ObjectiveTo investigate the application progress of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in various treatment methods of hepatocellular carcinoma(HCC), aiming to fully understand the value of NLR and PLR in various treatments of HCC.MethodRetrieved and reviewed domestic and foreign literatures related to peripheral blood NLR and PLR and HCC in recent years.ResultsThe treatment of HCC mainly included liver resection, liver transplantation, transarterial chemoembolization, radiofrequency ablation, and sorafenib. Peripheral blood NLR and PLR were related to the survival of HCC patients after treatment. High NLR and PLR often indicated poor prognosis for HCC patients.ConclusionNLR and PLR play a certain role in various treatment methods of HCC, and have a certain value in judging tumor prognosis, recurrence, and metastasis.
ObjectiveTo evaluate the predictive performance of a model integrating ultrasound radiomics features combined with clinical variables for postoperative recurrence in patients with papillary thyroid cancer (PTC) with concomitant Hashimoto thyroiditis (HT). MethodsPatients with PTC with concomitant HT treated at Handan First Hospital from May 2021 to May 2023 were retrospectively enrolled, and the occurrence of postoperative recurrence within two years was assessed. Univariate and multivariate logistic regression models were used to identify risk factors for postoperative recurrence. Ultrasound radiomic features were extracted using the PyRadiomics package. Stable features were selected based on an intraclass correlation coefficient (≥0.75), followed by Z-score normalization on the entire dataset. The Mann-Whitney U test and least absolute shrinkage and selection operator regression were applied to select ultrasound radiomic features, and the radiomics score (Rad-score) was calculated. The clinical variables screened via a multivariate logistic regression model were combined with the Rad-score to develop a nomogram. Internal validation was performed using 1 000 Bootstrap resampling. The predictive performance of the nomogram was quantified using receiver operating characteristic (ROC) curves; calibration performance was verified via calibration curves, and net clinical benefit was determined by decision curve analysis (DCA). ResultsA total of 316 patients were enrolled in this study, among whom 57 experienced recurrence, yielding a recurrence rate of 18.04%. Multivariate logistic regression analysis identified five clinical variables as risk factors for postoperative recurrence in patients with PTC with concurrent HT (all P<0.05): tumor multifocality, maximum nodule diameter > 1 cm, lymph node metastasis, positive thyroglobulin antibody, and thyroid stimulating hormone ≥ 0.38 mU/L. Multicollinearity analysis showed that all variance inflation factors were ＜10, indicating no significant multicollinearity among the independent variables. Through the radiomic feature extraction and selection procedure, 8 key radiomic features with non-zero regression coefficients were selected. Based on these 8 features, the Rad-score was calculated and was significantly higher in patients with recurrence than in those without recurrence [(0.56±0.14) points vs. (0.37±0.09) points, t=12.890, P<0.001]. A nomogram was constructed by incorporating the 5 clinical variables selected by multivariate logistic regression and the Rad-score. The area under the ROC curve of this nomogram was 0.886 [95%CI (0.837, 0.935)]. Internal validation was performed using the Bootstrap method (1 000 resamplings), and the bias-corrected C-index was 0.871. The calibration curve, as assessed by the Hosmer-Lemeshow test (χ2=2.182, P=0.134), demonstrated good agreement between the predicted and actual recurrence probabilities, with a Brier score of 0.088. DCA showed that patients with PTC and HT could benefit from intervention guided by the nomogram within a threshold probability range of 0.21 to 0.84. ConclusionThe nomogram integrating ultrasound radiomic features and clinical variables achieves favorable predictive performance and net clinical benefit for postoperative recurrence in patients with PTC with concomitantT, enabling early postoperative risk stratification and individualized follow-up.
ObjectiveIn light of the comprehensively implemented reform of medical insurance payments, this study analyzed the impact of the payment intervention and COVID-19 pandemic on hospitalization expenses for identical diseases between traditional Chinese medicine (TCM) and Western medicine hospitals, to provide evidence to promote high-quality coordinated development of hospitals and insurance while reducing patient load. MethodsFrom January 2014 to December 2020, we gathered data including 9 900 individual medical records of woman-related malignant tumors (WMT) from all 23 public hospitals in a district of Shanghai. We developed an interrupted time-series analysis model based on the above two interventions, to compare the inpatient average per-time expenses between different hospitals and different groups. ResultsThe average per-time expenses of WMT in Western hospitals changed from rising to declining after the policy intervention, and increased again during the pandemic. In TCM hospitals, the expenses continued to increase and fluctuated after the pandemic. ConclusionThe policy intervention has achieved a good effect on controlling the cost of Western hospitals, rather than the significant increase in TCM hospitals. Meanwhile, the COVID-19 pandemic has had a significant impact on hospitalization expenses. It’s urgent to develop a payment model that fits the development and characteristics of TCM, to control the unreasonable growth of expenses. Moreover, the financial compensation methods and supervision mechanism of public hospitals should be improved to effectively resist the threat of public health emergencies for the development of hospitals and the legitimate rights of patients.