A cost-utility study of elective haemorrhoidectomies in Canada.

AIM: The aim was to estimate the 10-year cost-utility of haemorrhoidectomy surgery with preference-based measures of health using Canadian health utility measures and costs. METHODS: Patients undergoing elective haemorrhoidectomies by general and colorectal surgeons in British Columbia, Vancouver, between September 2015 and November 2022, completed preoperatively and postoperatively the EuroQol five-dimension five-level health-related quality of life questionnaire (EQ-5D-5L). Quality-adjusted life years (QALYs) attributable to surgery were calculated by discounting preoperative and postoperative health utility values derived from the EQ-5D-5L. Costs were measured from a health system perspective which incorporated costs of hospital stay and specialists' fees. Results are presented in 2021 Canadian dollars. RESULTS: Of 94 (47%) patients who completed both the preoperative and postoperative questionnaires, the mean gain in QALYs 10 years after surgery was 1.0609, assuming a 3.5% annual discounting rate. The average cost of the surgery was $3166. The average cost per QALY was $2985 when benefits of the surgery were assumed to accrue for 10 years. The cost per QALY was higher for women ($3821) compared with men ($2485). Participants over the age of 70 had the highest cost per QALY ($8079/QALY). CONCLUSIONS: Haemorrhoidectomies have been associated with significant gains in health status and are inexpensive relative to the associated gains in quality of life based on patients' perspectives of their improvement in health and well-being.

Tumor habitat and peritumoral region evolution-based imaging features to assess risk categorization of thymomas.

AIM: To develop an aggregate model that integrated clinical data, habitat characteristics, and intratumoral and peritumoral features to assess the risk categorization of thymomas. MATERIALS AND METHODS: We retrospectively analyzed 140 thymoma patients (70 low-risk and 70 high-risk), including pathological data. The patients were randomly divided into training cohort (n = 114) and test cohort (n = 26). The k-means clustering was utilized to partition the primary tumor into habitats based on intratumoral radiomic features, 6 distinct habitats were identified. By expanding the region of interest (ROI) mask, 2 peritumoral regions were obtained. Finally, 7 clinical characteristics, 3 habitat values, 20 radiomic features were utilized to develop an aggregated model, to predict the risk of thymoma. Shapley additive explanations (SHAP) interpretation was used for features importance ranking. The accuracy and area under curve (AUC) were used to analyze the performance of the models. RESULTS: The aggregated model, which utilized the XGBoost classifier, demonstrated the best performance with an AUC of 0.811 and an accuracy of 0.769. In comparison, the radiomic model produced an AUC of 0.654 and an accuracy of 0.692. Additionally, the Intratumoral + peritumoral model exhibited an AUC of 0.728 and an accuracy of 0.769. CONCLUSION: Our study establishes a novel tool to predict the risk of thymoma with a good performance. If prospectively validated, the model may refine thymoma patient selection for risk-adaptative therapy and improve prognosis.

[Prognostic value of skeletal muscle measured by CT at the T4 level in advanced EGFR-positive non-small cell lung cancer patients treated with ecotinib].

Objective: To investigate the prognostic value of skeletal muscle measured by CT at the level of the fourth thoracic vertebra (T4) in advanced epidermal growth factor receptor (EGFR)-positive non-small cell lung cancer (NSCLC) patients treated with ecotinib. Methods: The study retrospectively reviewed clinical and pathological characteristics of 176 patients with advanced EGFR-positive NSCLC who received ecotinib and underwent chest CT scans at Wuhan Union Hospital between January 2017 and October 2020. Among them, 70 were male and 106 were female, with ages ranging from 27 to 80 (58.6±10.6) years. As of August 21, 2021, the median follow-up duration was 19.2 months (95%CI: 15.3 to 23.7 months). The optimal cut-off value of skeletal muscle density (T4-SMD) on CT images at the T4 level were determined using X-tile software. Kaplan-Meier analysis and log-rank test were used to plot progression-free survival curves. Cox proportional hazards regression models were employed to analyze factors influencing 1-year progression-free survival (PFS), and a nomogram prognostic model was constructed accordingly. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were utilized to evaluate the predictive value of the nomogram. Results: The T4-SMD [M (Q1,Q3)] of 176 patients was 42.56 (37.05, 45.93) HU. Patients were divided into low T4-SMD group (n=122) and high T4-SMD group (n=54) based on the cut-off value (The values for males and females were 49.44 and 41.41 HU, respectively) of T4-SMD. The median PFS time and 1-year PFS rate in the low T4-SMD group were significantly lower than those in the high T4-SMD group [10.4 (95%CI: 9.3-11.8) vs 13.7 (95%CI: 11.1-18.5) months, 36.1% vs 59.3%, respectively, P=0.034]. Eastern Cooperative Oncology Group performance status (HR=3.308, 95%CI: 1.183-9.247, P=0.023), lactate dehydrogenase level (HR=1.852, 95%CI: 1.037-3.307, P=0.037), systemic immune-inflammation index (HR=1.772, 95%CI: 1.019-3.080, P=0.043), and T4-SMD (HR=0.563, 95%CI: 0.325-0.974, P=0.040) were prognostic factors for 1-year PFS in advanced EGFR-positive NSCLC patients treated with ecotinib. A nomogram for predicting 1-year PFS of advanced EGFR-positive NSCLC patients treated with ecotinib was constructed based on the four indicators selected by multivariate Cox regression analysis. The area under the ROC curve of the nomogram was 0.775 (95%CI: 0.676-0.874). The calibration curve showed good consistency between the predicted and actual 1-year PFS. DCA demonstrated good clinical prediction effectiveness of the nomogram. Conclusion: Low T4-SMD is a prognostic risk factor for patients with advanced EGFR-positive NSCLC receiving icotinib therapy.

Safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia: A metanalysis in biomedicine.

Trigeminal neuralgia is a debilitating condition characterized by severe facial pain. Carbamazepine has been widely used as a first-line treatment option for trigeminal neuralgia, but there is a need to evaluate its safety and efficacy based on existing evidence. This meta-analysis aims to systematically assess the available literature and provide a comprehensive evaluation of the safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia. A thorough search of electronic databases yielded a total of 15 relevant studies that met the inclusion criteria. The pooled analysis of these studies revealed that carbamazepine demonstrated significant efficacy in reducing pain intensity and frequency in patients with trigeminal neuralgia. Moreover, the drug was generally well-tolerated, with the most common adverse events being mild and transient. Subgroup analyses based on different dosages and treatment durations further supported the overall findings. However, caution should be exercised in patients with certain comorbidities or specific populations, as some rare but severe adverse events were reported. In conclusion, this meta-analysis provides strong evidence supporting the safety and efficacy of carbamazepine as a valuable therapeutic option for the management of trigeminal neuralgia. These results can guide clinicians in making informed decisions regarding the use of carbamazepine and contribute to optimizing treatment strategies for patients with trigeminal neuralgia. Further research is warranted to explore long-term safety and efficacy outcomes, as well as to compare carbamazepine with alternative treatment modalities.

Non-criteria and criteria antiphospholipid antibodies and their association with pregnancy outcomes in women with a history of miscarriage: A retrospective study.

INTRODUCTION: The objective of this study was to investigate both antiphospholipid antibodies (aPLs) and non-criteria aPLs (NC-aPLs) in relation with pregnancy outcomes. METHODS: We retrospectively analyzed 1574 pregnant women with experienced at least one miscarriage who were tested for aPLs and NC-aPLs, and compared their clinical characteristics, immune biomarkers, and pregnancy outcomes. The χ2 test or Fisher's exact test compared pregnancy outcomes among patients negative for all aPLs, positive for NC­aPLs subtypes, and positive for criteria aPLs subtypes. RESULTS: Multivariate logistic regression analysis indicated that positive aPLs (OR = 2.216, 95 % CI 1.381-3.558), and positive NC-aPLs (OR = 1.619, 95 % CI 1.245-2.106) are linked to adverse outcomes. For fetal loss, positive aPLs (OR = 2.354, 95 % CI 1.448-3.829), NC-aPLs (OR = 1.443, 95 % CI 1.076-1.936) were significant. Premature delivery was associated with positive NC-aPLs (OR = 2.102, 95 % CI 1.452-3.043). In the NC-aPLs positive group, the rate of adverse outcomes was higher in the multiple-positive subgroup (77.8 %) compared to the double-positive (52.3 %) and single-positive (37.0 %) subgroups. The rates of fetal loss and premature delivery were also higher in the multiple-positive NC-aPLs subgroup compared to the single-positive subgroup (48.1 % vs. 22.6 % for fetal loss and 57.1 % vs. 16.5 % for premature delivery). DISCUSSION: Our findings suggest that both aPLs and NC-aPLs are associated with an increased incidence of adverse pregnancy outcomes, and patients presenting with multiple NC-aPLs positivity were found to have a higher incidence of adverse outcomes compared to their single-positive counterparts.

