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Economic Consequences of Surgery for Adhesive Small Bowel Obstruction: A Population-Based Study. 粘连性小肠梗阻手术的经济后果:一项基于人群的研究。
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/1844690
Thorbjörn Sakari, Sophie Langenskiöld, Filip Sköldberg, Urban Karlbom

Background and aims: Most patients develop adhesions after abdominal surgery, some will be hospitalized with small bowel obstruction (SBO), and some also require surgery. The operations and follow-up are expensive, but recent data of costs are scarce. The aim of this study was to describe the direct costs of SBO-surgery and follow-up, in a population-based setting. The association between cost of SBO and peri- and postoperative data was also studied.

Methods: In a retrospective cohort study, all patients (n = 402) operated for adhesive SBO in Gävleborg and Uppsala counties (2007-2012) were studied. The median follow-up was 8 years. Costs were calculated according to the pricelist of Uppsala University Hospital, Uppsala, Sweden.

Results: Overall total costs were €16.267 million, corresponding to a mean total cost per patient of €40,467 during the studied period. Diffuse adhesions and postoperative complications were associated with increased costs for SBO in a multivariable analysis (P < 0.001). Most costs, about €14 million (85%), arouse in conjunction with the SBO-index surgery period. In-hospital stay was the dominating cost, accounting for 70% of the total costs.

Conclusion: Surgery for SBO generates substantial economic burden for healthcare systems. Measures that reduce the incidence of SBO, the frequency of postoperative complication, or the length of stay have the potential to reduce this economic burden. The cost estimates from this study may be valuable for future cost-benefit analyses in intervention studies.

背景与目的:大多数患者在腹部手术后出现粘连,部分患者会因小肠梗阻(SBO)住院,部分患者还需要手术治疗。手术和随访费用昂贵,但最近的费用数据很少。本研究的目的是描述以人群为基础的sbo手术和随访的直接成本。SBO成本与围手术期和术后数据之间的关系也被研究。方法:回顾性队列研究,对2007-2012年在Gävleborg和乌普萨拉县(Uppsala county)接受黏附性SBO手术的所有患者(n = 402)进行研究。中位随访时间为8年。根据瑞典乌普萨拉乌普萨拉大学医院的价目表计算费用。结果:总体总成本为1626.7万欧元,相当于研究期间每位患者的平均总成本为40467欧元。在多变量分析中,弥漫性粘连和术后并发症与SBO的成本增加相关(P < 0.001)。大多数费用,约1400万欧元(85%),与sbo指数手术期有关。住院是主要成本,占总成本的70%。结论:SBO手术给医疗系统带来了巨大的经济负担。减少SBO发生率、术后并发症频率或住院时间的措施有可能减轻这一经济负担。本研究的成本估计可能对未来干预研究的成本效益分析有价值。
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引用次数: 0
Ultra-Proximal Jejunostomy Application after McKeown-Type Esophagectomy: A Retrospective Case-Series Study. mckeown型食管切除术后超近端空肠造口术的应用:回顾性病例系列研究。
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/5874332
Dongliang Lin, Zhendong Xu, Jinlong Huang, Wenshan Hong, Weiqing Zhang, Luoyu Lian

Background: Jejunostomy is the main form of enteral nutritional support after McKeown-type esophagectomy. However, this requires the jejunum to be secured to the abdominal wall, which can lead to catheter-related complications. Here, we present a new type of jejunostomy, ultra-proximal jejunostomy, which does not require fixation of the jejunum to the abdominal wall.

Methods: Patients who underwent McKeown-type esophagectomy between January 2021 and March 2022 were included in this study. Postoperative outcomes of patients who underwent ultra-proximal jejunostomy are also presented.

Results: Forty-three patients were able to receive enteral nutritional support via an ultra-proximal jejunostomy after McKeown-type esophagectomy, and no cases of enteral fistulas were observed. The pain in the left lower abdomen largely disappeared after the removal of the jejunostomy tube in all patients, and there was no difficulty in removing the tube. To date, none of these patients have experienced bowel obstruction or jejunal torsion.

Conclusion: An ultra-proximal jejunostomy is a safe and feasible method and a better option for enteral nutrition support after McKeown-type esophagectomy.

