The generic classification of the family Orthophlebiidae is revised systematically in the present paper. Genera Orthophlebia and Protophlebia are remained in the family Orthophlebiidae while genus Mesophlebia is disas...The generic classification of the family Orthophlebiidae is revised systematically in the present paper. Genera Orthophlebia and Protophlebia are remained in the family Orthophlebiidae while genus Mesophlebia is disassembled, in which the species are ascribed to Orthophlebia if Rs1 at least with 3 branches, and to Protophlebia if Rs1 only with 2 branches. Three subgenera are erected in Orthophlebia and Protophlebia respectively according to the relationship between stems of Rs and MA, i.e. Rs forking earlier or later than MA, or at the same level as MA.展开更多
AIM To evaluate the role of small bowel capsule endoscopy(SBCE)on the reclassification of colonic inflammatory bowel disease type unclassified(IBDU).METHODS We performed a multicenter,retrospective study including pat...AIM To evaluate the role of small bowel capsule endoscopy(SBCE)on the reclassification of colonic inflammatory bowel disease type unclassified(IBDU).METHODS We performed a multicenter,retrospective study including patients with IBDU undergoing SBCE,between 2002 and 2014.SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score(LS).Inflammatory activity was considered significant and consistent with Crohn's disease(CD)when the LS≥135.The definitive diagnosis during follow-up(minimum 12 mo following SBCE)was based on the combination of clinical,analytical,imaging,endoscopic and histological elements.RESULTS Thirty-six patients were included,21 females(58%)with mean age at diagnosis of 33±13(15-64)years.The mean follow-up time after the SBCE was 52±41(12-156)mo.The SBCE revealed findings consistent with significant inflammatory activity in the small bowel(LS≥135)in 9 patients(25%);in all of them the diagnosis of CD was confirmed during follow-up.In 27 patients(75%),the SBCE revealed no significant inflammatory activity(LS<135);among these patients,the diagnosis of Ulcerative Colitis(UC)was established in 16 cases(59.3%),CD in 1 case(3.7%)and 10 patients(37%)maintained a diagnosis of IBDU during follow-up.A LS≥135 at SBCE had a sensitivity=90%,specificity=100%,positive predictive value=100%and negative predictive value=94%for the diagnosis of CD.CONCLUSION SBCE proved to be fundamental in the reclassification of patients with IBDU.Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94%of cases.展开更多
This review revises the reclassification of the mem-branoproliferative glomerulonephritis （MPGN） after the consensus conference that by 2015 reclassified all the glomerulonephritis basing on etiology and patho-genes...This review revises the reclassification of the mem-branoproliferative glomerulonephritis （MPGN） after the consensus conference that by 2015 reclassified all the glomerulonephritis basing on etiology and patho-genesis, instead of the histomorphological aspects. After reclassification, two types of MPGN are to date recognized： The immunocomplexes mediated MPGN and the complement mediated MPGN. The latter type is more extensively described in the review either because several of these entities are completely new or because the improved knowledge of the complement cascade allowed for new diagnostic and therapeutic approaches. Overall the complement mediated MPGN are related to acquired or genetic cause. The presence of circulating auto antibodies is the principal acquired cause. Genetic wide association studies and family studies allowed to recognize genetic mutations of different types as causes of the complement dysregulation. The complement cascade is a complex phenomenon and activating factors and regulating factors should be distinguished. Genetic mutations causing abnormalities either in activating or in regulating factors have been described. The diagnosis of the complement mediated MPGN requires a complete study of all these different complement factors. As a consequence, new therapeutic approaches are becoming available. Indeed, in addition to a nonspecifc treatment and to the immunosuppression that has the aim to block the auto antibodies production, the specific inhibition of complement activation is relatively new and may act either blocking the C5 convertase or the C3 convertase. The drugs acting on C3 convertase are still in different phases of clinical development and might represent drugs for the future. Overall the authors consider that one of the principal problems in fnding new types of drugs are both the rarity of the disease and the consequent poor interest in the marketing and the lack of large international cooperative studies.展开更多
