The dynamic,heterogeneous nature of Edge computing in the Internet of Things(Edge-IoT)and Industrial IoT(IIoT)networks brings unique and evolving cybersecurity challenges.This study maps cyber threats in Edge-IoT/IIoT...The dynamic,heterogeneous nature of Edge computing in the Internet of Things(Edge-IoT)and Industrial IoT(IIoT)networks brings unique and evolving cybersecurity challenges.This study maps cyber threats in Edge-IoT/IIoT environments to the Adversarial Tactics,Techniques,and Common Knowledge(ATT&CK)framework by MITRE and introduces a lightweight,data-driven scoring model that enables rapid identification and prioritization of attacks.Inspired by the Factor Analysis of Information Risk model,our proposed scoring model integrates four key metrics:Common Vulnerability Scoring System(CVSS)-based severity scoring,Cyber Kill Chain–based difficulty estimation,Deep Neural Networks-driven detection scoring,and frequency analysis based on dataset prevalence.By aggregating these indicators,the model generates comprehensive risk profiles,facilitating actionable prioritization of threats.Robustness and stability of the scoring model are validated through non-parametric correlation analysis using Spearman’s and Kendall’s rank correlation coefficients,demonstrating consistent performance across diverse scenarios.The approach culminates in a prioritized attack ranking that provides actionable guidance for risk mitigation and resource allocation in Edge-IoT/IIoT security operations.By leveraging real-world data to align MITRE ATT&CK techniques with CVSS metrics,the framework offers a standardized and practically applicable solution for consistent threat assessment in operational settings.The proposed lightweight scoring model delivers rapid and reliable results under dynamic cyber conditions,facilitating timely identification of attack scenarios and prioritization of response strategies.Our systematic integration of established taxonomies with data-driven indicators strengthens practical risk management and supports strategic planning in next-generation IoT deployments.Ultimately,this work advances adaptive threat modeling for Edge/IIoT ecosystems and establishes a robust foundation for evidence-based prioritization in emerging cyber-physical infrastructures.展开更多
BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propos...BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.展开更多
AIM:To estimate the prognosis of patients with liver failure using a scoring model of severe viral hepatitis (SMSVH) and a model of end stage liver disease (MELD) to provide a scientific basis for clinical decision of...AIM:To estimate the prognosis of patients with liver failure using a scoring model of severe viral hepatitis (SMSVH) and a model of end stage liver disease (MELD) to provide a scientific basis for clinical decision of treatment. METHODS:One hundred and twenty patients with liver failure due to severe viral hepatitis were investigated with SMSVH established. Patients with acute,subacute,and chronic liver failure were 40,46 and 34,respectively. The follow-up time was 6 mo. The survival rates of patients with liver failure in 2 wk,4 wk,3 mo and 6 mo were estimated with Kaplan-Meier method. Comparison between SMSVH and MELD was made using ROC statistic analysis. RESULTS:The survival curves of group A (at low risk,SMSVH score ≤ 4) and group B (at high risk,SMSVH score ≥ 5) were significantly different (The 4-wk,3-mo,6-mo survival rates were 94.59%,54.05%,43.24% in group A,and 51.81%,20.48%,12.05% in group B,respectively,P < 0.001). The survival curves of group C (SMSVH scores unchanged or increased),group D (SMSVH scores decreased by 1) and group E (SMSVH scores decreased by 2 or more) were significantly different .The survival rates of groups C,D and E were 66.15%,100%,100% in 2-wk; 40.0%,91.18%,100% in 4-wk; 0%,58.82%,80.95% in 3-mo and 0%,38.24%,61.90% in 6-mo,respectively,P < 0.001). The area under the ROC curve (AUC) of SMSVH scores at baseline and after 2 wk of therapy was significantly higher than that under the ROC curve of MELD scores (0.804 and 0.934 vs 0.689,P < 0.001). CONCLUSION:SMSVH is superior to MELD in theestimation of the prognosis of patients with severe viral hepatitis within 6 mo. SMSVH may be regarded as a criterion for estimation of the efficacy of medical treatment and the decision of clinical treatment.展开更多
Small-and medium-sized enterprises(SMEs)have a crucial influence on the economic development of every nation,but access to formal finance remains a barrier.Similarly,financial institutions encounter challenges in the ...Small-and medium-sized enterprises(SMEs)have a crucial influence on the economic development of every nation,but access to formal finance remains a barrier.Similarly,financial institutions encounter challenges in the assessment of SMEs’creditworthiness for the provision of financing.Financial institutions employ credit scoring models to identify potential borrowers and to determine loan pricing and collateral requirements.SMEs are perceived as unorganized in terms of financial data management compared to large corporations,making the assessment of credit risk based on inadequate financial data a cause for financial institutions’concern.The majority of existing models are data-driven and have faced criticism for failing to meet their assumptions.To address the issue of limited financial record keeping,this study developed and validated a system to predict SMEs’credit risk by introducing a multicriteria credit scoring model.The model was constructed using a hybrid best–worst method(BWM)and the Technique for Order of Preference by Similarity to Ideal Solution(TOPSIS).Initially,the BWM determines the weight criteria,and TOPSIS is applied to score SMEs.A real-life case study was examined to demonstrate the effectiveness of the proposed model,and a sensitivity analysis varying the weight of the criteria was performed to assess robustness against unpredictable financial situations.The findings indicated that SMEs’credit history,cash liquidity,and repayment period are the most crucial factors in lending,followed by return on capital,financial flexibility,and integrity.The proposed credit scoring model outperformed the existing commercial model in terms of its accuracy in predicting defaults.This model could assist financial institutions,providing a simple means for identifying potential SMEs to grant credit,and advance further research using alternative approaches.展开更多
