ABSTRACT
OBJECTIVE To discuss medical insurance access and pricing methods for multi-indication drugs. METHODS The access situation of multi-indication drugs in China’s medical insurance negotiation over the years was sorted out. Referring to the economic theory of value-based pricing and the relevant experience of other countries， five applicable pricing methods of 3 categories for multi-indication drug in China were summarized. Taking ceftazidime-avibactam（CAZ-AVI） as an example， cost- utility analyses were performed for different indications， and appropriate pricing methods were applied. RESULTS & CONCLUSIONS All multi-indication drugs in China adopted a single pricing method. The pricing methods that could be explored include product-based pricing， such as single pricing based on the lower-value indication or mixed/weighted single pricing； indication-based pricing， such as developing a new agreement for single pricing under different discounts and listing with different brands and pricing of the same medicine for different indications； and compensation for access restrictions. Each method has its advantages and limitations. The case of CAZ-AVI showed that it is necessary to estimate the value of each indication for multi- indication drugs， and comprehensively consider appropriate access conditions and pricing methods based on value. Although single pricing is simple to operate， it is different to reflect the value entirely. The indication-based pricing and compensation for access restrictions all depend on the information collection system and the cooperation of multiple departments. China is supposed to carry out the value-based pricing of multi-indication drugs and constantly explore reasonable access methods to improve overall social welfare.
ABSTRACT
@#Objective To systematically evaluate the accuracy of endoscopy-based artificial intelligence (AI)-assisted diagnostic systems in the diagnosis of early-stage esophageal cancer and provide a scientific basis for its diagnostic value. Methods PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database were searched by computer to search for the relevant literature about endoscopy-based AI-assisted diagnostic systems for the diagnosis of early esophageal cancer from inception to March 2022. The QUADAS-2 was used for quality evaluation of included studies. Meta-analysis of the literature was carried out using Stata 16, Meta-Disc 1.4 and RevMan 5.4 softwares. A bivariate mixed effects regression model was utilized to calculate the combined diagnostic efficacy of the AI-assisted system and meta-regression analysis was conducted to explore the sources of heterogeneity. Results A total of 17 articles were included, which consisted of 13 retrospective cohort studies and 4 prospective cohort studies. The results of the quality evaluation using QUADAS-2 showed that all included literature was of high quality. The obtained meta-analysis results revealed that the AI-assisted system in the diagnosis of esophageal cancer presented a combined sensitivity of 0.94 (95%CI 0.91 to 0.96), a specificity of 0.85 (95%CI 0.74 to 0.92), a positive likelihood ratio of 6.28 (95%CI 3.48 to 11.33), a negative likelihood ratio of 0.07 (95%CI 0.05 to 0.11), a diagnostic odds ratio of 89 (95%CI 38 to 208) and an area under the curve of 0.96 (95%CI 0.94 to 0.98). Conclusion The AI-assisted diagnostic system has a high diagnostic value for early stage esophageal cancer. However, most of the included studies were retrospective. Therefore, further high-quality prospective studies are needed for validation.
ABSTRACT
OBJECTIVE：To pr ovide reference for the future pharmacoeconomic evaluation. METHODS ：Four typical cases of pharmacoeconomic evaluation showed the special situation that “not cost-effective at a zero price ”，defined the concept of “net value”to assist in theoretical analysis ，and summarized the possible causes of this situation . RESULTS & CONCLUSIONS ：The system（ATPS）：an overview and advances in its applica background treatment cost other than the target drug was too high ，the patient ’s quality of life during survival was too low ，the threshold of willingness to pay of incremental cost-effectiveness ratio was too low ，the cost of risk events during extended survival was too high or the health loss was too high ，and the price of the control scheme was too low ，which might affect the results of economic evaluation ，and even le d to the dilemma of pharmacoeconomic evaluation of “not cost-effective at a zero price ”. Pharmacoeconomic evaluation discusses the economy of intervention programs rather than the economy of drugs. The uneconomic results caused by various reasons need to be treated objectively ；theoretically，all“relevant”and“irrelevant”costs should be included in the calculation category in pharmacoeconomic evaluation ；pharmacoeconomics mainly solves the problem of “cost performance”comparison among several treatment schemes ，and the medical and health field often needs to face problems such as ethics and fairness. Therefore ，researchers may need to jump out of the framework of pharmacoeconomics analysis and conduct in-depth discussion from a higher and broader perspective.