Although Chinese Ditransitive Construction(CDC) and English Ditransitive Construction(EDC) respectively belong to two completely different languages, there do exist many similarities between them. One of the similarit...Although Chinese Ditransitive Construction(CDC) and English Ditransitive Construction(EDC) respectively belong to two completely different languages, there do exist many similarities between them. One of the similarities is the diversified classifications of the verbs that enter into them because different scholars, though under different theoretical frameworks, classified the DC verbs on the basis of the lexical meanings of the verbs, which is a boundless category. It is not difficult to find that all the constituents of DC and the construction as a whole interact with each other after the comparison of the similarities between CDC and EDC; the lexical meanings of the verbs that enter into DC do not exist in isolation but interact with the construction sense. Therefore, it may be the best choice to reclassify the DC verbs on the basis of the interaction between the lexical meaning of the verbs and the construction sense.展开更多
CHONDRULES are the major constituent of chondrites, but the nature of their origin remains elusive. Models based on nebular settings have attracted much support since Wood suggested that they formed there ascondensate...CHONDRULES are the major constituent of chondrites, but the nature of their origin remains elusive. Models based on nebular settings have attracted much support since Wood suggested that they formed there ascondensates. Subsequently, the melting of dust in the nebula has been widely invoked. Recently,however, models suggesting that chondrules formed in parent body regoliths have been revived, couldhelp to explain the coexistence of chondrules with chemically differentiated clasts The Boxian meteorite is a fall and was originally described as L4. The widely quoted classification of the chondrite is LL4. In this study, 362 chondrules were separated from the Boxian meteorite,and were measured for their grain sizes, masses and morphologies. 101 of these chondrules were successfully split and parts of them made into polished blocks; the remaining segments were individually set asidefor future oxygen isotopic analyses. Mineralogical investigation of the 101 chondrules was performed展开更多
Yang Hui was one of the most important authors of mathematical works during the thirteenth century.Mathematical Methods Explaining in Detail The Nine Chapters(Xiangjie jiuzhang suanfa詳解九章算法,1261 CE)is the earlie...Yang Hui was one of the most important authors of mathematical works during the thirteenth century.Mathematical Methods Explaining in Detail The Nine Chapters(Xiangjie jiuzhang suanfa詳解九章算法,1261 CE)is the earliest extant work attributed to Yang Hui.From the thirteenth to the fifteenth century,this work played a crucial role in the circulation and popularization of The Nine Chapters on Mathematical Procedures(Jiuzhang suanshu九章算术).However,the only surviving printed edition of Mathematical Methods is incomplete and contains many mistakes obstructing contemporary researchers'understanding of this work.The "Fangcheng" chapter of The Nine Chapters deals with problems related to solving what today are known as simultaneous sets of linear equations.However,interpreting the text in this chapter of Mathematical Methods and recovering the mathematical practices relating to fangcheng are difficult.Through detailed textual and mathematical analyses,the author of this paper explains Yang Hufs understanding and practice relating to〃the fangcheng method"and"the method of the positive and the negative".This paper includes an appendix that provides a detailed translation of the ambiguous text relating to"the method of the positive and the negative"and gives reasons supporting the interpretation provided here.Yang Hufs understanding of the concepts of"positive"and"negative"and his practice relating to these two concepts may easily be confused with their apparent counterparts in modem mathematics.Also,careful analysis of the mathematical methods in this work reveal that the order of problems in Yang Hufs Reclassifications of Mathematical Methods Explaining in Detail The Nine Chapters([Xiangjie jiuzhang suanfa zuanlei詳解九章算法纂類],namely,the last section of Mathematical Methods)were rearranged according to commentaries to specific methods that appear in Mathematical Methods.Some textual clues referring to the zzprevious question"(qianwen前問)in certain commentaries of Mathematical Methods indeed reflect the order of problems in Reclassifications.Yang Hui made especially detailed commentaries on the problems that he arranged in a sequence that differs with respect to the original order of problems as they appear in the ancient classic work,The Nine Chapters.All these discoveries reveal and serve to prove a close relationship between Yang Hufs Mathematical Methods and his Reclassifications.展开更多