Background Oral rehydration solution(ORS)is predominantly utilized in the management of hypovolemic postural orthostatic tachycardia syndrome(POTS).This study aimed to identify effective indicators and develop models ...Background Oral rehydration solution(ORS)is predominantly utilized in the management of hypovolemic postural orthostatic tachycardia syndrome(POTS).This study aimed to identify effective indicators and develop models to assess the impact of ORS on pediatric patients diagnosed with POTS.Methods We utilized a retrospective analysis of totally 158 pediatric patients with POTS receiving a 3-month course of ORS treatment.All patients were classified into training set(n=98)and validation set(n=60).Within the training set,univariate analysis and binary logistic regression were employed to select candidate predictors.To predict the efficacy of ORS in pediatric patients with POTS,a nomogram model and a scoring model were constructed and demonstrated.Additionally,the predictive ability and calibration performance were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow(H-L)goodness of fit test,and calibration plots.Decision curve analysis(DCA)was employed to assess the clinical applicability of the predictive models.Results Body mass index(BMI)z-score,serum chlorine,and urine specific gravity(USG)before treatment were identified as significant and independent predictors of efficacy of ORS in pediatric patients with POTS.Consequently,these indicators were included in the predictive models.A nomogram model was constructed in the training set(AUC=0.87,which yields a sensitivity of 84.5%and a specificity of 85.0%)and validated in the validation set(the sensitivity,specificity,and accuracy were 87.5%,85%,and 86.7%,respectively).A scoring model was advanced in the training set(AUC=0.88,which yields a sensitivity of 79.3%and a specificity of 82.5%)and validated in the validation set(the sensitivity,specificity,and accuracy were 77.5%,80.0%,and 78.3%,respectively).The H-L test results indicated a good model fit.The calibration plots and DCA for both models exhibited excellent calibration and satisfactory net benefit.Conclusions Based on pre-treatment BMI z-score,serum chlorine,and USG,a nomogram model and a scoring model were developed and validated.The models can effectively assess the efficacy of ORS in pediatric patients with POTS,offering an accurate and individualized therapeutic strategy.展开更多
Background:We investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence.Method...Background:We investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence.Methods:Cox regression analysis was used to identify factors that predicted tumor recurrence,and a scoring model was generated by assigning a value of 0 or 1 to each independent risk factor.The cut-off value for fibrinogen was determined by receiver operating characteristic curve analysis.Results:Preoperative fibrinogen concentration was significantly higher in patients with vs.without tumor recurrence(3.27 g/L vs.2.34 g/L,P<0.001),with vs.without macrovascular invasion(3.54 g/L vs.2.82 g/L,P?0.007),and with>400 vs.400 ng/mL plasma alpha-fetoprotein concentration(3.43 g/L vs.2.76 g/L,P?0.007).The 5-year disease-free survival rate was significantly lower for patients with elevated(2.68 g/L)vs.normal(<2.68 g/L)fibrinogen concentration(37.2%vs.78.4%,P?0.001).Macrovascular invasion,>3 tumor nodules,and elevated fibrinogen concentration were independent risk factors for tumor recurrence.A scoring model based on these risk factors predicted recurrence with a sensitivity of 68.3%and a specificity of 87.5%.Conclusions:Elevated preoperative plasma fibrinogen concentration is associated with tumor recurrence in HCC patients after liver transplantation.A new scoring model predicted recurrence with good sensitivity and specificity.展开更多
Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8^(+)T cell immune infiltration and immune suppression.We constructed a CD8^(+)T cells related risk score model to predic...Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8^(+)T cell immune infiltration and immune suppression.We constructed a CD8^(+)T cells related risk score model to predict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8^(+)T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS 2,and TNFRSF1B was constructed.The risk score model was well validated through an independent external validation cohort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P<0.0001)and lower CD8^(+)T cells infiltration(P<0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P<0.01).Drug sensitivity analysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene model was verified by immunohistochemistry.In summary,the establishment and validation of a CD8^(+)T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.展开更多
This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This ...This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This editorial provides an overview of the study,including the background of ACN risk prediction,the study design,key findings,and the significance and limitations of the new model.The study identified independent risk factors for ACN and developed a 7-point scoring model with better predictive performance than existing models.However,challenges,such as generalizability across ethnic groups and selection bias,exist.Further research involving multi-ethnic cohorts and the integration of novel biomarkers is needed to improve the model and its clinical application.展开更多
BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic co...BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.展开更多
BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for...BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.展开更多
Objective： In our previous work, we incorporated complete blood count （CBC） into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharynge...Objective： In our previous work, we incorporated complete blood count （CBC） into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharyngeal carcinoma （NPC）. The purpose of this study was to revalidate the accuracy of the model, and its superiority to TNM stage, through data from a prospective study.Methods： CBC of 249 eligible patients from the 863 Program No. 2006AA02Z4B4 was evaluated. Prognostic index （PI） of each patient was calculated according to the score model. Then they were divided by the PI into three categories： the low-, intermediate-and high-risk patients. The 5-year disease-specific survival （DSS） of the three categories was compared by a log-rank test. The model and TNM stage （Tth edition） were compared on efficiency for predicting the 5-year DSS, through comparison of the area under curve （AUC） of their receiver-operating characteristic curves.Results： The 5-year DSS of the low-, intermediate- and high-risk patients were 96.0%, 79.1% and 62.2%, respectively. The low- and intermediate-risk patients had better DSS than the high-risk patients （P〈0.001 and P〈0.005, respectively）. And there was a trend of better DSS in the low-risk patients, compared with the intermediate-risk patients （P=0.049）. The AUC of the model was larger than that of TNM stage （0.726 vs. 0.661, P：0.023）. Conclusions： A CBC-based prognostic score model was revalidated to be accurate and superior to TNM stage on predicting 5-year DSS of NPC.展开更多
