BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an...BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.展开更多
Microvascular invasion(MVI)is a critical factor in hepatocellular carcinoma(HCC)prognosis,particularly in hepatitis B virus(HBV)-related cases.This editorial examines a recent study by Xu et al who developed models to...Microvascular invasion(MVI)is a critical factor in hepatocellular carcinoma(HCC)prognosis,particularly in hepatitis B virus(HBV)-related cases.This editorial examines a recent study by Xu et al who developed models to predict MVI and high-risk(M2)status in HBV-related HCC using contrast-enhanced computed tomography(CECT)radiomics and clinicoradiological factors.The study analyzed 270 patients,creating models that achieved an area under the curve values of 0.841 and 0.768 for MVI prediction,and 0.865 and 0.798 for M2 status prediction in training and validation datasets,respectively.These results are comparable to previous radiomics-based approaches,which reinforces the potential of this method in MVI prediction.The strengths of the study include its focus on HBV-related HCC and the use of widely accessible CECT imaging.However,limitations,such as retrospective design and manual segmentation,highlight areas for improvement.The editorial discusses the implications of the study including the need for standardized radiomics approaches and the potential impact on personalized treatment strategies.It also suggests future research directions,such as exploring mechanistic links between radiomics features and MVI,as well as integrating additional biomarkers or imaging modalities.Overall,this study contributes significantly to HCC management,paving the way for more accurate,personalized treatment approaches in the era of precision oncology.展开更多
Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated ev...Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.展开更多
BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumo...BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.展开更多
BACKGROUND Gastric cancer(GC)remains a substantial global health burden,and its early detection and treatment is critical for optimizing patient outcomes.Endoscopic submucosal dissection(ESD)is a minimally invasive te...BACKGROUND Gastric cancer(GC)remains a substantial global health burden,and its early detection and treatment is critical for optimizing patient outcomes.Endoscopic submucosal dissection(ESD)is a minimally invasive technique for early GC but is linked to an increased risk of complications,such as delayed hemorrhage,which underscore the need for a comprehensive investigation into the disease’s risk factors.AIM To perform a comprehensive review and meta-analysis of the literature to identify and quantify risk factors associated with late-onset bleeding subsequent to ESD for early GC.METHODS Studies reporting risk factors for delayed bleeding after ESD for early GC were identified through a comprehensive search of electronic databases(PubMed,Embase,and Cochrane Library).The selection of studies,data retrieval,and quality evaluation were carried out separately by two reviewers.The combined odds ratios(OR)along with their 95%confidence intervals(CI)were calculated utilizing a random-effects approach.The meta-analysis has been registered on the International Registry of Systematic Review and Meta-analysis Protocols(INPLASY202540116).RESULTS A total of 11 publications comprising 1945 patients were incorporated into the present analysis.The following risk factors were found to be significantly associated with an increased risk of delayed bleeding after ESD:Long operation time(OR=2.55,95%CI:2.40–2.72,I^(2)=11%,n=5 studies),lesions detected in the upper part of the stomach(OR=3.44,95%CI:3.19-3.70,I^(2)=0%,n=4 studies),advanced age(OR=3.61,95%CI:3.47-3.76,I^(2)=38%,n=5 studies),history of taking antithrombotic drugs(OR=2.58,95%CI:2.48-2.68,I^(2)=45%,n=3 studies),resection size>40 mm(OR=3.01,95%CI:2.78-3.26,I^(2)=31%,n=5 studies),hemodialysis(OR=2.42,95%CI:2.33-2.51,I²=0%,n=4 studies),presence of ulcers(OR=2.54,95%CI:2.33-2.77,I^(2)=0%,n=3 studies).CONCLUSION This meta-analysis identified several risk factors associated with an increased probability of delayed bleeding after ESD for early GC,including long operation time,lesions in the upper stomach,advanced age,antithrombotic drug use,large resection size,hemodialysis,and the presence of ulcers.展开更多
We discuss what document types account for the calculation of the journal impact factor （JIF） as published in the Journal Citation Reports （JCR）. Based on a brief review of articles discussing how to predict JIFs ...We discuss what document types account for the calculation of the journal impact factor （JIF） as published in the Journal Citation Reports （JCR）. Based on a brief review of articles discussing how to predict JIFs and taking data differences between the Web of Science （WoS） and the JCR into account, we make our own predictions. Using data by cited-reference searching for Thomson Scientific＇s WoS, we predict 2007 impact factors （1Fs） for several journals, such as Nature, Science, Learned Publishing and some Library and Information Sciences journals. Based on our colleagues＇ experiences we expect our predictions to be lower bounds for the official journal impact factors. We explain why it is useful to derive one＇s own journal impact factor.展开更多
