Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplan...Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.展开更多
A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies...A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies.[1]A meta-analysis,on the other hand,is a statistical method that combines the quantitative results of available primary studies addressing the same question to generate a pooled summary estimate and confidence interval(CI).[2]Meta-analyses can increase statistical power,enhance precision,and answer questions that single trials are underpowered to address.Although there are systematic reviews where meta-analyses are not appropriate,when they are well-conducted and reported,systematic reviews combined with meta-analyses provide valuable information for clinicians,researchers,and policymakers.展开更多
To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,00...To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,000,probably due to a rising trend of obesity and gallstone disease.AP is associated with remarkable pain,reduced quality of life(QoL),and even death,thus posing a heavy socioeconomic burden.In addition,approximately 22%of AP patients experience recurrent AP(RAP)and 10%of AP patients progress to chronic pancreatitis.[2]Petrov and Yadav[3]have,therefore,argued that AP should not be considered as an acute and self-limiting disease.Treatment and long-term care after AP have drawn widespread attention,which has improved patients’physical and mental health.展开更多
Evidence-based medicine is widely promoted for decision-making in health care and is associated with improved patient outcomes.Critics have suggested that evidence-based medicine focuses primarily on groups of patient...Evidence-based medicine is widely promoted for decision-making in health care and is associated with improved patient outcomes.Critics have suggested that evidence-based medicine focuses primarily on groups of patients rather than individuals,but often fail to consider subgroup analyses,N-of-1 trials,and the incorporation of patient values and preferences.Precision medicine has been promoted as an approach to individualize diagnosis and treatment of diseases through genetic,biomarker,phenotypic,and psychosocial characteristics.However,there are often high costs associated with personalized medicine,and high-quality evidence is lacking for effectiveness in many applications.For the potential of personalized medicine to be realized,it must adhere to the principles of evidencebased medicine:(1)evidence in isolation is not sufficient to make clinical decisions—patient’s values and preferences as well as resource implications must be considered,and(2)there is a hierarchy of evidence to guide clinical decision-making and studies at lower risk of bias are likely to provide more trustworthy findings.展开更多
Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematical...Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematically searched seven English-and Chinese-language literature databases to identify sys-tematic reviews on the application of AI,deep learning,or machine learning in the diagnosis and treatment of any disease published in 2020.We evaluated the methodological quality of the included systematic reviews using“A Measurement tool for the assessment of multiple systematic reviews”(AMSTAR).We also conducted meta-analyses on the diagnostic accuracy of AI on selected disease categories with a large number of included studies and low clinical heterogeneity.Results A total of 40 systematic reviews reporting 1,083 original studies were included,covering 31 diseases from 11 groups of diseases.Eleven systematic reviews were related to neoplasms and nine were systematic reviews related to diseases of the digestive system.We selected digestive system diseases for the meta-analysis.The pooled sensitivities(with 95%confidence interval(CI))of AI to assist the diagnosis of helicobacter pylori,gastrointestinal ulcers,hemorrhage,esophageal tumors,gastric tumors,and intestinal tumors(with 95%CI)were 0.91(0.83-0.95),0.99(0.76-1.00),0.95(0.83-0.99),0.90(0.85-0.93),0.90(0.82-0.95),and 0.93(0.88-0.96),respectively,and the pooled specificities were 0.82(0.77-0.87),0.97(0.86-1.00),1.00(0.99-1.00),0.80(0.71-0.87),0.93(0.87-0.97),and 0.89(0.85-0.92),respectively.The AMSTAR items“the list of included studies”(n=39,97.5%)and“the characteristics of the included studies”(n=39,97.5%)had the highest compliance among the reviews;the compliance was relatively low to the items“the consideration of publication status”(n=1,2.5%),“the consideration of scientific quality”(n=19,47.5%),“data synthesis methods”(n=18,45.0%),and“the evaluation of publication bias”(n=13,32.5%).Conclusions The main subjects of systematic reviews on AI applications in clinical diagnosis and treatment pub-lished in 2020 were diseases of the digestive system and neoplasms.The methodological quality of the systematic reviews on AI needs to be improved,paying particular attention to publication bias and the rigorous evaluation of the quality of the included studies.展开更多
