Objective To make the cost-effectiveness analysis of pembrolizumab and platinum chemotherapy as the first-line treatment for advanced non-small cell lung cancer(NSCLC)in the population with tumor proportion score(TPS)≥1%of PD-L1,and provide some reference for the clinical use and future price negotiation of pembrolizumab.Methods Based on Pubmed database,the published RCT literatures of pembrolizumab were analyzed,and the survival data were extracted,combined with the treatment plan of a tertiary hospital,the Markov model were established to simulate the cost and health effectiveness of patients for twenty years,and the stability of the model was tested by one-way sensitivity analysis and probability sensitivity analysis.Results Twenty years later,the cost-effectiveness ratio of pembrolizumab group and chemotherapy group was ￥58 517.60/quality adjusted life month(QALM)and ￥41 213.08/QALM.Compared with the chemotherapy group,the incremental cost effective ratio(ICER)was ￥104 485.36/QALM.Conclusion When the willingness to pay(WTP)value was ￥30 902/QALM,the pembrolizumab therapy was not more cost-effective advantages than platinum chemotherapy,and the sensitivity analysis showed that the results of the model were relatively stable.

Background:Slight mucosal lesions in the early stage of gastric cancer(GC)are difficult to recognize,and the miss rate of early GC by conventional endoscopy is high.Artificial intelligence(AI)systems can assist in the identification of gastric neoplastic lesions and reduce miss rate,but it is not clear whether AI-assisted endoscopic screening is cost-effective.Aims:The subjects of this study were to evaluate the cost-effectiveness of a population-based endoscopy screening program for GC in high-incidence countries(China,Japan and South Korea),and to explore the applicability of domestic AI--Intelligent and real-time endoscopy analytical device(IREAD)-assisted endoscopy for GC screening in these three countries.Methods:Based on the natural history of GC,a Markov model with cycle year of 1 year was constructed to compare cost-effectiveness of two strategies for GC screening in recommended age group:no screening(the control strategy),conventional endoscopy screening and IREAD-assisted endoscopy screening.Data such as transition probabilities of different states and treatment costs were obtained from previously published studies.The cost-effectiveness analysis was conducted from the perspective of society by calculating cost,Quality adjusted life years(QALY),Incremental cost effectiveness ratio(ICER).Results:The cohort results showed that 15.87%and 24.52%of GC-related deaths could be respectively avoid by conventional endoscopy screening and IREAD-assisted endoscopy screening in China,which the screening effects were similar to Japan;In South Korea,Conventional endoscopic screening and IREAD-assisted endoscopic screening averted 41.34%and 53.15%of GC-related deaths,respectively.Between the two strategies,IREAD-assisted endoscopic screening is more economic,with ICER of $34 827.61/QALY,$87 978.71/QALY and $10 574.30/QALY in China,Japan and South Korea,respectively,which were lower than the willingness-to-pay(WTP)threshold.Conclusions:When the threshold of WTP is 3 times Gross domestic product per capita,the application of AI-assisted endoscopy for GC screening in age-specific population in high-incidence countries may be more cost-effective.Meanwhile,this study provides important evidence for the promotion of domestic IRAED-assisted endoscopy in GC screening in China,Japan and South Korea.