ABSTRACT
OBJECTIVE：To provide reference for the selection of more economical programmed death- 1（PD-1）/programmed death-ligand 1（PD-L1）inhibitors for National Medical Insurance List and the quality improvement of related economic evaluation. METHODS：Retrieved from CNKI ，VIP，Wanfang database ，PubMed，Web of Science and Ovid Embase ，economic evaluation studies including listed PD- 1/PD-L1 inhibitors of China were collected during the inception to Oct. 2020. CHEERS checklist was used to evaluate the quality of the included literatures ，and the methodological characteristics and economic evaluation results of the included studies were analyzed systematically. RESULTS ：A total of 14 literatures were included ，all of which were model-based and with moderate or high quality. However ，there were still some deficiencies in the included literatures ，mainly manifesting as the insufficient reports on the reasons for setting or selecting model parameters ，as well as the great uncertainty of clinical effect data and utility value. Only 3 of the 8 PD-1/PD-L1 inhibitors listed in China were involved in the included literatures. Compared with chemotherapy or targeted therapy plan ，9 literatures（64.29％）showed that the therapy plan containing PD- 1/PD-L1 inhibitors was not cost-effective. CONCLUSIONS ：The economic evidence of domestic PD- 1/PD-L1 inhibitors is lacking ，the higher price of imported PD- 1/PD-L1 inhibitors lead to poor economic performance. The existing economic evaluations has some shortcomings in methodological application and parameter selection. Pharmaceutical enterprises should fill in the data gaps and adjust the pricing strategy，researchers should improve the standardization of research ，and medical insurance decision-making departments should improve the judgment on the quality of economic evidences ，so as to promote more economical drugs to be included in the National Medical Insurance List.
ABSTRACT
Objective:To analyze bone strength index, osteoporosis and fracture in ankylosing spondylitis (AS) patients with radiologic hip involvement and explore the characteristics of bone strength in these patients.Methods:According to bath ankylosing spondylitis radiology hip index (BASRI-hip) score, 339 AS patients were divided into two groups. The differences of bone strength in each group were analyzed by t-test, Mann-Whitney U test and χ2 test. Logistic regression was used to analyze the risk factors of bone strength index. The correlation between quantitative ultrasound and dualenergy X-ray absorptiometry (DXA) (total hip, g/cm 2) was analyzed. Pearson correlation analysis was used. Results:①Bone strength index of quantitative ultrasound was positively correlated with bone mineral density of DXA (total hip, g/cm 2), r=0.553, P<0.01. ② The age of 27(23, 37) years old in radiographic hip involvement was lower than 37(28, 48) years old in non-radiographic hip involvement, and the difference was statistically significant ( Z=-5.986, P<0.01). There were no differences in gender and course of disease between the two groups ( P>0.05).③ The radiographic hip involvement in AS patients whose ages were younger than 50, when compared with non-radiographic hip involvement patients, the bone strength index was lower (78±18 vs 84±16), while bone strength was lower than patients at the same age (41.0% vs 18.4%), however, the incidences of osteoporosis (42.7% vs 28.8%) and fragility fracture (3.7% vs 0%) were significantly higher ( t=3.028, P<0.01; χ2=16.758, P<0.01; χ2=5.886, P=0.019; χ2=4.67, P=0.038). For AS patients whose ages were ≥50, there were no significant differences between the two groups ( P>0.05). ④ Multivariate analysis showed that radiographic hip involvement [ OR (95% CI)=1.912(1.05, 3.48)], age [ OR (95% CI)=0.94(0.911, 0.97)] and body mass index (BMI) (kg/m 2) [ OR (95% CI) =0.875(0.807, 0.948)] were associated with lower bone strength. Conclusion:There is positive correlation between the bone strength index of quantitative ultrasound and bone mineral density of DXA. AS patients with radiographic hip involvement are characterized by decreased bone strength and are more likely to develop osteoporosis and fragile fractures. The risk factors of low bone strength are radiographic hip involvement, age and BMI.