Objective Complete and transparent reporting is of critical importance for randomized controlled trials(RCTs).The present study aimed to determine the reporting quality and methodological quality of RCTs for intervent...Objective Complete and transparent reporting is of critical importance for randomized controlled trials(RCTs).The present study aimed to determine the reporting quality and methodological quality of RCTs for interventions involving artificial intelligence(AI)and their protocols.Methods We searched MEDLINE(via PubMed),Embase,Web of Science,CBMdisc,Wanfang Data,and CNKI from January 1,2016,to November 11,2020,to collect RCTs involving AI.We also extracted the protocol of each included RCT if it could be obtained.CONSORT-AI(Consolidated Standards of Reporting Trials-Artificial Intelligence)statement and Cochrane Collaboration’s tool for assessing risk of bias(ROB)were used to evaluate the reporting quality and methodological quality,respectively,and SPIRIT-AI(The Standard Protocol Items:Recommendations for Interventional Trials-Artificial Intelligence)statement was used to evaluate the reporting quality of the protocols.The associations of the reporting rate of CONSORT-AI with the publication year,journal’s impact factor(IF),number of authors,sample size,and first author’s country were analyzed univariately using Pearson’s chi-squared test,or Fisher’s exact test if the expected values in any of the cells were below 5.The compliance of the retrieved protocols to SPIRIT-AI was presented descriptively.Results Overall,29 RCTs and three protocols were considered eligible.The CONSORT-AI items“title and abstract”and“interpretation of results”were reported by all RCTs,with the items with the lowest reporting rates being“funding”(0),“implementation”(3.5%),and“harms”(3.5%).The risk of bias was high in 13(44.8%)RCTs and not clear in 15(51.7%)RCTs.Only one RCT(3.5%)had a low risk of bias.The compliance was not significantly different in terms of the publication year,journal’s IF,number of authors,sample size,or first author’s country.Ten of the 35 SPIRIT-AI items(funding,participant timeline,allocation concealment mechanism,implementation,data management,auditing,declaration of interests,access to data,informed consent materials and biological specimens)were not reported by any of the three protocols.Conclusions The reporting and methodological quality of RCTs involving AI need to be improved.Because of the limited availability of protocols,their quality could not be fully judged.Following the CONSORT-AI and SPIRIT-AI statements and with appropriate guidance on the risk of bias when designing and reporting AI-related RCTs can promote standardization and transparency.展开更多
To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway acc...To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.展开更多
Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depress...Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study.Follow-up assessments were performed at the following time points after stroke:in person,2 weeks,3 months,6 months,and 1 year;by telephone,5 years.National Institutes of Health Stroke Scale (NIHSS) score on admission,recurrence,disability,depression,QoL,and chronic complications were recorded.Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders.QoL was measured using short form-12 (SF-12).Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study,80 had persistent depression.The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]:0.48;95% confidence interval [CI]:0.29-0.81) and disability at 5 years (OR:0.34;95% CI:0.23-0.49) were associated with poor MCS scores at 5 years.Old age,a high NIHSS score on admission,disability at 5 years,and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up.The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.展开更多
Background Stroke is a major cause of death or long-term disability worldwide.Many patients with stroke receive integrative therapy consisting of Western medicine(WM)and routine rehabilitation in conjunction with Chin...Background Stroke is a major cause of death or long-term disability worldwide.Many patients with stroke receive integrative therapy consisting of Western medicine(WM)and routine rehabilitation in conjunction with Chinese medicine(CM),such as acupuncture and Chinese herbal medicine.However,there is no available evidence on the effectiveness of the combined use of WM and CM interventions in stroke rehabilitation.Aims The purpose of this meta-analysis is to evaluate the results of all individual studies to assess the combined use of CM and WM in stroke rehabilitation compared with WM only.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.MEDLINE,EMBASE,Cochrane and China National Knowledge Infrastructure(CNKI)were searched.The included outcomes were dependency,motor function,depression and swallowing function.Subgroup analysis was performed,and publication bias was assessed using funnel plots.Summary of review 58 studies and 6339 patients were included in the meta-analysis.Subgroup analysis revealed that combined therapy comprising both acupuncture and WM had a superior effect on improving dependency and swallowing function compared with standard WM therapy alone.Potential superiority of combined therapy comprising CM and WM in improving depression compared with standard WM therapy was also found.Conclusions Our results indicate that the combined use of CM and WM could be more efficacious in stroke rehabilitation compared with the use of WM therapy alone.However,most studies were short in duration(2 to 4 weeks)and prone to different types of biases,which prevents making any conclusion regarding the long-term effects and raises concerns regarding true efficacy in context of high likelihood of Hawthorn bias.So,more randomised controlled trials with more rigorous design and longer duration of treatment and follow-up need to be conducted to compare WM alone versus WM and CM combined.展开更多
