In the context of the rapid development of contemporary medical industry and the unbalanced development of various subspecialties, expert consensus plays an extremely important role in guiding clinical practice and improving the quality of medical care. However, there are some deficiencies and limitations in the formation process and final report of the expert consensus. Therefore, this paper summarizes and reviews the definition, applications, and functions of expert consensus and the new progress of expert consensus formation methods by fully reviewing the literature, and puts forward the prospect. The purpose is to provide a reference for the production and application of expert consensus related to medical care, improve the outcomes of medical care, and upgrade the quality and level of medical services.
ObjectivesTo systematically review the clinical response rate of CD19 chimeric antigen receptor modified-T cells (CD19CART) in the treatment of B cell hematological malignancies.MethodsPubMed, EMbase, CNKI, WanFang Data and VIP databases were searched to collect cohort studies about CD19CART in the treatment of B cell hematological malignancies from 2000 to 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, a single rate meta-analysis was performed by R software and SPSS 16.0 software.ResultsA total of 13 prospective cohort studies were included. The results of single group rate meta-analysis showed that the overall pooled response rate of CD19 CART was 68% (95%CI 0.51 to 0.82). The 6 months and 1-year PFS after CD19 CART infused by Kaplan-Meier were 46% (95%CI 0.35 to 0.56) and 24% (95%CI 0.16 to 0.34), respectively. The median duration was 180 days (95%CI 138 to 222). The COX regression model showed lymphodepletion to be the only influence factor of PFS.ConclusionsCD19 CART has a good clinical response rate in the treatment of B cell hematological malignancies. Lymphodepletion is the only important impact on the response rate and PFS. Due to limited quality and quantity of included studies, more high quality studies are required to verify the above conclusions.
Subpopulation treatment effect pattern plot (STEPP) method is a method for examining the relationship between treatment effects and continuous covariates and is characterized by dividing the study population into multiple overlapping subpopulations to be analyzed based on continuous covariate values. STEPP method has a different purpose than traditional subgroup analyses, and STEPP has a clear advantage in exploring the relationship between treatment effects and continuous covariates. In this study, the concepts, advantages, and subpopulation delineation methods of the STEPP method are introduced, and the specific operation process and result interpretation methods of STEPP method analysis using the STEPP package in R language are presented with examples.
ObjectiveTo explore the pathological role of high mobility group box chromosomal protein 1 (HMGB1) in osteoarthritis (OA) by comparing the difference of HMGB1 in the synoviocytes between OA and normal knees. MethodsSynoviocyte lines from OA and normal knees were collected and cultured. Immunohistochemistry and Western blot were applied to identify the difference of HMGB1 between the OA and normal synoviocyte lines. The eukaryotic expression vector containing human Pgenesil-1/HMGB1 small interfering RNA (siRNA) were constructed and identified. The synoviocyte lines were transfected with the eukaryotic expression vector of Pgenesil-1/HMGB1 siRNA (Pgenesil-1/HMGB1 siRNA group) and with Pgenesil-1 plasmid (Pgenesil-1 group) and were not transfected as a control (untransfected group). Western blot was applied to identify the difference of HMGB1 among groups, and the levels of interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) protein synthesis in the supernatants were measured by ELISA. ResultsPrimary knee synoviocytes cultured in vitro were fibroblast-like cells with longspindle shape. The immunohistochemistry and immunofluorescence results showed positive staining for HMGB1 in cytoplasm and weak positive staining in the nucleus in the OA synoviocyte line, but positive staining for HMGB1 in the nucleus and weak positive staining in the cytoplasm in the synoviocyte line of normal knee. The level of HMGB1 in the OA synoviocytes (0.687±0.025) was significantly higher than that of normal synoviocytes (0.172±0.030) (t=32.159, P=0.000) by Western blot. The recombinant plasmid Pgenesil-1/HMGB1 siRNA was successfully constructed. The expression of HMGB1 protein in Pgenesil-1/HMGB1 siRNA group (0.134±0.048) was significantly lower than that of Pgenesil-1 group (0.581±0.032) and untransfected group (0.514±0.069) (P<0.05). ELISA results showed that IL-1β and TNF-α in supernatants of Pgenesil-1/HMGB1 siRNA group were significantly lower than those of Pgenesil-1 group and untransfected group (P<0.05). ConclusionThe up-regulated expression and expressed location (from nucleus to cytoplasm) of HMGB1 in the synoviocyte are closely related to OA. The siRNA targeting inhibition of HMGB1 gene expression can obviously inhibit IL-1β and TNF-α in supernatants of the OA synoviocyte line and delayed the inflammation of OA.
As the most common active brain-computer interaction paradigm, motor imagery brain-computer interface (MI-BCI) suffers from the bottleneck problems of small instruction set and low accuracy, and its information transmission rate (ITR) and practical application are severely limited. In this study, we designed 6-class imagination actions, collected electroencephalogram (EEG) signals from 19 subjects, and studied the effect of collaborative brain-computer interface (cBCI) collaboration strategy on MI-BCI classification performance, the effects of changes in different group sizes and fusion strategies on group multi-classification performance are compared. The results showed that the most suitable group size was 4 people, and the best fusion strategy was decision fusion. In this condition, the classification accuracy of the group reached 77%, which was higher than that of the feature fusion strategy under the same group size (77.31% vs. 56.34%), and was significantly higher than that of the average single user (77.31% vs. 44.90%). The research in this paper proves that the cBCI collaboration strategy can effectively improve the MI-BCI classification performance, which lays the foundation for MI-cBCI research and its future application.
