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Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.
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ObjectiveTo investigate the clinical efficacy of Tenghuang Jiangu tablets （THJGT） combined with oral non-steroidal anti-inflammatory drugs （NSAIDs） in the treatment of osteoarthritis of the knee and its applicable stage based on real-world data， and provide a basis for the rational clinical use of THJGT. MethodA total of 218 cases treated with THJGT combined with oral NSAIDs included in the "THJGT for knee osteoarthritis case registry" from September 2019 to January 2021 were selected as the observation group， and 126 cases treated with oral NSAIDs alone as the control group （CG）. The data of gender， age， body mass index， Kellgren-Lawrence grading scale （K-L scale） score， visual analogue score （VAS score）， Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） score， swelling grade， joint fear of cold score， back pain and weakness score， and occurrence of adverse events/reactions of the patients in both groups were used for the evaluation of efficacy with full analysis set. The propensity score matching method was used to exclude the influence of confounding factors between groups， and the sub-data sets were established， with which the repeated measures analysis of variance （ANOVA） was carried out to evaluate the efficacy. Visit points were at registration， 4 weeks and 8 weeks after registration. The data were statistically analyzed in Excel 2019 and SPSS 23.0. ResultThe proportion of females in the observation group was 66.06% （144/218）， which was higher than that （58.73%， 74/126） in the control group （χ2=1.846）. The average age in the observation group was （61.12±7.01） years， which was higher than that ［（59.38±5.99） years］ in the control group （W=19 918.50， P<0.05）. The remission rate in the observation group was 98.17% （214/218）. In the observation group， the proportions of the patients at K-L grades Ⅱ and Ⅲ were 64.22% （144/218） and 25.23% （55/218）， respectively. The effect analysis of the whole data set for enrollment and treatment for 8 weeks showed that the VAS score of the experimental group decreased by （3.27±1.24） points on average， which was better than that of the control group [（2.75±1.20）， W=34 179.00， P<0.05]. The average WOMAC score decreased （23.43±11.46） points， which was better than that of the control group [（16.71±8.86）， W=32 387.00， P<0.05]. The average swelling grade decreased （0.63±0.64）， which was better than the control group [（0.33±0.59）， W=33 847.50， P<0.05]. The average score of joint chills decreased （1.90±1.84）， points， which was better than that of control group [（1.40±1.28）， W=35 165.00， P<0.05]. The average lumbar acid fatigue score decreased by （2.02±1.64） points, which was better than that of the control group [（1.10±1.28）， W=32 986.50， P<0.05]. Efficacy analysis of subdata sets for enrollment， 4 weeks of medication and 8 weeks of medication showed that VAS scores of both groups showed a downward trend after treatment， and the improvement of experimental group was more significant than that of control group at 4 weeks， with statistical significance （P<0.05）. After treatment， the total WOMAC score of both groups showed a downward trend， and the improvement of experimental groups was more significant at 4 weeks and 8 weeks （P<0.05）. After treatment， swelling， cold fear grade and lumbar acid fatigue score of both groups showed a decreasing trend,， and the improvement of experimental group was more significant at 8 weeks （P<0.05）. The therapeutic effect analysis of patients in the attack stage and remission stage of the experimental group showed that the total WOMAC score of the two groups showed a downward trend after treatment， and the trend was basically the same， and there was no statistical difference between the two groups at enrollment， 4 weeks after treatment， and 8 weeks after treatment （t=1.675， t=2.068， t=2.364）. The total WOMAC score of the patients in remission stage in the experimental group with K-L grading between grade 0 and grade Ⅲ had statistical significance at 4 weeks after treatment compared with the time of entry （P<0.05， P<0.01）. Group of adverse event rate was 4.13% （9/218）， lower than the control group 10.32% （13/126） （χ2= 5.109， P<0.05）. ConclusionThe population receiving THJGT combined with oral NSAIDs is mostly female， old， in remission， and with K-L grades Ⅱ and Ⅲ. THJGT can enhance the anti-inflammatory and analgesic effects of oral NSAIDs and keep the drug effect in improving joint function and alleviating fear of cold， swelling， and back pain and weakness. The drug combination can be applied to patients in both attack and remission， and the clinical application should take patient's disease stage and degree of osteoarthritis into account. Furthermore， the combination has the potential to reduce the incidence of adverse events caused by NSAIDs.