Background The vasovagal reflex syndrome （VVRS） is common in the patiems undergoing percutaneous coronary intervemion （PCI） However, prediction and prevention of the risk for the VVRS have not been completely fulf...Background The vasovagal reflex syndrome （VVRS） is common in the patiems undergoing percutaneous coronary intervemion （PCI） However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. Methods From the hos- pital electronic medical database, we idemified 3550 patients who received PCI （78.0% males, mean age 60 years） in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic 01OC） analysis were performed. Results The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation （all P 〈 0.001）. The rate of VVRS [95% confidence interval （CI）] in patients receiving PCI was 4.5% （4.1%-5.6%）. Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stems im- plantation in the left anterior descending （LAD）, and the femoral puncture site. The multivariate analysis suggested that they were independ- ent risk factors for predicting the incidence of VVRS （all P 〈 0.001）. We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI （c-statistic 0.76, 95% CI： 0.72-0.79, P 〈 0.001）. There were decreased evems of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute （AUC： 0.84, 95% CI： 0.81-0.87, P 〈 0.001）. Conclusion The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be in- volved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.展开更多
AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum ...AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.展开更多
BACKGROUND: Acute liver failure (ALF) remains a dramatic and unpredictable disease with high morbidity and mortality. Early and accurate prognostic assessment of patients with ALF is critically important for optimum c...BACKGROUND: Acute liver failure (ALF) remains a dramatic and unpredictable disease with high morbidity and mortality. Early and accurate prognostic assessment of patients with ALF is critically important for optimum clinical pathway. DATA SOURCES: Five English-language medical databases, MEDLINE, Science Direct, OVID, Springer Link and Wiley Interscience were searched for articles on 'acute liver failure', 'prognosis', and related topics. RESULTS: Multi-variable prognostic models including the King's College Hospital criteria and the model for end-stage liver disease score have been widely used in determination of the prognosis of ALF, but the results are far from satisfactory. Other prognostic indicators including serum Gc-globulin, arterial blood lactate, serum phosphate, arterial blood ammonia, and serum alpha-fetoprotein are promising but await further assessement. CONCLUSIONS: A reliable prognostic model to be developed in the future should not only have predictive value for poor outcome but also help to predict the survival of patients without a liver transplantation. Further studies are necessary to assess the prognostic accuracy of any new models. (Hepatobiliary Pancreat Dis Int 2010; 9: 122-128)展开更多
AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was co...AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical(ascites,encephalopathy and variceal bleeding) and biochemical(serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52-and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups(low risk≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fi t,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values(c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease(MELD) and Child-Pugh(CP) scores for 12-,52-and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow(H-L) statistic revealed that the biochemical and clinical model(H-L,4.69) is better calibrated than MELD(H-L,17.06) and CP(H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups(low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.展开更多
BACKGROUND:Decreased cardiac contractility has been observed in cirrhosis,suggesting a latent cardiomyopathy in these patients.This study was designed to evaluate left ventricular structure and function in patients wi...BACKGROUND:Decreased cardiac contractility has been observed in cirrhosis,suggesting a latent cardiomyopathy in these patients.This study was designed to evaluate left ventricular structure and function in patients with end-stage liver disease by the model for end-stage liver disease(MELD) scoring system. METHODS:We recruited 82 patients(72 male,10 female; mean age 50.3±8.9 years)with end-stage liver disease who underwent orthotopic liver transplantation between January 2002 and May 2008.Seventy-eight patients had cirrhosis and 4 had primary liver cancer.Patients were categorized into three groups on the basis of MELD score:≤9(27 patients, 33%);10-19(40,49%);and≥20(15,18%).The relationship between MELD score and cardiac structure and function was determined.Preoperative assessments of blood biochemistry, blood coagulation,serum virology,echocardiography and electrocardiography were performed. RESULTS:MELD score was positively correlated with enlarged left atrial diameter,increased interventricular septum thickness(IVST),increased aortic flow,corrected QT interval (QTc)extension and cardiac output(P=0.033,0.002,0.000, 0.000 and 0.009,respectively).International normalized ratio also had a correlation with the above parameters and enlarged left ventricular end-diastolic diameter(P=0.043,0.010,0.000, 0.001,0.016 and 0.008,respectively).Serum creatinine was positively correlated with IVST(r=0.257,P=0.020),but negatively correlated with early maximal ventricular filling velocity/late diastolic or atrial velocity ratio(r=-0.300, P=0.006).A difference of QTc>440 ms among the three groups was statistically significant(χ2=9.791,P=0.007).CONCLUSIONS:Abnormalities in cardiac structure and function are common in patients with end-stage liver disease. MELD score is a practically useful approach for the assessment of cardiac function in such patients.展开更多
BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(IC...BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.展开更多
AIM: To assess the impact of model for end-stage liver disease(MELD) score on patient survival and morbidity post living donor liver transplantation(LDLT). METHODS: A retrospective study was performed on 80 adult pati...AIM: To assess the impact of model for end-stage liver disease(MELD) score on patient survival and morbidity post living donor liver transplantation(LDLT). METHODS: A retrospective study was performed on 80 adult patients who had LDLT from 2011-2013. Nine patients were excluded and 71 patients were divided into two groups; Group 1 included 38 patients with a MELD score < 20, and Group 2 included 33 patients with a MELD score > 20. Comparison between both groups was done regarding operative time, intra-operative blood requirement, intensive care unit(ICU) and hospital stay, infection, and patient survival.RESULTS: Eleven patients died(15.5%); 3/38(7.9%)patients in Group 1 and 8/33(24.2%) in Group 2 with significant difference(P = 0.02). Mean operative time, duration of hospital stay, and ICU stay were similar in both groups. Mean volume of blood transfusion and cell saver re-transfusion were 8 ± 4 units and 1668 ± 202 m L, respectively, in Group 1 in comparison to 10 ± 6 units and 1910 ± 679 m L, respectively, in Group 2 with no significant difference(P = 0.09 and 0.167, respectively). The rates of infection and systemic complications(renal, respiratory, cardiovascular and neurological complications) were similar in both groups. CONCLUSION: A MELD score > 20 may predict mortality after LDLT.展开更多
This paper presents an approach for estimating power of the score test, based on an asymptotic approximation to the power of the score test under contiguous alternatives. The method is applied to the problem of power ...This paper presents an approach for estimating power of the score test, based on an asymptotic approximation to the power of the score test under contiguous alternatives. The method is applied to the problem of power calculations for the score test of heteroscedasticity in European rabbit data （Ratkowsky, 1983）. Simulation studies are presented which indicate that the asymptotic approximation to the finite-sample situation is good over a wide range of parameter configurations.展开更多
AIM： To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term （30 d and 90 d） mortality in patients with alcoholic hepa...AIM： To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term （30 d and 90 d） mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODS： Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. RESULTS： 30- and 90-d mortality rates were reported at 5.9% （2/34） and 14.7% （5/34）, respectively. Significant correlation was demonstrated for the Model for End- Stage Liver Disease （P30 = 0.094, P90 = 0.046） and the Maddrey Discriminant Function score （P30 = 0.033, P90 = 0.038） with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans- ferase （P = 0.057）, fibrin degradation products （P = 0.048） and C-reactive protein （P = 0.067） with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 （95%CI： 0.902-1.036, P = 0.028） for the Model for End-Stage Liver Disease score and 0.984 （95%CI： 0.942-1.027, P = 0.023） for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 （sensitivity 1, specificity 0.937） and 108.68 （sensitivity 1, specificity 0.969）, respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 （95%CI： 0.559-0.965, P = 0.065） for the Model for End-Stage Liver Disease score and 0.752 （95%CI： 0.465-1.038, P = 0.076） for the Maddrey Discriminant Function score with the optimal cut off point of 19 （sensitivity 0.6, specificity 0.6） and 92 （sensitivity 0.6, specificity 0.946）, respectively. The observed Kaplan Meier survival rates for different score-categories were compared with logrank tests and higher score values were correlated with a lower survival. CONCLUSION： Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotransferase as independent predictors of 90-d mortality has also been verified.展开更多
基金supported by the“Regional Innovation System&Education(RISE)”through the Seoul RISE Center,funded by the Ministry of Education(MOE)and the Seoul Metropolitan Government(2025-RISE-01-018-05)supported by Quad Miners Corp。
文摘The dynamic,heterogeneous nature of Edge computing in the Internet of Things(Edge-IoT)and Industrial IoT(IIoT)networks brings unique and evolving cybersecurity challenges.This study maps cyber threats in Edge-IoT/IIoT environments to the Adversarial Tactics,Techniques,and Common Knowledge(ATT&CK)framework by MITRE and introduces a lightweight,data-driven scoring model that enables rapid identification and prioritization of attacks.Inspired by the Factor Analysis of Information Risk model,our proposed scoring model integrates four key metrics:Common Vulnerability Scoring System(CVSS)-based severity scoring,Cyber Kill Chain–based difficulty estimation,Deep Neural Networks-driven detection scoring,and frequency analysis based on dataset prevalence.By aggregating these indicators,the model generates comprehensive risk profiles,facilitating actionable prioritization of threats.Robustness and stability of the scoring model are validated through non-parametric correlation analysis using Spearman’s and Kendall’s rank correlation coefficients,demonstrating consistent performance across diverse scenarios.The approach culminates in a prioritized attack ranking that provides actionable guidance for risk mitigation and resource allocation in Edge-IoT/IIoT security operations.By leveraging real-world data to align MITRE ATT&CK techniques with CVSS metrics,the framework offers a standardized and practically applicable solution for consistent threat assessment in operational settings.The proposed lightweight scoring model delivers rapid and reliable results under dynamic cyber conditions,facilitating timely identification of attack scenarios and prioritization of response strategies.Our systematic integration of established taxonomies with data-driven indicators strengthens practical risk management and supports strategic planning in next-generation IoT deployments.Ultimately,this work advances adaptive threat modeling for Edge/IIoT ecosystems and establishes a robust foundation for evidence-based prioritization in emerging cyber-physical infrastructures.
基金Supported by The Guangdong Medical Research Foundation of China,No.A2020603.