背景:空肠造口术是mckeown型食管切除术后肠内营养支持的主要形式。然而,这需要将空肠固定在腹壁上,这可能导致导管相关并发症。在这里,我们提出一种新型的空肠吻合术,超近端空肠吻合术,它不需要将空肠固定在腹壁上。方法:在2021年1月至2022年3月期间接受mckeown型食管切除术的患者纳入本研究。术后结果的病人谁接受超近端空肠造口也提出。结果:43例患者在mckeown型食管切除术后可通过超近端空肠造口获得肠内营养支持,无肠内瘘发生。所有患者切除空肠造口管后,左下腹疼痛基本消失,拔管无困难。迄今为止,这些患者均未发生肠梗阻或空肠扭转。结论:超近端空肠造口是mckeown型食管切除术后肠内营养支持的一种较好的选择,安全可行。
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引用次数: 0
Gastrointestinal Infection in South African Children under the Age of 5 years: A Mini Review. 南非5岁以下儿童胃肠道感染:综述
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/1906782
Tshepo Mafokwane, Appolinaire Djikeng, Lucky T Nesengani, John Dewar, Olivia Mapholi

Objective: To estimate gastroenteritis disease and its etiological agents in children under the age of 5 years living in South Africa.

Methods: A mini literature review of pertinent articles published in ScienceDirect, PubMed, GoogleScholar, and Scopus was conducted using search terms: "Gastroenteritis in children," "Gastroenteritis in the world," Gastroenteritis in South Africa," "Prevalence of gastroenteritis," "Epidemiological surveillance of gastroenteritis in the world," and "Causes of gastroenteritis".

Results: A total of 174 published articles were included in this mini review. In the last 20 years, the mortality rate resulting from diarrhea in children under the age of 5 years has declined and this is influenced by improved hygiene practices, awareness programs, an improved water and sanitation supply, and the availability of vaccines. More modern genomic amplification techniques were used to re-analyze stool specimens collected from children in eight low-resource settings in Asia, South America, and Africa reported improved sensitivity of pathogen detection to about 65%, that viruses were the main etiological agents in patients with diarrhea aged from 0 to 11 months but that Shigella, followed by sapovirus and enterotoxigenic Escherichia coli had a high incidence in children aged 12-24 months. In addition, co-infections were noted in nearly 10% of diarrhea cases, with rotavirus and Shigella being the main co-infecting agents together with adenovirus, enteropathogenic E. coli, Clostridium jejuni, or Clostridium coli.

Conclusions: This mini review outlines the epidemiology and trends relating to parasitic, viral, and bacterial agents responsible for gastroenteritis in children in South Africa. An increase in sequence-independent diagnostic approaches will improve the identification of pathogens to resolve undiagnosed cases of gastroenteritis. Emerging state and national surveillance systems should focus on improving the identification of gastrointestinal pathogens in children and the development of further vaccines against gastrointestinal pathogens.

目的:了解南非5岁以下儿童胃肠炎疾病及其病原。方法:通过检索词:“儿童胃肠炎”、“世界胃肠炎”、“南非胃肠炎”、“胃肠炎患病率”、“世界胃肠炎流行病学监测”和“胃肠炎病因”,对ScienceDirect、PubMed、GoogleScholar和Scopus上发表的相关文章进行小型文献综述。结果:这篇小型综述共纳入174篇已发表的文章。在过去20年里,5岁以下儿童因腹泻导致的死亡率有所下降,这是由于卫生习惯的改善、提高认识方案、水和卫生设施供应的改善以及疫苗的可用性。更现代的基因组扩增技术用于重新分析从亚洲、南美洲和非洲八个资源贫乏地区收集的儿童粪便标本,报告病原体检测的敏感性提高到约65%,病毒是0至11月龄腹泻患者的主要病因,但志贺氏菌,其次是萨普病毒和产肠毒素的大肠杆菌在12-24月龄儿童中发病率高。此外,近10%的腹泻病例共感染,轮状病毒和志贺氏菌是主要的共感染源,腺病毒、肠致病性大肠杆菌、空肠梭菌或大肠梭菌是主要的共感染源。结论:这篇小型综述概述了南非儿童胃肠炎的流行病学和趋势,包括寄生虫、病毒和细菌病原体。序列独立诊断方法的增加将提高病原体的识别,以解决未确诊的肠胃炎病例。新兴的州和国家监测系统应侧重于改进儿童胃肠道病原体的鉴定和开发针对胃肠道病原体的进一步疫苗。
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引用次数: 0
6-OHDA-Induced Changes in Colonic Segment Contractility in the Rat Model of Parkinson's Disease. 6-羟多巴胺诱导帕金森病大鼠模型结肠节段收缩性的变化
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/9090524
Maria Del Pilar Murillo, Ebba Johansson, Victoria Bryntesson, Patrik Aronsson, Gunnar Tobin, Michael Winder, Thomas Carlsson

Background: Gastrointestinal dysfunction is one of the most common non-motor symptoms in Parkinson's disease (PD). The exact mechanisms behind these symptoms are not clearly understood. Studies in the well-established 6-hydroxydopamine (6-OHDA) lesioned rats of PD have shown altered contractility in isolated circular and longitudinal smooth muscle strips of distal colon. Contractile changes in proximal colon and distal ileum are nevertheless poorly studied. Moreover, segments may serve as better tissue preparations to understand the interplay between circular and longitudinal smooth muscle. This study aimed to compare changes in contractility between isolated full-thickness distal colon muscle strips and segments, and extend the investigation to proximal colon and distal ileum in the 6-OHDA rat model.

