BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
Objective:To evaluate the predictive value of secreted phosphoprotein 1(SPP1)gene expression for postoperative survival in patients with advanced liver cancer undergoing hepatic artery interventional chemoembolization...Objective:To evaluate the predictive value of secreted phosphoprotein 1(SPP1)gene expression for postoperative survival in patients with advanced liver cancer undergoing hepatic artery interventional chemoembolization treatment.Method:Bioinformatics methods,including gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis,were used to identify genes related to survival prognosis in hepatocellular carcinoma(HCC)patients.A retrospective analysis of 115 advanced liver cancer patients treated between January 2016 and October 2017 was conducted.Patients were categorized into SPP1 high-expression(n=89)and low-expression groups(n=26).Additionally,115 healthy individuals served as the control group.The relationship between SPP1 expression and clinical pathological features was analyzed.A 60-month follow-up and logistic regression analysis identified risk factors affecting survival.Results:SPP1 mRNA expression was significantly higher in liver cancer patients compared to healthy controls(P<0.05).SPP1 expression levels were significantly associated with tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging(P<0.05).High SPP1 expression,along with tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging,were independent risk factors for survival(P<0.05).The 60-month survival rate was 17.39%,with a median survival of 40 months in the low-expression group versus 18 months in the high-expression group(P<0.05).Conclusion:SPP1 expression is significantly upregulated in advanced liver cancer patients and has predictive value for postoperative survival following hepatic artery chemoembolization treatment.SPP1,combined with clinical indicators such as tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging,may serve as a prognostic biomarker for interventional treatment outcomes.展开更多
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed...BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.展开更多
Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. I...Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.展开更多
Objective and Background Early and accurate diagnosis of spinal infections,including spinal tuberculosis,is pivotal for effective treatment but remains challenging.This study aims to assess the diagnostic yield of met...Objective and Background Early and accurate diagnosis of spinal infections,including spinal tuberculosis,is pivotal for effective treatment but remains challenging.This study aims to assess the diagnostic yield of metagenomic next-generation sequencing(mNGS)compared with that of conventional microbiological tests(CMTs)in identifying pathogens associated with spinal pathologies,with a special focus on infections leading to surgical interventions.Methods We enrolled 85 patients who underwent spinal surgery,comprising 63 patients with clinically diagnosed spinal infections,including patients with spinal tuberculosis,and 22 patients with noninfectious spinal conditions.The procedures involved irrigation and debridement for persistent wound drainage,with subsequent DNA extraction from plasma and joint fluid for mNGS and CMT analysis.Results Significantly increased C-reactive protein(CRP)levels were observed in patients with infections.The mNGS approach showed greater diagnostic sensitivity(92.06%)for detecting pathogens,including Mycobacterium tuberculosis,than did CMTs(36.51%).Despite its low specificity,mNGS had considerable negative predictive value(70.59%),underscoring its utility in ruling out infections.Conclusions The mNGS offers superior sensitivity over CMTs in the diagnosis of a variety of spinal infections,notably spinal tuberculosis.This study highlights the potential of mNGS in enhancing the diagnosis of complex spinal infections,thereby informing targeted treatment strategies.展开更多
BACKGROUND The International Study Group of Pancreatic Surgery has established the defi-nition and grading system for postpancreatectomy acute pancreatitis(PPAP).There are no established machine learning models for pr...BACKGROUND The International Study Group of Pancreatic Surgery has established the defi-nition and grading system for postpancreatectomy acute pancreatitis(PPAP).There are no established machine learning models for predicting PPAP following pancreaticoduodenectomy(PD).AIM To explore the predictive model of PPAP,and test its predictive efficacy to guide the clinical work.METHODS Clinical data from consecutive patients who underwent PD between 2016 and 2024 were retrospectively collected.An analysis of PPAP risk factors was performed,various machine learning algorithms[logistic regression,random forest,gradient boosting decision tree,extreme gradient boosting,light gradient boosting machine,and category boosting(CatBoost)]were utilized to develop predictive models.Recursive feature elimination was employed to select several variables to achieve the optimal machine algorithm.RESULTS The study included 381 patients,of whom 88(23.09%)developed PPAP.PPAP patients exhibited a significantly higher incidence of postoperative pancreatic fistula(55.68%vs 14.68%,P<0.001),grade C postoperative pancreatic fistula(9.09%vs 1.37%,P=0.001).The CatBoost algorithm outperformed other algorithms with a mean area under the receiver operating characteristic curve of 0.859[95%confidence interval(CI):0.814-0.905]in the training cohort and 0.822(95%CI:0.717-0.927)in the testing cohort.According to shapley additive explanations analysis,pancreatic texture,main pancreatic duct diameter,body mass index,estimated blood loss,and surgery time were the most important variables based on recursive feature elimination.The CatBoost algorithm based on selected variables demonstrated superior performance,with an area under the receiver operating characteristic curve of 0.837(95%CI:0.788-0.886)in the training cohort and 0.812(95%CI:0.697-0.927)in the testing cohort.CONCLUSION We developed the first machine learning-based predictive model for PPAP following PD.This predictive model can assist surgeons in anticipating and managing this complication proactively.展开更多
