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BACKGROUND@#This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.@*METHODS@#This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability.@*RESULTS@#STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.@*CONCLUSION@#The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
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Humanos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Guías de Práctica Clínica como AsuntoRESUMEN
Objective To analyse the current scientific research situation of the young doctors in Zhongshan Hospital.Methods We surveyed the young doctors with a questionnaire for their basic information,scientific research projects and published papers,research motivations and difficulties in scientific research.Results Their quantity of research projects and production of papers were less than that they were expected.The main motivation for scientific research was to gain promotion and their primary difficulty was heavy load of clinical work.Conclusion There is a gap between the general level of the young doctors in scientific research and the development require of Zhongshan hospital.
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Objective To assess clinicopathological features and prognosis of patients with combined hepatocellular and cholangiocarcinoma (cHCC-CC). Methods Clinicopathological and follow-up data of 115 cHCC-CC patients confirmed pathologically in Liver Cancer Institute of Fudan University from 1995 to 2007 were analyzed. Kaplan-Meier method was used to calculate 1-,3- and 5-year survival rates and tumor-free survival rates. Survival curves were analyzed using the log-rank test. The factors that impacted the prognosis of cHCC-CC were estimated. Results In 115 cases, one was Allen's type A, one was Allen's type B, and the other 113 were Allen's type C. Being with male in predominance, most of the cHCC-CC patients had liver cirrhosis background. They presented with elevated AFP or CA19-9, vascular invasion, resembling hepatocellular carcinoma(HCC)as well as lymph nodes metastasis. One-, 3-, 5-year survival rates of 115 patients were 68. 1%, 38. 1% and 33.6%, respectively, with median survival time of 13.0 months. Whereas the 1-, 3-, 5-year survival rates in radical resected patients were 78.4 % ,44.4 % and 44.4 % ,respectively, with median survival time of 16.0 months. Tumor free survival time at 1-, 3- and 5-year was 57.8 %, 12.6 % and 0.0 %,respectively,with median recurrent time of 10.0 months. One-, 3-, 5-year survival rates of 10 nonsurgical patients were 10/10,10/10 and 0/10,respectively, with median survival time of 5.3 months.TNM stage was independent factor for prognosis of the patients after resection. Whereas the lymph nodes involvement was independent factor for the tumor free survival time of radical resected patients.Conclusions Although clinicopathological characteristics of cHCC-CC are more similar to those of HCC, the prognosis of cHCC-CC is more unfavorable than that of HCC. TNM stage is an independent determinant of long time outcome for patients after resection.
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ObjectiveTo investigate the feasibility of examining aortic pulse wave velocity (PWV),aortic distensibility (AD) and brachial artery flow-mediated dilation (FMD) by means of highresolution 3.0 T MRI.MethodsA total of 32 healthy volunteers underwent high-resolution MRI to assess aortic PWV,and AD in ascending aorta (AA),proximal descending aorta (DA),distal descending aorta (DDA) and FMD of the brachial artery with repeat examination performed in 1-2 hours.PWV was evaluated by 2D Phase Contrast (PC) velocity-encoded MRI with a 4.7-7.8 ms temporal resolution.Fiesta-cine MRI was used to assess AD and FMD with a 18.75-31.25 ms temporal resolution.The image quality of these two scans was scored and the agreement between them was tested with Kappa analysis.The reproducibility of the results between repeated measurements of PWV,AA-AD,DA-AD,DDA-AD and FMD was assessed with intra-class correlation coefficient (ICC) analysis.The method of Bland-Altman plot was used to assess the agreement between results of repeated studies.Results Each examination including PWV,AD and FMD were completed in about half an hour.The image quality between repeated scans showed good agreement ( Kappa value 0.776 ) with the score of ( 3.53 ± 0.62 ) and ( 3.41 ± 0.67 ) respectively.Reproducibility between repeated measurements was high for aortic PWV [ (4.33 ± 0.88 ) vs ( 4.36 ±0.88) m/s],AA-AD [(8.60±3.11) × 10-3 vs (8.59 ± 3.10) × l0-3/mm Hg(1 mm Hg =0.133 kPa) ],DA-AD[ (6.95 ±2.44) × 10-3 vs (6.95 ±2.42) × 10-3/mm Hg],DDA [(10.54 ±2.91) ×l0-3 vs (10.55 ±2.90) × 10-3/mm Hg] and FMD [(24.94 ± 12.55)％ vs (24.92 ±1 2.38 ) ％ ].ICC were 0.95,0.97,0.99,0.98 and 0.94,P ＜ 0.01.Excellent agreement between repeated measurements was found for aortic PWV [ confidence interval (CI) between - 0.55 and 0.50 ],AA-AD ( CI between - 0.11 and 0.12 ),DA-AD ( CI between - 0.08 and 0.08 ),DDA-AD ( CI between - 0.23 and 0.21 ) and FMD (CI between - 1.46 and 1.51 ).The maximum difference percentage in minimum average for aortic PWV,AA-AD,DA-AD,DDA-AD and FMD was 38.53％,9.65％,3.86％,5.68％,42.37％,respectively,all less than 50％.Conclusion Comprehensive assessment of aortic compliance and brachial endothelial function can be achieved using 3.0 T high-resolution MRI with excellent reproducibility and within a reasonable amount of time.