When the unexpected happens,such as a pandemic caused by a novel virus,governmental agencies,organizations,and experts in the field are rightly concerned that the paucity of available evidence may trigger unsubstantia...When the unexpected happens,such as a pandemic caused by a novel virus,governmental agencies,organizations,and experts in the field are rightly concerned that the paucity of available evidence may trigger unsubstantiated or erroneous recommendations.The harms of which can be exacerbated with today’s massive spread of misinformation through unregulated social media or other trusted information sites,inevitably influencing frontline clinicians’and healthcare workers’behavior and practices.However,recommendations for clinical practices are essential for the prevention,detection,treatment,and management during a global crisis.In response to the COVID-19 pandemic,clinical and research experts,government agencies,and specialty societies immediately took action to provide guidance to their constituents on how to manage all aspect of the pandemic.展开更多
目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验(RCT)的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials(CENTRAL)、Clinical Trials....目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验(RCT)的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials(CENTRAL)、Clinical Trials.gov。纳入标准2型糖尿病患者使用胰高血糖素样肽-1(GLP-1)受体激动剂或二肽基肽酶-4(DPP-4)抑制剂与使用安慰剂或其他降糖药物治疗相比的RCT。数据收集和分析2名研究者独立筛选文献,评价纳入研究的偏倚风险,并提取数据。采用Peto法作为合并来自RCT效应估计的主要方法,采用其他统计方法进行敏感性分析,针对6种预先设定的假设开展meta回归来探索异质性。使用GRADE方法评价证据质量。结果纳入189个RCT(n=155145),偏倚风险为低至中等。其中77个RCT报告零死亡事件,112个RCT报告在151614例患者中发生3888例死亡事件。meta分析结果显示:肠促胰素类药物与对照组相比,死亡风险在组间差异无统计学意义f1925/84136比1963/67478;比值比(OR)=0.96,95%可信区间(CI):0.90-1.02,I^2=0%;率差(RD)=比对照低3/1000,95%C1(比对照低7/1000~比对照高1/1090)/5年·1000例患者;中等质量证据1。亚组分析结果提示:GLP-1受体激动剂可能降低死亡风险,但DPP-4抑制剂未发现类似结果;该亚组效应的可信度较低。敏感性分析结果未发现明显差异。结论当前证据不支持肠促胰素类药物增加2型糖尿病患者死亡风险的假设。需进一步研究证实GLP-1受体激动剂与DPP.4抑制剂两类肠促胰素类药物之间是否存在差异。展开更多
文摘Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.
文摘A systematic review synthesizes evidence addressing a structured clinical question using systematic and explicit methods to search,identify,screen,critically appraise,and extract and analyze data from relevant studies.[1]A meta-analysis,on the other hand,is a statistical method that combines the quantitative results of available primary studies addressing the same question to generate a pooled summary estimate and confidence interval(CI).[2]Meta-analyses can increase statistical power,enhance precision,and answer questions that single trials are underpowered to address.Although there are systematic reviews where meta-analyses are not appropriate,when they are well-conducted and reported,systematic reviews combined with meta-analyses provide valuable information for clinicians,researchers,and policymakers.
基金funded by grants from National Natural Science Foundation of China(No.32170788)National Clinical Key Specialty Construction Project(No.ZK108000)+1 种基金National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-023)Beijing Natural Science Foundation(No.7232123)
文摘To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,000,probably due to a rising trend of obesity and gallstone disease.AP is associated with remarkable pain,reduced quality of life(QoL),and even death,thus posing a heavy socioeconomic burden.In addition,approximately 22%of AP patients experience recurrent AP(RAP)and 10%of AP patients progress to chronic pancreatitis.[2]Petrov and Yadav[3]have,therefore,argued that AP should not be considered as an acute and self-limiting disease.Treatment and long-term care after AP have drawn widespread attention,which has improved patients’physical and mental health.
文摘Evidence-based medicine is widely promoted for decision-making in health care and is associated with improved patient outcomes.Critics have suggested that evidence-based medicine focuses primarily on groups of patients rather than individuals,but often fail to consider subgroup analyses,N-of-1 trials,and the incorporation of patient values and preferences.Precision medicine has been promoted as an approach to individualize diagnosis and treatment of diseases through genetic,biomarker,phenotypic,and psychosocial characteristics.However,there are often high costs associated with personalized medicine,and high-quality evidence is lacking for effectiveness in many applications.For the potential of personalized medicine to be realized,it must adhere to the principles of evidencebased medicine:(1)evidence in isolation is not sufficient to make clinical decisions—patient’s values and preferences as well as resource implications must be considered,and(2)there is a hierarchy of evidence to guide clinical decision-making and studies at lower risk of bias are likely to provide more trustworthy findings.
