Depression in Primary Care

Depression is a heterogeneous disorder with a wide range of presentations. Most patients with depression are seen in primary care, where it is often unrecognized; thus, screening for depression is important. Medical conditions can mimic depression and vice versa. For mild cases of depression, symptom monitoring and nonpharmacologic strategies are generally recommended initially, whereas psychotherapy and antidepressant drugs are first-line treatment for moderate to severe cases. Patients with depression often experience relapse, recurrence, or both, and multiple options are available. Primary care providers are central to screening, diagnosing, and subsequently treating or referring these patients.     

Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy

PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.     

新冠肺炎临床评价核心指标集比较分析＊

目的 对已公开发表的新冠肺炎核心指标集及其研究方法进行比较分析，为临床试验和证据转化研究提供参考信息。方法 计算机检索COMET数据库，并补充检索CNKI、WanFang、PubMed、Web of Science、The Cochrane Library等数据库，收集发表的新型冠状病毒肺炎（Coronavirus Disease 2019，COVID-19）核心指标集（Core Outcome Set，COS）研究，检索时间截至为2021年3月31日。按照纳入排除标准筛选文献，并提取研究基本信息、研究方法及指标数据，对其进行描述性分析。结果 共纳入5项COVID-19核心指标集相关研究（4项为COVID-19-COS研究，1项为COVID-19核心指标测量工具研究）。相同的结局指标包括死亡率、病毒核酸检测、临床进展、恢复期、临床症状评分及临床分型等。指标来源主要来自临床试验注册平台和问卷调查；达成共识的方法主要采用共识会议；利益相关群体中临床专家、方法学专家和医疗管理人员涉及较多。结论 不同的新冠肺炎核心指标集研究有一定的共性，但由于应用场景不同，也存在一定差异。随着对疾病认识的深化，相关COVID-19核心指标需要加强测量方法和疗程推荐。     

Reduced nontarget embolization and increased targeted delivery with a reflux-control microcatheter in a swine model

PurposeTo evaluate the potential differences in non-target embolization and vessel microsphere filling of a reflux-control microcatheter (RCM) compared to a standard end-hole microcatheter (SEHM) in a swine model.Materials and methodsRadiopaque microspheres were injected with both RCM and SEHM (2.4-Fr and 2.7-Fr) in the kidneys of a preclinical swine model. Transarterial renal embolization procedures with RCM or SEHM were performed in both kidneys of 14 pigs. Renal arteries were selectively embolized with an automated injection protocol of radio-opaque microspheres. Ex-vivo X-ray microtomography images of the kidneys were utilized to evaluate the embolization by quantification of the deposition of injected microspheres in the target vs. the non-target area of injection. X-ray microtomography images were blindly analyzed by five interventional radiologists. The degree of vessel filling and the non-target embolization were quantified using a scale from 1 to 5 for each parameter. An analysis of variance was used to compare the paired scores.ResultsTotal volumes of radio-opaque microspheres injected were similar for RCM (11.5 ± 3.6 [SD] mL; range: 6–17 mL) and SEHM (10.6 ± 5.2 [SD] mL; range: 4–19 mL) (P = 0.38). The voxels enhanced ratio in the target (T) vs. non-target (NT) areas was greater with RCM (T = 98.3% vs. NT = 1.7%) than with SEHM (T = 89% vs. NT = 11%) but the difference was not significant (P = 0.30). The total score blindly given by the five interventional radiologists was significantly different between RCM (12.3 ± 2.1 [SD]; range: 6–15) and the standard catheter (11.3 ± 2.5 [SD]; range: 4–15) (P = 0.0073), with a significant decrease of non-target embolization for RCM (3.8 ± 1.3 [SD]; range: 3.5–4.2) compared to SEHM (3.2 ± 1.5 [SD]; range: 2.9–3.5) (P = 0.014).ConclusionIn an animal model, RCM microcatheters reduce the risk of non-target embolization from 11% to 1.7%, increasing the delivery of microspheres of 98% to the target vessels, compared to SEHM microcatheters.     

Quality indicators for breast cancer care: A systematic review

ObjectivesWe evaluated breast cancer (BC) care quality indicators (QIs) in clinical pathways and integrated health care processes.MethodsFollowing protocol registration (Prospero n^o: CRD42021228867), relevant documents were identified, without language restrictions, through a systematic search of bibliographic databases (EMBASE, Scopus, Web of Science, MEDLINE), health care valuable representatives and the World Wide Web in April 2021. Data concerning QIs, measurement tools and compliance standards were extracted from European and North American sources in duplicate with 98% reviewer agreement.ResultsThere were 89 QIs found from 22 selected documents (QI per document mean 13.5 with standard deviation 11.9). The Belgian (38 QIs) and the EUSOMA (European Society of Breast Cancer Specialists) (34 QIs) documents were the ones that best reported the QIs. No identical QI was identified in all the documents analysed. There were 67/89 QIs covering processes (75.3%) and 11/89 (12.4%) for each structure and outcomes QIs. There were 21/89 QIs for diagnosis (30.3%), 43/89 for treatment (48.3%), and 19/89 for staging, counselling, follow-up and rehabilitation (21.4%). Of 67 process QIs and 11 outcome QIs, 20/78 (26%) did not report a minimum standard of care. Shared decision making was only included as a QI in the Italian document.ConclusionMore than half of countries have not established a national clinical pathway or integrated breast cancer care process to achieve the excellence of BC care. There was heterogeneity in QIs for the evaluation of BC care quality. Over two-thirds of the clinical pathways and integrated health care processes did not provide a minimum auditable standard of care for compliance, leaving open the definition of best practice. There is a need for harmonisation of BC care QIs.     