文摘BACKGROUND Designing a feasible risk prediction model for advanced colorectal neoplasia(ACN)can enhance colonoscopy screening efficiency.Abdominal obesity is associated with colorectal cancer development.AIM To propose and evaluate a modified scoring model incorporating waist-hip ratio for the prediction of ACN.METHODS A total of 6483 patients who underwent their first screening or diagnostic colonoscopy in our center between 2020 and 2023 were recruited,in which 4592 were in the derivation cohort and 1891 formed a validation cohort.Multivariate logistic regression was used to investigate the risk factors of ACN in the derivation cohort based on endoscopic findings,and a new scoring model for ACN prediction was developed.The discriminatory capability of the scoring model was validated by the validation cohort.RESULTS Age,male gender,smoking,and wait-to-hip ratio were identified as independent risk factors for ACN,and a 7-point scoring model was developed.The prevalence of ACN was 3.3%,9.3%and 18.5%in participants with scores of 0-2[low risk(LR)],3–4[moderate risk(MR)],and 5–7[high risk(HR)],respectively,in the derivation cohort.With the scoring model,49.9%,38.4%,and 11.7%of patients in the validation cohort were categorized as LR,MR,and HR,respectively.The corresponding prevalence rates of ACN were 5.0%,10.3%,and 17.6%,respectively.The C-statistic of the new scoring model was 0.66,which was higher than that of the Asia-Pacific Colorectal Screening model(0.63).CONCLUSION A modified scoring model incorporating waist-hip ratio has an improved predictive performance in the prediction of ACN.
基金Beijing Science and Technology Commission, No. H010210110129
文摘AIM:To estimate the prognosis of patients with liver failure using a scoring model of severe viral hepatitis (SMSVH) and a model of end stage liver disease (MELD) to provide a scientific basis for clinical decision of treatment. METHODS:One hundred and twenty patients with liver failure due to severe viral hepatitis were investigated with SMSVH established. Patients with acute,subacute,and chronic liver failure were 40,46 and 34,respectively. The follow-up time was 6 mo. The survival rates of patients with liver failure in 2 wk,4 wk,3 mo and 6 mo were estimated with Kaplan-Meier method. Comparison between SMSVH and MELD was made using ROC statistic analysis. RESULTS:The survival curves of group A (at low risk,SMSVH score ≤ 4) and group B (at high risk,SMSVH score ≥ 5) were significantly different (The 4-wk,3-mo,6-mo survival rates were 94.59%,54.05%,43.24% in group A,and 51.81%,20.48%,12.05% in group B,respectively,P < 0.001). The survival curves of group C (SMSVH scores unchanged or increased),group D (SMSVH scores decreased by 1) and group E (SMSVH scores decreased by 2 or more) were significantly different .The survival rates of groups C,D and E were 66.15%,100%,100% in 2-wk; 40.0%,91.18%,100% in 4-wk; 0%,58.82%,80.95% in 3-mo and 0%,38.24%,61.90% in 6-mo,respectively,P < 0.001). The area under the ROC curve (AUC) of SMSVH scores at baseline and after 2 wk of therapy was significantly higher than that under the ROC curve of MELD scores (0.804 and 0.934 vs 0.689,P < 0.001). CONCLUSION:SMSVH is superior to MELD in theestimation of the prognosis of patients with severe viral hepatitis within 6 mo. SMSVH may be regarded as a criterion for estimation of the efficacy of medical treatment and the decision of clinical treatment.
文摘Small-and medium-sized enterprises(SMEs)have a crucial influence on the economic development of every nation,but access to formal finance remains a barrier.Similarly,financial institutions encounter challenges in the assessment of SMEs’creditworthiness for the provision of financing.Financial institutions employ credit scoring models to identify potential borrowers and to determine loan pricing and collateral requirements.SMEs are perceived as unorganized in terms of financial data management compared to large corporations,making the assessment of credit risk based on inadequate financial data a cause for financial institutions’concern.The majority of existing models are data-driven and have faced criticism for failing to meet their assumptions.To address the issue of limited financial record keeping,this study developed and validated a system to predict SMEs’credit risk by introducing a multicriteria credit scoring model.The model was constructed using a hybrid best–worst method(BWM)and the Technique for Order of Preference by Similarity to Ideal Solution(TOPSIS).Initially,the BWM determines the weight criteria,and TOPSIS is applied to score SMEs.A real-life case study was examined to demonstrate the effectiveness of the proposed model,and a sensitivity analysis varying the weight of the criteria was performed to assess robustness against unpredictable financial situations.The findings indicated that SMEs’credit history,cash liquidity,and repayment period are the most crucial factors in lending,followed by return on capital,financial flexibility,and integrity.The proposed credit scoring model outperformed the existing commercial model in terms of its accuracy in predicting defaults.This model could assist financial institutions,providing a simple means for identifying potential SMEs to grant credit,and advance further research using alternative approaches.
基金provided by Clinical Medicine Plus X-Young Scholars Project(PKU2022LCXQ028)the Fundamental Research Funds for the Central Universities,China.
文摘Background Oral rehydration solution(ORS)is predominantly utilized in the management of hypovolemic postural orthostatic tachycardia syndrome(POTS).This study aimed to identify effective indicators and develop models to assess the impact of ORS on pediatric patients diagnosed with POTS.Methods We utilized a retrospective analysis of totally 158 pediatric patients with POTS receiving a 3-month course of ORS treatment.All patients were classified into training set(n=98)and validation set(n=60).Within the training set,univariate analysis and binary logistic regression were employed to select candidate predictors.To predict the efficacy of ORS in pediatric patients with POTS,a nomogram model and a scoring model were constructed and demonstrated.Additionally,the predictive ability and calibration performance were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow(H-L)goodness of fit test,and calibration plots.Decision curve analysis(DCA)was employed to assess the clinical applicability of the predictive models.Results Body mass index(BMI)z-score,serum chlorine,and urine specific gravity(USG)before treatment were identified as significant and independent predictors of efficacy of ORS in pediatric patients with POTS.Consequently,these indicators were included in the predictive models.A nomogram model was constructed in the training set(AUC=0.87,which yields a sensitivity of 84.5%and a specificity of 85.0%)and validated in the validation set(the sensitivity,specificity,and accuracy were 87.5%,85%,and 86.7%,respectively).A scoring model was advanced in the training set(AUC=0.88,which yields a sensitivity of 79.3%and a specificity of 82.5%)and validated in the validation set(the sensitivity,specificity,and accuracy were 77.5%,80.0%,and 78.3%,respectively).The H-L test results indicated a good model fit.The calibration plots and DCA for both models exhibited excellent calibration and satisfactory net benefit.Conclusions Based on pre-treatment BMI z-score,serum chlorine,and USG,a nomogram model and a scoring model were developed and validated.The models can effectively assess the efficacy of ORS in pediatric patients with POTS,offering an accurate and individualized therapeutic strategy.
