Objective To establish a cooperative decision-making model of county-level public hospitals, so as to freely select the best partner in different decision-making units and promote the optimal allocation of medical resources. Methods The input and output data of 10 adjacent county-level public hospitals in Henan province from 2017 to 2019 was selected. Based on the traditional data envelopment analysis (DEA) model, a generalized fuzzy DEA cooperative decision-making model with better applicability to fuzzy indicators and optional decision-making units was constructed. By inputting index information such as total number of employees, number of beds, annual outpatient and emergency volume, number of discharged patients, total income and hospital grade evaluation, the cooperation efficiency intervals of different hospitals were calculated to scientifically select the best partner in different decision-making units.Results After substituting the data of 10 county-level public hospitals in H1-H10 into the model, taking H2 hospital as an example to make cooperative decision, among the four hospitals in H1, H2, H7 and H10 of the same scale, under optimistic circumstances, the best partner of H2 hospital was H7 hospital, and the cooperation efficiency value was 1.97; in a pessimistic situation, the best partner of H2 hospital was H10 hospital, and the cooperation efficiency value was 0.98. The model had good applicability in the cooperative decision-making of county-level public hospitals. Conclusion The generalized fuzzy DEA model can better evaluate the cooperative decision-making analysis between county-level public hospitals.
Missing data represent a general problem in many scientific fields, especially in medical survival analysis. Dealing with censored data, interpolation method is one of important methods. However, most of the interpolation methods replace the censored data with the exact data, which will distort the real distribution of the censored data and reduce the probability of the real data falling into the interpolation data. In order to solve this problem, we in this paper propose a nonparametric method of estimating the survival function of right-censored and interval-censored data and compare its performance to SC (self-consistent) algorithm. Comparing to the average interpolation and the nearest neighbor interpolation method, the proposed method in this paper replaces the right-censored data with the interval-censored data, and greatly improves the probability of the real data falling into imputation interval. Then it bases on the empirical distribution theory to estimate the survival function of right-censored and interval-censored data. The results of numerical examples and a real breast cancer data set demonstrated that the proposed method had higher accuracy and better robustness for the different proportion of the censored data. This paper provides a good method to compare the clinical treatments performance with estimation of the survival data of the patients. This provides some help to the medical survival data analysis.
ObjectiveTo systematically review the intervention effects of high-intensity interval training (HIIT) on weight loss and blood lipid metabolism in overweight/obese populations. MethodsThe computer conducted searches in the PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WanFang Data database to collect randomized controlled trials (RCTs) related to HIIT and weight loss, fat reduction, and blood lipid metabolism in overweight/obese populations. The search was conducted from the inception of the databases to March 31, 2023. Two researchers independently conducted literature screening and data extraction. After evaluating the risk of bias of the included studies, a meta-analysis was performed using RevMan 5.4 software. ResultsA total of 19 RCTs, involving 595 overweight/obese participants, were included. The meta-analysis results showed that compared wtih the control group, HIIT interventions effectively reduced body weight (MD=−2.63, 95%CI −4.04 to −1.23, P<0.05), BMI (MD=−1.21, 95%CI −1.95 to −0.48, P<0.05), Fat% (MD=−1.66, 95%CI −2.28 to −1.04, P<0.05), TG (MD=−0.13, 95%CI −0.25 to −0.01, P=0.04), HDL (MD=0.14, 95%CI 0.05 to 0.23, P<0.05), and LDL (MD=−0.26, 95%CI −0.39 to −0.13, P<0.05) levels but did not improve TC (MD=−0.15, 95%CI −0.36 to 0.06, P=0.15) levels. ConclusionHIIT intervention can effectively improve body weight, BMI, Fat%, TG, HDL, and LDL levels in overweight/obese populations, particularly showing a more pronounced improvement in lipid profiles among overweight/obese adolescents, but it does not reduce TC levels. This study demonstrates that HIIT may be an effective strategy to assist in weight loss and prevent cardiovascular diseases in overweight/obese populations, with potential for broader application.