Majority of the population of Sri Lanka does not have modern pipe-born water system especially in rural areas.They depend entirely on deep hand pump tube wells and shallow dug wells for their domestic water requiremen...Majority of the population of Sri Lanka does not have modern pipe-born water system especially in rural areas.They depend entirely on deep hand pump tube wells and shallow dug wells for their domestic water requirements.Most of the shallow dug wells in the dry zone of Sri Lanka go dry during the dry period. So construction of tube wells increasing very rapidly in the dry zone of Sri Lanka.Groundwater potential zone maps are the most essential tool for locating tube wells.Arial photographs,Geographical Information Systems(GIS) data and satellite images have展开更多
Objective:This study aimed to examine whether integrating risk-enhancing factors into the Chinese Society of Car-diology-recommended clinical risk assessment tool(i.e.,the CSC model)for atherosclerotic cardiovascular ...Objective:This study aimed to examine whether integrating risk-enhancing factors into the Chinese Society of Car-diology-recommended clinical risk assessment tool(i.e.,the CSC model)for atherosclerotic cardiovascular disease(ASCVD)might improve 10-year ASCVD risk stratification in Chinese adults.Methods:A total of 4910 Chinese participants who were 50–79 years of age and free of cardiovascular disease in the 2007–2008 Survey from the Chinese Multi-provincial Cohort Study were included.We assessed the updated model’s clinical utility(i.e.,Harrell’s C-index and net reclassification improvement[NRI])by adding risk-enhancing factors individually or the number of risk-enhancing factors to the CSC model,for all individuals or those at intermediate risk.Risk-enhancing factors,including a family history of CVD,triglycerides≥2.3 mmol/L,high-sensitivity C-reactive pro-tein≥2 mg/L,Lipoprotein(a)≥50 mg/dL,non-high-density lipoprotein cholesterol≥4.9 mmol/L,overweight/obesity,and central obesity,were evaluated.ASCVD events were defined as a composite endpoint comprising ischemic stroke and acute coronary heart disease events(including nonfatal acute myocardial infarction and all coronary deaths).Results:During a median 10-year follow-up,449(9.1%)ASCVD events were recorded.Addition of≥2 risk-enhanc-ing factors to the CSC model yielded a significant improvement in the C-index(1.0%,95%confidence interval[CI]:0.2–1.7%)and a modest improvement in the NRI(2.0%,95%CI:-1.2–5.4%)in the total population.For intermediate-risk individuals,particularly individuals at high risk of developing ASCVD,significant improvements in NRI were observed after adding≥2 risk-enhancing factors(17.4%,95%CI:5.6–28.5%)to the CSC model.Conclusions:Addition of≥2 risk-enhancing factors refined 10-year ASCVD risk stratification,particularly for inter-mediate-risk individuals,supporting their potential in helping tailor targeted interventions in clinical practice.展开更多
Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hemat...Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the EmergencyyandCardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024.Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events:low MLR and high MLR group.MLR was defined as the ratio of monocytes to lymphocytes.Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression(including aortic dissection and penetrating aortic ulcers)within 30 days.The receiver operating characteristic(ROC)curve identified the optimal MLR cut-off value.Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days,based on which nomogram models were constructed:the clinical characteristics model and the clinical characteristics-MLR model.The DeLong test was used to evaluate the diagnostic performance of different risk models.The additional predictive value of MLR was assessed using the net reclassification index(NRI)and integrated discrimination improvement(IDI).Results A total of 332 patients were included,of whom 217 were male(65.4%),with an average age of(64.3±9.4)years.A total of 107 aortic-related adverse events occurred during the 30-day follow-up period.The optimal cut-off value for MLR was 0.529.There were 189 cases in the low MLR group(MLR<0.529)and 143 cases in the high MLR group(MLR≥0.529).The rate of aortic-related adverse events was higher in the high MLR group compared to.the low MLR group(44.1%(63/143)vs.23.3%(44/189),P<0.001),mainly due to a