ABSTRACT
OBJECTIVE：To com pare the efficacy and safety of 5 direct antiviral agents in the treatment of chronic hepatitis C infection as glecaprevir （GLE）/pibrentasvir（PIB），ledipasvir（LDV）/sofosbuvir（SOF），SOF/velpatasvir（VEL），elbasvir（EBR）/ grazoprevir（GZR）compound preparation and danoprevir （DNV）+ peginterferon combined with ribavirin （P/R）. METHODS ： Retrieved from PubMed ，Embase，Cochrane Library ，Web of Science ，CNKI，VIP，Wanfang database and other databases ，RCTs about 5 direct antiviral agents in the treatment of chronic hepatitis C infection were collected during the inception to Jun. 2020. After literature screening and data extraction ，the quality of included literatures were evaluated with bias risk evaluation tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis was performed by using Stata 15.0 software. RESULTS ： A total of 48 RCTs with 12 227 patients in trial group were included. Results of Meta-analysis showed that the descending order of sustained virological response （SVR）rate was GLE/PIB ＞LDV/SOF＞SOF/VEL＞EBR/GZR＞DNV+P/R；weighted SVR rates of GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZ were more than 95％. The incidence of any severe adverse event and adverse event in ascending order was EBR/GZR ＜GLE/PIB＜SOF/VEL＜LDV/SOF＜DNV+P/R. The incidence of nausea/vomiting in ascending order was GLE/PIB ＜LDV/SOF＜EBR/GZR＜SOF/VEL＜DNV+P/R. The incidence of rash in ascending order was LDV/SOF ＜ GLE/PIB＜SOF/VEL＜EBR/GZR＜DNV + P/R. The incidence of insomnia from low to high was GLE/PIB ＜EBR/GZR＜SOF/ VEL＜LDV/SOF＜DNV+P/R. CONCLUSIONS ：GLE/PIB，LDV/SOF，SOF/VEL and EBR/GZR have higher and similar effective rates in the treatment of chronic hepatitis C ，especially the weighted SVR rate of GLE/PIB is the best ，and the safety of EBR/GZR and GLE/PIB is relatively better.
ABSTRACT
BACKGROUND: Liver fibrosis has higher morbidity and mortality. Activation and proliferation of hepatic stellate cells is a key link in the progression of liver fibrosis. At present, there are still no effective anti-fibrosis agents targeting single links or targets. OBJECTIVE: To analyze the effect of human adipose stem cells derived exosomes on rats with liver fibrosis induced by carbon tetrachloride. METHODS: Human adipose stem cells were obtained from healthy people by enzyme dissolution method. After in vitro culture, human adipose stem cells derived exosomes were obtained by multiple ultrafiltration. Different concentrations of exosomes were used to treat the hepatic stellate cells activated by transforming growth factor β1. The human adipose stem cells activated by transforming growth factor β1 were treated with different concentrations of exosomes. The expression of α-smooth actin in the cells was detected by quantitative PCR, and the growth and apoptosis of activated hepatic stellate cells were detected by CCK-8 and flow cytometry respectively. Rat models of liver fibrosis were established by intraperitoneal injection of carbon tetrachloride and treated by tail vein injection of exosomes. Rat liver function, serum levels of type III procollagen and type IV collagen, and Ishak score were determined. Semi-quantitative analysis of liver fibrosis was performed. The expression levels of tissue inhibitor of matrix metalloproteinase-1, matrix metalloproteinase 9 and α-smooth actin in liver tissue were measured by immunofluorescence method. The study protocol was approved by the Animal Ethics Committee and Medical Ethics Committee, Tongji University, China in January, 2017. RESULTS AND CONCLUSION: Human adipose stem cells derived exosomes inhibited the proliferation of activated hepatic stellate cells. The possible mechanism is to inhibit the proliferation of activated macrophages, reduce the production of collagen fibers, α-smooth actin actin, and tissue inhibitor of matrix metalloproteinase-1, and to increase the expression of matrix metalloproteinase 9. These findings suggest that exosomes can be used to treat carbon tetrachloride induced liver fibrosis.