基金supported by Science and Technology Planning Project of Guangdong Province,China(2017B020209004)Major State Research Development Program of China(2017ZX10203205-006-001,2017ZX10203205-001-003).
文摘Background:We investigated the prognostic value of preoperative fibrinogen levels in hepatocellular carcinoma patients receiving liver transplantation by building a scoring model for predicting tumor recurrence.Methods:Cox regression analysis was used to identify factors that predicted tumor recurrence,and a scoring model was generated by assigning a value of 0 or 1 to each independent risk factor.The cut-off value for fibrinogen was determined by receiver operating characteristic curve analysis.Results:Preoperative fibrinogen concentration was significantly higher in patients with vs.without tumor recurrence(3.27 g/L vs.2.34 g/L,P<0.001),with vs.without macrovascular invasion(3.54 g/L vs.2.82 g/L,P?0.007),and with>400 vs.400 ng/mL plasma alpha-fetoprotein concentration(3.43 g/L vs.2.76 g/L,P?0.007).The 5-year disease-free survival rate was significantly lower for patients with elevated(2.68 g/L)vs.normal(<2.68 g/L)fibrinogen concentration(37.2%vs.78.4%,P?0.001).Macrovascular invasion,>3 tumor nodules,and elevated fibrinogen concentration were independent risk factors for tumor recurrence.A scoring model based on these risk factors predicted recurrence with a sensitivity of 68.3%and a specificity of 87.5%.Conclusions:Elevated preoperative plasma fibrinogen concentration is associated with tumor recurrence in HCC patients after liver transplantation.A new scoring model predicted recurrence with good sensitivity and specificity.
基金国家自然科学基金项目(No.81902513)山西省应用基础研究计划项目(No.202303021211114 and 202103021224228)山西省高等教育百亿工程“科技引导”专项(No.BYJL047)资助。
文摘Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8^(+)T cell immune infiltration and immune suppression.We constructed a CD8^(+)T cells related risk score model to predict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8^(+)T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS 2,and TNFRSF1B was constructed.The risk score model was well validated through an independent external validation cohort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P<0.0001)and lower CD8^(+)T cells infiltration(P<0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P<0.01).Drug sensitivity analysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene model was verified by immunohistochemistry.In summary,the establishment and validation of a CD8^(+)T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.
文摘This editorial discusses an article by Liu et al,which focuses on the development and evaluation of a modified scoring model incorporating the waist-to-hip ratio for predicting advanced colorectal neoplasia(ACN).This editorial provides an overview of the study,including the background of ACN risk prediction,the study design,key findings,and the significance and limitations of the new model.The study identified independent risk factors for ACN and developed a 7-point scoring model with better predictive performance than existing models.However,challenges,such as generalizability across ethnic groups and selection bias,exist.Further research involving multi-ethnic cohorts and the integration of novel biomarkers is needed to improve the model and its clinical application.
基金Supported by National Natural Science Foundation of China,No.82170555Shanghai Academic/Technology Research Leader,No.22XD1422400+2 种基金Shanghai“Rising Stars of Medical Talent”Youth Development Program,No.20224Z0005the 74th General Support of China Postdoctoral Science Foundation,No.2023M740675Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University.
文摘BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.
文摘BACKGROUND Colorectal cancer is a common digestive cancer worldwide.As a comprehensive treatment for locally advanced rectal cancer(LARC),neoadjuvant therapy(NT)has been increasingly used as the standard treatment for clinical stage II/III rectal cancer.However,few patients achieve a complete pathological response,and most patients require surgical resection and adjuvant therapy.Therefore,identifying risk factors and developing accurate models to predict the prognosis of LARC patients are of great clinical significance.AIM To establish effective prognostic nomograms and risk score prediction models to predict overall survival(OS)and disease-free survival(DFS)for LARC treated with NT.METHODS Nomograms and risk factor score prediction models were based on patients who received NT at the Cancer Hospital from 2015 to 2017.The least absolute shrinkage and selection operator regression model were utilized to screen for prognostic risk factors,which were validated by the Cox regression method.Assessment of the performance of the two prediction models was conducted using receiver operating characteristic curves,and that of the two nomograms was conducted by calculating the concordance index(C-index)and calibration curves.The results were validated in a cohort of 65 patients from 2015 to 2017.RESULTS Seven features were significantly associated with OS and were included in the OS prediction nomogram and prediction model:Vascular_tumors_bolt,cancer nodules,yN,body mass index,matchmouth distance from the edge,nerve aggression and postoperative carcinoembryonic antigen.The nomogram showed good predictive value for OS,with a C-index of 0.91(95%CI:0.85,0.97)and good calibration.In the validation cohort,the C-index was 0.69(95%CI:0.53,0.84).The risk factor prediction model showed good predictive value.The areas under the curve for 3-and 5-year survival were 0.811 and 0.782.The nomogram for predicting DFS included ypTNM and nerve aggression and showed good calibration and a C-index of 0.77(95%CI:0.69,0.85).In the validation cohort,the C-index was 0.71(95%CI:0.61,0.81).The prediction model for DFS also had good predictive value,with an AUC for 3-year survival of 0.784 and an AUC for 5-year survival of 0.754.CONCLUSION We established accurate nomograms and prediction models for predicting OS and DFS in patients with LARC after undergoing NT.
