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
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
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 The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperati...BACKGROUND The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperative bleeding affects its efficacy.AIM To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine(GBM)model for postoperative bleeding.METHODS The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively.Patients were divided into two groups(bleeding and non-bleeding).Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding,leading to the construction of the GBM prediction model.The receiver operating characteristic(ROC)curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan(BEST-J)score.RESULTS Among 178 patients who received ESD treatment,29 cases(16.29%)had bleeding,and 149 cases(83.71%)had no bleeding.The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that tumor size≥3 cm,surgical bleeding,and Creactive protein(CRP)were independent risk factors for bleeding after ESD in patients with early esophageal cancer(P<0.05).The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score(0.818 vs 0.653,P<0.05).CONCLUSION The GBM prediction model based on tumor size≥3 cm,surgical bleeding,and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.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
Objective:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive ...Objective:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive combined model.Methods:A total of 36 patients with pathologically confirmed benign lesions(44 foci)and 23 patients with PCa(49 foci),including 25 foci of csPCa and 68 foci of non-csPCa,were included.SyMRI quantitative maps and clinical indicators were collected,and 224 imaging features were extracted.The intra-and inter-group correlation coefficients(ICC)for each feature were calculated using intra-and inter-group correlation analysis,and features with an ICC>0.75 were selected as stable features that could be reproducibly extracted.Independent predictors were screened using logistic regression to construct single and combined models,and the performance was evaluated using ROC curves.Results:Age,PSAD,PD map contrast,and T2 map joint entropy were significantly higher in the PCa group compared to the benign group,while the median ADC was significantly lower(p<0.05).The above-mentioned indicators were significantly correlated with PCa and csPCa,and the diagnostic performance of the combined model was superior to that of a single MRI or clinical model.Conclusion:MRI features combined with PSAD can effectively differentiate PCa and predict csPCa,providing a non-invasive quantitative diagnostic basis for clinical practice.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
AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recent...AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP). CLIP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not published. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma replaced by tumor), TNM stage, CLIP score, and resection margin were the risk factors for early recurrence, whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. In univariate survival analysis, Child-Pugh stages, resection margin, tumor size, microsatellite, venous invasion, tumor type, tumor extension, TNM stages, and CLIP score were associated with prognosis. The multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.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
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
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
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
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
Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients ...Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data,were collected.Pearson’s Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses.Combined analysis of multiple risk and protective factors for lymph node metastasis(LNM)of EGC was performed.A negative predictive value(NPV)combination model was built and validated.Results:LNM occurred in 85 of 561 patients with EGC,and the LNM rate was 15.15%.NPV for LNM reached 100%based on three characteristics,including ulcer-free,moderately well differentiation and patient<65years old or tumor located at the proximal 1/3 of the stomach.Regarding lymphatic basin metastasis,multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients(65.96%vs.38.89%,P<0.05).The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter>2 cm was significantly greater than that noted in patients with a maximum tumor diameter≤2 cm(60.78%vs.28.13%,P<0.05).Conclusions:Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection.The NPV for LNM reaches 100%based on the following two conditions:young and middle-aged EGC patients,well-differentiated tumors,and without ulcers;or well-differentiated tumors,without ulcers,and tumors located in the proximal stomach.These findings can be used as the recommended indications for functionpreserving curative gastrectomy and sentinel lymph node navigation surgery.展开更多
A suitable pH value of the slurry is a key to efficient mineral flotation. Considering the control delay problem of pH value caused by offline pH measurement, an integrated prediction model for pH value in bauxite fro...A suitable pH value of the slurry is a key to efficient mineral flotation. Considering the control delay problem of pH value caused by offline pH measurement, an integrated prediction model for pH value in bauxite froth flotation is proposed, which considers the effect of ore compositions on pH value. Firstly, a regression model is obtained for alkali(Na_2CO_3) consumed by the reaction between ore and alkali. According to the first-order hydrolysis of the remaining alkali, a mechanism-based prediction model is presented for the pH value. Then, considering the complexity of the flotation mechanism, an error prediction model which uses time series of the error of the mechanism model as inputs is presented based on autoregressive moving average(ARMA) method to compensate the mechanism model. Finally, expert rules are established to correct the error compensation direction, which could reflect the dynamic changes during the process accurately and effectively. Simulation results using industrial data show that the presented model meets the needs of the industrial process, which laid the foundation for predictive control of pH regulator.展开更多
Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-rel...Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely.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
<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient...<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. <strong>Methods:</strong> We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. <strong>Results:</strong> Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. <strong>Conclusion: </strong>The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.展开更多
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.