ABSTRACT
OBJECTIVE：To provide evidence-ba sed evidence for clinical treatment and decision by evaluating efficacy ，safety and cost-effectiveness of denosumab in the treatment of giant cell tumor of bone （GCTB）. METHODS ：Retrieved from PubMed ， the Cochrane Library ，ScienceDirect，CNKI，Wanfang database and VIP as well as health technology assessment （HTA）organi- zation websites ，HTA reports ，randomized controlled trials （RCTs），single-arm trials and retrospective studies were included about denosumab in the treatment of GCTB in the adults and adolescents with mature bone ，and their qualities were evaluated. HTA reports were analyzed with descriptive analysis qualitatively ；Meta-analysis was conducted for single-arm clinical studies and retrospective studies by using R version 3.6.0 software. RESULTS ：Among 49 screened literatures ，there were 6 HTA reports ，5 single-arm trials and 3 retrospective studies ．No eligible RCTs were retrieved. HTA reports of various countries generally believed that denosumab possessed good efficacy and safety ；HTA reports of France ，Austrila and other contries showed that denosumab possessed economics. For the GCTB patients who was unresectable ，denosumab would bring the clinical benefits to about 81％ [95％CI（77％，86％）] of patients. The complete response rate and partial response rate was around 14％[95％CI（10％，19％）] and 51％[95％CI（32％，70％）]，respectively. For the GCTB patients was resectable ，denosumab would prevent some patients from receiving surgery （35％）[95％CI（21％，49％）] or bring surgical down staging to them （40％）[95％CI（36％，45％）]，the postoperative recurrence rate after experiencing the denosumab therapy was about 19％[95％CI（7％，35％）]，and median relapse time was approximately 6.73 months [ 95％CI（3.92，9.55）] after receiving surgery. Main grade 3-4 or high frequercy ADR requiring treatment was back pain ，limbs pain ，hypophosphatemia and jaw osteonecrosis. CONCLUSIONS ：Based on the currently available evidence，among the studies and regions covered in this study ，denosumab has favorable efficacy ，safety and cost-effectiveness in the treatment of TCTB.
ABSTRACT
OBJECTIVE：To provide reference for scientific decision-making of evaluation and application of clinical comprehensive value of drugs from the perspective of the public decision-making in China. METHODS ：Based on relevant documents and literatures ，drug clinical comprehensive value in other countries and areas ，the core indicators of drug clinical comprehensive value evaluation in China were confirmed. The concept and evaluation methods of each indicator were evaluated ， and relevant suggestions were put forward. RESULTS & CONCLUSIONS ：It’s suggested that the core indicators of China ’s drug clinical comprehensive value evaluation are safety and efficacy ，economy and affordability ，accessibility and fairness adherence ， suitability. The concepts of safety ，efficacy，economy，affordability and adherence indexes are clearly defined ，evaluation methods are systematic ，data sources are sufficient ，and international consensus exists in research design. There is no uniform definition of accessibility which composed of availability ，deliverability，availability，affordability and timeliness. The concept of equity is clearly defined and the evaluation method is systematic ，but the data source is insufficient. Appropriateness is evaluated by drug suitability index but there is no clear definition. Taking efficacy as an example ，efficacy includes intermediate indicators ，outcome indicators and quality of life indicators ，which are often confirmed by epidemiological research ，systematic evaluation and expert consensus. It ’s suggested that the Real World Study data should be used as much as possible when selecting or formulating the clinical comprehensive value indicators of drugs. With the help of multi-criteria decision-making analysis ，technical support should be provided by professional evaluation institutions ，and with the support of experts and researchers ，the above indicators should be empowered to form the clinical comprehensive value judgment of a drug by different public decision-making departments ，so as to decide whether to purchase ，use clinically ，or incorporate medical insurance reimbursement.