BACKGROUND Colorectal cancer(CRC)ranks among the most prevalent malignancies in elderly populations,and chemotherapy resistance remains a critical clinical challenge.Emerging evidence highlights the interplay between ...BACKGROUND Colorectal cancer(CRC)ranks among the most prevalent malignancies in elderly populations,and chemotherapy resistance remains a critical clinical challenge.Emerging evidence highlights the interplay between chronic inflammation,gut microbiome dysbiosis,and CRC progression.Proinflammatory cytokines[e.g.,interleukin(IL)-6,tumor necrosis factor-alpha(TNF-α)]and mediators like S100 calcium-binding protein A12(S100A12)/soluble receptor for advanced glycation end products(sRAGE)are implicated in tumorigenesis,while gut microbial imbalances may exacerbate inflammatory microenvironments conducive to che-motherapy resistance.However,the triad relationship between S100A12/sRAGE,gut microbiota profiles,and chemotherapy efficacy in elderly patients with CRC remains unexplored,limiting biomarker-driven therapeutic strategies.AIM To analyze the correlation between serum levels of S100A12,sRAGE,gut microbiome dysbiosis,and systemic inflammation in elderly patients with CRC and to assess their predictive value for chemotherapy efficacy.METHODS A retrospective analysis was conducted on the clinical data of 120 elderly patients with advanced-stage CRC who visited our hospital from August 2023 to May 2024.These patients were enrolled in the study group.Additionally,120 healthy individuals undergoing routine health check-ups during the same period were selected as the control group.Serum S100A12,sRAGE,IL-6,and TNF-αlevels were measured by ELISA,and fresh stool samples were collected before chemotherapy to analyze gut microbiome composition in the study group.Follow-up observations were conducted after chemotherapy.Pearson correlation analysis was used to explore the relationship between serum S100A12,sRAGE levels,and gut microbiome dysbiosis in patients with CRC.The predictive diagnostic value of pre-chemotherapy serum S100A12 and sRAGE levels for chemotherapy efficacy was assessed using receiver operating characteristic curves.RESULTS Pre-chemotherapy serum S100A12,sRAGE,IL-6,and TNF-αlevels were significantly elevated in patients with CRC vs controls(all P<0.05).These biomarkers progressively increased with microbiota dysbiosis severity(severe vs mild dysbiosis:S100A12:340.26±52.39μg/L vs 302.53±56.97μg/L;sRAGE:525.64±37.32 ng/L vs 441.38±48.73 ng/L,P<0.05)and correlated strongly with IL-6(r=0.712)and TNF-α(r=0.698).Post-chemotherapy,biomarker levels decreased(P<0.05),coinciding with beneficial microbiota recovery(Bifidobacterium 176%,Lactobacillus 153%)and pathogenic taxa reduction(Escherichia coli 62%).The combined S100A12/sRAGE model predicted chemotherapy resistance with an area under the curve of 0.914(sensitivity=86.07%,specificity=88.89%),outper-forming individual biomarkers.CONCLUSION Elevated serum S100A12 and sRAGE in elderly patients with CRC reflected gut microbiome dysbiosis and systemic inflammation,driven by IL-6/TNF-αsignaling.Their post-chemotherapy decline parallels microbiota restoration,supporting a microbiome-inflammation-biomarker axis.The combined biomarker model offers robust clinical utility for chemotherapy efficacy prediction and personalized therapeutic strategies.展开更多
Background: The use of assisted reproductive technique (ART) is becoming more common in infertility. During ART most patients undergo ovarian stimulation. In this study we study the correlation between ovarian reserve...Background: The use of assisted reproductive technique (ART) is becoming more common in infertility. During ART most patients undergo ovarian stimulation. In this study we study the correlation between ovarian reserve markers: Anti-Mullerian hormone (AMH) and antral follicle count (AFC), and the response to ovarian stimulation at in vitro fertilization (IVF) centres in Douala Cameroon. Methods: This was a hospital based cross-sectional sectional analytic study carried out over a period of 3 years, 4 months at Clinique de l’Aéroport, Clinique Odyssée and Clinique Urogyn. Inclusion criteria were: Female partners of infertile couples undergoing ovarian stimulation for an in vitro fertilization cycle, patients who had both ovaries and had done either AMH, AFC or both before ovarian stimulation. Patients were divided into three groups based on the number of oocytes retrieved: low ovarian response for ≤3 oocytes, normal ovarian response for 4 - 15 oocytes and high ovarian response for >15 oocytes. Data obtained was analyzed by SPSS version 25.0. Results: The ages of participants ranged from 20 - 4 7 years, with a mean age of 34.11 ± 5.11 years. Most of them had secondary infertility (57.9%). The GnRH antagonist protocol was mainly used, and ovulation was triggered using HCG predominantly. On Multivariate analysis, age and history of PCOS were significantly associated with ovarian response in the low and high ovarian response groups, respectively. Conclusion: AMH has a better predictive value than AFC, however, it is less sensitive but more specific than AFC.展开更多
BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive m...BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonu...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.展开更多
Objective:To evaluate the value of real-time two-dimensional shear wave elastography(SWE)in predicting liver parenchymal stiffness in non-alcoholic fatty liver disease(NAFLD).Methods:A total of 200 NAFLD patients(70 i...Objective:To evaluate the value of real-time two-dimensional shear wave elastography(SWE)in predicting liver parenchymal stiffness in non-alcoholic fatty liver disease(NAFLD).Methods:A total of 200 NAFLD patients(70 in the mild group,70 in the moderate group,and 60 in the severe group)and 60 healthy individuals(control group)who visited the hospital from December 2023 to December 2024 underwent real-time two-dimensional SWE examinations.Results:Except for high-density lipoprotein,comparisons of body mass index and biochemical indicators showed that the severe group>moderate group>mild group>control group,with P<0.05.Comparisons of liver stiffness values also showed that the severe group>moderate group>mild group>control group,with P<0.05.Pearson correlation analysis revealed a positive correlation between liver stiffness values and body mass index,triglycerides,total cholesterol,low-density lipoprotein,fasting blood glucose,and glycosylated hemoglobin.Analysis of the ROC curve indicated that the AUC,standard deviation,and P-value for liver stiffness values were 0.901,0.025,and 0.01,respectively,suggesting that liver stiffness values can predict the severity of NAFLD.Conclusion:The real-time two-dimensional shear wave elastography(SWE)technique for diagnosing NAFLD can differentiate between NAFLD patients and healthy individuals,as well as determine liver parenchymal stiffness,thereby assisting physicians in quantifying the degree of fatty liver.展开更多