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The purpose of this paper was to introduce how to combine the propensity score analysis to reasonably carry out multiple linear regression analysis. Firstly， it introduced 3 basic concepts related to the propensity score analysis. Secondly， it presented the core contents of the propensity score analysis， that was， three matching methods. Thirdly， through an epidemiological survey example， it gave the whole process of how to use SAS software for the analysis. The contents were as follows： ① for the original data set， test whether the difference of covariates between the treatment group and the control group was statistically significant； ② directly implement the multiple linear regression analysis for the original data set； ③ the propensity score analysis was used to generate the matched data set； ④ for the matched data set， test whether the difference of covariates between the treatment group and the control group was statistically significant； ⑤ a reasonable multiple linear regression analysis was used for the matched data set.
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Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.
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Objective To investigate the effect of short-term complications after D2 radical gastrectomy on long-term survival rate of gastric cancer patients. Methods A retrospective case-control study was conducted on 421 patients with gastric cancer who underwent D2 radical gastrectomy. According to the short-term postoperative complications, they were divided into experimental group (complication group, n=76) and control group (without complication group, n=345). In order to reduce the selection bias, the long-term survival rate of the two groups was tested by Kaplan-Meier survival analysis method after balancing the variables by propensity score matching (PSM). Log rank method was used for univariate analysis and Cox multivariate analysis was used for prognostic factors. Results There was no significant difference in long-term survival rate between the experimental group and the control group (P > 0.05). Histological type, lymph node metastasis rate and pTNM stage were independent risk factors for long-term survival. Conclusion The short-term complications after D2 radical gastrectomy have no significant impact on the long-term survival rate of gastric cancer patients, but it has certain clinical significance to actively prevent and control complications.
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OBJECTIVE@#To evaluate the clinical therapeutic effect of electroacupuncture (EA) at @*METHODS@#The data of 318 patients undergoing anal fistula surgery were analyzed retrospectively. In accordance with whether accepted the combined treatment with EA at bilateral @*RESULTS@#For VAS score, there was an interaction between therapeutic method and treatment duration (@*CONCLUSION@#Electroacupuncture at
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Humans , Acupuncture Points , Acupuncture, Ear , Electroacupuncture , Rectal Fistula/therapy , Retrospective StudiesABSTRACT
Objective This paper focuses on the field of clinical medicine,with the aim of verifying the feasibility of interdisciplinary literature evaluation model based on feature matching method,to provide support for further interdisciplinary scientific research evaluation.Methods Feature matching method,Delphi expert enquiry,and normalization method were adopted to establish an evaluation system in clinical medicine,which was further verified by case studies.Results The normalization coefficient reflects the difficulty of publishing articles with high impact factors.Through the process of feature matching and normalization,it was found that compared with the fields of Neurology,Psychiatry and Surgery,researchers in the fields of Oncology and Internal Medicine were more likely to publish articles with high impact factors.Conclusions Through case analysis,this study verifies the feasibility of interdisciplinary scientific paper evaluation system.The interdisciplinary paper evaluation system based on feature matching method and normalized evaluation method comprehensively considers the characteristics of various disciplines of clinical medicine and provides a new idea for the evaluation of clinical scientific research talents.