higher rate of progression to aortic dissection(9.8%(14/143)vs.1.1%(2/189),P<0.001)and penetrating aortic ulcers(31.5%(45/143)vs.20.6%(39/189),P=0.025).Multivariate analysis identified diabetes(OR=0.25,95%CI 0.08-0.78,P=0.017),anemia(0R=3.45,95%CI 1.28-9.27,P=0.014),maximum descending aorta diameter(0R=1.08,95%CI 1.02-1.15,P=0.007),ulcerlike projections(OR=4.04,95%CI 2.26-7.24,P<0.001),and MLR(0R=6.61,95%CI 2.50-17.46,P<0.001)as independent predictors of aortic-related adverse events during the 30-day follow-up period.The clinical characteristics model includes diabetes,anemia,ulcer-like projections and maximum diameter of the descending aorta,and the clinical characteristics-MLR model includes the above clinical characteristics and MLR.The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone(0.784(95%CI 0.736-0.841)vs.0.742(95%CI0.691-0.788),P=0.031).The continuous NRI was 0.461(95%CI 0.237-0.685,P<0.001)and the IDI was 0.077(95%CI 0.043-0.112,P<0.001),indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy.Conclusion The integration of MLR with other clinical characteristics improves the early identification ofhigh-risk patients with acute uncomplicated type B aortic intramural hematoma,optimizing clinical decisions and improving patient outcomes.展开更多
We provide a detailed review for the statistical analysis of diagnostic accuracy in a multi-category classification task.For qualitative response variables with more than two categories,many traditional accuracy measu...We provide a detailed review for the statistical analysis of diagnostic accuracy in a multi-category classification task.For qualitative response variables with more than two categories,many traditional accuracy measures such as sensitivity,specificity and area under the ROC curve are no longer applicable.In recent literature,new diagnostic accuracy measures are introduced in medical research studies.In this paper,important statistical concepts for multi-category classification accuracy are reviewed and their utilities are demonstrated with real medical examples.We offer problem-based R code to illustrate how to perform these statistical computations step by step.We expect such analysis tools will become more familiar to practitioners and receive broader applications in biostatistics.Our program can be adapted to many classifiers among which logistic regression may be the most popular approach.We thus base our discussion and illustration completely on the logistic regression in this paper.展开更多
基金the Beijing Natural Science Foundation (5052013)the Program of the Excellent Young Scientists of the Ministry of Land Resources(2005)
文摘The generic classification of the family Orthophlebiidae is revised systematically in the present paper. Genera Orthophlebia and Protophlebia are remained in the family Orthophlebiidae while genus Mesophlebia is disassembled, in which the species are ascribed to Orthophlebia if Rs1 at least with 3 branches, and to Protophlebia if Rs1 only with 2 branches. Three subgenera are erected in Orthophlebia and Protophlebia respectively according to the relationship between stems of Rs and MA, i.e. Rs forking earlier or later than MA, or at the same level as MA.
文摘AIM To evaluate the role of small bowel capsule endoscopy(SBCE)on the reclassification of colonic inflammatory bowel disease type unclassified(IBDU).METHODS We performed a multicenter,retrospective study including patients with IBDU undergoing SBCE,between 2002 and 2014.SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score(LS).Inflammatory activity was considered significant and consistent with Crohn's disease(CD)when the LS≥135.The definitive diagnosis during follow-up(minimum 12 mo following SBCE)was based on the combination of clinical,analytical,imaging,endoscopic and histological elements.RESULTS Thirty-six patients were included,21 females(58%)with mean age at diagnosis of 33±13(15-64)years.The mean follow-up time after the SBCE was 52±41(12-156)mo.The SBCE revealed findings consistent with significant inflammatory activity in the small bowel(LS≥135)in 9 patients(25%);in all of them the diagnosis of CD was confirmed during follow-up.In 27 patients(75%),the SBCE revealed no significant inflammatory activity(LS<135);among these patients,the diagnosis of Ulcerative Colitis(UC)was established in 16 cases(59.3%),CD in 1 case(3.7%)and 10 patients(37%)maintained a diagnosis of IBDU during follow-up.A LS≥135 at SBCE had a sensitivity=90%,specificity=100%,positive predictive value=100%and negative predictive value=94%for the diagnosis of CD.CONCLUSION SBCE proved to be fundamental in the reclassification of patients with IBDU.Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94%of cases.