文摘Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematically searched seven English-and Chinese-language literature databases to identify sys-tematic reviews on the application of AI,deep learning,or machine learning in the diagnosis and treatment of any disease published in 2020.We evaluated the methodological quality of the included systematic reviews using“A Measurement tool for the assessment of multiple systematic reviews”(AMSTAR).We also conducted meta-analyses on the diagnostic accuracy of AI on selected disease categories with a large number of included studies and low clinical heterogeneity.Results A total of 40 systematic reviews reporting 1,083 original studies were included,covering 31 diseases from 11 groups of diseases.Eleven systematic reviews were related to neoplasms and nine were systematic reviews related to diseases of the digestive system.We selected digestive system diseases for the meta-analysis.The pooled sensitivities(with 95%confidence interval(CI))of AI to assist the diagnosis of helicobacter pylori,gastrointestinal ulcers,hemorrhage,esophageal tumors,gastric tumors,and intestinal tumors(with 95%CI)were 0.91(0.83-0.95),0.99(0.76-1.00),0.95(0.83-0.99),0.90(0.85-0.93),0.90(0.82-0.95),and 0.93(0.88-0.96),respectively,and the pooled specificities were 0.82(0.77-0.87),0.97(0.86-1.00),1.00(0.99-1.00),0.80(0.71-0.87),0.93(0.87-0.97),and 0.89(0.85-0.92),respectively.The AMSTAR items“the list of included studies”(n=39,97.5%)and“the characteristics of the included studies”(n=39,97.5%)had the highest compliance among the reviews;the compliance was relatively low to the items“the consideration of publication status”(n=1,2.5%),“the consideration of scientific quality”(n=19,47.5%),“data synthesis methods”(n=18,45.0%),and“the evaluation of publication bias”(n=13,32.5%).Conclusions The main subjects of systematic reviews on AI applications in clinical diagnosis and treatment pub-lished in 2020 were diseases of the digestive system and neoplasms.The methodological quality of the systematic reviews on AI needs to be improved,paying particular attention to publication bias and the rigorous evaluation of the quality of the included studies.
文摘Objective Complete and transparent reporting is of critical importance for randomized controlled trials(RCTs).The present study aimed to determine the reporting quality and methodological quality of RCTs for interventions involving artificial intelligence(AI)and their protocols.Methods We searched MEDLINE(via PubMed),Embase,Web of Science,CBMdisc,Wanfang Data,and CNKI from January 1,2016,to November 11,2020,to collect RCTs involving AI.We also extracted the protocol of each included RCT if it could be obtained.CONSORT-AI(Consolidated Standards of Reporting Trials-Artificial Intelligence)statement and Cochrane Collaboration’s tool for assessing risk of bias(ROB)were used to evaluate the reporting quality and methodological quality,respectively,and SPIRIT-AI(The Standard Protocol Items:Recommendations for Interventional Trials-Artificial Intelligence)statement was used to evaluate the reporting quality of the protocols.The associations of the reporting rate of CONSORT-AI with the publication year,journal’s impact factor(IF),number of authors,sample size,and first author’s country were analyzed univariately using Pearson’s chi-squared test,or Fisher’s exact test if the expected values in any of the cells were below 5.The compliance of the retrieved protocols to SPIRIT-AI was presented descriptively.Results Overall,29 RCTs and three protocols were considered eligible.The CONSORT-AI items“title and abstract”and“interpretation of results”were reported by all RCTs,with the items with the lowest reporting rates being“funding”(0),“implementation”(3.5%),and“harms”(3.5%).The risk of bias was high in 13(44.8%)RCTs and not clear in 15(51.7%)RCTs.Only one RCT(3.5%)had a low risk of bias.The compliance was not significantly different in terms of the publication year,journal’s IF,number of authors,sample size,or first author’s country.Ten of the 35 SPIRIT-AI items(funding,participant timeline,allocation concealment mechanism,implementation,data management,auditing,declaration of interests,access to data,informed consent materials and biological specimens)were not reported by any of the three protocols.Conclusions The reporting and methodological quality of RCTs involving AI need to be improved.Because of the limited availability of protocols,their quality could not be fully judged.Following the CONSORT-AI and SPIRIT-AI statements and with appropriate guidance on the risk of bias when designing and reporting AI-related RCTs can promote standardization and transparency.
基金CAMS Innovation Fund for Medical Sciences(CIFMSNo.2022-I2M-1-003)Peking Union Medical College(No.2019zlgc0503)
文摘To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.