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OBJECTIVES@#Contrast-induced acute kidney injury (CI-AKI) is the third cause of hospital-acquired AKI, and existing clinical prevention and treatment measures such as hydration therapy and/or administration of antioxidants N-acetylcysteine treatment and other treatments still show little effect on the prevention and treatment of CI-AKI. This study aims to explore the effect of Danhong injection on prevention of CI-AKI.@*METHODS@#A total of 12 867 patients, who received coronary angiography, percutaneous coronary intervention, enhanced CT or vascular intervention in a tertiary hospital, were enrolled for this study. Among them, 423 in the treatment group received intravenous drip of Danhong injection, and 12 444 in the control group received routine medicine. Propensity score matching was conducted to balance confounding factors between the 2 groups and then the prevention effect of Danhong injection on CI-AKI was compared between them.@*RESULTS@#A total of 423 pairs of patients were matched successfully. The incidence of CI-AKI in the non-Danhong control group was higher than that in the Danhong treatment group (5.7% vs 2.4%). The difference between the 2 groups was statistically significant (@*CONCLUSIONS@#The results of this study support the use of Danhong injection in the prevention of the Stage 1 of CI-AKI.
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Humans , Acute Kidney Injury/prevention & control , Contrast Media/adverse effects , Drugs, Chinese Herbal , Injections , Percutaneous Coronary Intervention , Propensity Score , Risk Factors , Treatment OutcomeABSTRACT
Objective To compare the effect of intensity modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) combined with intracavitary brachytherapy on patients with cervical stump cancer. Methods A total of 47 patients with cervical stump cancer who were admitted to the First Hospital of China Medical University from October 2007 to September 2017 were retrospectively reviewed. Of the 47 patients, 19 patients received CRT combined with intracavitary brachytherapy (CRT group), and 28 patients received IMRT combined with intracavitary brachytherapy (IMRT group). In order to reduce the effects of selection bias and confounding factors, propensity score matching was performed to compare the groups. Results After the propensity score matching, there were 19 patients in each group. The 1-, 3-and 5-year overall survival (OS) rate for matched patients were 100.0％, 85.1％ and 63.8％ in IMRT group, and 84.2％, 57.9％ and 42.1％ in CRT group, respectively, and the difference in survival between the two groups was statistically significant (PLog-rank= 0.029, PCox= 0.043, HR= 3.723, 95％CI 1.044-13.280). The median progression-free survival (PFS) time of the IMRT group was better than that of the CRT group [median PFS time had not been reached (7-72 months) vs. 17 months (2-125 months), PLog-rank= 0.032, PCox= 0.042, HR=2.773, 95％CI 1.037-7.417]. The incidence of late rectal and bladder radiation injury was 15.8％ (3/19) and 0 (0/19) in IMRT group, and 57.9％ (11/19) and 26.3 ％(5/19) in CRT group, respectively, and the difference was statistically significant (P= 0.017, P= 0.046). Conclusion Compared with CRT combined with intracavitary brachytherapy, IMRT combined with intracavitary brachytherapy has a better effect on patients with cervical stump cancer, and the incidence of complications is low, this method is worthy of clinical application.
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OBJECTIVE： To compare the efficacy and safety of domestic vancomycin and imported vancomycin in the treatment of methicillin-resistant Staphylococcus aureus （MRSA） caused lung infection after neurosurgery. METHODS： The patients after neurosurgery with MRSA pulmonary infection diagnosed in our hospital from Jan. 2014 to Jun. 2015 and using domestic vancomycin were included in domestic vancomycin group， while those who used imported vancomycin from Jul. 2015 to Dec. 2018 were included in imported vancomycin group. The baseline data of the two groups were matched by 1 ∶ 1 according to propensity score matching method. The 30-day all-cause mortality， 90-day all-cause mortality of severe patients， 7 d effective bacterial clearance rate and the incidence of ADR were compared between 2 groups. RESULTS： There were 108 cases in domestic vancomycin group and 279 cases in imported vancomycin group. After propensity score matching， 108 cases in domestic and 108 cases in imported vancomycin group were finally included. The 30-day mortality rates of domestic group and imported group were 10.19％（11/108） and 7.41％（8/108） respectively， and the 90-day all-cause mortality of 22 pairs of severe patients were 63.64％. The 7 d effective bacterial clearance rates were 75.00％（48/64） and 81.94％（59/72）， and there was no statistical significance （P＞0.05）. The incidences of creatinine increase ＞1 fold were 25.93％（28/108） and 12.04％（13/108）， the total incidences of ADR were 29.63％（32/108） and 15.74％（17/108）， respectively， with statistical significance （P＜0.05）. CONCLUSIONS： The therapeutic efficacy of imported vancomycin is similar to that of domestic vancomycin in the treatment of postoperative pulmonary infection with MRSA after neurosurgery， but the safety needs to pay close attation， especially the rise of serum creatinime.
