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Patients with chronic diseases, such as cancer or epilepsy, are often followed through multiple stages of clinical interventions. Dynamic treatment regimes (DTRs) are sequences of decision rules that assign treatments at each stage based on measured covariates for each patient. A DTR is said to be optimal if the expectation of the desirable clinical benefit reaches a maximum when applied to a population. When there are three or more options for treatments at each decision point and the clinical outcome of interest is a time-to-event variable, estimating an optimal DTR can be complicated. We propose a doubly robust method to estimate optimal DTRs with multicategory treatments and survival outcomes. A novel blip function is defined to measure the difference in expected outcomes among treatments, and a doubly robust weighted least squares algorithm is designed for parameter estimation. Simulations using various weight functions and scenarios support the advantages of the proposed method in estimating optimal DTRs over existing approaches. We further illustrate the practical value of our method by applying it to data from the Standard and New Antiepileptic Drugs study. In this analysis, the proposed method supports the use of the new drug lamotrigine over the standard option carbamazepine. When the actual treatments match the estimated optimal treatments, survival outcomes tend to be better. The newly developed method provides a practical approach for clinicians that is not limited to cases of binary treatment options. [ABSTRACT FROM AUTHOR]

Objective To explore whether early treatment with integrated Chinese and western medicine can prolong the survival time of patients with advanced digestive tract malignant tumors using a new statistical analysis method and real-world data. Methods Based on the left truncated data, the Copula model was used to construct a joint model of the time from stage IV diagnosis to treatment and the time to overall survival. The estimated value and significance of the Copula dependence parameter, η, were obtained to evaluate the dependence strength between the two event times of interest. Results The numerical simulation showed that this method performed well when the left truncation rate was 20%. The estimated Copula dependence parameter η), in the real data analysis was 0.279 (P<0.05), indicating that there was a significant correlation between times to treatment and overall survival. Gender, the Eastern Cooperative Oncology Group score, targeted treatment, and metastatic site 1 were significant factors associated with overall survival. Conclusion The new statistical method provided valuable insights and analytical tools for the effectiveness of integrated traditional Chinese and western medicine in treating patients with advanced digestive tract malignant tumors. [ABSTRACT FROM AUTHOR]

Objective To explore the prognostic factors that affect patients with advanced esophageal cancer treated with Traditional Chinese medicine (TCM). Methods A total of 72 patients with stage IV esophageal cancer were selected for analysis, and the advantaged and disadvantaged groups of TCM treatment were defined according to survival time. The log-rank method was used for the univariate analysis, the rank-sum test was used for the correlation between the syndrome type and the prognostic grouping, and the Cox proportional risk model was used for multiple factors. Results The median survival of the 72 patients with esophageal cancer was 17.9 months. The univariate analysis of the result showed that the presence of organ metastasis, the presence of lung metastasis, and the post-treatment symptom self-assessment and length of herbal medication were related to the prognosis of advanced esophageal cancer treated with TCM. The rank-sum test between the TCM syndrome elements, and survival prognosis grouping showed that the syndrome element of Qi stagnation may also affect prognosis. The result of the multi-factorial analysis showed that the factor of the duration of the TCM administration was an independent factor that affects the prognosis of advanced esophageal cancer treated with TCM. Conclusion The duration of TCM treatment affected the prognosis of patients with advanced esophageal cancer. [ABSTRACT FROM AUTHOR]

To improve the gelling property of konjac gum (KGM) and enhance the application value of Abelmoschus manihot (L.) medic gum (AMG), a novel type of gel was prepared using KGM and AMG in this study. The effects of AMG content, heating temperature and salt ions on the characteristics of KGM/AMG composite gels were studied by Fourier transform infrared spectroscopy (FTIR), zeta potential, texture analysis and dynamic rheological behavior analysis. The results indicated that the AMG content, heating temperature and salt ions could affect the gel strength of KGM/AMG composite gels. Hardness, springiness, resilience, G′, G* and η* of KGM/AMG composite gels increased when AMG content increased from 0 to 2.0 %, but they decreased when AMG increased from 2.0 % to 3.5 %. High-temperature treatment significantly enhanced the texture and rheological properties of KGM/AMG composite gels. The addition of salt ions reduced the zeta potential absolute value and weakened the texture and rheological properties of KGM/AMG composite gels. Furthermore, the KGM/AMG composite gels could be classified as non-covalent gels. The non-covalent linkages included hydrogen bonding and electrostatic interactions. These findings would help understand the properties and formation mechanism of KGM/AMG composite gels and help improve the application value of KGM and AMG. [ABSTRACT FROM AUTHOR]