Methods: Spontaneous contractions and contractions induced by electrical field stimulation (EFS) and by the non-selective muscarinic agonist methacholine were investigated in strip and/or segment preparations of smooth muscle tissue from distal and proximal colon and distal ileum in an in vitro organ bath comparing 6-OHDA-lesioned rats with Sham-operated animals. Key Results. Our data showed increased contractility evoked by EFS and methacholine in segments, but not in circular and longitudinal tissue strips of distal colon after central 6-OHDA-induced dopamine denervation. Changes in proximal colon segments were also displayed in high K+ Krebs-induced contractility and spontaneous contractions.

Conclusions: This study further confirms changes in smooth muscle contractility in distal colon and to some extent in proximal colon, but not in distal ileum in the 6-OHDA rat model of PD. However, the changes depended on tissue preparation.

背景:胃肠功能障碍是帕金森病(PD)最常见的非运动症状之一。这些症状背后的确切机制尚不清楚。对6-羟多巴胺(6-OHDA)损伤的PD大鼠的研究表明,结肠远端离体圆形和纵向平滑肌条的收缩性改变。然而,结肠近端和回肠远端收缩性改变的研究很少。此外,节段可以作为更好的组织准备,以了解圆形和纵向平滑肌之间的相互作用。本研究旨在比较6-OHDA大鼠模型中离体全层结肠远端肌条和肌段的收缩性变化,并将研究范围扩大到结肠近端和回肠远端。方法:在离体器官液中对6-羟多巴胺损伤大鼠和假手术大鼠进行条状和节段状制备的结肠远端、近端和回肠远端平滑肌组织的自发收缩和电场刺激(EFS)及非选择性毒蕈碱激动剂甲胆碱诱导的收缩进行研究。关键的结果。我们的数据显示,在中枢6-羟多巴胺诱导的多巴胺去神经后,电刺激和甲胆碱引起的结肠远端节段收缩性增加,但在圆形和纵向组织条中没有。近端结肠段的变化也表现为高K+ krebs诱导的收缩力和自发收缩。结论:本研究进一步证实了6-OHDA PD大鼠模型中结肠远端和结肠近端有一定程度的平滑肌收缩性变化,而回肠远端无变化。然而,这种变化取决于组织制备。
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引用次数: 0
Risk Factors Associated with Acute Pancreatitis after Percutaneous Biliary Intervention: We Do Not Know Nearly Enough. 经皮胆道介入治疗后急性胰腺炎的相关危险因素:我们知道的还不够。
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/9563074
Jing Song, Jun Deng, Feng Wen

Percutaneous transhepatic cholangiodrainage (PTCD) and percutaneous transhepatic biliary stenting (PTBS) may be used as a palliative treatment for inoperable patients with malignant biliary obstruction (MBO) to improve the prognosis and their quality of life. However, acute pancreatitis is a common and severe complication that cannot be ignored after PTCD and PTBS in patients with MBO. A few cases may develop severe pancreatitis with a higher mortality rate. In this study, we summarize the known risk factors for acute pancreatitis after percutaneous biliary interventional procedures and investigate possible risk factors to reduce its occurrence by early identifying high-risk patients and taking appropriate measures.

经皮经肝胆管引流术(PTCD)和经皮经肝胆道支架置入术(PTBS)可作为不能手术的恶性胆道梗阻(MBO)患者的姑息性治疗,以改善预后和生活质量。然而,急性胰腺炎是MBO患者PTCD和PTBS后不可忽视的常见严重并发症。少数病例可发展为重症胰腺炎,死亡率较高。在本研究中,我们总结了已知的经皮胆道介入手术后急性胰腺炎的危险因素,并探讨可能的危险因素,通过早期识别高危患者并采取适当措施来减少其发生。
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引用次数: 1
A Clinic-Radiomics Model for Predicting the Incidence of Persistent Organ Failure in Patients with Acute Necrotizing Pancreatitis. 预测急性坏死性胰腺炎患者持续器官衰竭发生率的临床-放射组学模型。
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/2831024
Nan Liu, Yidong Wan, Yifan Tong, Jie He, Shufeng Xu, Xi Hu, Chen Luo, Lei Xu, Feng Guo, Bo Shen, Hong Yu

Background: Persistent organ failure (POF) is the leading cause of death in patients with acute necrotizing pancreatitis (ANP). Although several risk factors have been identified, there remains a lack of efficient instruments to accurately predict the incidence of POF in ANP.