Objective:To investigate the safety and efficacy of the novel single-port surgical robotic surgical system in extraperitoneal urological surgery.Methods:From February to April 2022, patients was prospectively enrolled who required laparoscopic radical prostatectomy, partial nephrectomy and adrenal tumor resection in urology department. Inclusion criteria were: age ≥ 18 years old; BMI 18.5-30 kg/m 2; American Society of Anesthesiologists (ASA) physical status classification system grades 1 to 3; can cooperate with the completion of the visits and related examinations stipulated in the plan, and participate voluntarily clinical trials, and consent or the guardian agrees to sign the informed consent form; tumor indicators meet one of the following surgical treatment indications: kidney tumor T 1 stage, single, maximum tumor diameter ≤ 4 cm; prostate cancer, stage ≤ T 2b, preoperative PSA ≤ 20 ng /ml; Gleason score ≤ 7; adrenal tumor diameter ≤ 7 cm, for non-functioning adrenal adenoma, tumor diameter ≥ 3 cm. Exclusion criteria were: patients with other malignancies or a history of other malignancies and the investigators believe that they are not suitable for inclusion in this researcher; patients who have received the same type of urological surgery in the past and are not suitable for participating in this study as assessed by the investigators; included Those who have undergone other major surgery within the first 3 months and during the trial period, or who cannot recover from the side effects of any such surgery; syphilis, hepatitis B, HIV infection and carriers; long-term use of anticoagulants or blood system diseases; Unable to use effective contraception during the trial period and other conditions that the investigators deem inappropriate to participate in this trial. All operations were performed by a novel single-port robotic surgical operating system, and all surgical procedures were performed through an extraperitoneal approach. Surgical method: the surgical system is mainly composed of a remote console including a high-definition display, a surgical equipment trolley, a surgical execution system that accommodates a serpentine robotic arm, and a bendable serpentine robotic arm. In this study, the extraperitoneal approach was used. For radical prostatectomy, the patient was placed in a supine position, a longitudinal incision of about 3 cm was made below the umbilicus, the anterior rectus sheath was incised, the extraperitoneal space was separated, and an operating sheath was placed. A 12 mm trocar is placed between the right McBurney point and the umbilicus as an auxiliary hole. For partial nephrectomy and adrenal tumor resection, the patient is placed in the lateral position, and an 3cm incision is made 2 cm above the iliac crest on the midaxillary line as the main operating hole. The skin, subcutaneous tissue, and muscle were incised to the retroperitoneal cavity, and a 12mm trocar was placed at the level of the anterior superior iliac spine on the anterior axillary line as an auxiliary hole. The operation was performed after connecting each robotic arm. After the operation, the specimen was placed in the specimen bag, and a drainage tube is placed in the auxiliary hole, the specimen was taken out, and the incision was closed in turn. Preoperative basic information, operation time, blood loss, incision size, postoperative complications, preoperative and postoperative PSA score, eGFR index, postoperative pathological information and other perioperative information were collected. Results:A total of 17 patients were included in this study, including 6 with prostate cancer, 8 with renal tumor, and 3 with adrenal tumor. There were 9 males and 8 females, with an average age of (56.7±14.6) years and a BMI of (23.3±3.4) kg/m 2. The mean operation time of radical prostatectomy was (244.6±35.1) min, the mean operating time of the chief surgeon was (184.0±39.0) min, and the mean blood loss was (36.6±23.8) ml. Postoperative positive margin was found in 2 cases. The average operation time of partial nephrectomy was (189.6±49.4) minutes, the average operating time of the chief surgeon was (115±39.7) minutes, the average blood loss was (12.7±8.3) ml, and the average warm ischemia time was (23.1±10.8) minutes. There was no significant difference in the eGFR index before and after the operation ( P>0.05). The average operation time of adrenalectomy was (177.6±26.9) min, the average operating time of the chief surgeon was (99±20.4) min, and the average blood loss was (11.6±6.2) ml. The overall average operation time of the three surgical methods was (206.9±50.1) min, the overall average operating time of the chief surgeon was (136.5±51.1) min, the overall average blood loss was (21.0±9.2) ml, and the overall average incision size was (3.5±0.5) cm, all added a 12 mm auxiliary channel, and the overall average hospital stay was (8.1±2.7) days. All operations were successfully completed, and there was no conversion to open surgery during the operation, and no operation holes were added. There was no Clavien-Dindo≥grade 3 complication after operation. Conclusions:The novel single-port robot could safely and effectively perform radical prostatectomy, partial nephrectomy and adrenalectomy which are common in urology through extraperitoneal approach.

Objective:To investigate the effect of albumin to fibrinogen ratio on the prognosis of patients undergoing radical resection for colorectal cancer.Methods:Clinical and pathological data of 216 patients who underwent laparoscopic radical resection of colorectal cancer at the General Surgery Department of Taizhou People's Hospital from Aug 2015 to Jul 2017 were retrospectively analyzed. Albumin and fibrinogen results within 7 days before surgery was collected. The optimal cut-off point of AFR was determined by Youden index of ROC curve. Kaplan-Meier analysis, univariate and multivariate COX regression models were used to analyze the prognostic factors of OS and DFS.Results:The best postoperative OS threshold of AFR for patients undergoing laparoscopic radical resection of colorectal cancer was 9.43. Univariate analysis and multivariate COX regression analysis showed that age ≤65 years, TNM stage Ⅰ-Ⅱ, and AFR≥9.43 had better OS and DFS (all P<0.05). Conclusions:Preoperative AFR level had a good predictive value on postoperative survival of patients undergoing laparoscopic radical resection of colorectal cancer, and AFR<9.43 was an independent risk factor for postoperative OS and DFS.