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Objective The incidence of early allograft dysfunction (EAD) following deceased donor liver transplantation (DDLT) is high and affects the prognosis of the recipient. This study aimed to investigate the risk factors for EAD following DDLT. Methods This retrospective study included 79 cases of liver transplantation performed in the No. 900 Hospital of PLA Joint Logistic Support Force from January 2015 to December 2017. We collected the clinical data on the donors and recipients, propensity-score matched the pre- and intra-operative data on the recipients, and analyzed the risk factors for EAD identified among 17 donor-related variables. Results EAD was found in 26 (32.9%) of the recipients. Univariate analysis showed statistically significant differences between the EAD and non-EAD groups in the body mass index, warm ischemia time, and cold ischemia time of the donors (P < 0.05), and so did multivariate logistic regression analysis in the levels of serum sodium and alanine aminotransferase and warm ischemia time of the donors (P < 0.05). The best cut-off values of the serum sodium level and warm ischemia time of the donors for predicting post-operative EAD were 152.7 mmol/L and 8 min, respectively. Conclusion The serum sodium and alanine aminotransferase levels and warm ischemia time of the donors are independent risk factors for EAD after DDLT. The serum sodium level and warm ischemia time of the donors play an important role in evaluating the quality of deceased donor organs.
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Through analyzing the project relationship and differences of the Government Accounting System and the Hospital Accounting System, it explored a generalized method about the connection between the old and the new subjects of account based on subject comparison table. Based on the subject matching relationship graph, the connecting relationship between the old and the new was found according to the subject classification. A new hospital government accounting subjects system was setup based on the connected relationship between the old and the new subjects of accounts.
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Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.
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Objective To verify the feasibility of interdisciplinary literature evaluation model based on feature matching method,and provide support for further interdisciplinary scientific research evaluation.Methods Feature matching method,Delphi expert enquiry,and normalization methods were used to analyze the keywords and journals of 24 secondary subjects in public health.Relevant journals analysis was conducted to establish a new evaluation model,which was also verified by case studies.Results The interdisciplinary literature evaluation model was feasible.Conclusions This study provided feasibility evidence for interdisciplinary scientific research evaluation to improve the justice and reliability of interdisciplinary scientific research evaluation results.
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Objective To provide a new way for public hospitals to evaluate the interdisciplinary scientific innovation capacity.Methods Literature review method was adopted to analyze the current problems of public hospital evaluation model of scientific papers,feature matching method was used to build interdisciplinary science and technology innovation ability evaluation model.Results From the perspective of differences among disciplines,the characteristics of each clinical medicine course was analyzed,and feature matching method is applied to determine the academic journals directory by rele vant experts to verify the rationality of affiliation,and then through the analysis of the academic influence of journal size,a comprehensive consideration of public hospitals interdisciplinary characteristics index evaluation system were built.Conclusions As one of the matured sorting algorithms,feature matching method and its application to the different disciplines of science and technology innovation model construction will obviously provide a good theoretical basis for scientific evaluation.