Methods: Retrospectively, the clinical and imaging data of 178 patients with ANP were collected from our database, and the patients were divided into training (n = 125) and validation (n = 53) cohorts. Through computed tomography image acquisition, the volume of interest segmentation, and feature extraction and selection, a pure radiomics model in terms of POF prediction was established. Then, a clinic-radiomics model integrating the pure radiomics model and clinical risk factors was constructed. Both primary and secondary endpoints were compared between the high- and low-risk groups stratified by the clinic-radiomics model.

Results: According to the 547 selected radiomics features, four models were derived from features. A clinic-radiomics model in the training and validation sets showed better predictive performance than pure radiomics and clinical models. The clinic-radiomics model was evaluated by the ratios of intervention and mechanical ventilation, intensive care unit (ICU) stays, and hospital stays. The results showed that the high-risk group had significantly higher intervention rates, ICU stays, and hospital stays than the low-risk group, with the confidence interval of 90% (p < 0.1 for all).

Conclusions: This clinic-radiomics model is a useful instrument for clinicians to evaluate the incidence of POF, facilitating patients' and their families' understanding of the ANP prognosis.

背景:持续性器官衰竭(POF)是急性坏死性胰腺炎(ANP)患者死亡的主要原因。虽然已经确定了几个危险因素,但仍然缺乏有效的工具来准确预测ANP中POF的发生率。方法:回顾性收集我院数据库中178例ANP患者的临床及影像学资料,将患者分为训练组(125例)和验证组(53例)。通过计算机断层图像采集、兴趣量分割、特征提取和选择,建立了基于POF预测的纯放射组学模型。然后,将纯放射组学模型与临床危险因素相结合,构建临床-放射组学模型。通过临床放射组学模型对高危组和低危组的主要和次要终点进行了比较。结果:根据选取的547个放射组学特征,由特征衍生出4个模型。临床-放射组学模型在训练集和验证集中的预测性能优于单纯的放射组学和临床模型。临床-放射组学模型通过干预与机械通气的比率、重症监护病房(ICU)住院时间和住院时间进行评估。结果显示,高危组干预率、ICU住院时间、住院时间均显著高于低危组,置信区间均为90% (p < 0.1)。结论:该临床-放射组学模型是临床医生评估POF发病率的有效工具,有助于患者及其家属了解ANP预后。
{"title":"A Clinic-Radiomics Model for Predicting the Incidence of Persistent Organ Failure in Patients with Acute Necrotizing Pancreatitis.","authors":"Nan Liu,&nbsp;Yidong Wan,&nbsp;Yifan Tong,&nbsp;Jie He,&nbsp;Shufeng Xu,&nbsp;Xi Hu,&nbsp;Chen Luo,&nbsp;Lei Xu,&nbsp;Feng Guo,&nbsp;Bo Shen,&nbsp;Hong Yu","doi":"10.1155/2023/2831024","DOIUrl":"https://doi.org/10.1155/2023/2831024","url":null,"abstract":"<p><strong>Background: </strong>Persistent organ failure (POF) is the leading cause of death in patients with acute necrotizing pancreatitis (ANP). Although several risk factors have been identified, there remains a lack of efficient instruments to accurately predict the incidence of POF in ANP.</p><p><strong>Methods: </strong>Retrospectively, the clinical and imaging data of 178 patients with ANP were collected from our database, and the patients were divided into training (<i>n</i> = 125) and validation (<i>n</i> = 53) cohorts. Through computed tomography image acquisition, the volume of interest segmentation, and feature extraction and selection, a pure radiomics model in terms of POF prediction was established. Then, a clinic-radiomics model integrating the pure radiomics model and clinical risk factors was constructed. Both primary and secondary endpoints were compared between the high- and low-risk groups stratified by the clinic-radiomics model.</p><p><strong>Results: </strong>According to the 547 selected radiomics features, four models were derived from features. A clinic-radiomics model in the training and validation sets showed better predictive performance than pure radiomics and clinical models. The clinic-radiomics model was evaluated by the ratios of intervention and mechanical ventilation, intensive care unit (ICU) stays, and hospital stays. The results showed that the high-risk group had significantly higher intervention rates, ICU stays, and hospital stays than the low-risk group, with the confidence interval of 90% (<i>p</i> < 0.1 for all).</p><p><strong>Conclusions: </strong>This clinic-radiomics model is a useful instrument for clinicians to evaluate the incidence of POF, facilitating patients' and their families' understanding of the ANP prognosis.</p>","PeriodicalId":12597,"journal":{"name":"Gastroenterology Research and Practice","volume":"2023 ","pages":"2831024"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Downregulation of LncRNA SNHG7 Sensitizes Colorectal Cancer Cells to Resist Anlotinib by Regulating miR-181a-5p/GATA6. LncRNA SNHG7下调通过调节miR-181a-5p/GATA6使结直肠癌细胞对Anlotinib的抗性增敏
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/6973723
Deng Pan, Kehe Chen, Ping Chen, Yu Liu, Yingying Wu, Jingning Huang