文摘This review revises the reclassification of the mem-branoproliferative glomerulonephritis （MPGN） after the consensus conference that by 2015 reclassified all the glomerulonephritis basing on etiology and patho-genesis, instead of the histomorphological aspects. After reclassification, two types of MPGN are to date recognized： The immunocomplexes mediated MPGN and the complement mediated MPGN. The latter type is more extensively described in the review either because several of these entities are completely new or because the improved knowledge of the complement cascade allowed for new diagnostic and therapeutic approaches. Overall the complement mediated MPGN are related to acquired or genetic cause. The presence of circulating auto antibodies is the principal acquired cause. Genetic wide association studies and family studies allowed to recognize genetic mutations of different types as causes of the complement dysregulation. The complement cascade is a complex phenomenon and activating factors and regulating factors should be distinguished. Genetic mutations causing abnormalities either in activating or in regulating factors have been described. The diagnosis of the complement mediated MPGN requires a complete study of all these different complement factors. As a consequence, new therapeutic approaches are becoming available. Indeed, in addition to a nonspecifc treatment and to the immunosuppression that has the aim to block the auto antibodies production, the specific inhibition of complement activation is relatively new and may act either blocking the C5 convertase or the C3 convertase. The drugs acting on C3 convertase are still in different phases of clinical development and might represent drugs for the future. Overall the authors consider that one of the principal problems in fnding new types of drugs are both the rarity of the disease and the consequent poor interest in the marketing and the lack of large international cooperative studies.
文摘Although Chinese Ditransitive Construction(CDC) and English Ditransitive Construction(EDC) respectively belong to two completely different languages, there do exist many similarities between them. One of the similarities is the diversified classifications of the verbs that enter into them because different scholars, though under different theoretical frameworks, classified the DC verbs on the basis of the lexical meanings of the verbs, which is a boundless category. It is not difficult to find that all the constituents of DC and the construction as a whole interact with each other after the comparison of the similarities between CDC and EDC; the lexical meanings of the verbs that enter into DC do not exist in isolation but interact with the construction sense. Therefore, it may be the best choice to reclassify the DC verbs on the basis of the interaction between the lexical meaning of the verbs and the construction sense.
文摘CHONDRULES are the major constituent of chondrites, but the nature of their origin remains elusive. Models based on nebular settings have attracted much support since Wood suggested that they formed there ascondensates. Subsequently, the melting of dust in the nebula has been widely invoked. Recently,however, models suggesting that chondrules formed in parent body regoliths have been revived, couldhelp to explain the coexistence of chondrules with chemically differentiated clasts The Boxian meteorite is a fall and was originally described as L4. The widely quoted classification of the chondrite is LL4. In this study, 362 chondrules were separated from the Boxian meteorite,and were measured for their grain sizes, masses and morphologies. 101 of these chondrules were successfully split and parts of them made into polished blocks; the remaining segments were individually set asidefor future oxygen isotopic analyses. Mineralogical investigation of the 101 chondrules was performed
基金research projects“Elements of Continuity between Mathematical Writings from the Thirteenth to the Fifteenth Century in China(十三至十五世纪中国数学著作连续性Y950051)”“Transmission of the Knowledge of Science and Technology along the Silk Road(丝绸之路科技知识传播Y921011012,Director:Guo Yuanyuan郭园园)”of the Institute for the History of Natural Sciences,Chinese Academy of Sciences.The paper has been copyedited by John Moffett。