ABSTRACT
OBJECTIVE：To systematically e valuate the efficacy and safety of duloxetine in the improvement of pain symptoms of knee osteoarthritis （KOA），and to provide evidence-based reference for clinical treatment of KOA. METHODS ：Retrieved from PubMed，Embase，Medline，Cochrane Library ，CNKI，VIP and Wanfang database ，during the establishment of the database to Sept. 2019，RCTs about duloxetine （trial group ）vs. placebo （control group ）in the improvement of pain symptoms of KOA were collected. After data extraction and quality evaluation using Cochrane system evaluator ’s manual 5.1.0，Meta-analysis was performed by using Stata 14.0 software for WOMAC total score ，WOMAC pain score ，WOMAC stiffness score ，WOMAC function score and BPI-S score ，as well as the incidence of adverse reaction such as dry mouth ，somnolence and nausea. RESULTS：A total of 6 RCTs were included ，involving 2 059 patients. Meta-analysis results showed that WOMAC total score [MD＝－0.34，95％CI（－0.48，－0.20），P＜0.05]，WOMAC pain score [MD ＝－0.41，95％CI（－0.54，－0.29），P＜0.05]， WOMAC stiffness score [MD ＝－0.24，95％ CI（－0.37，－0.12），P＜0.05]，WOMAC function score [MD ＝－0.43，95％CI （－0.55，－0.31），P＜0.05]，BPI-S score [MD ＝－0.38，95％CI（－0.48，－0.28），P＜0.05] of trial group were significantly lower than those of control group ；the incidence of dry mouth [RR ＝3.55，95％CI（2.00，6.29），P＜0.05]，somnolence [RR ＝3.23， 95％CI（1.88，5.54），P＜0.05] and nausea [RR ＝6.95，95％CI（2.99，16.15），P＜0.05] in trial group were significantly higher than control group ，with significant difference. CONCLUSIONS ：Duloxetine can relieve the pain and improve knee function in patients with KOA ，but it is necessary to pay attention to its adverse reactions.
ABSTRACT
Objective:To explore the clinical characteristics of juvenile-onset ankylosing spondylitis.Methods:Clinical data of 350 cases of ankylosing spondylitis diagnosed in Beijing Jishuitan Hospital from January 2014 to December 2019 were collected. There were 75 cases with the symptom onset in age ≤16 years (juvenile-onset ankylosing spondylitis, JoAS), and 275 cases with the symptom onset in age>16 years (adult-onset ankylosing spondylitis, AoAS). The clinical characteristics of two groups were analyzed.Results:Compared with AoAS, JoAS had a higher proportion of males [98.7% (74/75) vs. 79.6% (219/275); χ 2=15.65, P<0.01] and longer course of disease [11(8,15) vs. 8(4,15) years; Z=-3.09, P<0.01]. Compared with AoAS, JoAS was more prone to have peripheral joint swelling and pain [45.3%(34/75) vs. 18.9%(52/275), χ 2=22.20, P<0.01], hip pain [26.7%(20/75) vs. 15.3%(42/275), χ 2=5.25, P=0.03] or heel pain [9.3%(7/75) vs. 2.9%(8/275), χ 2=5.93, P=0.02] as the first clinical manifestation. Compared with AoAS, JoAS had a higher incidence of radiological hip involvement [77.3%(58/75) vs. 43.3%(119/275), OR=4.71, Wald=25.60, P<0.01], lower bone mineral density than peers [34.7%(26/75) vs. 23.3%(64/275), OR=2.23, Wald=7.20, P<0.01], higher incidence of malnutrition [25.3%(19/75) vs. 13.8%(38/275), OR=2.16, Wald=5.84, P=0.02] and higher incidence of acute uveitis [17.3%(13/75) vs. 6.5%(18/275), OR=2.72, Wald=6.24, P=0.01] after adjusting the course of disease. Conclusion:Compared with adult-onset ankylosing spondylitis, juvenile-onset ankylosing spondylitis is more prone to have peripheral joint swelling or hip pain as the first clinical manifestation; the radiological hip involvement, lower bone mineral density than peers, malnutrition and uveitis are more likely to occur.
ABSTRACT
BACKGROUND: Liver fibrosis has higher morbidity and mortality. Activation and proliferation of hepatic stellate cells is a key link in the progression of liver fibrosis. At present, there are still no effective anti-fibrosis agents targeting single links or targets.OBJECTIVE: To analyze the effect of human adipose stem cells derived exosomes on rats with liver fibrosis induced by carbon tetrachloride. METHODS: Human adipose stem cells were obtained from healthy people by enzyme dissolution method. After in vitro culture, human adipose stem cells derived exosomes were obtained by multiple ultrafiltration. Different concentrations of exosomes were used to treat the hepatic stellate cells activated by transforming growth factor β1. The human adipose stem cells activated by transforming growth factor β1 were treated with different concentrations of exosomes. The expression of α-smooth actin in the cells was detected by quantitative PCR, and the growth and apoptosis of activated hepatic stellate cells were detected by CCK-8 and flow cytometry respectively. Rat models of liver fibrosis were established by intraperitoneal injection of carbon tetrachloride and treated by tail vein injection of exosomes. Rat liver function, serum levels of type III procollagen and type IV collagen, and Ishak score were determined. Semi-quantitative analysis of liver fibrosis was performed. The expression levels of tissue inhibitor of matrix metalloproteinase-1, matrix metalloproteinase 9 and α-smooth actin in liver tissue were measured by immunofluorescence method. The study protocol was approved by the Animal Ethics Committee and Medical Ethics Committee, Tongji University, China in January, 2017. RESULTS AND CONCLUSION: Human adipose stem cells derived exosomes inhibited the proliferation of activated hepatic stellate cells. The possible mechanism is to inhibit the proliferation of activated macrophages, reduce the production of collagen fibers, α-smooth actin actin, and tissue inhibitor of matrix metalloproteinase-1, and to increase the expression of matrix metalloproteinase 9. These findings suggest that exosomes can be used to treat carbon tetrachloride induced liver fibrosis.