Most statistical data in observational studies is expressed as the effect value and its 95% confidence interval (95% CI), which do not correspond to the data format used for traditional meta-analyses, so special data conversion is to be needed when Review Manager software is applied to do a meta-analysis for this type of data, which will make the operation complicated and cumbersome. In addition, Stata software is such a powerful statistical software that can be used directly to conduct a meta-analysis with the effect value and its 95% CI. Therefore, it is an indispensable statistical tool for meta-analysis in observational studies. And this study will give a brief introduction how to use Stata software to conduct a meta-analysis with effect value and its 95% CI based on the published meta-analysis data.
With the prevalence of cardiovascular diseases, the development of cardiac rehabilitation is an inevitable trend. Cardiac rehabilitation is a comprehensive and long-term plan including medical assessment, exercise prescription, correction of cardiovascular risk factors, education, counseling, and behavioral intervention. Evidence-based medical evidence confirms that cardiac rehabilitation plays an important role in the three level prevention of cardiovascular disease. In this paper, we searched the literature in recent 10 years to explain the current situation and future research direction of cardiac rehabilitation, and explore the best mode of cardiac rehabilitation.
ObjectiveTo evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae. MethodsThe clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C1 and C2. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded. Results The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores (P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation (P>0.05). ConclusionThe treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.
Objective To investigate the effectiveness and long-term stability of small fenestration vertebral bone grafting and transpedicular bone grafting in the treatment of Denis types A and B thoracolumbar burst fractures. Methods Between January 2012 and February 2014, 50 patients with Denis type A or B thoracolumbar burst fractures were treated with vertebroplasty and pedicle screw rod fixation system, and the clinical data were retrospectively analyzed. Small fenestration vertebral bone grafting by trans-interlaminar approach was used in 30 cases (group A), and bone grafting by unilateral transpedicular approach was used in 20 cases (group B). X-ray and CT examinations of the thoracolumbar vertebrae were performed routinely before and after operation. There was no significant difference in sex, age, cause of injury, time from injury to operation, fracture type, injury segment, and preoperative Frankel classification, the percentage of the anterior body height of the injured vertebra, and visual analogue scale (VAS) score between two groups (P>0.05). There was significant difference in preoperative Cobb angle of kyphosis between two groups (P<0.05). The Cobb angle of kyphosis, the percentage of the anterior body height of the injured vertebra, and the recovery of neurological function were recorded and compared between two groups. Results The patients were followed up for 16-31 months (mean, 19.1 months) in group A and for 17-25 months (mean, 20.2 months) in group B. Primary healing of incisions was obtained in the two groups; no nerve injury and other operative complications occurred. The neurological function was improved in varying degrees in the other patients with neurological impairment before operation except patients at grade A of Frankel classification. The lumbar back pain was relieved in two groups. There was significant difference in VAS score between before operation and at 3 months after operation or last follow-up in two groups (P<0.05), but no significant difference was found between at 3 months and last follow-up in two groups and between two groups at each time point after operation (P>0.05). X-ray examination showed that there was no breakage of nail and bar, or dislocation and loosening of internal fixation during follow-up period. The bone grafts filled well and fused in the fractured vertebra. The vertebral height recovered well after operation. The percentage of the anterior body height of the in-jured vertebra and Cobb angle of kyphosis at 1 week, 3 months, and last follow-up were significantly better than preope-rative ones in two groups (P<0.05), but there was no significant difference between different time points after operation (P>0.05), and between two groups at each time point after operation (P>0.05). Conclusion For Denis types A and B thoracolumbar burst fractures, vertebral bone grafting and pedicle screw internal fixation through interlaminal small fene-stration or transpedicular approach can restore the vertebral height, correct kyphosis, and maintain the vertebral stability, which reduce the risk of complications of loosening and breakage of internal fixators. The appropriate bone grafting approach can be chosen based on the degree of spinal canal space occupying, collapse of vertebral and spinal cord injury.