BACKGROUND With sentinel node metastasis in breast cancer(BC)patients,axillary lymph node(ALN)dissection is often omitted from cases with breast-conserving surgery.Omission of lymph node dissection reduces the invasiv...BACKGROUND With sentinel node metastasis in breast cancer(BC)patients,axillary lymph node(ALN)dissection is often omitted from cases with breast-conserving surgery.Omission of lymph node dissection reduces the invasiveness of surgery to the patient,but it also obscures the number of metastases to non-sentinel nodes.The possibility of finding≥4 lymph nodes(pN2a/pN3a)preoperatively is important given the ramifications for postoperative treatment.AIM To search for clinicopathological factors that predicts upstaging from N0 to pN2a/pN3a.METHODS Patients who were sentinel lymph node(SLN)-positive and underwent ALN dissection between September 2007 and August 2018 were selected by retrospective chart review.All patients had BC diagnosed preoperatively as N0 with axillary evaluation by fluorodeoxyglucose(FDG) positron emission tomography/computed tomography and ultrasound (US)examination. When suspicious FDG accumulation was found in ALN, the presence of metastasiswas reevaluated by second US. We examined predictors of upstaging from N0 to pN2a/pN3a.RESULTSAmong 135 patients, we identified 1-3 ALNs (pN1) in 113 patients and ³4 ALNs (pN2a/pN3a) in22 patients. Multivariate analysis identified the total number of SLN metastasis, the maximaldiameter of metastasis in the SLN (SLNDmax), and FDG accumulation of ALN as predictors ofupstaging to pN2a/pN3a.CONCLUSIONWe identified factors involved in upstaging from N0 to pN2a/pN3a. The SLNDmax and numberof SLN metastasis are predictors of ≥ 4 ALNs (pN2a/pN3a) and predictors of metastasis to nonsentinelnodes, which have been reported in the past. Attention should be given to axillaryaccumulations of FDG, even when faint.展开更多
Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early ide...Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early identification.Methods:A prospective observational study of PCNL performed at our institution was done.All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy,planned for additional procedures.Factors including gender,co-morbidities,body mass index,stone burden,puncture site,tract dilatation size,operative position,surgeon's seniority,and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin(Hb)deficiency.Results:Overall,4.86%patients(n=7)received packed cells transfusion.The mean estimated Hb deficiency was 1.3(range 0-6.5)g/dL and the median was 1.0 g/dL.Stepwise multivariate regression analysis revealed that absence of hypertension(p=0.024),puncture site(p=0.027),and operative duration(p=0.023)were significantly associated with higher estimated Hb deficiency.However,the effect sizes are rather small with partial eta-squared of 0.037,0.066,and 0.038,respectively.Observed power obtained was 0.621,0.722,and 0.625,respectively.Other factors studied did not correlate with Hb difference.Conclusion:Hypertension,puncture site,and operative duration have significant impact on estimated Hb deficiency during PCNL.However,the effect size is rather small despite adequate study power obtained.Nonetheless,operative position(supine or prone),puncture number,or tract dilatation size did not correlate with Hb difference.The mainstay of reducing bleeding in PCNL is still meticulous operative technique.Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient,without increasing risk of bleeding.展开更多
BACKGROUND Acute pancreatitis in pregnancy(APIP)is a rare and serious condition,and severe APIP(SAPIP)can lead to pancreatic necrosis,abscess,multiple organ dysfunction,and other adverse maternal and infant outcomes.T...BACKGROUND Acute pancreatitis in pregnancy(APIP)is a rare and serious condition,and severe APIP(SAPIP)can lead to pancreatic necrosis,abscess,multiple organ dysfunction,and other adverse maternal and infant outcomes.Therefore,early identification or prediction of SAPIP is important.AIM To assess factors for early identification or prediction of SAPIP.METHODS The clinical data of patients with APIP were retrospectively analyzed.Patients were classified with mild acute pancreatitis or severe acute pancreatitis,and the clinical characteristics and laboratory biochemical indexes were compared between the two groups.Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.RESULTS A total of 45 APIP patients were enrolled.Compared with the mild acute pancreatitis group,the severe acute pancreatitis group had significantly increased(P<0.01)heart rate(HR),hemoglobin,neutrophil ratio(NEUT%),and neutrophil–lymphocyte ratio(NLR),while lymphocytes were significantly decreased(P<0.01).Logical regression analysis showed that HR,NEUT%,NLR,and lymphocyte count differed significantly(P<0.01)between the groups.These may be factors for early identification or prediction of SAPIP.The area under the curve of HR,NEUT%,NLR,and lymphocyte count in the receiver operating characteristic curve analysis was 0.748,0.732,0.821,and 0.774,respectively.The combined analysis showed that the area under the curve,sensitivity,and specificity were 0.869,90.5%,and 70.8%,respectively.CONCLUSION HR,NEUT%,NLR,and lymphocyte count can be used for early identification or prediction of SAPIP,and the combination of the four factors is expected to improve identification or prediction of SAPIP.展开更多
Advanced carbon emission factors of a power grid can provide users with effective carbon reduction advice,which is of immense importance in mobilizing the entire society to reduce carbon emissions.The method of calcul...Advanced carbon emission factors of a power grid can provide users with effective carbon reduction advice,which is of immense importance in mobilizing the entire society to reduce carbon emissions.The method of calculating node carbon emission factors based on the carbon emissions flow theory requires real-time parameters of a power grid.Therefore,it cannot provide carbon factor information beforehand.To address this issue,a prediction model based on the graph attention network is proposed.The model uses a graph structure that is suitable for the topology of the power grid and designs a supervised network using the loads of the grid nodes and the corresponding carbon factor data.The network extracts features and transmits information more suitable for the power system and can flexibly adjust the equivalent topology,thereby increasing the diversity of the structure.Its input and output data are simple,without the power grid parameters.We demonstrated its effect by testing IEEE-39 bus and IEEE-118 bus systems with average error rates of 2.46%and 2.51%.展开更多