ABSTRACT
OBJECTIVE： To provide reference for improving medication compliance and therapeutic efficacy in community patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The data was from the “Economic Study of Diabetic Medications in Patients with T2DM in China”， which was conducted by China Center for Health Economic Research of Peking University. Both univariate analysis and Logistic regression model were used for single factor analysis and multiple factor analysis of medication compliance. RESULTS： Totally 2 236 community T2DM patients were included. The rate of good medication compliance was estimated at as low as 23.48％. Monthly household income and duration of the disease had significant impact on medication compliance. Incidence of good the medication compliance for patients with monthly household income ≥6 000 yuan and during 3 000-＜6 000 yuan， compared to those with monthly household income ＜3 000 yuan， were 70.8％ [95％CI（0.532，0.944）] and 78.5％ [95％CI（0.614，1.004）] respectively. Incidence of good medication compliance for the patients with 5 to 10 years and ＞10 years of disease duration， compared to those with ＜5 years of disease duration， were 69.0％ [95％CI（0.542， 0.878）] and 59.1％ [95％CI（0.459， 0.760）] respectively. CONCLUSIONS： The medication compliance among community patients with T2DM in China was generally poor. Longer duration of the disease and higher monthly household income are associated with poorer medication adherence.
ABSTRACT
OBJECTIVE： To provide reference for improving the treatment compliance and therapeutic effect of patients with type 2 diabetes mellitus （T2DM） in China. METHODS： The follow-up data was from the issue of Pharmacoeconomic Study of Diabetic Drugs in China， which was conducted by China Center for Health Economic Research （CCHER） of Peking University. Using follow-up endpoint HbA1c level as clinical output indicator， univariate analysis and multivariable regression analysis of binary and numerical variables were performed to evaluate the effect of treatment compliance on short-term clinical outcomes. RESULTS： Totally 2 236 community T2DM patients were included for the analysis. The patients with good and poor medication compliance accounted for 23.48％ and 76.52％； the patients with good and poor blood glucose monitoring compliance accounted for 7.02％ and 93.98％； 66.3％， 23.5％ and 10.2％ of the patients had good， medium and poor diet control compliance， respectively. Univariate analysis showed that there was a significant difference in the “good control” group of blood glucose and the “poor control” group of blood glucose in terms of patient age， body mass index， education level， duration of disease， exercise， and eating habits，etc （P＜0.05）. Similar results were obtained in the analysis of multiple Logistic regression and multivariate loglinear regression models， that is， blood glucose monitoring compliance and diet control compliance had significant positive effects on end-point HbA1c （P＜0.05）， but drug compliance had no significant effect （P＞0.05）. CONCLUSIONS： The treatment compliance among community patients with T2DM in China was generally poor. After controlling for other variables， patients’ treatment compliance has a positive effect on end-point HbA1c， especially better blood glucose monitoring compliance and diet control compliance contribute to blood glucose control， but medication compliance has no significantly effect.