Objective:To construct a real-time monitoring system based on computer vision for monitoring withdrawal speed of colonoscopy and to validate its feasibility and performance.Methods:A total of 35 938 images and 63 videos of colonoscopy were collected in endoscopic database of Renmin Hospital of Wuhan University from May to October 2018. The images were divided into two datasets, one dataset included in vitro, in vivo and unqualified colonoscopy images, and another dataset included ileocecal and non-cecal area images. And then 3 594 and 2 000 images were selected respectively from the two datasets for testing the deep learning model, and the remaining images were used to train the model. Three colonoscopy videos were selected to evaluate the feasibility of real-time monitoring system, and 60 colonoscopy videos were used to evaluate its performance.Results:The accuracy rate of the deep learning model for classification for in vitro, in vivo, and unqualified colonoscopy images was 90.79% (897/988), 99.92% (1 300/1 301), and 99.08% (1 293/1 305), respectively, and the overall accuracy rate was 97.11% (3 490/3 594). The accuracy rate of identifying ileocecal and non-cecal area was 96.70% (967/1 000) and 94.90% (949/1 000), respectively, and the overall accuracy rate was 95.80% (1 916/2 000). In terms of feasibility evaluation, 3 colonoscopy videos data showed a linear relationship between the retraction speed and the image processing interval, which indicated that the real-time monitoring system automatically monitored the retraction speed during the colonoscopy withdrawal process. In terms of performance evaluation, the real-time monitoring system correctly predicted entry time and withdrawal time of all 60 examinations, and the results showed that the withdrawal speed and withdrawal time was significantly negative-related ( R=-0.661, P<0.001). The 95% confidence interval of withdrawal speed for the colonoscopy with withdrawal time of less than 5 min, 5-6 min, and more than 6 min was 43.90-49.74, 40.19-45.43, and 34.89-39.11 respectively. Therefore, 39.11 was set as the safe withdrawal speed and 45.43 as the alarm withdrawal speed. Conclusion:The real-time monitoring system we constructed can be used to monitor real-time withdrawal speed of colonoscopy and improve the quality of endoscopy.

Objective:To establish a deep convolutional neural network (DCNN) model based on YOLO and ResNet algorithm for automatic detection of colorectal polyps and to test its function.Methods:Colonoscopy images and videos collected from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University from January 2018 to March 2019 were divided into three databases (database 1, 3, 4). The public database CVC-ClinicDB (composed of 612 polyp images extracted from 29 colonoscopy videos provided by Barcelona Hospital, Spain) was used as the database 2. Database 1 (4 700 colonoscopy images from January 2018 to November 2018, including 3 700 intestinal polyp images and 1 000 non-polyp images) was used for establishing training and verifying the DCNN model. Database 2 (CVC-ClinicDB) and database 3 (720 colonoscopy images from January 2019 to March 2019, including 320 intestinal polyp images and 400 non-polyp images) were used for testing the DCNN model on image detection. Database 4 (15 colonoscopy videos in December 2019, containing 33 polyps) was used for testing the DCNN model on video detection. The sensitivity, specificity, accuracy and false positive rate of the DCNN model for detecting intestinal polyps were calculated.Results:The sensitivity of the DCNN model for detecting intestinal polyps in database 2 was 93.19% (602/646). In database 3, the DCNN model showed the accuracy of 95.00% (684/720), sensitivity of 98.13% (314/320), specificity of 92.50% (370/400), and false positive rate of 7.50% (30/400) for detecting intestinal polyps. In database 4, the DCNN model achieved a per-polyp-sensitivity of 100.00% (33/33), a per-image-accuracy of 96.29% (133 840/138 998), a per-image-sensitivity of 90.24% (4 066/4 506), a per-image-specificity of 96.49% (129 774/134 492), and a per-image-false positive rate of 3.51% (4 718/134 492).Conclusion:The DCNN model constructed in the study has a high sensitivity and specificity for automatic detection of colorectal polyps both in the colonoscopy images and videos, has a low false positive rate in the videos, and has the potential to assist endoscopists in diagnosis of colorectal polyps.