Introduction: Sickle cell disease, which is the most common hereditary hemoglobinopathy in the world, attacks all body systems, particularly the kidneys. The view of this study was to investigate the predictive factor...Introduction: Sickle cell disease, which is the most common hereditary hemoglobinopathy in the world, attacks all body systems, particularly the kidneys. The view of this study was to investigate the predictive factors of kidney damage during sickle cell disease. Materials and methods: It was a retrospective, descriptive and analytical study on files of sickle cell patients hospitalized in the Hematology-Oncology Department of Donka University Hospital during a period from January 1, 2016 to December 31, 2019. Records of sickle cell patients with one or more renal abnormalities were retained. Sickle cell patients without kidney damage were also selected for a comparative study. Only patients without sickle cell disease were excluded. Results: Seventy-five (75) medical records were collected during the study period. From these cases, thirteen (13) records with kidney disease were observed, a frequency of 17%. The mean age of patients was 24.2 years for extremes of 10 and 65 years. The sex ratio was 1.6 in favor of men. The SSFA2 form was the most represented with 92%. 24-hour proteinuria was measured in 13 patients between whom 6 patients (46.2%) had a proteinuria level ≤ 1 g. Eight (8) patients (61.5%) were in stage 1 of chronic kidney disease. The most common type of renal involvement was tubulo-interstitial nephropathy with 8 patients (61.5%). Bivariate analysis showed that elevated serum creatinine (P 2 form of the sickness (P Conclusion: After the observation of an increased serum creatinine and urea, a predominance observation of the SSFA2 form, it should be possible to target patients for whom screening for kidney damage should henceforth be systematic.展开更多
Introduction: Pre-eclampsia is a major cause of maternal and prenatal morbidity and mortality, that complicates 2% to 8% of pregnancies worldwide. The aim of this study was to determine the predictive factors for pre-...Introduction: Pre-eclampsia is a major cause of maternal and prenatal morbidity and mortality, that complicates 2% to 8% of pregnancies worldwide. The aim of this study was to determine the predictive factors for pre-eclampsia in two hospitals in the city of Yaoundé. Methods: A case-control study was conducted at the Gynaecology & Obstetrics department of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Main Maternity of the Yaoundé Central Hospital (MM-YCH) from February 1 to July 30, 2022. The cases were all pregnant women presenting with pre-eclampsia. The control group included pregnant women without pre-eclampsia. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value Results: Included in the study were 33 cases and 132 controls, giving a total of 165 participants. The predictive factors for pre-eclampsia after multivariate analysis were: primiparity (aOR = 51.86, 95% CI: 3.01 - 1230.96, p = 0.045), duration of exposure to partner’s sperm Conclusion: The odds of pre-eclampsia increased with primiparity, duration of exposure to partner’s sperm < 3 months, personal history of pre-eclampsia and maternal history of pre-eclampsia. Recognition of these predictor factors would improve the ability to diagnose and monitor women likely to develop pre-eclampsia before the onset of disease for timely interventions.展开更多
In this editorial,we comment on the article by Chen et al.We specifically focus on the risk factors,prognostic factors,and management of brain metastasis(BM)in breast cancer(BC).BC is the second most common cancer to ...In this editorial,we comment on the article by Chen et al.We specifically focus on the risk factors,prognostic factors,and management of brain metastasis(BM)in breast cancer(BC).BC is the second most common cancer to have BM after lung cancer.Independent risk factors for BM in BC are:HER-2 positive BC,triplenegative BC,and germline BRCA mutation.Other factors associated with BM are lung metastasis,age less than 40 years,and African and American ancestry.Even though risk factors associated with BM in BC are elucidated,there is a lack of data on predictive models for BM in BC.Few studies have been made to formulate predictive models or nomograms to address this issue,where age,grade of tumor,HER-2 receptor status,and number of metastatic sites(1 vs>1)were predictive of BM in metastatic BC.However,none have been used in clinical practice.National Comprehensive Cancer Network recommends screening of BM in advanced BC only when the patient is symptomatic or suspicious of central nervous system symptoms;routine screening for BM in BC is not recommended in the guidelines.BM decreases the quality of life and will have a significant psychological impact.Further studies are required for designing validated nomograms or predictive models for BM in BC;these models can be used in the future to develop treatment approaches to prevent BM,which improves the quality of life and overall survival.展开更多
Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in thi...Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.展开更多
Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infec...Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.展开更多
Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn...Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease,smoking, duration of Crohn's disease before surgery,prophylactic medical treatment (corticosteroids, 5-amino salicylic acid [5-ASA] and immunosuppressants),anatomical site of involvement, indication for surgery (perforating or non-perforating disease), length of resected bowel, anast-omotic technique, presence of granuloma in the specimen, involvement of disease at the resection margin, blood transfusions and postoperative complications. Smoking significantly increases the risk of recurrence (risk is approximately twice as high), especially in women and heavy smokers. Quitting smoking reduces the post-operative recurrence rate. A number of studies have shown a higher risk when the duration of the disease before surgery was short. There were, however, different definitions of 'short' among the studies. Prophylactic cortic-osteroids therapy is not effective in reducing the post-operative recurrence. A number of randomized controlled trials offered evidence of the efficacy of 5-ASA (mesalazine) in reducing post-operative recurrence. Recently, the thera-peutic efficacy of immunosuppressive drugs (azathioprine and 6-mercaptopurine) in the prevention of post-operative recurrence has been investigated and several studies have reported that these drugs might help prevent the recurrence. Further clinical trials would be necessary to evaluate the prophylactic efficacy of immunosuppressants.Several studies showed a higher recurrence rate in patients with perforating disease than in those with non-perforating disease. However, evidence for differing recurrence rates in perforating and non-perforating diseases is inconclusive.A number of retrospective studies reported that a stapled functional end-to-end anastomosis was associated with a lower recurrence rate compared with other types of anastomosis. However, prospective randomized studies would be necessary to draw a definite conclusion. Many studies found no difference in the recurrence rates between patients with radical resection and non-radical resection. Therefore, minimal surgery including strictureplasty has been justified in the management of Crohn's disease. In this review, the following factors do not seem to be predictive of post-operative recurrence:age at onset of disease, sex, family history of Crohn's disease, anatomical site of disease, length of resected bowel, presence of granuloma in the specimen, blood transfusions and post-operative complications. The most significant factor affecting post-operative recurrence of Crohn's disease is smoking. Smoking significantly increases the risk of recurrence. A short disease duration before surgery seems, albeit to a very minor degree, to be associated with a higher recurrence rate. 5-ASA has been shown with some degree of confidence to lead to a lower recurrence rate. The prophylactic efficacy of immunosuppressive drugs should be assessed in future.A wider anastomotic technique after resection may reduce the post-operative recurrence rate, though this should be investigated with prospective randomized controlled trials.展开更多
AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen b...AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.展开更多
AIM： To study predictive factors of thyroid dysfunction associated with interferon-alpha （IFNa） therapy in chronic hepatitis C （CHC） and to describe its long-term evolution in a large population without previous ...AIM： To study predictive factors of thyroid dysfunction associated with interferon-alpha （IFNa） therapy in chronic hepatitis C （CHC） and to describe its long-term evolution in a large population without previous thyroid dysfunction. METHODS： We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNα from 1999 to 2004. RESULTS： Thyroid disorder developed in 30/301 （10%） patients with a mean delay of 6 ± 3.75 mo： 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 ± 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 ± 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment （P = 0.02）. Women had significantly more dysthyroidism （P = 0.05）. Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism （P 〈 0.0003 and P = 0.0003, respectively）. In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism （P = 0.039）.CONCLUSION： In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients, Low fibrosis was found to be a predictive factor of dysthyroidism, Thyroid disorder recovered in 16/30 patients （53%） and recovery was better in the non-autoimrnune form,展开更多
AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist...AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.展开更多
AIM: To identify suitable biomarkers of response to bevacizumab(BV)- it remains an open question. The measurement of serum vascular endothelial growth factor(VEGF) has been proposed as a predictive factor for this dru...AIM: To identify suitable biomarkers of response to bevacizumab(BV)- it remains an open question. The measurement of serum vascular endothelial growth factor(VEGF) has been proposed as a predictive factor for this drug, even if literature data are contradictory. METHODS: We prospectively evaluated the role of BV, total and not BV-bound VEGF and angiopoietin-2(Ang-2) serum levels as potential predictive factors of response for BV in combination with an oxaliplatinbased chemotherapy. BV, Ang-2, total and not BVbound VEGF levels were measured at baseline, before 2^(nd) and 5^(th) cycle of oxaliplatin-based chemotherapy in 20 consecutive metastatic colorectal cancer patients. RESULTS: Results were correlated to response to treatment. Variability in BV levels have been found, with decreased level in less responding patients. In particular, the concentration of BV increased of 3.96 ± 0.69 folds in serum of responsive patients after 3 more cycles of therapy compared to those with stable or progressive disease with a 0.72 ± 0.25 and 2.10 ± 0.13 fold increase, respectively. The determination of free and total VEGF demonstrated that the ratio between the two values, evaluated immediately before the 2^(nd) and the 5^(th) cycle of therapy, decreased from 26.65% ± 1.33% to 15.50% ± 3.47% in responsive patients and from 53.41% ± 4.75 to 34.95% ± 2.88% in those with stable disease. Conversely, in those with progression of disease, the ratio showed the opposite behavior coming up from 25.99% ± 5.23% to 51.71% ± 5.28%. The Ang-2 levels did not show any relationship. CONCLUSION: Our data show that the ratio of not BV-bound VEGF to total VEGF serum and BV plasma concentrations for predicting the response to BV plus oxaliplatin-based chemotherapy could be a promising biomarker of response to BV.展开更多
文摘BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.