Due to global warming and diminishing ice cover in Arctic regions,the northern sea route(NSR)has attracted increasing attention in recent years.Extreme cold temperatures and high wind speeds in Arctic regions present ...Due to global warming and diminishing ice cover in Arctic regions,the northern sea route(NSR)has attracted increasing attention in recent years.Extreme cold temperatures and high wind speeds in Arctic regions present substantial risks to vessels operating along the NSR.Consequently,analyzing extreme temperature and wind speed values along the NSR is essential for ensuring maritime operational safety in the region.This study analyzes wind and temperature data spanning 40 years,from 1981 to 2020,at four representative sites along the NSR for extreme value analysis.The average conditional exceedance rate(ACER)method and the Gumbel method are employed to estimate extreme wind speed and air temperature at these sites.Comparative analysis reveals that the ACER method provides higher accuracy and lower uncertainty in estimations.The predicted extreme wind speed for a 100-year return period is 30.36 m/s,with a minimum temperature of-56.66°C,varying across the four sites.Furthermore,the study presents extreme values corresponding to each return period,providing temperature extremes as a basis for guiding steel thickness specifications.These findings provide valuable reference for designing polar vessels and offshore structures,contributing to enhanced engineering standards for Arctic conditions.展开更多
AIM:To analyze the performance value of high risk factors in population-based colorectal cancer(CRC) screening in China.METHODS:We compared the performance value of the immunochemical fecal occult blood test(iFOBT) an...AIM:To analyze the performance value of high risk factors in population-based colorectal cancer(CRC) screening in China.METHODS:We compared the performance value of the immunochemical fecal occult blood test(iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation.Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy.RESULTS:The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia.The iFOBT had the highest sensitivity,lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas.A history of chronic cholecystitis or cholecystectomy,chronic appendicitis or appendectomy,and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas.The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for nonadenomatous polyps.A history of chronic appendicitis or appendectomy,chronic constipation,chronic diarrhea,mucous and bloody stool,CRC in first degree relatives,malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps.Except for a history of malignant tumor in screening for non-adenomatous polyps,the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality.CONCLUSION:The iFOBT may be the best marker for screening for advanced neoplasias and adenomas.Some unique high risk factors may play an important role in CRC screening in China.展开更多
BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a r...BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a routine diagnostic procedure.The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.METHODS:In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008,baseline data and perioperative information of 2060 patients (male to female ratio 542:1518,mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed.The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.RESULTS:Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%,respectively.Both early mortality and morbidity due to cholecystectomy were higher in male than female.The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female,P=0.008).Among those without gallstones,8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones.The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were:advanced age (OR=1.022,P=0.001),male gender (OR=1.498,P=0.050),history of abdominal surgery (OR=1.543,P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400,P<0.001).CONCLUSIONS:IOC is a safe and accurate method for the assessment of bile duct anatomy and stones.Therefore,the routine use of IOC within cholecystectomy seems reasonable and is recommended.展开更多
Aim: To determine the predictive value of the hypo-osmotic swelling (HOS) test to identify viable, non-motile sperm. Methods: Semen samples from 20 men with severe asthenozoospermia underwent traditional seminal analy...Aim: To determine the predictive value of the hypo-osmotic swelling (HOS) test to identify viable, non-motile sperm. Methods: Semen samples from 20 men with severe asthenozoospermia underwent traditional seminal analysis, eosin-nigrosin (EN) staining and the HOS test. A further EN stain was then performed on a HOS pre-treated aliquot and a total of 2000 further sperm examined. Results: The median sperm density was 5.1 million/mL (IQR 4.3-13.1) and the median motility was 3.0 % (IQR 0-7). Seven samples showed complete asthenozoospermia. Initial EN staining showed 59 % viability (range 48-69) despite the poor standard parameters and 47 % (range 33-61) in the complete asthenozoospermia subgroup. The HOS test showed 49.9 % reacted overall (range 40-59) and 41.7 % (range 22-61) in the complete asthenozoospermia subgroup. The combined HOS/EN stain showed the positive predictive value of the HOS test to identify viable sperm was 84.2 % overall and 79.7 % in the complete asthenozoospermia subgroup. Conclusion: The HOS test can effectively predict sperm viability in patients with severe and complete asthenozoospermia.展开更多
As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this r...As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.展开更多
Objective： To determine the predictive ability of biomarkers for responses to neoadjuvant endocrine therapy （NET） in postmenopausal breast cancer. Methods： Consecutive 160 postmenopausal women with T 1-3 N 0-1 M 0...Objective： To determine the predictive ability of biomarkers for responses to neoadjuvant endocrine therapy （NET） in postmenopausal breast cancer. Methods： Consecutive 160 postmenopausal women with T 1-3 N 0-1 M 0 hormone receptor （HR）-positive invasive breast cancer were treated with anastrozole for 16 weeks before surgery. New slides of tumor specimens taken before and after treatment were conducted centrally for biomarker analysis and classified using the Applied Imaging Ariol MB-8 system. The pathological response was evaluated using the Miller ＆ Payne classification. The cell cycle response was classified according to the change in the Ki67 index after treatment. Multivariable logistic regression analysis was used to calculate the combined index of the biomarkers. Receiver operating characteristic （ROC） curves were used to determine whether parameters may predict response. Results： The correlation between the pathological and cell cycle responses was low （Spearman correlation coefficient =0.241, P〈0.001; Kappa value =0.119, P=0.032）. The cell cycle response was significantly associated with pre-treatment estrogen receptor （ER） status （P=0.001）, progesterone receptor （PgR） status （P〈0.001）, human epidermal growth factor receptor 2 （Her-2） status （P=0.050） and the Ki67 index （P〈0.001）, but the pathological response was not correlated with these factors. Pre-treatment ER levels [area under the curve （AUC） =0.634, 95% confidence interval （95% CI）, 0.534-0.735, P=0.008] and combined index of pre-treatment ER and PgR levels （AUC =0.684, 95% CI, 0.591-0.776, P〈0.001） could not predict the cell cycle response, but combined index including per-treatment ER/PR/Her-2/Ki67 expression levels could （AUC =0.830, 95% CI, 0.759-0.902, P〈0.001）. Conclusions： The combined use of pre-treatment ER/PgR/Her-2/Ki67 expression levels, instead of HR expression levels, may predict the cell cycle response to NET.展开更多