ABSTRACT
Objective To investigate the clinical characteristics of paraneoplastic syndrome with prominent osteoarticular involvement. Methods The clinical materials of 20 patients with paraneoplastic syndrome with prominent osteoarticular involvement were collected. The characteristics of clinical manifest-ations, laboratory tests and imagines were analyzed. Results Among the 20 patients, 16 were male and 4 were female, with a mean age of 44.5 years and a median course of 6 months. Ten cases were associated with hematological tumor and 10 cases were associated with solid tumor. Eleven cases presented as peripheral arthritis (7 cases of polyarthritis, 4 cases of oligoarthritis/monoarthritis), 5 cases presented with hypertrophic osteoarthropathy (HOA) and 4 cases presented with tumor-induced osteomalacia (TIO). Three cases were acute lymphocytic leukemia, 2 cases were multiple myeloma, 1 case was lymphoma, and 1 case was bone tumor in polyarthritis. Four oligoarthritis cases were all associated with acute lymphocytic leukemia. All 5 cases of HOA were associated with lung cancer. All 4 cases of TIO were associated with tumor of mesenchymal tissue. Extra-articular manifestations presented in 14 cases and inflammatory markers increased in 15 cases. anti-cyclic cirullinated peptide (anti-CCP) antibodies was low titer positive in only 1 case and other parameters including rheumatoid factor (RF), anti-CCP antibodies, antinuclear antibodies spectrum (ANAs) and human leukocyte antigen (HLA)-B27 were negative. Multiple bone imaging abnormalities appeared in 15 cases. Conclusion Osteoarticular manifestations may be the first symptom of malignancy and difficult to diagnose. It is necessary to be highly aware of potential malignancy.
ABSTRACT
OBJECTIVE:To provide methodological reference for converting non-utility scale measurement results into health utility values. METHODS:Referring to domestic and foreign literatures,mapping methods and relevant models in health utility measurement were summarized. The effect of each model on probability mapping was introduced by taking the Medical outcomes study 12-item short form health survey measurement results converting into the EuroQol group's 5-domain utility values as exam-ple.RESULTS:The mapping methods can be adopted to obtain the health utility values by establishing the mapping relationship be-tween non-utility scale and utility scale. The common models included ordinary least square(OLS)model,censored least absolute deviations(CLAD)model,Tobit model,multinomial Logistic regression(MNL)model,Bayesian networks(BN)model,etc. OLS model was relatively simple with a good predictive validity,but it would be limited by the ceiling effect;Tobit model was not limit-ed by the ceiling or floor effect,when the error term satisfied the variance homogeneity and normality,prediction result of Tobit model was better than OLS model;CLAD model can be used for the situation of Tobit model unsuitable for non-variance homoge-neity of the error term;MNL model firstly determined a health state by regression analysis and then determined its utility value;the prediction validity of BN model was good and it didn't involved many assumptions and restrictions condition in econometrics, but the construction of BN model was greatly influenced by domain experts. Main methods for the calculation of health utility value with MNL or BN model were Monte Carlo simulation method,expected-utility method,most-likely probability methed,etc. We can carry out the model performance evaluation by using the R2,the adjusted R2,the mean error,the mean squared error and the mean absolute error,and then select the optimal model to calculate health utility values. CONCLUSIONS:Due to the advantages and disadvantages of each mapping model,it is necessary to select different mapping models based on the actual conditions.
ABSTRACT
OBJECTIVE:To provide methodological reference for converting non-utility scale measurement results into health utility values. METHODS:Referring to domestic and foreign literatures,mapping methods and relevant models in health utility measurement were summarized. The effect of each model on probability mapping was introduced by taking the Medical outcomes study 12-item short form health survey measurement results converting into the EuroQol group's 5-domain utility values as exam-ple.RESULTS:The mapping methods can be adopted to obtain the health utility values by establishing the mapping relationship be-tween non-utility scale and utility scale. The common models included ordinary least square(OLS)model,censored least absolute deviations(CLAD)model,Tobit model,multinomial Logistic regression(MNL)model,Bayesian networks(BN)model,etc. OLS model was relatively simple with a good predictive validity,but it would be limited by the ceiling effect;Tobit model was not limit-ed by the ceiling or floor effect,when the error term satisfied the variance homogeneity and normality,prediction result of Tobit model was better than OLS model;CLAD model can be used for the situation of Tobit model unsuitable for non-variance homoge-neity of the error term;MNL model firstly determined a health state by regression analysis and then determined its utility value;the prediction validity of BN model was good and it didn't involved many assumptions and restrictions condition in econometrics, but the construction of BN model was greatly influenced by domain experts. Main methods for the calculation of health utility value with MNL or BN model were Monte Carlo simulation method,expected-utility method,most-likely probability methed,etc. We can carry out the model performance evaluation by using the R2,the adjusted R2,the mean error,the mean squared error and the mean absolute error,and then select the optimal model to calculate health utility values. CONCLUSIONS:Due to the advantages and disadvantages of each mapping model,it is necessary to select different mapping models based on the actual conditions.