文摘Microvascular invasion(MVI)is a critical factor in hepatocellular carcinoma(HCC)prognosis,particularly in hepatitis B virus(HBV)-related cases.This editorial examines a recent study by Xu et al who developed models to predict MVI and high-risk(M2)status in HBV-related HCC using contrast-enhanced computed tomography(CECT)radiomics and clinicoradiological factors.The study analyzed 270 patients,creating models that achieved an area under the curve values of 0.841 and 0.768 for MVI prediction,and 0.865 and 0.798 for M2 status prediction in training and validation datasets,respectively.These results are comparable to previous radiomics-based approaches,which reinforces the potential of this method in MVI prediction.The strengths of the study include its focus on HBV-related HCC and the use of widely accessible CECT imaging.However,limitations,such as retrospective design and manual segmentation,highlight areas for improvement.The editorial discusses the implications of the study including the need for standardized radiomics approaches and the potential impact on personalized treatment strategies.It also suggests future research directions,such as exploring mechanistic links between radiomics features and MVI,as well as integrating additional biomarkers or imaging modalities.Overall,this study contributes significantly to HCC management,paving the way for more accurate,personalized treatment approaches in the era of precision oncology.
文摘Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.
文摘BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.
基金Supported by Zhejiang Province Medical and Health Science and Technology Plan Project,No.2024KY190。
文摘BACKGROUND Gastric cancer(GC)remains a substantial global health burden,and its early detection and treatment is critical for optimizing patient outcomes.Endoscopic submucosal dissection(ESD)is a minimally invasive technique for early GC but is linked to an increased risk of complications,such as delayed hemorrhage,which underscore the need for a comprehensive investigation into the disease’s risk factors.AIM To perform a comprehensive review and meta-analysis of the literature to identify and quantify risk factors associated with late-onset bleeding subsequent to ESD for early GC.METHODS Studies reporting risk factors for delayed bleeding after ESD for early GC were identified through a comprehensive search of electronic databases(PubMed,Embase,and Cochrane Library).The selection of studies,data retrieval,and quality evaluation were carried out separately by two reviewers.The combined odds ratios(OR)along with their 95%confidence intervals(CI)were calculated utilizing a random-effects approach.The meta-analysis has been registered on the International Registry of Systematic Review and Meta-analysis Protocols(INPLASY202540116).RESULTS A total of 11 publications comprising 1945 patients were incorporated into the present analysis.The following risk factors were found to be significantly associated with an increased risk of delayed bleeding after ESD:Long operation time(OR=2.55,95%CI:2.40–2.72,I^(2)=11%,n=5 studies),lesions detected in the upper part of the stomach(OR=3.44,95%CI:3.19-3.70,I^(2)=0%,n=4 studies),advanced age(OR=3.61,95%CI:3.47-3.76,I^(2)=38%,n=5 studies),history of taking antithrombotic drugs(OR=2.58,95%CI:2.48-2.68,I^(2)=45%,n=3 studies),resection size>40 mm(OR=3.01,95%CI:2.78-3.26,I^(2)=31%,n=5 studies),hemodialysis(OR=2.42,95%CI:2.33-2.51,I²=0%,n=4 studies),presence of ulcers(OR=2.54,95%CI:2.33-2.77,I^(2)=0%,n=3 studies).CONCLUSION This meta-analysis identified several risk factors associated with an increased probability of delayed bleeding after ESD for early GC,including long operation time,lesions in the upper stomach,advanced age,antithrombotic drug use,large resection size,hemodialysis,and the presence of ulcers.
文摘We discuss what document types account for the calculation of the journal impact factor （JIF） as published in the Journal Citation Reports （JCR）. Based on a brief review of articles discussing how to predict JIFs and taking data differences between the Web of Science （WoS） and the JCR into account, we make our own predictions. Using data by cited-reference searching for Thomson Scientific＇s WoS, we predict 2007 impact factors （1Fs） for several journals, such as Nature, Science, Learned Publishing and some Library and Information Sciences journals. Based on our colleagues＇ experiences we expect our predictions to be lower bounds for the official journal impact factors. We explain why it is useful to derive one＇s own journal impact factor.
文摘BACKGROUND With sentinel node metastasis in breast cancer(BC)patients,axillary lymph node(ALN)dissection is often omitted from cases with breast-conserving surgery.Omission of lymph node dissection reduces the invasiveness of surgery to the patient,but it also obscures the number of metastases to non-sentinel nodes.The possibility of finding≥4 lymph nodes(pN2a/pN3a)preoperatively is important given the ramifications for postoperative treatment.AIM To search for clinicopathological factors that predicts upstaging from N0 to pN2a/pN3a.METHODS Patients who were sentinel lymph node(SLN)-positive and underwent ALN dissection between September 2007 and August 2018 were selected by retrospective chart review.All patients had BC diagnosed preoperatively as N0 with axillary evaluation by fluorodeoxyglucose(FDG) positron emission tomography/computed tomography and ultrasound (US)examination. When suspicious FDG accumulation was found in ALN, the presence of metastasiswas reevaluated by second US. We examined predictors of upstaging from N0 to pN2a/pN3a.RESULTSAmong 135 patients, we identified 1-3 ALNs (pN1) in 113 patients and ³4 ALNs (pN2a/pN3a) in22 patients. Multivariate analysis identified the total number of SLN metastasis, the maximaldiameter of metastasis in the SLN (SLNDmax), and FDG accumulation of ALN as predictors ofupstaging to pN2a/pN3a.CONCLUSIONWe identified factors involved in upstaging from N0 to pN2a/pN3a. The SLNDmax and numberof SLN metastasis are predictors of ≥ 4 ALNs (pN2a/pN3a) and predictors of metastasis to nonsentinelnodes, which have been reported in the past. Attention should be given to axillaryaccumulations of FDG, even when faint.