The paper presents two statistical methods to compare summary estimates of different subgroups in meta-analysis. It also shows how to use Z test and meta-regression model with dichotomous data and continuous data in R software to explain the similarities and differences between the two statistical methods by examples.
This article is based on the work practice of Medical-lnsurance-Medicine Linkage carried out by the Nanping First Hospital Affiliated to Fujian Medical University under the reform of payment based on diagnosis related group (DRG). It outlines the connotation and extension of Medical-lnsurance-Medicine Linkage in the hospital, including concept definition, organizational structure, the relationship between DRG payment and Medical-lnsurance-Medicine Linkage, and summarizes the specific measures and positive results of the Medical-lnsurance-Medicine Linkage work mechanism from four aspects: medical quality management, medical insurance management, medical drugs/consumables management, and performance evaluation. These experiences are of great significance for improving the quality and efficiency of medical care, actively responding to the reform of medical insurance payment methods, enhancing the level of medical services in public hospitals, and achieving a win situation among the medical insurance management departments, hospitals, and patients.
ObjectiveTo analyze the issues and risks associated with the policy of temporary import of urgently needed clinical drugs and offer optimized suggestions for this domain in our country. MethodsThe focus group interview method and in-depth interview method were employed, and 34 individuals related to the temporary import of urgently needed clinical drugs were selected for the interviews. Based on the results of the review of domestic and international policies for the temporary import of urgently needed clinical drugs and the conclusions drawn from the interviews, a questionnaire was formulated. The Delphi expert consultation method was utilized to select 14 experts from various relevant fields, and questionnaires were distributed and collected by mail for objective presentation. Through an expert consensus meeting, the final suggestions were formed. ResultsInitially, 20 suggestions were proposed for each stage of the temporary import of urgently needed clinical drugs. After expert consultation, 32 questionnaires were retrieved (a response rate of 91%), and all were valid (a validity rate of 100%). Through discussions at the expert consensus meeting, 17 policy suggestions were ultimately formed. ConclusionIt is recommended that the National Health Commission, in collaboration with the National Medical Products Administration and the customs, conduct in-depth discussions and refine the specific implementation measures for the temporary import of urgently needed clinical drugs to guarantee the safety, efficacy, and timeliness of clinical drug use.
The main approaches to medical education reform that have been introduced elsewhere in the world, including the integration of basic and clinical sciences into organ-based model, the establishment of a Center for Faculty Development and problem-based learning (PBL) have been introduced to the College of Medicine, Chung Shan Medical University (CSMU) since the mid 1990s. The process of developing the PBL approach can be divided into the following stages: Observation (1994-2000): In this stage, CSMU observed the practice and effectiveness of PBL programs in other domestic and foreign medical schools. At the same time, we assessed the possibility of introducing PBL to Chung Shan. When the authority decided to introduce PBL, a PBL committee was inaugurated. Preparation (2000-2002): In this stage, tutor training took place, as well as PBL case writing workshops to reach consensus among the faculty. To reduce the total amount of curricula and traditional teaching hours, we combined and simplified related curricula, so that one and half weekdays were reserved for PBL tutorials and students’ self-study. A preliminary course about how to learn well, including the philosophy and methodology of learning as well as evidence-based medicine (EBM), was integrated into premedical curricula. Practice (2002-2004): In light of the number of trained tutors and written cases that have been prepared, and the desire that the PBL would be successful from the start, CSMU chose to introduce PBL to the clinical curricula first in a hybrid curriculum design. This meant that the traditional teaching was retained at the beginning. Evaluation of PBL by the students was done at the end of each semester. Tutor meetings were held twice per semester. Advancement (2004-2006): In this stage, PBL was introduced to the basic medical curricula as well as to the premedical general curricula. Based on our experience and comprehensive evaluation, a PBL guidebook for tutors and students has been published and delivered to both groups. We also developed an on-line evaluation system containing the evaluation forms for students and tutors. Excellence (2006 onwards): In this stage, the PBL website and learning resources will be further developed, and we are designing the system for on-line PBL practice.In conclusion, the introduction to PBL for medical education is reasonable and feasible. It requires b administrative support, a long-standing and high commitment of the PBL committee, consensus among the faculty and an appropriate planning and evaluation mechanism.
ObjectiveTo explore the effects of intraoperative lymphatic chemotherapy (LC) on immune functions of patients after esophageal carcinoma resection. MethodsPatients who underwent intraoperative LC during esophageal carcinoma resection in the Department of Thoracic Surgery of West China Hospital from March to October,2013 were prospectively included in this study, and patients who underwent esophageal carcinoma resection without intraoperative LC during the same period were also included as the control group. All the patients were divided into a pacitaxel LC group,a fluorouracil LC group,and a control group without LC. A total of 37 patients were included in this study including 25 male and 12 female patients with their age of 42-76 (61.89±7.95) years. There were 15 patients in the pacitaxel LC group,15 patients in the fluorouracil LC group,and 7 patients in the control group. Representative indexes of humoral immunity and cellular immunity in peripheral blood of all the patients were examined preoperatively and on the third and seventh postoperative day, and then compared among the 3 groups. ResultsAll the immune indexes of the 3 groups decreased after surgery to different extent. There was no statistical difference in preoperative and postoperative difference of immunoglobulin concentration between LC groups and the control group (P>0.05). CD8+ T cell count recovered more rapidly after surgery in LC groups than the control group. CD3+ T cells recovered most rapidly after surgery in the fluorouracil LC group. ConclusionLC is beneficial for the recovery of cytotoxic effects of T lymphocytes but may not promote humoral immunity for patients after esophageal carcinoma resection.