This study aimed to compare the predictive value of six selected anthropometric indicators for benign prostatic hyperplasia(BPH).Males over 50 years of age who underwent health examinations at the Health Management Ce...This study aimed to compare the predictive value of six selected anthropometric indicators for benign prostatic hyperplasia(BPH).Males over 50 years of age who underwent health examinations at the Health Management Center of the Second Xiangya Hospital,Central South University(Changsha,China)from June to December 2020 were enrolled in this study.The characteristic data were collected,including basic anthropometric indices,lipid parameters,six anthropometric indicators,prostate-specific antigen,and total prostate volume.The odds ratios(ORs)with 95%confidence intervals(95%CIs)for all anthropometric parameters and BPH were calculated using binary logistic regression.To assess the diagnostic capability of each indicator for BPH and identify the appropriate cutoff values,receiver operating characteristic(ROC)curves and the related areas under the curves(AUCs)were utilized.All six indicators had diagnostic value for BPH(all P≤0.001).The visceral adiposity index(VAI;AUC:0.797,95%CI:0.759–0.834)had the highest AUC and therefore the highest diagnostic value.This was followed by the cardiometabolic index(CMI;AUC:0.792,95%CI:0.753–0.831),lipid accumulation product(LAP;AUC:0.766,95%CI:0.723–0.809),waist-to-hip ratio(WHR;AUC:0.660,95%CI:0.609–0.712),waist-to-height ratio(WHtR;AUC:0.639,95%CI:0.587–0.691),and body mass index(BMI;AUC:0.592,95%CI:0.540–0.643).The sensitivity of CMI was the highest(92.1%),and WHtR had the highest specificity of 94.1%.CMI consistently showed the highest OR in the binary logistic regression analysis.BMI,WHtR,WHR,VAI,CMI,and LAP all influence the occurrence of BPH in middle-aged and older men(all P≤0.001),and CMI is the best predictor of BPH.展开更多
BACKGROUND Preoperative therapy is widely used in locally advanced rectal cancer.It can improve local control of rectal cancer.However,there are few indicators that can predict the effect of preoperative chemotherapy ...BACKGROUND Preoperative therapy is widely used in locally advanced rectal cancer.It can improve local control of rectal cancer.However,there are few indicators that can predict the effect of preoperative chemotherapy accurately.AIM To investigate whether the increase in serumα-fetoprotein(AFP)can predict better efficacy of preoperative chemotherapy.METHODS This was a retrospective study.We analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer.All patients received six cycles of preoperative chemotherapy(mFOLFOX6 every 2 wk).Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy,and fell to normal again within 2 mo.The other 99 patients had a normal level of serum AFP during chemotherapy.Patients were divided into two groups(AFP risen and AFP normal).According to postoperative pathology,we compared tumor regression and complete response rate between the two groups.The primary outcome measure was the tumor regression grade(TRG)after chemotherapy.The difference in pathological complete response between the two groups was also investigated.RESULTS There were no tumor progression and distant metastasis in both groups during preoperative chemotherapy.Patients in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group(61.5%vs 39.4%).The increase in AFP was a significant predictor for better tumor regression[χ2=4.144,odds ratio(OR)=2.666,P=0.04].In the AFP risen group,the complete response rate was 30.8%,which was higher than in the AFP normal group(30.8%vs 12.1%,χ2=4.542,OR=3.251,P=0.03).CONCLUSION Patients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy,and are more likely to achieve pathological complete response.展开更多
BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been a...BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.展开更多
文摘BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
基金Medical Research Project of Xi’an Science and Technology Bureau“Molecular Mechanism of miR-1305 Competitive Endogenous circRNA in the Development of Liver Cancer”(Project No.22YXYJ0134)General Project of Key Research and Development Program of Shaanxi Provincial Department of Science and Technology“Mechanism Study on the Inhibition of Liver Cancer Invasion and Metastasis by Downregulating METTL3 and Reducing the m6A Modification Level of MMP3 with Honokiol”(Project No.2023-YBSF-631)。
文摘Objective:To evaluate the predictive value of secreted phosphoprotein 1(SPP1)gene expression for postoperative survival in patients with advanced liver cancer undergoing hepatic artery interventional chemoembolization treatment.Method:Bioinformatics methods,including gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analysis,were used to identify genes related to survival prognosis in hepatocellular carcinoma(HCC)patients.A retrospective analysis of 115 advanced liver cancer patients treated between January 2016 and October 2017 was conducted.Patients were categorized into SPP1 high-expression(n=89)and low-expression groups(n=26).Additionally,115 healthy individuals served as the control group.The relationship between SPP1 expression and clinical pathological features was analyzed.A 60-month follow-up and logistic regression analysis identified risk factors affecting survival.Results:SPP1 mRNA expression was significantly higher in liver cancer patients compared to healthy controls(P<0.05).SPP1 expression levels were significantly associated with tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging(P<0.05).High SPP1 expression,along with tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging,were independent risk factors for survival(P<0.05).The 60-month survival rate was 17.39%,with a median survival of 40 months in the low-expression group versus 18 months in the high-expression group(P<0.05).Conclusion:SPP1 expression is significantly upregulated in advanced liver cancer patients and has predictive value for postoperative survival following hepatic artery chemoembolization treatment.SPP1,combined with clinical indicators such as tumor size,Child-Pugh grading,lymph node metastasis,and BCLC staging,may serve as a prognostic biomarker for interventional treatment outcomes.