尿液外泌体lncRNA PCAT-1评估非浸润性膀胱癌患者复发的价值

目的探究尿液外泌体长链非编码RNA前列腺癌相关转录本1（lncRNA PCAT-1）评估非浸润性膀胱癌患者复发的价值。方法随机选取2015年1月—2016年3月进行治疗的非浸润性膀胱癌患者50例作为非浸润性膀胱癌组，选取同期在进行健康体检的健康受检者50例作为对照组。测定两组尿液外泌体中lncRNA PCAT-1表达情况。分析尿液外泌体lncRNA PCAT-1表达与临床病理参数的相关性、尿液外泌体lncRNA PCAT-1与尿液脱落细胞学对非浸润性膀胱癌的诊断价值、影响非浸润性膀胱癌患者复发的相关因素，评估非浸润性膀胱癌复发的价值及尿液外泌体lncRNA PCAT-1表达与非浸润性膀胱癌患者预后的关系。结果与对照组比较，非浸润性膀胱癌组患者尿液外泌体lncRNA PCAT-1表达水平明显升高（P<0.01）。尿液外泌体lncRNA PCAT-1表达与病理分期具有明显相关性（P<0.01）。尿液外泌体lncRNA PCAT-1诊断非浸润性膀胱癌的曲线下面积明显高于尿液脱落细胞学。采用Cox比例风险因素回归模型分析，病理分期及lncRNA PCAT-1均为影响非浸润性膀胱癌患者复发的独立危险因素。以尿液外泌体lncRNA PCAT-1相对表达量5.14±1.04分为高表达组（23例）与低表达组（27例），Kaplan-Meier生存曲线分析结果显示，lncRNA PCAT-1低表达量组生存期明显高于lncRNA PCAT-1高表达组。结论外泌体lncRNA PCAT-1在非浸润性膀胱癌患者尿液中的表达水平较健康受检者明显升高，且其表达水平与患者病理分期明显相关。尿液外泌体lncRNA PCAT-1对评估非浸润性膀胱癌患者的复发具有重要作用。     

Cost-effectiveness frameworks for comparing genome and exome sequencing versus conventional diagnostic pathways: A scoping review and recommended methods

PurposeMethodological challenges have limited economic evaluations of genome sequencing (GS) and exome sequencing (ES). Our objective was to develop conceptual frameworks for model-based cost-effectiveness analyses (CEAs) of diagnostic GS/ES.MethodsWe conducted a scoping review of economic analyses to develop and iterate with experts a set of conceptual CEA frameworks for GS/ES for prenatal testing, early diagnosis in pediatrics, diagnosis of delayed-onset disorders in pediatrics, genetic testing in cancer, screening of newborns, and general population screening.ResultsReflecting on 57 studies meeting inclusion criteria, we recommend the following considerations for each clinical scenario. For prenatal testing, performing comparative analyses of costs of ES strategies and postpartum care, as well as genetic diagnoses and pregnancy outcomes. For early diagnosis in pediatrics, modeling quality-adjusted life years (QALYs) and costs over ≥20 years for rapid turnaround GS/ES. For hereditary cancer syndrome testing, modeling cumulative costs and QALYs for the individual tested and first/second/third-degree relatives. For tumor profiling, not restricting to treatment uptake or response and including QALYs and costs of downstream outcomes. For screening, modeling lifetime costs and QALYs and considering consequences of low penetrance and GS/ES reanalysis.ConclusionOur frameworks can guide the design of model-based CEAs and ultimately foster robust evidence for the economic value of GS/ES.     

德尔菲法在中医临床证候应用中的系统评价＊

目的 系统评价德尔菲法在中医临床证候应用中的应用现状，为后续规范与完善证候研究方法提供参考。方法 计算机检索五大数据库关于中医临床证候研究中应用德尔菲法的研究，检索时限自建库至2021年6月1日，由两名研究人员独立进行文献筛选、质量评估和资料提取，对质量A级和B级的研究进行分析。结果 经过质量评价共纳入201篇文献，其中原始研究199篇，方法学研究9篇。研究方向包括候分布特点、证候诊断标准、单一证候研究、证候要素研究、证候变化规律等八类。192篇文献对德尔菲法具体实施进行报道。结论 中医临床证候研究中德尔菲法应用整体较为科学，但在证候研究细节实施尚有不足，有待形成符合中医证候特色的德尔菲法标准规范临床应用。