Long noncoding RNAs are a novel class of regulators in human cancers. It has been reported that small nucleolar RNA hostgene 7 (SNHG7) can sponge microRNAs to regulate colorectal cancer (CRC) progression. Given its important regulatory role in cancer biology, we wondered whether SNHG7 is involved in drug resistance to anlotinib (ATB) in CRC. To answer this, we quantified the expression of SNHG7 by quantitative real-time PCR. We performed the Cell Counting Kit-8 and Colony formation assay, flow cytometric analysis, RNA pull-down, RNA-binding protein immunoprecipitation assay, and Luciferase reporter assay to confirm the interaction among SNHG7, miR-181a-5p, and GATA6. We found that SNHG7 was significantly upregulated in CRC tissues and cell lines and ATB-resistant cell lines, which was closely related to the poor overall survival of patients. Loss-of-function studies demonstrated that SNHG7 knockdown can inhibit CRC cell proliferation, increase apoptosis, and sensitize CRC cells to resist ATB. Mechanistic studies showed that SNHG7 acted as a competitive endogenous RNA to sponge miR-181a-5p to regulate the expression of GATA6, thereby promoting ATB resistance in ATB-resistant cell lines. In conclusion, SNHG7 plays an important role in ATB resistance, and it may be used to monitor ATB resistance in CRC.

长链非编码rna是一类新的人类癌症调控因子。据报道,小核仁RNA主基因7 (SNHG7)可以吸收microrna来调节结直肠癌(CRC)的进展。鉴于SNHG7在癌症生物学中的重要调控作用,我们想知道SNHG7是否参与了结直肠癌对anlotinib (ATB)的耐药。为了回答这个问题,我们用实时荧光定量PCR方法定量了SNHG7的表达。我们通过细胞计数试剂盒-8和集落形成实验、流式细胞术分析、RNA下拉、RNA结合蛋白免疫沉淀实验和荧光素酶报告基因实验来证实SNHG7、miR-181a-5p和GATA6之间的相互作用。我们发现,SNHG7在结直肠癌组织细胞系和atb耐药细胞系中表达显著上调,这与患者总生存率较差密切相关。功能缺失研究表明,SNHG7敲低可抑制CRC细胞增殖,增加凋亡,并使CRC细胞对ATB敏感。机制研究表明,SNHG7作为竞争性内源性RNA海绵miR-181a-5p调节GATA6的表达,从而促进ATB耐药细胞系对ATB的抗性。综上所述,SNHG7在ATB耐药中发挥重要作用,可用于CRC ATB耐药监测。
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引用次数: 1
Monitoring a Mandatory Nonmedical Switching Policy from Originator to Biosimilar Infliximab in Patients with Inflammatory Bowel Diseases: A Population-Based Cohort Study. 监测炎症性肠病患者从原药到生物仿制药英夫利昔单抗的强制性非医疗转换政策:一项基于人群的队列研究
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/2794220
Anat Fisher, Jason D Kim, Colin R Dormuth

Background: On September 5, 2019, British Columbia announced a new policy (the Biosimilars Initiative) to switch from originator to biosimilar infliximab for patients with inflammatory bowel diseases.

Objective: To monitor the impacts of the policy on the use of medications and health services during the first year of the policy.

Methods: In this population-based cohort study, we used administrative health data to construct three historical cohorts and one policy cohort of patients with inflammatory bowel diseases who used the originator infliximab. We then monitored the cumulative incidence of medications and health services. Log-likelihood ratios were used to quantify differences between the policy cohort and the average of the historical cohorts.

Results: The cohorts included 1839-2368 users of the originator infliximab, ages 4-90 years, mean age 43 years. During the first year of follow-up, we found: (1) a 0.9% increase in the first dispensation of infliximab, biosimilar, or originator; (2) a 16.2% increase in infliximab dose escalation; (3) a decrease of 2.4% in the dispensation of antibiotics and a 2.6% decrease in new use of prednison; (4) an anticipated increase in visits to physicians and gastroenterologists to manage switching to biosimilars (24.0%); (5) a 4.0% decrease in discharges from hospital; and (6) a 2.9% decrease in emergency admissions to hospital.