文摘Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early identification.Methods:A prospective observational study of PCNL performed at our institution was done.All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy,planned for additional procedures.Factors including gender,co-morbidities,body mass index,stone burden,puncture site,tract dilatation size,operative position,surgeon's seniority,and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin(Hb)deficiency.Results:Overall,4.86%patients(n=7)received packed cells transfusion.The mean estimated Hb deficiency was 1.3(range 0-6.5)g/dL and the median was 1.0 g/dL.Stepwise multivariate regression analysis revealed that absence of hypertension(p=0.024),puncture site(p=0.027),and operative duration(p=0.023)were significantly associated with higher estimated Hb deficiency.However,the effect sizes are rather small with partial eta-squared of 0.037,0.066,and 0.038,respectively.Observed power obtained was 0.621,0.722,and 0.625,respectively.Other factors studied did not correlate with Hb difference.Conclusion:Hypertension,puncture site,and operative duration have significant impact on estimated Hb deficiency during PCNL.However,the effect size is rather small despite adequate study power obtained.Nonetheless,operative position(supine or prone),puncture number,or tract dilatation size did not correlate with Hb difference.The mainstay of reducing bleeding in PCNL is still meticulous operative technique.Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient,without increasing risk of bleeding.
文摘BACKGROUND Acute pancreatitis in pregnancy(APIP)is a rare and serious condition,and severe APIP(SAPIP)can lead to pancreatic necrosis,abscess,multiple organ dysfunction,and other adverse maternal and infant outcomes.Therefore,early identification or prediction of SAPIP is important.AIM To assess factors for early identification or prediction of SAPIP.METHODS The clinical data of patients with APIP were retrospectively analyzed.Patients were classified with mild acute pancreatitis or severe acute pancreatitis,and the clinical characteristics and laboratory biochemical indexes were compared between the two groups.Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.RESULTS A total of 45 APIP patients were enrolled.Compared with the mild acute pancreatitis group,the severe acute pancreatitis group had significantly increased(P<0.01)heart rate(HR),hemoglobin,neutrophil ratio(NEUT%),and neutrophil–lymphocyte ratio(NLR),while lymphocytes were significantly decreased(P<0.01).Logical regression analysis showed that HR,NEUT%,NLR,and lymphocyte count differed significantly(P<0.01)between the groups.These may be factors for early identification or prediction of SAPIP.The area under the curve of HR,NEUT%,NLR,and lymphocyte count in the receiver operating characteristic curve analysis was 0.748,0.732,0.821,and 0.774,respectively.The combined analysis showed that the area under the curve,sensitivity,and specificity were 0.869,90.5%,and 70.8%,respectively.CONCLUSION HR,NEUT%,NLR,and lymphocyte count can be used for early identification or prediction of SAPIP,and the combination of the four factors is expected to improve identification or prediction of SAPIP.
基金This work is supposed by the Science and Technology Projects of China Southern Power Grid(YNKJXM20222402).
文摘Advanced carbon emission factors of a power grid can provide users with effective carbon reduction advice,which is of immense importance in mobilizing the entire society to reduce carbon emissions.The method of calculating node carbon emission factors based on the carbon emissions flow theory requires real-time parameters of a power grid.Therefore,it cannot provide carbon factor information beforehand.To address this issue,a prediction model based on the graph attention network is proposed.The model uses a graph structure that is suitable for the topology of the power grid and designs a supervised network using the loads of the grid nodes and the corresponding carbon factor data.The network extracts features and transmits information more suitable for the power system and can flexibly adjust the equivalent topology,thereby increasing the diversity of the structure.Its input and output data are simple,without the power grid parameters.We demonstrated its effect by testing IEEE-39 bus and IEEE-118 bus systems with average error rates of 2.46%and 2.51%.
文摘Introduction: Sickle cell disease, which is the most common hereditary hemoglobinopathy in the world, attacks all body systems, particularly the kidneys. The view of this study was to investigate the predictive factors of kidney damage during sickle cell disease. Materials and methods: It was a retrospective, descriptive and analytical study on files of sickle cell patients hospitalized in the Hematology-Oncology Department of Donka University Hospital during a period from January 1, 2016 to December 31, 2019. Records of sickle cell patients with one or more renal abnormalities were retained. Sickle cell patients without kidney damage were also selected for a comparative study. Only patients without sickle cell disease were excluded. Results: Seventy-five (75) medical records were collected during the study period. From these cases, thirteen (13) records with kidney disease were observed, a frequency of 17%. The mean age of patients was 24.2 years for extremes of 10 and 65 years. The sex ratio was 1.6 in favor of men. The SSFA2 form was the most represented with 92%. 24-hour proteinuria was measured in 13 patients between whom 6 patients (46.2%) had a proteinuria level ≤ 1 g. Eight (8) patients (61.5%) were in stage 1 of chronic kidney disease. The most common type of renal involvement was tubulo-interstitial nephropathy with 8 patients (61.5%). Bivariate analysis showed that elevated serum creatinine (P 2 form of the sickness (P Conclusion: After the observation of an increased serum creatinine and urea, a predominance observation of the SSFA2 form, it should be possible to target patients for whom screening for kidney damage should henceforth be systematic.
