 years）, and a course of disease ranging 3-11 years. Diagnosis of mental disorders was in accordance with Chinese Classification of Mental Disorders. Written informed consent was obtained from all patients and their families, and the treatment protocol was approved by the Ethics Committee of the Hospital. METHODS： Under venous inhalation anesthesia, the disease targets, including bilateral corpus callosum, bilateral amygdala, and bilateral medial septal area, as well as unilateral Forel-H area, were coagulated by RFG-3CF radiofrequency thermocoagnlation at 75-80 ℃ for 60-70 seconds. During thermocoagulation, the targets were identified using deep-brain microelectrodes and localized according to electrophysiology and electric resistance values. MAIN OUTCOME MEASURES： One year post-surgery, epileptic seizures were assessed on the basis of the Tan classification, and psychogenic （non-epileptic） seizures were evaluated using a 5-grade system. RESULTS： All enrolled 13 epileptic patients were included in the final analysis. The results of follow-up evaluations demonstrated that epilepsy was well-controlled. In total, nine patients did not experience relapse, and the frequency of seizures was reduced by 75% in two patients, and 50%-74% in another two patients. Psychogenic seizures were ameliorated in 11 cases （class 1, recovery） and improved significantly in two cases （class 2, significant improvement）. CONCLUSION： Radiofrequency ablation of bilateral corpus callosum, bilateral amygdala, bilateral medial septal area, and unilateral Forel-H area exhibits certain efficacy in treating epileptic patients suffering from persistent mental disorders.

Multi-institutional retrospective analysis of FOLFIRI in patients with advanced biliary tract cancers

BACKGROUND Gemcitabine plus platinum is the standard of care first-line treatment for advanced biliary tract cancers(BTC).There is no established second-line therapy,and retrospective reviews report median progression-free survival(PFS)less than 3 mo on second-line therapy.5-Fluorouracil plus irinotecan(FOLFIRI)is a commonly used regimen in patients with BTC who have progressed on gemcitabine plus platinum,though there is a paucity of data regarding its efficacy in this population.AIM To assess the efficacy of FOLFIRI in patients with biliary tract cancers.METHODS We retrospectively identified patients with advanced BTC who were treated with FOLFIRI at MD Anderson,University of Michigan and Mayo Clinic in Jacksonville.Data were collected on patient demographics,BTC subtype,response per RECIST v1.1,progression and survival.RESULTS Ninety-eight patients were included of which 74(75%)had metastatic and 24(25%)had locally advanced disease at the time of treatment with FOLFIRI.The median age was 60(range,22-86)years.The number of patients with extrahepatic cholangiocarcinoma,gall bladder cancer and intrahepatic cholangiocarcinoma were 10,17 and 71,respectively.FOLFIRI was used as 1st,2nd,3rd or 4th–Nth lines in 8,50,36 and 4 patients,respectively.Median duration on FOLFIRI in the entire cohort was 2.2(range,0.5-8.4)mo.The median PFS and overall survival were 2.4(95%confidence interval(CI):1.7-3.1)and 6.6(95%CI:4.7-8.4)mo,respectively.Median PFS for patients treated with FOLFIRI in 1st,2nd,3rd or 4th–Nth lines were 3.1,2.5,2.3 and 1.5 mo,respectively.Eighteen patients received concurrent bevacizumab(n=13)or EGFR-targeted therapy(n=5)with FOLFIRI,with a median PFS of 2.7 mo(95%CI:1.7-5.1).CONCLUSION In this largest multi-institution retrospective review of 98 patients with BTC treated with FOLFIRI,efficacy appears to be modest with outcomes similar to other cytotoxic chemotherapy regimens.

Enzyme-linked immunosorbent assay of 3 Screen Islet Cell Autoantibody in patients with autoimmune thyroid disease

BACKGROUND In recent years,the emergence of multiplex technology that can simultaneously measure multiple anti-islet autoantibodies has become particularly valuable for the staging and early diagnosis of immune-mediated type 1 diabetes(T1D).While it has been established that 20%-30%of T1D patients suffer from autoimmune thyroid disease(AITD),there is limited available data regarding the presence of anti-islet autoantibodies in AITD patients.Among commercially available anti-islet autoantibodies,glutamic acid decarboxylase 65 autoantibodies(GADAs)are often the first marker measured in general clinical practice.AIM To investigate the frequency of anti-islet autoantibodies in AITD patients.METHODS Our study involved four hundred ninety-five AITD patients,categorized into three distinct groups:AITD with T1D(n=18),AITD with phenotypic type 2 diabetes(T2D)(n=81),and AITD without diabetes(n=396),and the enzyme-linked immunosorbent assay(ELISA)was employed to determine the frequencies of 3 Screen Islet Cell Autoantibody(3 Screen ICA),GADA,insulinoma-associated antigen-2 autoantibodies(IA-2As),and zinc transporter 8 autoantibodies(ZnT8As)within these groups.RESULTS The frequency of 3 Screen ICA in AITD patients with T1D,T2D,and those without diabetes were 88.9%,6.2%,and 5.1%,respectively,with no significant difference seen between the latter two groups.Notably,the frequency of 3 Screen ICA was 11.1%higher in AITD patients with T1D,1.3%higher in AITD patients with T2D,and 1.1%higher in AITD patients without diabetes compared to GADA,respectively.Furthermore,12.5%,20.0%,and 20.0%of the 3 Screen ICA-positive patients were negative for GADA.Additionally,1.3%of the AITD patients who tested negative for 3 Screen ICA in both the AITD with T2D and non-diabetic AITD groups were found to be positive for individual autoantibodies.Among the 3 Screen ICA-positive patients,there was a significantly higher proportion of individuals with multiple autoantibodies in AITD patients with T1D compared to those without diabetes(37.5%vs 5.0%,P<0.05).However,this proportion was similar to that in AITD patients with T2D(20.0%).Nevertheless,there was no significant difference in 3 Screen ICA titers between AITD patients with T1D and those without diabetes(436.8±66.4 vs 308.1±66.4 index).Additionally,no significant difference in 3 Screen ICA titers was observed between Graves’disease and Hashimoto’s thyroiditis in any of the groups.CONCLUSION Our findings reveal that some AITD patients without diabetes exhibit 3 Screen ICA titers comparable to those in AITD patients with T1D.Thus,3 Screen ICA outperforms GADA in identifying latent anti-islet autoantibody-positive individuals among AITD patients.

MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

Comparative efficacy and safety between endoscopic submucosal dissection,surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer

BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.