Conclusion: British Columbia's Biosimilars Initiative for nonmedical switching from originator to biosimilar infliximab for inflammatory bowel diseases was not associated with harmful impacts on medications and health services use. An increase in dose escalation was accompanied by an improvement in health status proxies.

背景:2019年9月5日,不列颠哥伦比亚省宣布了一项新政策(生物类似药倡议),将炎症性肠病患者的英夫利昔单抗从原研药转为生物类似药。目的:监测政策实施第一年对药物使用和卫生服务的影响。方法:在这项以人群为基础的队列研究中,我们使用行政卫生数据构建了使用原药英夫利昔单抗的炎症性肠病患者的三个历史队列和一个政策队列。然后我们监测药物和卫生服务的累积发生率。对数似然比用于量化政策队列与历史队列平均值之间的差异。结果:队列包括1839-2368名原药英夫利昔单抗使用者,年龄4-90岁,平均年龄43岁。在第一年的随访中,我们发现:(1)英夫利昔单抗、生物仿制药或原研药的首次配药增加了0.9%;(2)英夫利昔单抗剂量增加16.2%;(3)抗生素配药减少2.4%,泼尼松新用药减少2.6%;(4)为管理转向生物仿制药而到内科医生和胃肠病学家就诊的人数预计会增加(24.0%);(5)出院人数减少4.0%;(6)急诊入院率下降2.9%。结论:不列颠哥伦比亚省的生物类似药倡议将炎症性肠病从原研药转向英夫利昔单抗生物类似药,与药物和卫生服务使用的有害影响无关。剂量增加的同时,健康状况指标也有所改善。
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引用次数: 0
Correlation between Preoperative Platelet Count/(Lymphocyte Count × Prealbumin Count) Ratio and the Prognosis of Patients with Gastric Cancer Undergoing Radical Operation. 胃癌根治术患者术前血小板计数/(淋巴细胞计数×前白蛋白计数)比值与预后的关系
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/8401579
Yi Liu, Yanguang Yang, Guomei Tai, Feng Ni, Cenming Yu, Wenjing Zhao, Ding Wang
<p><strong>Objective: </strong>To clarify the relationship between preoperative platelet count/(lymphocyte count × prealbumin count) ratio (PLPR) and the prognosis of patients with gastric cancer undergoing a radical operation, combined with Tumor Node Metastasis (TNM) staging, a scoring system was established to guide clinical application.</p><p><strong>Methods: </strong>The clinical data of 238 patients receiving radical operations for gastric cancer were retrospectively analyzed. According to the area under the Receiver operating characteristic curve, the predictive value of the preoperative PLPR for the 5-year overall survival (OS) of gastric cancer was determined, and the best cut-off value of the ratio was corresponding to the maximum value of Yoden index. Chi-squared test was applied to analyze the correlation between the ratio and clinicopathological features. Kaplan-Meier curve was applied to analyze the influence of this ratio on 5-year OS. The Cox regression model was applied to analyze the hazards affecting the long-term survival of patients. The nomogram model was used to predict the long-term survival rate.</p><p><strong>Results: </strong>The optimal cut-off point of preoperative PLPR ratio was 7.46, and the patients were segmented into two sets: one set of ratio <7.46 and another set of ratio ≥7.46. The ratio was correlated with the size of the tumor, T stage, N stage, total stage, vascular cancer thrombus, and nerve invasion. In stage I-III patients, the prognosis was better in the low-ratio set than in the high-ratio set (<i>P</i> < 0.001), subgroup analysis indicated the prognosis was obviously better in the low-ratio set than in the high-ratio set in stage II and III patients (<i>P</i> < 0.05 and <i>P</i> < 0.001), but there was no difference in stage I patients (<i>P</i> > 0.05). Age, T stage, N stage, total TNM stage, tumor size, vascular tumor thrombus, nerve invasion, preoperative neutrophil count/lymphocyte count (NLR; reference value 3.68), preoperative PLPR (reference value 7.46), preoperative platelet count/lymphocyte count (PLR; reference value 159.56), and preoperative platelet count × NLR (SII; reference value 915.48) were related to patient prognosis (<i>P</i> < 0.05); meanwhile age, total TNM stage, preoperative PLPR (reference value 7.46), preoperative PLR (reference value 159.56), and preoperative SII (reference value 915.48) were independent hazards for prognosis (<i>P</i> < 0.05). Five independent risk factors were analyzed by nomogram model to predict the 5-year OS of patients who underwent a radical operation for carcinoma of the stomach.</p><p><strong>Conclusion: </strong>Preoperative PLPR ratio (reference value 7.46) is an independent risk factor for long-term prognosis in patients undergoing a radical operation for gastric cancer. The nomogram scoring system established by postoperative TNM staging combined with this ratio and age, PLR, and SII can better forecast the survival of patients who underwent rad