文摘Introduction: Pre-eclampsia is a major cause of maternal and prenatal morbidity and mortality, that complicates 2% to 8% of pregnancies worldwide. The aim of this study was to determine the predictive factors for pre-eclampsia in two hospitals in the city of Yaoundé. Methods: A case-control study was conducted at the Gynaecology & Obstetrics department of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Main Maternity of the Yaoundé Central Hospital (MM-YCH) from February 1 to July 30, 2022. The cases were all pregnant women presenting with pre-eclampsia. The control group included pregnant women without pre-eclampsia. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value Results: Included in the study were 33 cases and 132 controls, giving a total of 165 participants. The predictive factors for pre-eclampsia after multivariate analysis were: primiparity (aOR = 51.86, 95% CI: 3.01 - 1230.96, p = 0.045), duration of exposure to partner’s sperm Conclusion: The odds of pre-eclampsia increased with primiparity, duration of exposure to partner’s sperm < 3 months, personal history of pre-eclampsia and maternal history of pre-eclampsia. Recognition of these predictor factors would improve the ability to diagnose and monitor women likely to develop pre-eclampsia before the onset of disease for timely interventions.
文摘In this editorial,we comment on the article by Chen et al.We specifically focus on the risk factors,prognostic factors,and management of brain metastasis(BM)in breast cancer(BC).BC is the second most common cancer to have BM after lung cancer.Independent risk factors for BM in BC are:HER-2 positive BC,triplenegative BC,and germline BRCA mutation.Other factors associated with BM are lung metastasis,age less than 40 years,and African and American ancestry.Even though risk factors associated with BM in BC are elucidated,there is a lack of data on predictive models for BM in BC.Few studies have been made to formulate predictive models or nomograms to address this issue,where age,grade of tumor,HER-2 receptor status,and number of metastatic sites(1 vs>1)were predictive of BM in metastatic BC.However,none have been used in clinical practice.National Comprehensive Cancer Network recommends screening of BM in advanced BC only when the patient is symptomatic or suspicious of central nervous system symptoms;routine screening for BM in BC is not recommended in the guidelines.BM decreases the quality of life and will have a significant psychological impact.Further studies are required for designing validated nomograms or predictive models for BM in BC;these models can be used in the future to develop treatment approaches to prevent BM,which improves the quality of life and overall survival.
文摘Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.
文摘Background:Cardiac implantable electronic devices(CIEDs)are essential for preventing sudden cardiac death in patients with cardiovascular diseases,but implantation procedures carry risks of complications such as infection,hematoma,and bleeding,with incidence rates of 3–4%.Previous studies have examined individual risk factors separately,but integrated predictive models are lacking.We compared the predictive performance and interpretability of artificial neural network(ANN)and logistic regression models to evaluate their respective strengths in clinical risk assessment.Methods:This retrospective study analyzed data from 180 patients who underwent cardiac implantable electronic device(CIED)implantation in Taiwan between 2017 and 2018.To address class imbalance and enhance model training,the dataset was augmented to 540 records using the Synthetic Minority Oversampling Technique(SMOTE).A total of 13 clinical risk factors were evaluated(e.g.,age,body mass index(BMI),platelet count,left ventricular ejection fraction(LVEF),prothrombin time/international normalized ratio(PT/INR),hemoglobin(Hb),comorbidities,and antithrombotic use).Results:The most influential risk factors identified by the ANN model were platelet count,PT/INR,LVEF,Hb,and age.In the logistic regression analysis,reduced LVEF,lower hemoglobin levels,prolonged PT/INR,and lower BMI were significantly associated with an increased risk of complications.ANN model achieved a higher area under the curve(AUC=0.952)compared to the logistic regression model(AUC=0.802),indicating superior predictive performance.Additionally,the overall model quality was also higher for the ANN model(0.93)than for logistic regression(0.76).Conclusions:This study demonstrates that ANN models can effectively predict complications associated CIED procedures and identify critical preoperative risk factors.These findings support the use of ANN-based models for individualized risk stratification,enhancing procedural safety,improving patient outcomes,and potentially reducing healthcare costs associated with postoperative complications.