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 The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperative bleeding affects its efficacy.AIM To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine(GBM)model for postoperative bleeding.METHODS The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively.Patients were divided into two groups(bleeding and non-bleeding).Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding,leading to the construction of the GBM prediction model.The receiver operating characteristic(ROC)curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan(BEST-J)score.RESULTS Among 178 patients who received ESD treatment,29 cases(16.29%)had bleeding,and 149 cases(83.71%)had no bleeding.The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that tumor size≥3 cm,surgical bleeding,and Creactive protein(CRP)were independent risk factors for bleeding after ESD in patients with early esophageal cancer(P<0.05).The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score(0.818 vs 0.653,P<0.05).CONCLUSION The GBM prediction model based on tumor size≥3 cm,surgical bleeding,and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.
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Objective:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive combined model.Methods:A total of 36 patients with pathologically confirmed benign lesions(44 foci)and 23 patients with PCa(49 foci),including 25 foci of csPCa and 68 foci of non-csPCa,were included.SyMRI quantitative maps and clinical indicators were collected,and 224 imaging features were extracted.The intra-and inter-group correlation coefficients(ICC)for each feature were calculated using intra-and inter-group correlation analysis,and features with an ICC>0.75 were selected as stable features that could be reproducibly extracted.Independent predictors were screened using logistic regression to construct single and combined models,and the performance was evaluated using ROC curves.Results:Age,PSAD,PD map contrast,and T2 map joint entropy were significantly higher in the PCa group compared to the benign group,while the median ADC was significantly lower(p<0.05).The above-mentioned indicators were significantly correlated with PCa and csPCa,and the diagnostic performance of the combined model was superior to that of a single MRI or clinical model.Conclusion:MRI features combined with PSAD can effectively differentiate PCa and predict csPCa,providing a non-invasive quantitative diagnostic basis for clinical practice.
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AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP). CLIP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not published. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. Six patients who died in the hospital after operation and 11 patients with the recurrence of the disease were excluded at 1 month after hepatectomy. By the end of June 2001, 4 patients were lost and 153 patients with curative resection have been followed up for at least three years. Among 153 patients, 115 developed intrahepatic recurrence and 10 developed extrahepatic recurrence, whereas the other 28 remained free of recurrence. Recurrences were classified into early (【 or =3 year) and late (】3 year) recurrence. The CLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portal thrombosis (0-1). By contrast, portal vein thrombosis was defined as the presence of tumor emboli within vascular channel analyzed by microscopic examination in this study. Risk factors for recurrence and prognostic factors for survival in each group were analyzed by the chi-square test, the Kaplan-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-,and 10-year disease-free survival rates after curative resection of HCC were 57.2%, 28.3%, 23.5%, 18.8%, and 17.8%, respectively. Median survival time was 28, 10, 4, and 5 mo for CLIP score 0, 1, 2, 3, and 4 to 5, respectively. Early and late recurrence developed in 109 patients and 16 patients respectively. By the chi-square test, tumor size, microsatellite, venous invasion, tumor type (uninodular, multinodular, massive), tumor extension (【 or = or 】50% of liver parenchyma replaced by tumor), TNM stage, CLIP score, and resection margin were the risk factors for early recurrence, whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. In univariate survival analysis, Child-Pugh stages, resection margin, tumor size, microsatellite, venous invasion, tumor type, tumor extension, TNM stages, and CLIP score were associated with prognosis. The multivariate analysis by COX proportional hazards model showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION: CLIP score has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis in the patients with HCC after resection.