文摘Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study.Follow-up assessments were performed at the following time points after stroke:in person,2 weeks,3 months,6 months,and 1 year;by telephone,5 years.National Institutes of Health Stroke Scale (NIHSS) score on admission,recurrence,disability,depression,QoL,and chronic complications were recorded.Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders.QoL was measured using short form-12 (SF-12).Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study,80 had persistent depression.The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]:0.48;95% confidence interval [CI]:0.29-0.81) and disability at 5 years (OR:0.34;95% CI:0.23-0.49) were associated with poor MCS scores at 5 years.Old age,a high NIHSS score on admission,disability at 5 years,and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up.The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.
基金funded by Innovative Technology Commission of the government of Hong Kong SAR(GSP/008/18).
文摘Background Stroke is a major cause of death or long-term disability worldwide.Many patients with stroke receive integrative therapy consisting of Western medicine(WM)and routine rehabilitation in conjunction with Chinese medicine(CM),such as acupuncture and Chinese herbal medicine.However,there is no available evidence on the effectiveness of the combined use of WM and CM interventions in stroke rehabilitation.Aims The purpose of this meta-analysis is to evaluate the results of all individual studies to assess the combined use of CM and WM in stroke rehabilitation compared with WM only.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.MEDLINE,EMBASE,Cochrane and China National Knowledge Infrastructure(CNKI)were searched.The included outcomes were dependency,motor function,depression and swallowing function.Subgroup analysis was performed,and publication bias was assessed using funnel plots.Summary of review 58 studies and 6339 patients were included in the meta-analysis.Subgroup analysis revealed that combined therapy comprising both acupuncture and WM had a superior effect on improving dependency and swallowing function compared with standard WM therapy alone.Potential superiority of combined therapy comprising CM and WM in improving depression compared with standard WM therapy was also found.Conclusions Our results indicate that the combined use of CM and WM could be more efficacious in stroke rehabilitation compared with the use of WM therapy alone.However,most studies were short in duration(2 to 4 weeks)and prone to different types of biases,which prevents making any conclusion regarding the long-term effects and raises concerns regarding true efficacy in context of high likelihood of Hawthorn bias.So,more randomised controlled trials with more rigorous design and longer duration of treatment and follow-up need to be conducted to compare WM alone versus WM and CM combined.
文摘When the unexpected happens,such as a pandemic caused by a novel virus,governmental agencies,organizations,and experts in the field are rightly concerned that the paucity of available evidence may trigger unsubstantiated or erroneous recommendations.The harms of which can be exacerbated with today’s massive spread of misinformation through unregulated social media or other trusted information sites,inevitably influencing frontline clinicians’and healthcare workers’behavior and practices.However,recommendations for clinical practices are essential for the prevention,detection,treatment,and management during a global crisis.In response to the COVID-19 pandemic,clinical and research experts,government agencies,and specialty societies immediately took action to provide guidance to their constituents on how to manage all aspect of the pandemic.
文摘目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验(RCT)的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials(CENTRAL)、Clinical Trials.gov。纳入标准2型糖尿病患者使用胰高血糖素样肽-1(GLP-1)受体激动剂或二肽基肽酶-4(DPP-4)抑制剂与使用安慰剂或其他降糖药物治疗相比的RCT。数据收集和分析2名研究者独立筛选文献,评价纳入研究的偏倚风险,并提取数据。采用Peto法作为合并来自RCT效应估计的主要方法,采用其他统计方法进行敏感性分析,针对6种预先设定的假设开展meta回归来探索异质性。使用GRADE方法评价证据质量。结果纳入189个RCT(n=155145),偏倚风险为低至中等。其中77个RCT报告零死亡事件,112个RCT报告在151614例患者中发生3888例死亡事件。meta分析结果显示:肠促胰素类药物与对照组相比,死亡风险在组间差异无统计学意义f1925/84136比1963/67478;比值比(OR)=0.96,95%可信区间(CI):0.90-1.02,I^2=0%;率差(RD)=比对照低3/1000,95%C1(比对照低7/1000~比对照高1/1090)/5年·1000例患者;中等质量证据1。亚组分析结果提示:GLP-1受体激动剂可能降低死亡风险,但DPP-4抑制剂未发现类似结果;该亚组效应的可信度较低。敏感性分析结果未发现明显差异。结论当前证据不支持肠促胰素类药物增加2型糖尿病患者死亡风险的假设。需进一步研究证实GLP-1受体激动剂与DPP.4抑制剂两类肠促胰素类药物之间是否存在差异。