文摘BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.
文摘Background Acute myocarditis is a disease characterized by inflammation of the heart muscle, usually caused by viral infection, autoimmune reactions, or toxins, resulting in damage and dysfunction of cardiomyocytes. In recent years, the incidence of acute myocarditis has gradually increased, especially in young people and athletes, which can cause serious cardiac complications and even lead to heart failure, cardiac arrest or major adverse cardiovascular events(MACEs). Methods A total of 90 patients with acute myocarditis(acute myocarditis group) and 30 healthy subjects(control group) admitted to our hospital from November 2021 to November 2023 were selected. Cardiac magnetic resonance(CMR) T1 and T2 mapping sequence scanning and cardiac function parameter measurement was performed on all subjects. The acute myocarditis group was followed up for 12 months and divided into the MACEs group and the non-MACEs group according to whether MACEs occurred. The differences in CMR parameters were analyzed, and receiver operating characteristic(ROC) curve was applied to analyze the predictive value of cardiac CMR T1 and T2 techniques for the occurrence of MACEs in patients with acute myocarditis. Results Compared with the control group, the level of left ventricular ejection fraction(LVEF) in the acute myocarditis group was significantly decreased, while left ventricular end-diastole volume(LVEDV), left ventricular endsystolic volume(LVESV), lactate dehydrogenase(LDH) and creatine kinase MB isoenzyme(CK-MB) increased significantly(P<0.05);T1 and T2 values, late gadolinium enhancement(LGE) percentage of left ventricle, left ventricular entropy and extracellular volume(ECV) in acute myocarditis group were significantly higher than those in the control group(P<0.05). Pearson correlation analysis showed that T1 and T2 values were negatively correlated with LVEF, while T1 and T2 values were positively correlated with LVESV, CK-MB, left ventricular entropy and ECV in patients with acute myocarditis(P<0.05). Among patients with acute myocarditis, the values of T1 and T2, left ventricular entropy and ECV in MACEs group were higher than those in non-MACEs group(P<0.05). Further multivariate analysis also showed that T1 and T2 values had independent predictive capacity for MACEs in patients with acute myocarditis(P<0.05). The maximum area under ROC curve was 0.894 and 0.912, and the sensitivity was 89.35% and 90.40% in patients with acute myocarditis predicted by T1 and T2 mapping. The specificity was 80.34% and 84.25%. Conclusions CMR T1 and T2 mapping techniques can effectively evaluate the cardiac function status of patients with acute myocarditis, and provide an important reference for the prognosis assessment of acute myocarditis.
基金supported by the Hubei Provincial Natural Science Foundation of China(No.2023AFB646)Knowledge Innovation Program of Wuhan(No.2023020201010155)Educational Research Program of Huazhong University of Science and Technology(No.2022135).
文摘Objective and Background Early and accurate diagnosis of spinal infections,including spinal tuberculosis,is pivotal for effective treatment but remains challenging.This study aims to assess the diagnostic yield of metagenomic next-generation sequencing(mNGS)compared with that of conventional microbiological tests(CMTs)in identifying pathogens associated with spinal pathologies,with a special focus on infections leading to surgical interventions.Methods We enrolled 85 patients who underwent spinal surgery,comprising 63 patients with clinically diagnosed spinal infections,including patients with spinal tuberculosis,and 22 patients with noninfectious spinal conditions.The procedures involved irrigation and debridement for persistent wound drainage,with subsequent DNA extraction from plasma and joint fluid for mNGS and CMT analysis.Results Significantly increased C-reactive protein(CRP)levels were observed in patients with infections.The mNGS approach showed greater diagnostic sensitivity(92.06%)for detecting pathogens,including Mycobacterium tuberculosis,than did CMTs(36.51%).Despite its low specificity,mNGS had considerable negative predictive value(70.59%),underscoring its utility in ruling out infections.Conclusions The mNGS offers superior sensitivity over CMTs in the diagnosis of a variety of spinal infections,notably spinal tuberculosis.This study highlights the potential of mNGS in enhancing the diagnosis of complex spinal infections,thereby informing targeted treatment strategies.