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Beijing Hospitals Authority Clinical Medicine Development of Special Funding(No.XMLX202119)Open Project funded by Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education/Beijing(No.2022 Open Project-6)。
文摘Objective:To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer(EGC).Methods:The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data,were collected.Pearson’s Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses.Combined analysis of multiple risk and protective factors for lymph node metastasis(LNM)of EGC was performed.A negative predictive value(NPV)combination model was built and validated.Results:LNM occurred in 85 of 561 patients with EGC,and the LNM rate was 15.15%.NPV for LNM reached 100%based on three characteristics,including ulcer-free,moderately well differentiation and patient<65years old or tumor located at the proximal 1/3 of the stomach.Regarding lymphatic basin metastasis,multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients(65.96%vs.38.89%,P<0.05).The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter>2 cm was significantly greater than that noted in patients with a maximum tumor diameter≤2 cm(60.78%vs.28.13%,P<0.05).Conclusions:Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection.The NPV for LNM reaches 100%based on the following two conditions:young and middle-aged EGC patients,well-differentiated tumors,and without ulcers;or well-differentiated tumors,without ulcers,and tumors located in the proximal stomach.These findings can be used as the recommended indications for functionpreserving curative gastrectomy and sentinel lymph node navigation surgery.
基金Supported by the National Natural Science Foundation of China(61673401)the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(61621062)the Fundamental Research Funds for the Central Universities of Central South University(2016zzts343)
文摘A suitable pH value of the slurry is a key to efficient mineral flotation. Considering the control delay problem of pH value caused by offline pH measurement, an integrated prediction model for pH value in bauxite froth flotation is proposed, which considers the effect of ore compositions on pH value. Firstly, a regression model is obtained for alkali(Na_2CO_3) consumed by the reaction between ore and alkali. According to the first-order hydrolysis of the remaining alkali, a mechanism-based prediction model is presented for the pH value. Then, considering the complexity of the flotation mechanism, an error prediction model which uses time series of the error of the mechanism model as inputs is presented based on autoregressive moving average(ARMA) method to compensate the mechanism model. Finally, expert rules are established to correct the error compensation direction, which could reflect the dynamic changes during the process accurately and effectively. Simulation results using industrial data show that the presented model meets the needs of the industrial process, which laid the foundation for predictive control of pH regulator.
文摘Objective:To determine the predictive value of P2/MS in patients with chronic HBV-related cirrhosis, and to predict high-risk esophageal varices, and obtain a cut-off value.Methods:A total of 412 patients with HBV-related cirrhosis who were admitted to our hospital between August 2014 and August 2017 were retrospectively evaluated. A diagnosis of cirrhosis was made with standard laboratory, radiological and physical examination findings. According to these evaluations, esophageal varices were classified as small, medium and large. For all obtained data, P2/MS was calculated. Two threshold values (P2/MS<11 and P2/MS>25) were considered in predicting the presence of high-risk EVs during recording. And the optimal cut-off value of the P2/MS index was determined for high-risk esophageal varices in patients with chronic viral hepatitis B.Results:A total of 375 patients who met the inclusion criteria were included in the study. When the P2/MS index was compared with other noninvasive tests, the mean and median P2/MS scores were respectively 54.17 and 33.25. The P2/MS value of the patients without esophageal varices was higher than that of the patients with esophageal varices. When these results were evaluated, the higher the score, the lower the risk of varices. We obtained a positive predictive value of 93.80% [95%CI(80.20-98.70)] when the cut-off value of P2/MS was taken as <11, and obtained a negative predictive value of 94.30% [95%CI(86.20-98.20%)] when the cut-off value of P2/MS was taken as >25.Conclusions:We could predict the patients with high-risk esophageal varices within this group at a extremely good rate. We also compared the results of this test with other non-invasive tests and achieved successful results. We have shown that P2/MS can be used in order to optimally select patients for endoscopic screening and prevent all of the expensive and unnecessary procedures safely.
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.
文摘<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. <strong>Methods:</strong> We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. <strong>Results:</strong> Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. <strong>Conclusion: </strong>The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.