Attentional bias modulation by reappraisal in patients with generalized anxiety disorder: an event-related potential study

Affective states influence subsequent attention allocation. We evaluated emotional negativity bias modulation by reappraisal in patients with generalized anxiety disorder (GAD) relative to normal controls. Event-related potential (ERP) recordings were obtained, and changes in P200 and P300 amplitudes in response to negative or neutral words were noted after decreasing negative emotion or establishing a neutral condition. We found that in GAD patients only, the mean P200 amplitude after negative word presentation was much higher than after the presentation of neutral words. In normal controls, after downregulation of negative emotion, the mean P300 amplitude in response to negative words was much lower than after neutral words, and this was significant in both the left and right regions. In GAD patients, the negative bias remained prominent and was not affected by reappraisal at the early stage. Reappraisal was observed to have a lateralized effect at the late stage.

Comparison of clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve

Purpose. Little is known about the features of gastric cancer located in the lesser and greater curve. This study aims to investigate the clinicopathological features and prognosis of gastric cancer located in the lesser and greater curve. Patients. From September 2008 to March 2015, 780 gastric cancer patients were enrolled in the present study. The associations between locations and features of patients were analyzed. Results. There were 571 male (73.2 %) and 209 female (26.8 %) patients. The median age was 56 years (ranged 21-86). There were 684 tumors located in the lesser curve (87.7 %) and 96 located in the greater curve (12.3 %). The incidence of melena was significantly lower in patients with tumors located in the lesser curve than that in the greater curve (8.5 vs 15.6 %, P = 0.024). The median size of tumors in the lesser curve was significantly larger than that in the greater curve (5.0 (0.3-15) vs 4.0 cm (0.5-15), P = 0.001). The remaining clinicopathological features were comparable between the two groups (all P > 0.05). Tumor location was not a risk factor for the prognosis of gastric cancer by univariate and multivariate analysis (both P > 0.05). The postoperative complications (all P > 0.05) and prognoses (P = 0.279) were comparable between tumors located in the lesser and greater curve. Conclusions. The ratio of gastric cancer located in the lesser to greater curve was 7.1:1. Compared with tumors located in the greater curve, the incidence of melena was significantly lower and the tumor size was significantly larger in tumors located in the lesser curve. The prognoses were comparable between tumors located in the lesser and greater curve (AU)

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Angiotensin-converting enzyme gene insertion/deletion polymorphisms and the susceptibility to allergic rhinitis

BACKGROUND: Angiotensin-converting enzyme (ACE) gene I/D polymorphism might be linked to the risk of the allergic rhinitis (AR). OBJECTIVE: In the present study, we assessed the association of ACE gene I/D polymorphisms with AR susceptibility using a meta-analysis. MATERIALS AND METHODS: We carried out a retrieval of studies and included the eligible studies if they met the criteria. After the data extraction, the Stata software was used to analyse the genotype frequencies. RESULTS: In total, five studies with 561 patients and 603 controls were included. However, the genotype distribution among the control of one study was not consistent with the Hardy-Weinberg equilibrium. After pooling all studies, the results indicated an association between ACE gene I/D polymorphism and AR risk in the overall analysis (II vs. others: OR = 0.70, 95% CI = 0.54-0.92, P = 0.010; D vs. I: OR = 1.29, 95% CI = 1.08-1.54, P = 0.005). In the further analysis of the East Asians, no association between ACE gene I/D polymorphism and AR risk was observed. CONCLUSION: ACE gene I/D polymorphisms were not associated with the risk of AR in East Asians. These results need to be confirmed in the following studies

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Evolutionary tree reconstruction using structural expectation maximization and homotopy

The evolutionary tree reconstruction algorithm called SEMPHY using structural expectation maximization (SEM) is an efficient approach but has local optimality problem. To improve SEMPHY, a new algorithm named HSEMPHY based on the homotopy continuation principle is proposed in the present study for reconstructing evolutionary trees. The HSEMPHY algorithm computes the condition probability of hidden variables in the structural through maximum entropy principle. It can reduce the influence of the initial value of the final resolution by simulating the process of the homotopy principle and by introducing the homotopy parameter â. HSEMPHY is tested on real datasets and simulated dataset to compare with SEMPHY and the two most popular reconstruction approaches PHYML and RAXML. Experimental results show that HSEMPHY is at least as good as PHYML and RAXML and is very robust to poor starting trees.