文摘BACKGROUND The International Study Group of Pancreatic Surgery has established the defi-nition and grading system for postpancreatectomy acute pancreatitis(PPAP).There are no established machine learning models for predicting PPAP following pancreaticoduodenectomy(PD).AIM To explore the predictive model of PPAP,and test its predictive efficacy to guide the clinical work.METHODS Clinical data from consecutive patients who underwent PD between 2016 and 2024 were retrospectively collected.An analysis of PPAP risk factors was performed,various machine learning algorithms[logistic regression,random forest,gradient boosting decision tree,extreme gradient boosting,light gradient boosting machine,and category boosting(CatBoost)]were utilized to develop predictive models.Recursive feature elimination was employed to select several variables to achieve the optimal machine algorithm.RESULTS The study included 381 patients,of whom 88(23.09%)developed PPAP.PPAP patients exhibited a significantly higher incidence of postoperative pancreatic fistula(55.68%vs 14.68%,P<0.001),grade C postoperative pancreatic fistula(9.09%vs 1.37%,P=0.001).The CatBoost algorithm outperformed other algorithms with a mean area under the receiver operating characteristic curve of 0.859[95%confidence interval(CI):0.814-0.905]in the training cohort and 0.822(95%CI:0.717-0.927)in the testing cohort.According to shapley additive explanations analysis,pancreatic texture,main pancreatic duct diameter,body mass index,estimated blood loss,and surgery time were the most important variables based on recursive feature elimination.The CatBoost algorithm based on selected variables demonstrated superior performance,with an area under the receiver operating characteristic curve of 0.837(95%CI:0.788-0.886)in the training cohort and 0.812(95%CI:0.697-0.927)in the testing cohort.CONCLUSION We developed the first machine learning-based predictive model for PPAP following PD.This predictive model can assist surgeons in anticipating and managing this complication proactively.
文摘BACKGROUND Colorectal cancer(CRC)ranks among the most prevalent malignancies in elderly populations,and chemotherapy resistance remains a critical clinical challenge.Emerging evidence highlights the interplay between chronic inflammation,gut microbiome dysbiosis,and CRC progression.Proinflammatory cytokines[e.g.,interleukin(IL)-6,tumor necrosis factor-alpha(TNF-α)]and mediators like S100 calcium-binding protein A12(S100A12)/soluble receptor for advanced glycation end products(sRAGE)are implicated in tumorigenesis,while gut microbial imbalances may exacerbate inflammatory microenvironments conducive to che-motherapy resistance.However,the triad relationship between S100A12/sRAGE,gut microbiota profiles,and chemotherapy efficacy in elderly patients with CRC remains unexplored,limiting biomarker-driven therapeutic strategies.AIM To analyze the correlation between serum levels of S100A12,sRAGE,gut microbiome dysbiosis,and systemic inflammation in elderly patients with CRC and to assess their predictive value for chemotherapy efficacy.METHODS A retrospective analysis was conducted on the clinical data of 120 elderly patients with advanced-stage CRC who visited our hospital from August 2023 to May 2024.These patients were enrolled in the study group.Additionally,120 healthy individuals undergoing routine health check-ups during the same period were selected as the control group.Serum S100A12,sRAGE,IL-6,and TNF-αlevels were measured by ELISA,and fresh stool samples were collected before chemotherapy to analyze gut microbiome composition in the study group.Follow-up observations were conducted after chemotherapy.Pearson correlation analysis was used to explore the relationship between serum S100A12,sRAGE levels,and gut microbiome dysbiosis in patients with CRC.The predictive diagnostic value of pre-chemotherapy serum S100A12 and sRAGE levels for chemotherapy efficacy was assessed using receiver operating characteristic curves.RESULTS Pre-chemotherapy serum S100A12,sRAGE,IL-6,and TNF-αlevels were significantly elevated in patients with CRC vs controls(all P<0.05).These biomarkers progressively increased with microbiota dysbiosis severity(severe vs mild dysbiosis:S100A12:340.26±52.39μg/L vs 302.53±56.97μg/L;sRAGE:525.64±37.32 ng/L vs 441.38±48.73 ng/L,P<0.05)and correlated strongly with IL-6(r=0.712)and TNF-α(r=0.698).Post-chemotherapy,biomarker levels decreased(P<0.05),coinciding with beneficial microbiota recovery(Bifidobacterium 176%,Lactobacillus 153%)and pathogenic taxa reduction(Escherichia coli 62%).The combined S100A12/sRAGE model predicted chemotherapy resistance with an area under the curve of 0.914(sensitivity=86.07%,specificity=88.89%),outper-forming individual biomarkers.CONCLUSION Elevated serum S100A12 and sRAGE in elderly patients with CRC reflected gut microbiome dysbiosis and systemic inflammation,driven by IL-6/TNF-αsignaling.Their post-chemotherapy decline parallels microbiota restoration,supporting a microbiome-inflammation-biomarker axis.The combined biomarker model offers robust clinical utility for chemotherapy efficacy prediction and personalized therapeutic strategies.
文摘Background: The use of assisted reproductive technique (ART) is becoming more common in infertility. During ART most patients undergo ovarian stimulation. In this study we study the correlation between ovarian reserve markers: Anti-Mullerian hormone (AMH) and antral follicle count (AFC), and the response to ovarian stimulation at in vitro fertilization (IVF) centres in Douala Cameroon. Methods: This was a hospital based cross-sectional sectional analytic study carried out over a period of 3 years, 4 months at Clinique de l’Aéroport, Clinique Odyssée and Clinique Urogyn. Inclusion criteria were: Female partners of infertile couples undergoing ovarian stimulation for an in vitro fertilization cycle, patients who had both ovaries and had done either AMH, AFC or both before ovarian stimulation. Patients were divided into three groups based on the number of oocytes retrieved: low ovarian response for ≤3 oocytes, normal ovarian response for 4 - 15 oocytes and high ovarian response for >15 oocytes. Data obtained was analyzed by SPSS version 25.0. Results: The ages of participants ranged from 20 - 4 7 years, with a mean age of 34.11 ± 5.11 years. Most of them had secondary infertility (57.9%). The GnRH antagonist protocol was mainly used, and ovulation was triggered using HCG predominantly. On Multivariate analysis, age and history of PCOS were significantly associated with ovarian response in the low and high ovarian response groups, respectively. Conclusion: AMH has a better predictive value than AFC, however, it is less sensitive but more specific than AFC.