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Lactoferrin has antitumoral activity. Lactoferrin exerts anti-carcinogenic effects via its ability to modulate host immunity, suppress proliferation, induce apoptosis, block cell cycle, inhibit angiogenesis, regulate carcinogen-metabolizing enzymes and sequester iron, etc. Safety and no toxicity of lactoferrin provide a new selection for cancer treatment.
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Objective To compare the Barcelona clinic liver cancer staging classification (BCLC), the Japan integrated staging score (JIS), the cancer of the liver Italian program score (CLIP) and Chinese staging system in terms of their ability to predict outcomes and to guide option of therapy in patients with hepatocellular carcinoma (HCC) in China.Methods Clinical data of 861 HCC patients from Zhongshan Hospital between 2001 and 2002 were retrospectively analyzed. Patients were classified acccording to different staging systems. Survival for patients in different stages and the effects of therapeutic methods on survival time were compared. Results BCLC, JIS and Chinese staging system showed the ability in predicting survival for patients in different staging. CLIP failed to show significant difference in survival rates for each subgroup. There was no significant difference in survival rate between surgery and transarterial chemoembolization (TACE)/transarterial embolization (TAE) for patients classified as BCLC stage C, CLIP scores more than 3 or Chinese stage Ⅲ a.The survival rate, however, was higher in patients received operation than those received TACE/TAE if they were classified as earlier stages. Conclusions The BCLC, JIS and Chinese staging systems show prospective ability for Chinese HCC patients in prediction outcomes, whereas the BCLC and the Chinese staging systems are better at both predicting outcomes and guiding the option of treatment.
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Objective To investigate the diagnostic value of ADC for breast lesions with different enhancement shape or mass size. Methods One hundred and thirty-six breast lesions confirmed by histopathology were included in this study. According to enhancement shape and size of the lesion, all lesions were divided into 3 groups: non-masslike enhancement ( G1 ), masslike enhancement with the largest diameter ＜ 2. 0 cm (G2a) and masslike enhancement with the largest diameter ＞ 2. 0 cm (G2b). Echo planar imaging DWI was performed and three b-values (0,500 and 1000 s/mm2) were applied. The t-test was used for testing the difference of ADC between malignant and non-malignant breast lesions in each group. ROC curve was deduced to test the diagnostic efficiency of ADC. The sensitivity, specificity, negative predictive value( NPV), positive predictive value(PPV) and accuracy of ADC for the diagnosis of breast lesions were calculated under the different threshold. Appropriate b value and threshold were determined with the combination of morphologic evaluation. Results There were no significant differences for the mean ADC values between malignant [b =800 mm2/s: ADC value = ( 1.13 ±0. 23) × 10-3 mm2/s,b=1000 mm2/s: ADC value = (1.05 ±0.20) × 10-3 mm2/s] and non-malignant breast lesions [b =800 mm2/s: ADC value = ( 1.28 ±0. 27) × 10-3 mm2/s, t = 1. 636, P =0. 112,b = 1000 mm2/s: ADC value=(1.20 ±0.23) × 10-3 mm2/s, t = 1.720, P =0. 109] in Group 1. The mean ADC values of malignant breast lesion [b =800 mm2/s: ADC value = (1.07 ±0. 15) × 10-3 mm2/s,b = 1000 mm2/s:ADC value = (0. 99 ±0. 14) × 10-3 mm2/s] were significantly lower than that of non-malignant lesion [b =800 mm2/s: ADC value = ( 1.37 ± 0. 37 ) × 10-3 mm2/s, t = 4. 803, P = 0. 000; b = 1000 mm2/s: ADC value= (1.30 ±0.34) × 10-3 mm2/s, t =4.227, P =0.000] in Group 2a. The mean ADC values of malignant breast lesion [b =800 mm2/s: ADC value = (0. 97 ±0. 14) × 10-3 mm2/s; b = 1000 mm2/s:ADC value = (0. 93 ±0. 14) × 10-3 mm2/s] were significantly lower than that of non-malignant lesion [b =800 mm2/s: ADC value = ( 1.40 ± 0. 39) × 10 -3 mm2/s, t = 4. 227, P = 0. 000; b = 1000 mm2/s: ADC value = ( 1.35 ±0. 36) × 10-3 mm2/s, t =4. 329, P =0. 000] in Group 2b. The diagnostic efficiency was equal( x2 =0. 36,P =0. 5460) whenever b value of 800 or 1000 s/mm2 was selected. The highest sensitivity (97.7%) and NPV (97. 1%) were obtained with b value of 1000 s/mm2 and threshold of 1.25 ×10 -3 s/mm2. Conclusion MR DWI is useful for the differential diagnosis of breast lesions with masslike enhancement rather than nonmasslike enhancement.