Objective To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves ( a real-time gastroscopic monitoring system) in gastroscopy. Methods A total of 38522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves. Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. Results The total position recognition accuracy of gastroscopic elves was 85. 125％ ( 1156/1358) . The coverage rate of gastroscopic sites for the endoscopist A was (76. 790±8. 848)％ and (87. 325±7. 065)％, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75. 926 ±11. 565)％ and (75. 253 ± 14. 662)％, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0. 324, P=0. 747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves ( t=6. 222, P=0. 001) , and that of the endoscopist B in the same period ( t'=3. 588, P=0. 002) . The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20. 956 ± 3. 406 and ( 77. 613 ± 12. 613)％, and 15. 467 ± 2. 296 and ( 57. 284 ± 8. 503)％, respectively, with statistical differences ( t=11. 523, P=0. 000; t=11. 523, P=0. 000). Conclusion Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics.

Objective To investigate the association of COL4A2 gene polymorphism rs9521733 with lacunar stroke in Xinjiang Han populations.Methods A total of 406 Han lacunar stroke patients and 425 controls enrolled from the First Hospital of Xinjiang Medical University and the 7th Division Hospital of Xinjiang Production and Construction Corps between March 2016 and September 2017 were recruited in the study.Clinical data were collected from all subjects.The improved multiple ligase detection reaction method was used to analyze the genotypes of rs9521733 in the COL4A2 gene.SPSS 17.0 was used for data analysis.Results There was no statistically significant difference in genotype and allele frequency of rs9521733 between case group and control group.Stratification analyses showed that the CC genotype of rs9521733 was associated with a significant increase in risk of lacunar stroke in the group of age ≥≥60 years (adjusted OR =1.950,95％ CI 1.222-3.112,P =0.005).Conclusion The rs9521733 of the COL4A2 gene might be associated with a higher risk of lacunar stroke in the group of age ≥60 years.

Background and objective Neoadjuvant chemotherapy is a new development in the treatment of lung cancer. In recent years, cetuximab and celecoxib have been commonly used in this procedure. This study aims to explore the effect of cetuximab combined with celecoxib on apoptosis and KDR and AQP1 expression in lung cancer A549 cells. Method The cells were cultured in RPMI-1640 and then divided into four groups: control group, 1 nmol/L cetuximab group, 25 μmol/ L celecoxib group, and 1 nmol/L cetuximab+25 μmol/L celecoxib group. The treatment time was 48 h. The mRNA and protein expression levels of KDR and AQP1 were detected by RT-PCR and Western blot, respectively. The apoptosis, proliferation, and invasive ability of A549 cells before and after transfection were examined using flow cytometry, MTT, and transwell methods. Results Cetuximab and celecoxib inhibited the growth of A549 cells in a dose-dependent manner. Their combination produced a greater growth inhibition than when either was used alone (P<0.01). Cetuximab and celecoxib both induced the apoptosis of A549 cells, and their combination produced a higher apoptosis rate (P<0.01). Cetuximab in combination with celecoxib also induced G1 phase arrest and downregulated the expression of KDR and AQP1 in A549 cells (P<0.05). As a result, the invasion ability of the A549 cells was significantly decreased. Conclusion Cetuximab in combination with celecoxib can synergistically inhibit the growth of A549 cells and downregulate the expression of KDR and AQP1 in A549 cells. The combination of cetuximab and celecoxib is a potential strategy for lung cancer therapy.

Objective To discuss the technical factors of extrapleural locating in CT-guided percutaneous pulmonary biopsy. Methods 137 cases undervent CT-guided percutaneous pulmonary biopsy were retrospectively analyzed. The technical methods of operation,points and points for attention were analyzed. Results In this group the success rate of data manipulation was 98.5%. No serious complications of the operation were occured. Scan completed within 40-story biopsy rate was 71.5%. The needle into the target rate for the first time was 93.4%. Conclusion CT-guided biopsy could increase the detection rate of difficult lesions and patient satisfaction rate paying attention on thinking and practice in the preoperative preparation and intraoperative specific operations.