文摘BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.
文摘Objective:To evaluate the value of real-time two-dimensional shear wave elastography(SWE)in predicting liver parenchymal stiffness in non-alcoholic fatty liver disease(NAFLD).Methods:A total of 200 NAFLD patients(70 in the mild group,70 in the moderate group,and 60 in the severe group)and 60 healthy individuals(control group)who visited the hospital from December 2023 to December 2024 underwent real-time two-dimensional SWE examinations.Results:Except for high-density lipoprotein,comparisons of body mass index and biochemical indicators showed that the severe group>moderate group>mild group>control group,with P<0.05.Comparisons of liver stiffness values also showed that the severe group>moderate group>mild group>control group,with P<0.05.Pearson correlation analysis revealed a positive correlation between liver stiffness values and body mass index,triglycerides,total cholesterol,low-density lipoprotein,fasting blood glucose,and glycosylated hemoglobin.Analysis of the ROC curve indicated that the AUC,standard deviation,and P-value for liver stiffness values were 0.901,0.025,and 0.01,respectively,suggesting that liver stiffness values can predict the severity of NAFLD.Conclusion:The real-time two-dimensional shear wave elastography(SWE)technique for diagnosing NAFLD can differentiate between NAFLD patients and healthy individuals,as well as determine liver parenchymal stiffness,thereby assisting physicians in quantifying the degree of fatty liver.
基金supported by the National Natural Science Foundation of China(Grant No.52201379)the Fundamental Research Funds for the Central Universities(Grant No.WUT:3120622898)+2 种基金State Key Laboratory of Structural Analysis,Optimization and CAE Software for Industrial Equipment,Dalian University of Technology(Grant No.GZ 231088)Shanghai Key Laboratory of Naval Architecture Engineering(Grant No.SE202305)funded by European Research Council project under the European Union’s Horizon 2020 research and innovation program(Grant No.TRUST CoG 2019864724).
文摘Due to global warming and diminishing ice cover in Arctic regions,the northern sea route(NSR)has attracted increasing attention in recent years.Extreme cold temperatures and high wind speeds in Arctic regions present substantial risks to vessels operating along the NSR.Consequently,analyzing extreme temperature and wind speed values along the NSR is essential for ensuring maritime operational safety in the region.This study analyzes wind and temperature data spanning 40 years,from 1981 to 2020,at four representative sites along the NSR for extreme value analysis.The average conditional exceedance rate(ACER)method and the Gumbel method are employed to estimate extreme wind speed and air temperature at these sites.Comparative analysis reveals that the ACER method provides higher accuracy and lower uncertainty in estimations.The predicted extreme wind speed for a 100-year return period is 30.36 m/s,with a minimum temperature of-56.66°C,varying across the four sites.Furthermore,the study presents extreme values corresponding to each return period,providing temperature extremes as a basis for guiding steel thickness specifications.These findings provide valuable reference for designing polar vessels and offshore structures,contributing to enhanced engineering standards for Arctic conditions.
基金Supported by 11th 5-Year Key Programs for Science and Technology Development of China,No.2006BAI02A08
文摘AIM:To analyze the performance value of high risk factors in population-based colorectal cancer(CRC) screening in China.METHODS:We compared the performance value of the immunochemical fecal occult blood test(iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation.Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy.RESULTS:The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia.The iFOBT had the highest sensitivity,lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas.A history of chronic cholecystitis or cholecystectomy,chronic appendicitis or appendectomy,and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas.The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for nonadenomatous polyps.A history of chronic appendicitis or appendectomy,chronic constipation,chronic diarrhea,mucous and bloody stool,CRC in first degree relatives,malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps.Except for a history of malignant tumor in screening for non-adenomatous polyps,the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality.CONCLUSION:The iFOBT may be the best marker for screening for advanced neoplasias and adenomas.Some unique high risk factors may play an important role in CRC screening in China.
文摘BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a routine diagnostic procedure.The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.METHODS:In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008,baseline data and perioperative information of 2060 patients (male to female ratio 542:1518,mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed.The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.RESULTS:Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%,respectively.Both early mortality and morbidity due to cholecystectomy were higher in male than female.The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female,P=0.008).Among those without gallstones,8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones.The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were:advanced age (OR=1.022,P=0.001),male gender (OR=1.498,P=0.050),history of abdominal surgery (OR=1.543,P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400,P<0.001).CONCLUSIONS:IOC is a safe and accurate method for the assessment of bile duct anatomy and stones.Therefore,the routine use of IOC within cholecystectomy seems reasonable and is recommended.
文摘Aim: To determine the predictive value of the hypo-osmotic swelling (HOS) test to identify viable, non-motile sperm. Methods: Semen samples from 20 men with severe asthenozoospermia underwent traditional seminal analysis, eosin-nigrosin (EN) staining and the HOS test. A further EN stain was then performed on a HOS pre-treated aliquot and a total of 2000 further sperm examined. Results: The median sperm density was 5.1 million/mL (IQR 4.3-13.1) and the median motility was 3.0 % (IQR 0-7). Seven samples showed complete asthenozoospermia. Initial EN staining showed 59 % viability (range 48-69) despite the poor standard parameters and 47 % (range 33-61) in the complete asthenozoospermia subgroup. The HOS test showed 49.9 % reacted overall (range 40-59) and 41.7 % (range 22-61) in the complete asthenozoospermia subgroup. The combined HOS/EN stain showed the positive predictive value of the HOS test to identify viable sperm was 84.2 % overall and 79.7 % in the complete asthenozoospermia subgroup. Conclusion: The HOS test can effectively predict sperm viability in patients with severe and complete asthenozoospermia.
