目的 探讨电子阴道镜在宫颈病变诊断中的价值。 方法 对2001年1月-2006年12月786例宫颈病变患者的阴道镜下行病检结果和巴氏刮片细胞学诊断结果进行对比性研究。 结果 慢性宫颈炎、宫颈上皮内瘤样病变和宫颈癌在阴道镜下图像均呈多样性；阴道镜诊断宫颈癌前病变及宫颈癌的正确率、灵敏度及特异度均高于宫颈巴氏刮片，差异有统计学意义(Plt;0.05)。 结论 阴道镜操作灵活简便，在宫颈病变的诊断中有较大价值，其图像管理系统更有利于宫颈病变的动态观察和随访。
Randomized double-blind controlled trials (RCTs) conduct researches in carefully selected populations to ensure results of RCTs are unaffected by external disturbances and provide evidence of safety and efficacy. Real-world researches further help to understand the real world effects of new technologies in different medical environments after-market authorization. RCTs are the evidence foundation of real-world researches, and real-world researches provide valuable complement to RCTs. Medical insurance database is one of the most important database in real-world researches. Now, China's national medical insurance is entering a new era and transits from passive payment and compensation into a value-based strategic purchase mechanism for its insured population to buy the most cost-effective services. It is necessary to establish a mature, well-organized and value-based mechanism. The core of such mechanism is values, which is the price/performance ratio of innovative medicines and technologies rather than looking at the price solely. Demonstrating innovative drug value is an essential part of health care assessment. The authors argue that the assessment of the overall value of innovative technologies or medicines should include and based on the following four dimensions: clinical value, economic value, patient value and society value.
ObjectiveTo investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed 222 patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022 were included, and were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. ResultsExcept for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; except for postoperative pain scores (P<0.001), there was no statistically significant difference in complications between the two groups (all P>0.05).ConclusionEndoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe.Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.
Serum marker Golgi protein 73 (GP73) is a type Ⅱ integral membrane protein located in cellular Golgi apparatus. GP73 not only processes proteins, but also participates in cell differentiation, intercellular signaling, and apoptosis. With the development of proteomics technology, GP73 has been used as a novel serum marker for detecting liver diseases. This article reviews the research progress of GP73 in the clinical diagnosis value and prognosis prediction of chronic hepatitis B in recent years, in order to provide new ideas for the diagnosis and treatment of patients with chronic hepatitis B.
ObjectiveTo explore the clinical value of transthoracic echocardiography (TTE) in the diagnosis of infective endocarditis. MethodsWe retrospectively analyzed the transthoracic echocardiogram in 35 patients with infective endocarditis confirmed between September 2003 and September 2013. Patients underwent routine heart scan in all sections to measure sizes of all chambers and cardiac function, observe morphologies, activities and functions of all valves and ventricular walls, and diagnose whether underlying heart diseases exist, focusing on intracardiac vegetations and their distributions, morphologies, sizes, numbers, echoes and activities, and a full analysis of the blood culture findings was also conducted. ResultsOf the 35 patients undergoing initial TTE, 29 were positive, and 6 were negative (2 positive and 4 negative in the reexamination one week later). Vegetations were found in the mitral valve (8/35), aortic valve (15/35), tricuspid valve (5/35), pulmonary valve (1/35), pulmonary arterial wall (1/35) and right ventricle (1/35), respectively. There were 29 (8 and 21 with congenital and acquired heart diseases, respectively) and 6 patients with and without underlying heart diseases, respectively. Of the 35 blood cultures, 33 were positive and 2 were negative. ConclusionsTTE is rapid and accurate for early diagnosis of infective endocarditis, precise localization and rough quantification of vegetations, determination of whether valve damage occurs and what its severity is, and detection of whether complications exist. It is valuable for early diagnosis, treatment, follow-up and prognosis judgment.
With the acceleration of global innovative drug development, selecting safe, effective, and cost-effective products from numerous drugs has posed new challenges for the decision-making process of medical insurance drug access and dynamic updating of insurance directory. Real-world data (RWD) provides a new perspective for evaluation of clinical and economic value of drugs, but there are still uncertainties regarding the scope, quality standards, and evidence categories of RWD that can be used. Based on the current status of domestic and international RWD supporting the assessment of the clinical and economic value of drugs, this paper, in collaboration with national RWD and healthcare experts, has developed the key considerations for using real-world data to evaluate the clinical and economic value of drugs. This paper first clarifies the scope of RWD that can be used to evaluate the clinical and economic value of drugs evaluate; secondly, provides specific requirements and guidance on data attribution, data governance, and quality standards for RWD; finally, summarizes the evidence categories of RWD supporting evaluate the clinical and economic value of drugs evaluate.
Objective To investigate the CT manifestation and clinical significance of the gastrointestinal tract involvement in acute pancreatitis (AP). Methods Two hundreds CT scans in 131 patients with acute pancreatitis between Jan. 1, 2009 and Jun. 30, 2009 were included into the study. Two radiologists analyzed the images retrospectively, paying attention to the CT features of the gastrointestinal tract involvement, such as the style, distribution, and so on. The correlation between gastrointestinal tract involvement and CT severity index, clinical severity grading, and turnover of acute pancreatitis were studied using a SPSS 14.0 for windows statistics software. Results The CT images in 109 (83.2%) patients showed gastrointestinal tract involvement, which distributing mainly stomach, duodenum, jejunum, and transverse colon, and showing mainly the gastrointestinal tract wall thickening and distension. The gastrointestinal tract involvement had positive correlation with CT severity index, clinical severity grading, and turnover of acute pancreatitis (r=0.689， P=0.000; r=0.584， P=0.000; r=0.346， P=0.000). Conclusions The gastrointestinal tract involvement is common complication in acute pancreatitis and concerns with severity and prognosis of the disease. As other extrapancreatic organs involvement, the gastrointestinal tract involvement has important value for severity assessment, prognosis evaluation, and therapeutic effect monitoring of acute pancreatitis.
With the advancement of modern research in traditional Chinese medicine (TCM), evidence regarding the clinical efficacy and mechanisms of action of TCM has rapidly accumulated. However, due to a lack of methodological safeguards, the disconnection between clinical and basic research in TCM has become increasingly prominent, making it difficult to form an evidence chain that supports the scientific value of TCM in a manner that is "clear and understandable". Therefore, it is necessary to develop methods for the translation and integration of clinical and basic research evidence oriented towards clinical value, to form a reliable evidence chain that can further discover patterns, confirm efficacy, and highlight advantages. This article discusses the construction and evaluation methods of the evidence chain for the efficacy of TCM, aiming to provide theoretical and methodological references for related work.