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Objective To explore the application of Propensity Score Matching Methods in medical scientific research,and demonstrate the operation process of SPSS.Methods This article summarized and discussed the principle and application of PSM through the literature,a real example was adopted to introduce the operation procedures of SPSS.Results We can use PSM process to control confounding factors between the retrospective study groups effectively through SPSS.Conclusions PSM is an efficient tool to conduct retrospective study.It can provide necessary help for clinical data mining.
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Propensity score matching method (PSM) is widely used in observational study to reduce selection bias. Observational study lacks randomization, hence, statistical inferences without bias adjustments usually include observed or unobserved effects of covariates. If a subject with specific characteristics has a higher chance to be selected for a specific treatment, the characteristics have a possible effect on statistical results. PSM is the method for controlling covariate imbalance that produces the selection bias. In this paper, we introduce the basic concepts of PSM and simplified methods of PSM process. However, PSM is a rapidly developing statistical area with many limitations and some disadvantages. These points are described in the concluding section to emphasize the importance of considering the various features of PSM in the study design.
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Bias , Methods , Observational Study , Propensity Score , Random Allocation , Selection BiasABSTRACT
Objective To balance the covariatesby propensity score matching for better evaluating the efficiencies of surgery resection (SR) and transcatheter arterial chemoembolization (TACE) for treatment of early-stage hepatocellular carcinoma (HCC) patients. Methods A total of 350 early-stage HCC patients treated by SR(192 cases) or TACE (158 cases) were collected from Shandong Tumor Hospital (2003 to 2011). Propensity score caliper matching was used to balance the covariance between the two groups. And then the matched data were subjected to survival analysis and the survival rates were comparedbetween the two groups. Results The covariates were imbalanced before matching; the1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 80. 92%, 49. 44%, 33. 73%, 19. 72%, and 2. 00 years, respectively; those of TACE group were 80. 02%, 53. 92%, 31. 21%, 13. 42%, and 2. 40 years, respectively; and log-rank test showed no significant differences in the survival rates between the two treatment groups (P = 0. 710 8). The covariates were balanced after matching; the 1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 84. 22%, 57. 68%, 36. 80%, 24. 09%, and 2. 50 years, respectively; those of TACE group were 73. 84%, 47. 26%, 28. 31%, 10. 69%, and 2. 00 years, respectively; and log-rank test showed significant difference in the survival rates between the two groups (P = 0. 018 2). The survival rate of SR group was higher than that of TACE group. Conclusion After reducing the confounding bias by Propensity score matching method, SR showes a better efficiency for early HCC patients compared with TACE.
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Objective To balance the covariatesby propensity score matching for better evaluating the efficiencies of surgery resection (SR) and transcatheter arterial chemoembolization (TACE) for treatment of early-stage hepatocellular carcinoma (HCC) patients. Methods A total of 350 early-stage HCC patients treated by SR(192 cases) or TACE (158 cases) were collected from Shandong Tumor Hospital (2003 to 2011). Propensity score caliper matching was used to balance the covariance between the two groups. And then the matched data were subjected to survival analysis and the survival rates were comparedbetween the two groups. Results The covariates were imbalanced before matching; the1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 80. 92%, 49. 44%, 33. 73%, 19. 72%, and 2. 00 years, respectively; those of TACE group were 80. 02%, 53. 92%, 31. 21%, 13. 42%, and 2. 40 years, respectively; and log-rank test showed no significant differences in the survival rates between the two treatment groups (P = 0. 710 8). The covariates were balanced after matching; the 1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 84. 22%, 57. 68%, 36. 80%, 24. 09%, and 2. 50 years, respectively; those of TACE group were 73. 84%, 47. 26%, 28. 31%, 10. 69%, and 2. 00 years, respectively; and log-rank test showed significant difference in the survival rates between the two groups (P = 0. 018 2). The survival rate of SR group was higher than that of TACE group. Conclusion After reducing the confounding bias by Propensity score matching method, SR showes a better efficiency for early HCC patients compared with TACE.