文摘As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.
文摘Objective： To determine the predictive ability of biomarkers for responses to neoadjuvant endocrine therapy （NET） in postmenopausal breast cancer. Methods： Consecutive 160 postmenopausal women with T 1-3 N 0-1 M 0 hormone receptor （HR）-positive invasive breast cancer were treated with anastrozole for 16 weeks before surgery. New slides of tumor specimens taken before and after treatment were conducted centrally for biomarker analysis and classified using the Applied Imaging Ariol MB-8 system. The pathological response was evaluated using the Miller ＆ Payne classification. The cell cycle response was classified according to the change in the Ki67 index after treatment. Multivariable logistic regression analysis was used to calculate the combined index of the biomarkers. Receiver operating characteristic （ROC） curves were used to determine whether parameters may predict response. Results： The correlation between the pathological and cell cycle responses was low （Spearman correlation coefficient =0.241, P〈0.001; Kappa value =0.119, P=0.032）. The cell cycle response was significantly associated with pre-treatment estrogen receptor （ER） status （P=0.001）, progesterone receptor （PgR） status （P〈0.001）, human epidermal growth factor receptor 2 （Her-2） status （P=0.050） and the Ki67 index （P〈0.001）, but the pathological response was not correlated with these factors. Pre-treatment ER levels [area under the curve （AUC） =0.634, 95% confidence interval （95% CI）, 0.534-0.735, P=0.008] and combined index of pre-treatment ER and PgR levels （AUC =0.684, 95% CI, 0.591-0.776, P〈0.001） could not predict the cell cycle response, but combined index including per-treatment ER/PR/Her-2/Ki67 expression levels could （AUC =0.830, 95% CI, 0.759-0.902, P〈0.001）. Conclusions： The combined use of pre-treatment ER/PgR/Her-2/Ki67 expression levels, instead of HR expression levels, may predict the cell cycle response to NET.
文摘This study aimed to compare the predictive value of six selected anthropometric indicators for benign prostatic hyperplasia(BPH).Males over 50 years of age who underwent health examinations at the Health Management Center of the Second Xiangya Hospital,Central South University(Changsha,China)from June to December 2020 were enrolled in this study.The characteristic data were collected,including basic anthropometric indices,lipid parameters,six anthropometric indicators,prostate-specific antigen,and total prostate volume.The odds ratios(ORs)with 95%confidence intervals(95%CIs)for all anthropometric parameters and BPH were calculated using binary logistic regression.To assess the diagnostic capability of each indicator for BPH and identify the appropriate cutoff values,receiver operating characteristic(ROC)curves and the related areas under the curves(AUCs)were utilized.All six indicators had diagnostic value for BPH(all P≤0.001).The visceral adiposity index(VAI;AUC:0.797,95%CI:0.759–0.834)had the highest AUC and therefore the highest diagnostic value.This was followed by the cardiometabolic index(CMI;AUC:0.792,95%CI:0.753–0.831),lipid accumulation product(LAP;AUC:0.766,95%CI:0.723–0.809),waist-to-hip ratio(WHR;AUC:0.660,95%CI:0.609–0.712),waist-to-height ratio(WHtR;AUC:0.639,95%CI:0.587–0.691),and body mass index(BMI;AUC:0.592,95%CI:0.540–0.643).The sensitivity of CMI was the highest(92.1%),and WHtR had the highest specificity of 94.1%.CMI consistently showed the highest OR in the binary logistic regression analysis.BMI,WHtR,WHR,VAI,CMI,and LAP all influence the occurrence of BPH in middle-aged and older men(all P≤0.001),and CMI is the best predictor of BPH.
基金the China-Japan Friendship Hospital Institutional Review Board,No.2021-117-K75.Youth Foundation of China–Japan Friendship Hospital,No.2019-1-QN-42。
文摘BACKGROUND Preoperative therapy is widely used in locally advanced rectal cancer.It can improve local control of rectal cancer.However,there are few indicators that can predict the effect of preoperative chemotherapy accurately.AIM To investigate whether the increase in serumα-fetoprotein(AFP)can predict better efficacy of preoperative chemotherapy.METHODS This was a retrospective study.We analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer.All patients received six cycles of preoperative chemotherapy(mFOLFOX6 every 2 wk).Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy,and fell to normal again within 2 mo.The other 99 patients had a normal level of serum AFP during chemotherapy.Patients were divided into two groups(AFP risen and AFP normal).According to postoperative pathology,we compared tumor regression and complete response rate between the two groups.The primary outcome measure was the tumor regression grade(TRG)after chemotherapy.The difference in pathological complete response between the two groups was also investigated.RESULTS There were no tumor progression and distant metastasis in both groups during preoperative chemotherapy.Patients in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group(61.5%vs 39.4%).The increase in AFP was a significant predictor for better tumor regression[χ2=4.144,odds ratio(OR)=2.666,P=0.04].In the AFP risen group,the complete response rate was 30.8%,which was higher than in the AFP normal group(30.8%vs 12.1%,χ2=4.542,OR=3.251,P=0.03).CONCLUSION Patients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy,and are more likely to achieve pathological complete response.
基金Supported by the Key Research and Development Program of Shaanxi Province,No.2017ZDXMSF-046.
文摘BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.