目的:明确胃癌根治性手术患者术前血小板计数/(淋巴细胞计数×前白蛋白计数)比(PLPR)与预后的关系,并结合肿瘤淋巴结转移(TNM)分期,建立评分体系,指导临床应用。方法:回顾性分析238例胃癌根治术患者的临床资料。根据Receiver operating characteristic curve下面积确定术前PLPR对胃癌5年总生存期(OS)的预测值,该比值的最佳截断值对应Yoden指数的最大值。采用卡方检验分析该比值与临床病理特征的相关性。应用Kaplan-Meier曲线分析该比值对5年OS的影响。采用Cox回归模型分析影响患者长期生存的危险因素。采用nomogram模型预测远期生存率。结果:术前PLPR比最佳分界点为7.46,将患者分为两组:一组比P < 0.001),亚组分析显示,II期和III期患者低比组预后明显好于高比组(P < 0.05和P < 0.001),而I期患者无差异(P > 0.05)。年龄、T分期、N分期、TNM总分期、肿瘤大小、血管肿瘤血栓、神经侵犯、术前中性粒细胞计数/淋巴细胞计数(NLR;参考值3.68)、术前PLPR(参考值7.46)、术前血小板/淋巴细胞计数(PLR;参考值159.56),术前血小板计数× NLR (SII;参考值915.48)与患者预后相关(P < 0.05);年龄、TNM总分期、术前PLPR(参考值7.46)、术前PLR(参考值159.56)、术前SII(参考值915.48)是影响预后的独立危险因素(P < 0.05)。采用nomogram模型分析5个独立危险因素,预测胃癌根治性手术患者的5年OS。结论:术前PLPR比(参考值7.46)是胃癌根治术患者长期预后的独立危险因素。术后TNM分期结合该比值与年龄、PLR、SII建立的nomogram评分系统能更好地预测胃癌根治性手术患者的生存率。
{"title":"Correlation between Preoperative Platelet Count/(Lymphocyte Count × Prealbumin Count) Ratio and the Prognosis of Patients with Gastric Cancer Undergoing Radical Operation.","authors":"Yi Liu,&nbsp;Yanguang Yang,&nbsp;Guomei Tai,&nbsp;Feng Ni,&nbsp;Cenming Yu,&nbsp;Wenjing Zhao,&nbsp;Ding Wang","doi":"10.1155/2023/8401579","DOIUrl":"https://doi.org/10.1155/2023/8401579","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To clarify the relationship between preoperative platelet count/(lymphocyte count × prealbumin count) ratio (PLPR) and the prognosis of patients with gastric cancer undergoing a radical operation, combined with Tumor Node Metastasis (TNM) staging, a scoring system was established to guide clinical application.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of 238 patients receiving radical operations for gastric cancer were retrospectively analyzed. According to the area under the Receiver operating characteristic curve, the predictive value of the preoperative PLPR for the 5-year overall survival (OS) of gastric cancer was determined, and the best cut-off value of the ratio was corresponding to the maximum value of Yoden index. Chi-squared test was applied to analyze the correlation between the ratio and clinicopathological features. Kaplan-Meier curve was applied to analyze the influence of this ratio on 5-year OS. The Cox regression model was applied to analyze the hazards affecting the long-term survival of patients. The nomogram model was used to predict the long-term survival rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The optimal cut-off point of preoperative PLPR ratio was 7.46, and the patients were segmented into two sets: one set of ratio &lt;7.46 and another set of ratio ≥7.46. The ratio was correlated with the size of the tumor, T stage, N stage, total stage, vascular cancer thrombus, and nerve invasion. In stage I-III patients, the prognosis was better in the low-ratio set than in the high-ratio set (&lt;i&gt;P&lt;/i&gt; &lt; 0.001), subgroup analysis indicated the prognosis was obviously better in the low-ratio set than in the high-ratio set in stage II and III patients (&lt;i&gt;P&lt;/i&gt; &lt; 0.05 and &lt;i&gt;P&lt;/i&gt; &lt; 0.001), but there was no difference in stage I patients (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). Age, T stage, N stage, total TNM stage, tumor size, vascular tumor thrombus, nerve invasion, preoperative neutrophil count/lymphocyte count (NLR; reference value 3.68), preoperative PLPR (reference value 7.46), preoperative platelet count/lymphocyte count (PLR; reference value 159.56), and preoperative platelet count × NLR (SII; reference value 915.48) were related to patient prognosis (&lt;i&gt;P&lt;/i&gt; &lt; 0.05); meanwhile age, total TNM stage, preoperative PLPR (reference value 7.46), preoperative PLR (reference value 159.56), and preoperative SII (reference value 915.48) were independent hazards for prognosis (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). Five independent risk factors were analyzed by nomogram model to predict the 5-year OS of patients who underwent a radical operation for carcinoma of the stomach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Preoperative PLPR ratio (reference value 7.46) is an independent risk factor for long-term prognosis in patients undergoing a radical operation for gastric cancer. The nomogram scoring system established by postoperative TNM staging combined with this ratio and age, PLR, and SII can better forecast the survival of patients who underwent rad","PeriodicalId":12597,"journal":{"name":"Gastroenterology Research and Practice","volume":"2023 ","pages":"8401579"},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10308278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Distribution Characteristics and Identification for Significant Liver Inflammation of Patients in Chronic Hepatitis B with Indeterminate Phase. 不确定期慢性乙型肝炎患者显著肝脏炎症的临床分布特征及鉴别。
IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1155/2023/7264601
Shanshan Chen, Xuan Dai, Yueyue Zhao, Jie Li, Xuehan Zou, Haijun Huang