基金supported by Hi-Tech Research and Development Program of China (863 Program) (No.2006AA02Z4B4)
文摘Objective： In our previous work, we incorporated complete blood count （CBC） into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharyngeal carcinoma （NPC）. The purpose of this study was to revalidate the accuracy of the model, and its superiority to TNM stage, through data from a prospective study.Methods： CBC of 249 eligible patients from the 863 Program No. 2006AA02Z4B4 was evaluated. Prognostic index （PI） of each patient was calculated according to the score model. Then they were divided by the PI into three categories： the low-, intermediate-and high-risk patients. The 5-year disease-specific survival （DSS） of the three categories was compared by a log-rank test. The model and TNM stage （Tth edition） were compared on efficiency for predicting the 5-year DSS, through comparison of the area under curve （AUC） of their receiver-operating characteristic curves.Results： The 5-year DSS of the low-, intermediate- and high-risk patients were 96.0%, 79.1% and 62.2%, respectively. The low- and intermediate-risk patients had better DSS than the high-risk patients （P〈0.001 and P〈0.005, respectively）. And there was a trend of better DSS in the low-risk patients, compared with the intermediate-risk patients （P=0.049）. The AUC of the model was larger than that of TNM stage （0.726 vs. 0.661, P：0.023）. Conclusions： A CBC-based prognostic score model was revalidated to be accurate and superior to TNM stage on predicting 5-year DSS of NPC.
文摘Background The vasovagal reflex syndrome （VVRS） is common in the patiems undergoing percutaneous coronary intervemion （PCI） However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. Methods From the hos- pital electronic medical database, we idemified 3550 patients who received PCI （78.0% males, mean age 60 years） in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic 01OC） analysis were performed. Results The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation （all P 〈 0.001）. The rate of VVRS [95% confidence interval （CI）] in patients receiving PCI was 4.5% （4.1%-5.6%）. Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stems im- plantation in the left anterior descending （LAD）, and the femoral puncture site. The multivariate analysis suggested that they were independ- ent risk factors for predicting the incidence of VVRS （all P 〈 0.001）. We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI （c-statistic 0.76, 95% CI： 0.72-0.79, P 〈 0.001）. There were decreased evems of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute （AUC： 0.84, 95% CI： 0.81-0.87, P 〈 0.001）. Conclusion The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be in- volved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.
文摘AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.
基金supported by grants from the NationalS&T Major Project for Infectious Disease Control of China(2008ZX10002-005)the National High Technology Research and Development Program of China(2006AA02A140)+1 种基金the National Natural Science Foundation of China(30630023)Zhejiang Health Science Foundation(2009A076)
文摘BACKGROUND: Acute liver failure (ALF) remains a dramatic and unpredictable disease with high morbidity and mortality. Early and accurate prognostic assessment of patients with ALF is critically important for optimum clinical pathway. DATA SOURCES: Five English-language medical databases, MEDLINE, Science Direct, OVID, Springer Link and Wiley Interscience were searched for articles on 'acute liver failure', 'prognosis', and related topics. RESULTS: Multi-variable prognostic models including the King's College Hospital criteria and the model for end-stage liver disease score have been widely used in determination of the prognosis of ALF, but the results are far from satisfactory. Other prognostic indicators including serum Gc-globulin, arterial blood lactate, serum phosphate, arterial blood ammonia, and serum alpha-fetoprotein are promising but await further assessement. CONCLUSIONS: A reliable prognostic model to be developed in the future should not only have predictive value for poor outcome but also help to predict the survival of patients without a liver transplantation. Further studies are necessary to assess the prognostic accuracy of any new models. (Hepatobiliary Pancreat Dis Int 2010; 9: 122-128)
文摘AIM:To investigate the capability of a biochemical and clinical model,BioCliM,in predicting the survival of cirrhotic patients.METHODS:We prospectively evaluated the survival of 172 cirrhotic patients.The model was constructed using clinical(ascites,encephalopathy and variceal bleeding) and biochemical(serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model.It was applied to estimate 12-,52-and 104-wk survival.The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset.Finally,the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups(low risk≤8 and high risk>8).RESULTS:In the validation cohort,all measures of fi t,discrimination and calibration were improved when the biochemical and clinical model was used.The proposed model had better predictive values(c-statistic:0.90,0.91,0.91) than the Model for End-stage Liver Disease(MELD) and Child-Pugh(CP) scores for 12-,52-and 104-wk mortality,respectively.In addition,the Hosmer-Lemeshow(H-L) statistic revealed that the biochemical and clinical model(H-L,4.69) is better calibrated than MELD(H-L,17.06) and CP(H-L,14.23).There were no significant differences between the observed and expected survival curves in the stratified risk groups(low risk,P=0.61;high risk,P=0.77).CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.