文摘Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease,smoking, duration of Crohn's disease before surgery,prophylactic medical treatment (corticosteroids, 5-amino salicylic acid [5-ASA] and immunosuppressants),anatomical site of involvement, indication for surgery (perforating or non-perforating disease), length of resected bowel, anast-omotic technique, presence of granuloma in the specimen, involvement of disease at the resection margin, blood transfusions and postoperative complications. Smoking significantly increases the risk of recurrence (risk is approximately twice as high), especially in women and heavy smokers. Quitting smoking reduces the post-operative recurrence rate. A number of studies have shown a higher risk when the duration of the disease before surgery was short. There were, however, different definitions of 'short' among the studies. Prophylactic cortic-osteroids therapy is not effective in reducing the post-operative recurrence. A number of randomized controlled trials offered evidence of the efficacy of 5-ASA (mesalazine) in reducing post-operative recurrence. Recently, the thera-peutic efficacy of immunosuppressive drugs (azathioprine and 6-mercaptopurine) in the prevention of post-operative recurrence has been investigated and several studies have reported that these drugs might help prevent the recurrence. Further clinical trials would be necessary to evaluate the prophylactic efficacy of immunosuppressants.Several studies showed a higher recurrence rate in patients with perforating disease than in those with non-perforating disease. However, evidence for differing recurrence rates in perforating and non-perforating diseases is inconclusive.A number of retrospective studies reported that a stapled functional end-to-end anastomosis was associated with a lower recurrence rate compared with other types of anastomosis. However, prospective randomized studies would be necessary to draw a definite conclusion. Many studies found no difference in the recurrence rates between patients with radical resection and non-radical resection. Therefore, minimal surgery including strictureplasty has been justified in the management of Crohn's disease. In this review, the following factors do not seem to be predictive of post-operative recurrence:age at onset of disease, sex, family history of Crohn's disease, anatomical site of disease, length of resected bowel, presence of granuloma in the specimen, blood transfusions and post-operative complications. The most significant factor affecting post-operative recurrence of Crohn's disease is smoking. Smoking significantly increases the risk of recurrence. A short disease duration before surgery seems, albeit to a very minor degree, to be associated with a higher recurrence rate. 5-ASA has been shown with some degree of confidence to lead to a lower recurrence rate. The prophylactic efficacy of immunosuppressive drugs should be assessed in future.A wider anastomotic technique after resection may reduce the post-operative recurrence rate, though this should be investigated with prospective randomized controlled trials.
文摘AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.
文摘AIM： To study predictive factors of thyroid dysfunction associated with interferon-alpha （IFNa） therapy in chronic hepatitis C （CHC） and to describe its long-term evolution in a large population without previous thyroid dysfunction. METHODS： We performed a follow-up of thyroid function and detection of thyroid antibodies in 301 patients treated for CHC with IFNα from 1999 to 2004. RESULTS： Thyroid disorder developed in 30/301 （10%） patients with a mean delay of 6 ± 3.75 mo： 13 patients had hyperthyroidism, 11 had hypothyroidism, and 6 had biphasic evolution. During a mean follow-up of 41.59 ± 15.39 mo, 9 patients with hyperthyroidism, 3 with hypothyroidism, and 4 with biphasic evolution normalized thyroid function in 7.88 ± 5.46 mo. Recovery rate of dysthyroidism was not modified by treatment discontinuation, but was better for patients with negative thyroid antibodies before antiviral treatment （P = 0.02）. Women had significantly more dysthyroidism （P = 0.05）. Positive thyroid peroxidase and thyroglobulin antibodies were more frequent before antiviral treatment in patients who developed dysthyroidism （P 〈 0.0003 and P = 0.0003, respectively）. In a multivariate model, low fibrosis was found to be a predictive factor of dysthyroidism （P = 0.039）.CONCLUSION： In this monocentric population of CHC, dysthyroidism, especially hyperthyroidism, developed in 10% of patients, Low fibrosis was found to be a predictive factor of dysthyroidism, Thyroid disorder recovered in 16/30 patients （53%） and recovery was better in the non-autoimrnune form,
文摘AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.
文摘AIM: To identify suitable biomarkers of response to bevacizumab(BV)- it remains an open question. The measurement of serum vascular endothelial growth factor(VEGF) has been proposed as a predictive factor for this drug, even if literature data are contradictory. METHODS: We prospectively evaluated the role of BV, total and not BV-bound VEGF and angiopoietin-2(Ang-2) serum levels as potential predictive factors of response for BV in combination with an oxaliplatinbased chemotherapy. BV, Ang-2, total and not BVbound VEGF levels were measured at baseline, before 2^(nd) and 5^(th) cycle of oxaliplatin-based chemotherapy in 20 consecutive metastatic colorectal cancer patients. RESULTS: Results were correlated to response to treatment. Variability in BV levels have been found, with decreased level in less responding patients. In particular, the concentration of BV increased of 3.96 ± 0.69 folds in serum of responsive patients after 3 more cycles of therapy compared to those with stable or progressive disease with a 0.72 ± 0.25 and 2.10 ± 0.13 fold increase, respectively. The determination of free and total VEGF demonstrated that the ratio between the two values, evaluated immediately before the 2^(nd) and the 5^(th) cycle of therapy, decreased from 26.65% ± 1.33% to 15.50% ± 3.47% in responsive patients and from 53.41% ± 4.75 to 34.95% ± 2.88% in those with stable disease. Conversely, in those with progression of disease, the ratio showed the opposite behavior coming up from 25.99% ± 5.23% to 51.71% ± 5.28%. The Ang-2 levels did not show any relationship. CONCLUSION: Our data show that the ratio of not BV-bound VEGF to total VEGF serum and BV plasma concentrations for predicting the response to BV plus oxaliplatin-based chemotherapy could be a promising biomarker of response to BV.