文摘Yang Hui was one of the most important authors of mathematical works during the thirteenth century.Mathematical Methods Explaining in Detail The Nine Chapters(Xiangjie jiuzhang suanfa詳解九章算法,1261 CE)is the earliest extant work attributed to Yang Hui.From the thirteenth to the fifteenth century,this work played a crucial role in the circulation and popularization of The Nine Chapters on Mathematical Procedures(Jiuzhang suanshu九章算术).However,the only surviving printed edition of Mathematical Methods is incomplete and contains many mistakes obstructing contemporary researchers'understanding of this work.The "Fangcheng" chapter of The Nine Chapters deals with problems related to solving what today are known as simultaneous sets of linear equations.However,interpreting the text in this chapter of Mathematical Methods and recovering the mathematical practices relating to fangcheng are difficult.Through detailed textual and mathematical analyses,the author of this paper explains Yang Hufs understanding and practice relating to〃the fangcheng method"and"the method of the positive and the negative".This paper includes an appendix that provides a detailed translation of the ambiguous text relating to"the method of the positive and the negative"and gives reasons supporting the interpretation provided here.Yang Hufs understanding of the concepts of"positive"and"negative"and his practice relating to these two concepts may easily be confused with their apparent counterparts in modem mathematics.Also,careful analysis of the mathematical methods in this work reveal that the order of problems in Yang Hufs Reclassifications of Mathematical Methods Explaining in Detail The Nine Chapters([Xiangjie jiuzhang suanfa zuanlei詳解九章算法纂類],namely,the last section of Mathematical Methods)were rearranged according to commentaries to specific methods that appear in Mathematical Methods.Some textual clues referring to the zzprevious question"(qianwen前問)in certain commentaries of Mathematical Methods indeed reflect the order of problems in Reclassifications.Yang Hui made especially detailed commentaries on the problems that he arranged in a sequence that differs with respect to the original order of problems as they appear in the ancient classic work,The Nine Chapters.All these discoveries reveal and serve to prove a close relationship between Yang Hufs Mathematical Methods and his Reclassifications.
文摘Majority of the population of Sri Lanka does not have modern pipe-born water system especially in rural areas.They depend entirely on deep hand pump tube wells and shallow dug wells for their domestic water requirements.Most of the shallow dug wells in the dry zone of Sri Lanka go dry during the dry period. So construction of tube wells increasing very rapidly in the dry zone of Sri Lanka.Groundwater potential zone maps are the most essential tool for locating tube wells.Arial photographs,Geographical Information Systems(GIS) data and satellite images have
基金This work was supported by the National Natural Science Foundation of China(grant numbers 82073635,82103962,and 12226005)National Key Research and Development Program of China(grant number 2022YFC3602501)+1 种基金Beijing Municipal Medical Research Institutes Pilot Reform Project(grant number 2021-07)Beijing Natural Science Foundation(grant number 7212006).
文摘Objective:This study aimed to examine whether integrating risk-enhancing factors into the Chinese Society of Car-diology-recommended clinical risk assessment tool(i.e.,the CSC model)for atherosclerotic cardiovascular disease(ASCVD)might improve 10-year ASCVD risk stratification in Chinese adults.Methods:A total of 4910 Chinese participants who were 50–79 years of age and free of cardiovascular disease in the 2007–2008 Survey from the Chinese Multi-provincial Cohort Study were included.We assessed the updated model’s clinical utility(i.e.,Harrell’s C-index and net reclassification improvement[NRI])by adding risk-enhancing factors individually or the number of risk-enhancing factors to the CSC model,for all individuals or those at intermediate risk.Risk-enhancing factors,including a family history of CVD,triglycerides≥2.3 mmol/L,high-sensitivity C-reactive pro-tein≥2 mg/L,Lipoprotein(a)≥50 mg/dL,non-high-density lipoprotein cholesterol≥4.9 mmol/L,overweight/obesity,and central obesity,were evaluated.ASCVD events were defined as a composite endpoint comprising ischemic stroke and acute coronary heart disease events(including nonfatal acute myocardial infarction and all coronary deaths).Results:During a median 10-year follow-up,449(9.1%)ASCVD events were recorded.Addition of≥2 risk-enhanc-ing factors to the CSC model yielded a significant improvement in the C-index(1.0%,95%confidence interval[CI]:0.2–1.7%)and a modest improvement in the NRI(2.0%,95%CI:-1.2–5.4%)in the total population.For intermediate-risk individuals,particularly individuals at high risk of developing ASCVD,significant improvements in NRI were observed after adding≥2 risk-enhancing factors(17.4%,95%CI:5.6–28.5%)to the CSC model.Conclusions:Addition of≥2 risk-enhancing factors refined 10-year ASCVD risk stratification,particularly for inter-mediate-risk individuals,supporting their potential in helping tailor targeted interventions in clinical practice.