基金supported by a grant from the Science and Technology Bureau of Liaoning Province,China(2007225011-1)
文摘BACKGROUND:Decreased cardiac contractility has been observed in cirrhosis,suggesting a latent cardiomyopathy in these patients.This study was designed to evaluate left ventricular structure and function in patients with end-stage liver disease by the model for end-stage liver disease(MELD) scoring system. METHODS:We recruited 82 patients(72 male,10 female; mean age 50.3±8.9 years)with end-stage liver disease who underwent orthotopic liver transplantation between January 2002 and May 2008.Seventy-eight patients had cirrhosis and 4 had primary liver cancer.Patients were categorized into three groups on the basis of MELD score:≤9(27 patients, 33%);10-19(40,49%);and≥20(15,18%).The relationship between MELD score and cardiac structure and function was determined.Preoperative assessments of blood biochemistry, blood coagulation,serum virology,echocardiography and electrocardiography were performed. RESULTS:MELD score was positively correlated with enlarged left atrial diameter,increased interventricular septum thickness(IVST),increased aortic flow,corrected QT interval (QTc)extension and cardiac output(P=0.033,0.002,0.000, 0.000 and 0.009,respectively).International normalized ratio also had a correlation with the above parameters and enlarged left ventricular end-diastolic diameter(P=0.043,0.010,0.000, 0.001,0.016 and 0.008,respectively).Serum creatinine was positively correlated with IVST(r=0.257,P=0.020),but negatively correlated with early maximal ventricular filling velocity/late diastolic or atrial velocity ratio(r=-0.300, P=0.006).A difference of QTc>440 ms among the three groups was statistically significant(χ2=9.791,P=0.007).CONCLUSIONS:Abnormalities in cardiac structure and function are common in patients with end-stage liver disease. MELD score is a practically useful approach for the assessment of cardiac function in such patients.
基金Beijing Municipal Science and Technology Commision,No.Z181100001718097.
文摘BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.
文摘AIM: To assess the impact of model for end-stage liver disease(MELD) score on patient survival and morbidity post living donor liver transplantation(LDLT). METHODS: A retrospective study was performed on 80 adult patients who had LDLT from 2011-2013. Nine patients were excluded and 71 patients were divided into two groups; Group 1 included 38 patients with a MELD score < 20, and Group 2 included 33 patients with a MELD score > 20. Comparison between both groups was done regarding operative time, intra-operative blood requirement, intensive care unit(ICU) and hospital stay, infection, and patient survival.RESULTS: Eleven patients died(15.5%); 3/38(7.9%)patients in Group 1 and 8/33(24.2%) in Group 2 with significant difference(P = 0.02). Mean operative time, duration of hospital stay, and ICU stay were similar in both groups. Mean volume of blood transfusion and cell saver re-transfusion were 8 ± 4 units and 1668 ± 202 m L, respectively, in Group 1 in comparison to 10 ± 6 units and 1910 ± 679 m L, respectively, in Group 2 with no significant difference(P = 0.09 and 0.167, respectively). The rates of infection and systemic complications(renal, respiratory, cardiovascular and neurological complications) were similar in both groups. CONCLUSION: A MELD score > 20 may predict mortality after LDLT.
基金Supported by SSFC（04BTJ002）,the National Natural Science Foundation of China（10371016） and the Post-Doctorial Grant in Southeast University.
文摘This paper presents an approach for estimating power of the score test, based on an asymptotic approximation to the power of the score test under contiguous alternatives. The method is applied to the problem of power calculations for the score test of heteroscedasticity in European rabbit data （Ratkowsky, 1983）. Simulation studies are presented which indicate that the asymptotic approximation to the finite-sample situation is good over a wide range of parameter configurations.
文摘AIM： To validate the statistic utility of both the Maddrey Discriminant Function score and the Model for End-Stage Liver Disease as predictors of short term （30 d and 90 d） mortality in patients with alcoholic hepatitis and to assess prognostic factors among clinical characteristics and laboratory variables of patients with alcoholic hepatitis. METHODS： Thirty-four patients with the diagnosis of alcoholic hepatitis admitted to Hippokration University Hospital of Athens from 2000 to 2005 were assessed in the current retrospective study and a statistical analysis was conducted. RESULTS： 30- and 90-d mortality rates were reported at 5.9% （2/34） and 14.7% （5/34）, respectively. Significant correlation was demonstrated for the Model for End- Stage Liver Disease （P30 = 0.094, P90 = 0.046） and the Maddrey Discriminant Function score （P30 = 0.033, P90 = 0.038） with 30- and 90-d mortality whereas a significant association was also established for alanine aminotrans- ferase （P = 0.057）, fibrin degradation products （P = 0.048） and C-reactive protein （P = 0.067） with 90-d mortality. For 30-d mortality the Area Under the Curve was 0.969 （95%CI： 0.902-1.036, P = 0.028） for the Model for End-Stage Liver Disease score and 0.984 （95%CI： 0.942-1.027, P = 0.023） for the Maddrey Discriminant Function score with the optimal cut off point of 30.5 （sensitivity 1, specificity 0.937） and 108.68 （sensitivity 1, specificity 0.969）, respectively. Accordingly, for 90-d mortality the Area Under the Curve was 0.762 （95%CI： 0.559-0.965, P = 0.065） for the Model for End-Stage Liver Disease score and 0.752 （95%CI： 0.465-1.038, P = 0.076） for the Maddrey Discriminant Function score with the optimal cut off point of 19 （sensitivity 0.6, specificity 0.6） and 92 （sensitivity 0.6, specificity 0.946）, respectively. The observed Kaplan Meier survival rates for different score-categories were compared with logrank tests and higher score values were correlated with a lower survival. CONCLUSION： Equivalency of the Model for End-Stage Liver Disease and the Maddrey Discriminant Function score is implied by the current study, verified by the plotted Receiver Operative Curves and the estimated survival rates. A statistically significant utility of C-reactive protein, fibrin degradation products and alanine aminotransferase as independent predictors of 90-d mortality has also been verified.
