This is the seventh paper in the evidence-based medicine glossary series. In this paper, We mainlyintroduced five terms related to meta-analysis——prospective meta-analysis, individual patient data meta-analysis,cumulative meta-analysis, multiple-treatments meta-analysis and meta regression.We also gave some examples to helpreaders better understand and use them.
Evidence-based psychotherapy is an idea and performance reform in the clinical practice of psychology which is influenced by evidence-based medicine. It proposes to integrate the best available evidence provided by researchers, the clinical expertise of practitioners, and the patient’s characteristics, cultures and preferences, so as to achieve the best treatment. The development of evidence-based psychotherapy can be divided into two stages: empirically supported treatments and evidence-based practice. This paper reviews existing problems as well as developing tendencies.
ObjectiveTo explore the dynamic changes of immune cell populations in Panc02 pancreatic cancer bearing immunocompetent mice. MethodsThe C57BL6/J mice syngeneic pancreatic cancer cell line Panc02 were subcutaneously implanted to establish the immunocompetent murine pancreatic cancer bearing model.According to the tumor size, the tumor was classified into 4 stages, named T1-T4, respectively.The flow cytometry was performed to identify the dynamic changes of different cell populations, such as inflammatory cells (CD45+), T helper (Th) lymphocytes, cytotoxic T lymphocytes (CTL), B lymphocytes, granulocytes, macrophages, dendritic cells (DC), natural killer (NK) cells, and natural killer T (NKT) cells in the peripheral blood and tumor tissue. ResultsThree dynamic types of immune cells with the tumor progression were identified:consistent increase, consistent decrease, increase and then decrease.①In peripheral blood:The proportion of the Th lymphocytes, CTL, and B lymphocytes consistently decreased; The proportion of granulocytes consistently increased; The proportion of the DC, macrophages, NK cells, and NKT cells increased from T1 to T3 stage but sharply decreased at T4 stage.②In tumor tissue:The intratumoral CD45+ cells consis-tently increased; The proportion of the granucolyte, macrophages, and DC consistently increased; The proportion of the Th lymphocytes and the CTL consistently decreased; The proportion of the B lymphocytes did not change significantly; The proportion of the NK cells or NKT cells increased from T1 to T3 stage but sharply decreased at T4 stage. ConclusionWith pancreatic cancer progression, the immune cell populations show different dynamic change models, which imply their important roles in predicting the prognosis and the integrated treatments of pancreatic cancer.
Objective To review the research progress on the correlation between sarcopenia and osteoarthritis (OA). Methods The basic and clinical studies at home and abroad in recent years on sarcopenia and OA were extensively reviewed. The correlation between sarcopenia and OA was analyzed and summarized from five aspects: epidemiological status, risk factors, pathogenesis, clinical treatments, and the impact on joint arthroplasty. Results Sarcopenia and OA are common diseases in the elderly with high prevalence and can increase the ill risk of each other. They share a set of risk factors, and show negative interactive and influence on pathogenesis and clinical treatments, thus participating in each other’s disease process and reducing the treatment benefits. Clinical studies show that sarcopenia can affect the rehabilitation effect and increase the risk of postoperative complications after total joint arthroplasty in many ways. ConclusionCurrent research results show that sarcopenia and OA are related and can be mutually affected in the above 5 aspects, but more studies are needed to further clarify the relationship between them, so as to provide more theoretical basis for the understanding, prevention, diagnosis, and treatments of the two diseases.
Objective To compare the ability of three propensity score weighting methods to balance the covariates and the advantages and disadvantages to estimate the treatment effects when dealing with multiple treatment data under different sample sizes. Methods Monte Carlo simulation was used to generate data sets and the advantages and disadvantages of balancing covariates and estimating the treatment effects of three propensity score weighting methods, Logistic-IPTW, Logistic-OW and GBM-OW were compared. The evaluation index of covariate equilibrium level was the absolute standard mean difference. The evaluation indexes of effect estimation included the point estimate of treatment effect, root mean square error and confidence interval coverage. Results Compared with Logistic-IPTW and Logistic-OW, GBM-OW was better in effect estimation and had a smaller root mean square error in five scenarios where covariates were related to treatment factors and outcome variables with different varying degrees of complexity. In terms of covariate equilibrium, all three methods had good effects. GBM-OW method performed better when the overlap of propensity score distribution of multiple treatment data was relatively low and covariables had increasingly complex nonlinear relationships with treatment factors and outcome variables. Conclusion When dealing with multiple treatment data, GBM-OW method has advantages over the other two methods when there is nonlinearity and/or interaction between covariates and treatment factors and outcome variables. Using this method, the effect estimation is closer to the real value, which is a better choice.
The umbrella trial has received increasing attention in the design of clinical trials for oncology drugs in recent years. This trial design categorizes a single disease into multiple sub-types based on predictive biomarkers or other predictive factors, and simultaneously evaluates the efficacy of multiple targeted therapies. When compared with the traditional drug development model of phase Ⅰ, phaseⅡ, and phase Ⅲ randomized controlled trials, umbrella trials are a more scientifically rigorous trial design that can speed up drug evaluation to address the conflict between numerous untested drugs and diseases with a lack of effective treatment options. This article will focus on the concept, main characteristics, eligibility criteria, design and statistical considerations, ethical considerations, and future directions of umbrella trials, with the aim of providing methodological guidance for the design of clinical trials for oncology drugs.
Lumbar disc herniation (LDH) is one of the most important causes of back and leg pain, which seriously affects the quality of life of patients. As the first-line treatment for LDH, non-operative treatment can relieve 80% to 90% of symptoms among the patients with LDH. This guideline followed Guidelines for the Formulation/Revision of Clinical Treatment Guidelines in China (2022 edition) and WHO handbook for guideline development (2014 edition) to set up guideline working group. This guideline identified fourteen clinical questions through the literature review and clinical experts’ consensus. We drafted the recommendations after systematically searching and evaluating the evidence; delphi method was adopted for expert consensus on the preliminary recommendations, finally, 19 recommendations were made to guide non-operative treatments for LDH. This guideline can provide guidance for the clinical practice of Chinese and western orthopedics practitioners.
ObjectiveTo understand the role of complement system in the immune mechanism of hepatocellular carcinoma (HCC) and its potential therapeutic value, and to provide reference for related research in the field of HCC immunotherapy. MethodsRead and review the national and international literature on hepatocellular carcinoma and complement-related studies. ResultsA total of eight complement components closely related to HCC were summarized, which play an important role in the immune regulation of HCC, and their activation can be involved in the occurrence and development of HCC through a variety of mechanisms, and their use as complement inhibitors can regulate the activity of complement-related activation pathways and enhance anti-tumor ability, potentially providing a new strategy for the treatment of HCC. ConclusionA variety of complement components in the complement system play an important role in regulating the immune mechanism of HCC, and the activation of the complement system is closely related to the occurrence and development of HCC, which is expected to be a potential immunotherapeutic target for HCC. However, the combination of complement-related inhibitor therapy with other antitumor immunotherapies carries certain risks and benefits, which need to be thoroughly investigated.