文摘Objective To develop a nomogram based on the monocyte-to-lymphocyte ratio(MLR)for predicting the risk of aortic-related adverse events within 30 days in patients with acute uncomplicated type B aortic intramural hematoma.Methods This single-center retrospective cohort study screened consecutive patients with acute uncomplicated type B aortic intramural hematoma treated at the EmergencyyandCardiovascular Medicine Departments of the General Hospital of the Northern Theater Command from April 2018 to April 2024.Patients were divided into two groups based on the optimal MLR cut-off value for predicting aortic-related adverse events:low MLR and high MLR group.MLR was defined as the ratio of monocytes to lymphocytes.Aortic-related adverse events were defined as a composite of aortic-related death or aortic intramural hematoma progression(including aortic dissection and penetrating aortic ulcers)within 30 days.The receiver operating characteristic(ROC)curve identified the optimal MLR cut-off value.Multivariate logistic regression was used to identify independent predictors of aortic-related adverse events within 30 days,based on which nomogram models were constructed:the clinical characteristics model and the clinical characteristics-MLR model.The DeLong test was used to evaluate the diagnostic performance of different risk models.The additional predictive value of MLR was assessed using the net reclassification index(NRI)and integrated discrimination improvement(IDI).Results A total of 332 patients were included,of whom 217 were male(65.4%),with an average age of(64.3±9.4)years.A total of 107 aortic-related adverse events occurred during the 30-day follow-up period.The optimal cut-off value for MLR was 0.529.There were 189 cases in the low MLR group(MLR<0.529)and 143 cases in the high MLR group(MLR≥0.529).The rate of aortic-related adverse events was higher in the high MLR group compared to.the low MLR group(44.1%(63/143)vs.23.3%(44/189),P<0.001),mainly due to a higher rate of progression to aortic dissection(9.8%(14/143)vs.1.1%(2/189),P<0.001)and penetrating aortic ulcers(31.5%(45/143)vs.20.6%(39/189),P=0.025).Multivariate analysis identified diabetes(OR=0.25,95%CI 0.08-0.78,P=0.017),anemia(0R=3.45,95%CI 1.28-9.27,P=0.014),maximum descending aorta diameter(0R=1.08,95%CI 1.02-1.15,P=0.007),ulcerlike projections(OR=4.04,95%CI 2.26-7.24,P<0.001),and MLR(0R=6.61,95%CI 2.50-17.46,P<0.001)as independent predictors of aortic-related adverse events during the 30-day follow-up period.The clinical characteristics model includes diabetes,anemia,ulcer-like projections and maximum diameter of the descending aorta,and the clinical characteristics-MLR model includes the above clinical characteristics and MLR.The results of the DeLong test showed that the clinical characteristic-MLR model demonstrated a higher area under the ROC curve compared to the clinical characteristic model alone(0.784(95%CI 0.736-0.841)vs.0.742(95%CI0.691-0.788),P=0.031).The continuous NRI was 0.461(95%CI 0.237-0.685,P<0.001)and the IDI was 0.077(95%CI 0.043-0.112,P<0.001),indicating that the inclusion of the MLR in the model significantly improved the predictive accuracy.Conclusion The integration of MLR with other clinical characteristics improves the early identification ofhigh-risk patients with acute uncomplicated type B aortic intramural hematoma,optimizing clinical decisions and improving patient outcomes.
基金Li’s work was partially supported by National Medical Research Council in Singapore and AcRF R-155-000-174-114.NNSF[grant number 11371142].
文摘We provide a detailed review for the statistical analysis of diagnostic accuracy in a multi-category classification task.For qualitative response variables with more than two categories,many traditional accuracy measures such as sensitivity,specificity and area under the ROC curve are no longer applicable.In recent literature,new diagnostic accuracy measures are introduced in medical research studies.In this paper,important statistical concepts for multi-category classification accuracy are reviewed and their utilities are demonstrated with real medical examples.We offer problem-based R code to illustrate how to perform these statistical computations step by step.We expect such analysis tools will become more familiar to practitioners and receive broader applications in biostatistics.Our program can be adapted to many classifiers among which logistic regression may be the most popular approach.We thus base our discussion and illustration completely on the logistic regression in this paper.