Aim: In clinical practice, a considerable proportion of patients with chronic hepatitis B (CHB) who do not conform to any immune status are considered to be in the "indeterminate phase". In this study, we aim to study the clinical distribution characteristics and identification of significant liver inflammation in patients in indeterminate phase.

Methods: This study retrospectively analyze clinical data of 1226 patients with CHB at two medical centers in Zhejiang province. According to American Association for the Study of Liver Diseases (AASLD) 2018 hepatitis B guidance, CHB can be divided into four phases: immune-tolerant phase, HBeAg-positive immune active phase, inactive phase, and HBeAg-negative immune active phase. Liver inflammation grade was evaluated using the Scheuer scoring system, and significant liver inflammation was defined as G ≥ 2.

Results: The distribution of different immune status was as follows: 259 (21.1%) patients in immune-tolerant phase, 365 (29.8%) patients in HBeAg-positive immune active phase, 128 (10.4%) patients in inactive phase, and 33 (2.7%) patients in HBeAg-negative immune active phase. However, 441 (36.0%) patients did not meet any of the above immune phases, which were defined as indeterminate phase. Significant liver inflammation (54.1%) was common in CHB patients with indeterminate phase. Prothrombin time (PT), platelet count (PLT), alanine aminotransferase (ALT), and hepatitis B virus (HBV)-DNA were associated with significant inflammation.

Conclusions: The results of this study showed that about 36.0% of patients were divided into indeterminate phase. The proportion of patients with significant inflammation in indeterminate phase and liver inflammation becomes more severe with aggravation of fibrosis stage. PT, PLT, ALT, and HBV-DNA may have a significant correlation with severe inflammation and prognosis of CHB.

目的:在临床实践中,相当一部分不符合任何免疫状态的慢性乙型肝炎(CHB)患者被认为处于“不确定期”。在本研究中,我们旨在研究不确定期患者显著肝脏炎症的临床分布特征和鉴别。方法:回顾性分析浙江省两所医疗中心1226例慢性乙型肝炎患者的临床资料。根据美国肝病研究协会(AASLD) 2018年乙型肝炎指南,CHB可分为四个阶段:免疫耐受期、hbeag阳性免疫活动性期、非活动性期和hbeag阴性免疫活动性期。采用Scheuer评分系统评价肝脏炎症程度,以G≥2为显著性肝脏炎症。结果:不同免疫状态的分布为:免疫耐受期259例(21.1%),hbeag阳性免疫活动性365例(29.8%),非活动性128例(10.4%),hbeag阴性免疫活动性33例(2.7%)。然而,441例(36.0%)患者未达到上述任何一个免疫期,定义为不确定期。明显的肝脏炎症(54.1%)常见于分期不确定的CHB患者。凝血酶原时间(PT)、血小板计数(PLT)、丙氨酸转氨酶(ALT)和乙型肝炎病毒(HBV)-DNA与显著炎症相关。结论:本研究结果显示,约36.0%的患者分为不确定期。随着纤维化分期的加重,不确定分期有明显炎症的患者所占比例和肝脏炎症的比例越来越严重。PT、PLT、ALT和HBV-DNA可能与慢性乙型肝炎的严重炎症和预后有显著相关性。
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引用次数: 0
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Gastroenterology Research and Practice
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