ObjectiveTo investigate the effect of the interval between neoadjuvant chemoradiotherapy (nCRT) and surgery on the clinical outcome of esophageal cancer.MethodsPubMed and EMbase databases from inception to March 2018 were retrieved by computer. A random-effect model was used for all meta-analyses irrespective of heterogeneity. The meta-analysis was performed by RevMan5.3 software. The primary outcomes were operative mortality, incidence of anastomotic leakage, and overall survival; secondary outcomes were pathologic complete remission rate, R0 resection rate, and positive resection margin rate.ResultsA total of 17 studies with 18 173 patients were included. Among them, 13 were original studies with 2 950 patients, and 4 were database-based studies with a total of 15 223 patients. The results showed a significant positive correlation between the interval and operative mortality (Spearman coefficient=0.360, P=0.027). Dose-response meta-analysis revealed that there was a relatively better time window for surgery after nCRT. Further analysis for primary outcomes at different time cut-offs found the following results: (1) when the time cut-off point within 30-70 days, the shorter interval was associated with a reduced operative mortality (7-8 weeks: RR=0.67, 95% CI 0.55-0.81, P<0.05; 30-46 days: RR=0.63, 95%CI 0.47-0.85, P<0.05; 60-70 days: RR=0.64, 95%CI 0.48-0.85, P<0.05); (2) when the time cut-off point within 30-46 days, the shorter interval correlated with a reduced incidence of anastomotic leakage (RR=0.39, 95%CI 0.21-0.72, P<0.05); when the time cut-off point within 7-8 weeks, the shorter interval could achieve a critical-level effect of reducing the incidence of anastomotic leakage (RR=0.73, 95%CI 0.52-1.03, P>0.05); (3) when the time cut-off point within 7-8 weeks, increased interval significantly was associated with the poor overall survival (HR=1.17, 95% CI 1.00-1.36, P<0.05). Secondary outcomes found that the shorter interval could significantly reduce the positive resection margin rate (RR=0.53, 95% CI 0.38-0.75, P<0.05) when time cut-off point within 56-60 days.ConclusionShortening the interval between nCRT and surgery can reduce the operative mortality, the incidence of anastomotic leakage, long-term mortality risk, and positive resection margin rate. It is recommended that surgery should be performed as soon as possible after the patient's physical recovery, preferably no more than 7-8 weeks, which supports the current study recommendation (within 3-8 weeks after nCRT).
It is a significant challenge to improve the blood-brain barrier (BBB) permeability of central nervous system (CNS) drugs in their development. Compared with traditional pharmacokinetic property tests, machine learning techniques have been proven to effectively and cost-effectively predict the BBB permeability of CNS drugs. In this study, we introduce a high-performance BBB permeability prediction model named balanced-stacking-learning based BBB permeability predictor(BSL-B3PP). Firstly, we screen out the feature set that has a strong influence on BBB permeability from the perspective of medicinal chemistry background and machine learning respectively, and summarize the BBB positive(BBB+) quantification intervals. Then, a combination of resampling algorithms and stacking learning(SL) algorithm is used for predicting the BBB permeability of CNS drugs. The BSL-B3PP model is constructed based on a large-scale BBB database (B3DB). Experimental validation shows an area under curve (AUC) of 97.8% and a Matthews correlation coefficient (MCC) of 85.5%. This model demonstrates promising BBB permeability prediction capability, particularly for drugs that cannot penetrate the BBB, which helps reduce CNS drug development costs and accelerate the CNS drug development process.
Objective To explore the difference of intervention effect between high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on patients with metabolic syndrome (MetS). Methods China National Knowledge Infrastructure, WanFang Data, PubMed, Web of Science and EBSCO were searched for randomized controlled trials (RCTs) till May 2022. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. Comprehensive Meta-Analysis software was used for meta-analysis. Result A total of 5 RCTs were included, including 216 patients. The results of meta-analysis showed that: except fasting blood glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, body mass index and body fat percentage (P>0.005), low-density lipoprotein cholesterol [mean difference (MD)=−7.487 mg/dL, 95% confidence interval (CI) (−12.543, −2.431) mg/dL, P=0.004], total cholesterol [MD=−11.487 mg/dL, 95%CI (−16.523, −6.452) mg/dL, P<0.001], triglycerides [MD=−26.296 mg/dL, 95%CI (−50.557, −2.035) mg/dL, P=0.034] and diastolic blood pressure [MD=−2.770 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−5.131, −0.409) mm Hg, P=0.021] of HIIT were better than MICT. Conclusion In terms of blood glucose indicators and morphological indicators, the effect of HIIT group and MICT group was similar, but the effect of HIIT on blood lipid indicators and blood pressure indicators of patients with MetS was better than MICT.