ABSTRACT
Objective To learn quality of life of acute upper respiratory tract infection patients and their influence factors.Methods We conducted questionnaire investigation on acute upper respiratory tract infection patients from five hospitals,respectively located in Wuhan,Hefei and Jinhua.The scale we used is EQ-5D.We calculated EQ-5D score through three different integration systems,which are from China,Korea and the UK,in order to compare difference among different countries' integration systems.Then econometric model was used to carry out regression analysis on factors affected EQ-5D score.Results 659 samples was included,with 319 from Wuhan,235 from Hefei and 105 from Jinhua.Among EQ-5D five dimensions,the first three dimensions do not have problems.However,81.94％ of the patients have problems in pain/discomfort and 47.8％ of them have problems in anxiety/depression.In regression analysis,location,severity level of disease and whether accompanied by chronic diseases or not have influence on EQ-5D score.Compared with utilities of patients who are suffered from other diseases,utilities of acute upper respiratory tract infection patients are lower than that of cerebral apoplexy,hypertension,coronary heart diseaseand diabetes patients;but are higher than that of Chronic lymphatic filariasis,chronic obstructive pneumonia and rheumatoid arthritis patients.Conclusion Chinese acute upper respiratory tract infection patients mainly have problems in the dimension of pain/discomfort and anxiety/depression.Compared to British integration system,Korean's is more applicable to Chinese population.Acute upper respiratory tract infection patients' utilities are lower than that of healthy population and chronic invalids with no obvious symptoms,and higher than that of chronic invalids with obvious symptoms.
ABSTRACT
BACKGROUND: It has been believed mesenchymal stem cells (MSCs) play a role in treatment through paracrine mechanism. Various side effects such as embolism, tumorigenesis and immunological reaction caused by direct injection of MSCs can be avoided by extracting MSC lysate. However, there is a larger difference in current collection methods and standards of MSC lysate. OBJECTIVE: To compare repeated freeze-thaw and ultrasonication for the collection of lysate of MSCs. METHODS: Adipose-derived mesenchymal stem cells (ADMSCs) were isolated from the abdominal subcutaneous fat of healthy individuals, and purified with adherence screening method, followed by in vitro amplification using fetal bovine serum medium. The common surface makers of these cells were tested by flow cytometry (1×109, 2×109, 4×109/L). Repeated freeze-thaw and ultrasonication were employed for cell cytoclasis at three different densities respectively in saline and double distilled water, and a comprehensive comparison was performed on cytoclasis rate and the content of protein in cell lysate between the two methods. RESULTS AND CONCLUSION: (1) ADMSCs obtained from in vitro isolated human adipose tissue grew in a swirl or radial pattern with a homogenous size and neat arrangement. CD44, CD90, CD105 and other commonly used surface markers were highly expressed. (2) The study for optimization of lysate collection revealed that the higher cell density implicated a longer time for cell wall disruption and cytoclasis, as well as significantly increased cytoclasis rate. (3) BCA protein assay showed that the highest content of protein was obtained in saline solvent using ultrasonication method. Comprehensive analysis on the results leads to a conclusion that ultrasonication method with saline as the solvent is the optimized method for extraction of ADMSCs lysate, and the cell concentration of less than 4×109/L is recommended.
ABSTRACT
Objective To investigate the clinical characteristics of Turner syndrome in patients with spondyloarthropathy.MethodsSix patients from our hospital were included and the clinical manifestations,laboratory parameters and imaging presentations were analyzed retrospectively and the relevant literature were reviewed.ResultsThe mean age of these 6 cases was (27±5) years.Two cases were spondyloarthropathy,3 cases were ankylosing spondylitis,1 was psoriatic arthritis.Five cases were complicated with peripheral arthriris,2 cases were complicated with inflammatory back pain,4 cases had vertebral activity limitation,3 cases had joint deformity.The karyotype of 6 cases was 45,XO.Six cases were complicated with osteoporosis.Conclusion Turner syndrome can be presented with spondyloarthropathy,arthritis,osteoporosis.Dysplasia of bone is common.