Clinical manifestation,lifestyle,and treatment patterns of chronic erosive gastritis:A multicenter real-world study in China

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.

On Treatment Patterns for Modeling Medical Treatment Processes in Clinical Practice Guidelines

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.

Real-world treatment patterns of gastrointestinal neuroendocrine tumors: A claims database analysis

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.

Medical Treatment Process Modeling Based on Process Mining and Treatment Patterns

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.

Prevalence and treatment patterns of ranibizumab and photodynamic therapy in a tertiary care setting in Malaysia

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.

Treatment Patterns and Healthcare Costs among U.S. Patients with Advanced Melanoma Initiating Subsequent Systemic Therapy Following Use of Ipilimumab (IPI)

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 1st-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.

Treatment Patterns and Economic Assessment of Systemic Therapy for Metastatic Colorectal Cancer

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.

Trends in medication use and treatment patterns in Chinese patients with inflammatory bowel disease

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.

Temporal Change in Treatment Patterns of Metastatic Colorectal Cancer and Its Association with Patient Survival:A Retrospective Cohort Study Based on an Intelligent Big-Data Platform

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.

Pharmacotherapy treatment patterns at hospital discharge and clinical outcomes among patients with heart failure with reduced ejection fraction

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.

Comparing the effectiveness of pattern differentiation treatment and fixed formula treatment for perimenopausal syndrome with Chinese herbal medicine:A study protocol

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.

The Morphology of Patterning with Pseudoplastic Metal Nanoparticle Fluids during Heat Treatment

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.

Chinese Medicine Prolongs Overall Survival of Chinese Patients with Advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study

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)

Features of hepatocellular carcinoma in Hispanics differ from African Americans and non-Hispanic Whites

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.

A Comparative Study of The Regular Pattern of Syndrome and Treatment of Lung-intestine Related Diseases in Ancient and Modern Medical Cases Based on Data Mining

Objective: To analyze the similarities and differences of the applications of "the lung and large intestine being interior-exteriorly related"between the ancient and modern clinical practices, and to reveal the theory meaning.Method: Based on the ancient and modern medical cases database, 245 ancient medical records and 373 modern medical records were studied with the general statistical description and analysis of association rules, and the results were compared to summarize the similarities and differences of the regular pattern of syndrome and treatment on lung-large intestine related diseases in ancient and modern medical records.Results: In modern medical cases, intestinal diseases appeared with the main symptom of constipation due to deficiency of lung qi and qi stagnation of large intestine were always treated by purgation together with replenishing and restoring lung qi. In ancient medical cases, large intestine heat was always caused by lung heat and a variety of diarrhea symptoms appeared. They were always treated by clearing heat and moistening lungs. In addition, the symptom of bound stool caused by qi stagnation of large intestine due to lung qi stagnation was always treated by lowering lung qi to regulate and smooth large intestine qi. And Armeniae Amarum Semen was used by both as a core medicinal herb.Conclusion: Ascending-descending of qi movement is the core of the lung and large intestine relationship. In other words, the lung and the large intestine communicate through qi.

Integrative medicine in the era of cancer immunotherapy: Challenges and opportunities

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.

Effectiveness of quality of care for patients with type 2 diabetes in China:findings from the Shanghai Integration Model(SIM)

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and intermediate outcomes were determined.The patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)years.The percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 years.Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive medication.In conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target level.The percentage of patients who achieved all three target levels needs significant improvement.