Development and validation of artificial intelligence models for preoperative prediction of inferior mesenteric artery lymph nodes metastasis in left colon and rectal cancer

BackgroundDissection of lymph nodes at the roots of the inferior mesenteric artery (IMAN) should be offered only to selected patients at a major risk of developing IMAN involvement. The aim of this study is to present the first artificial intelligence (AI) models to predict IMAN metastasis risk in the left colon and rectal cancer patients.MethodsA total of 2891 patients with descending colon including splenic flexure, sigmoid colon and rectal cancer undergoing major primary surgery and IMAN dissection were included as a study cohort, which was then split into a training set (67%) and a testing set (33%). Feature selection was conducted using the least absolute shrinkage and selection operator (LASSO) regression model. Seven AI algorithms, namely Support Vector Machine (SVM), Logistic Regression (LR), Extreme Gradient Boosting (XGB), Light Gradient Boosting (LGB), Decision Tree Classifier (DTC), Random Forest (RF) classifier, and Multilayer Perceptron (MLP), as well as traditional multivariate LR model were employed to construct predictive models. The optimal hyperparameters were determined with 5 fold cross-validation. The predictive performance of models and the expert surgeon was assessed and compared in the testing set independently.ResultsThe IMAN involvement incidence was 4.6%. The optimal set of features selected by LASSO included 10 characteristics: neoadjuvant treatment, age, synchronous liver metastasis, synchronous lung metastasis, signet ring adenocarcinoma, neural invasion, lymphovascular invasion, CA199, endoscopic obstruction, T stage evaluated by MRI. The most accurate model derived from MLP showed excellent prediction power with area under the receiver operating characteristic curve (AUROC) of 0.873 and produced 81.0% recognition sensitivity and 82.5% specificity in the testing set independently. In contrast, the judgment of IMAN metastasis by expert surgeon yield rather imprecise and unreliable results with a significantly lower AUROC of 0.509. Additionally, the proposed MLP had the highest net benefits and the largest reduction of unnecessary IMAN dissection without the cost of additional involved IMAN missed.ConclusionMLP model was able to maintain its prediction accuracy in the testing set better than other models and expert surgeons. Our MLP model could be used to help identify IMA nodal metastasis and to select candidates for individual IMAN dissection.     

高校实验事故致因模型机理分析的应用研究

实验室安全建设是推进学校实验教学科研改革的基础工程和基本保障,实验事故管理是实验保护管理科学的重要组成部分,它研究实验事故的现象、发生的规律以及隐患转化规律和预防对策,从而达到减少或者消灭实验事故、保证学生及教师安全.高校实验事故致因理论的选择应用研究,主要用于扩大实验室和实验教学示范中心建设过程中安全理论建设视野,在...     

老年高血压病患者尿转铁蛋白/肌酐的相关因素研究

目的：通过筛选老年高血压病（EH）患者尿转铁蛋白/肌酐（TRF/Cr）的相关因素,来寻找减少老年EH患者尿转铁蛋白（TRF）排出的方法。方法：对1058例老年EH患者进行24h动态血压检测、实验室检查、尿TRF和肌酐（Cr）检测,运用Logistic回归分析方法筛选老年EH患者尿TRF/Cr的独立相关因素。结果：老年EH患者尿TRF/Cr的独立相关因素有24hSBP（β=0.029,P=0.007）、高血压病程（β=0.017,P=0.012）、低密度脂蛋白胆固醇（β=0.347,P=0.047）。结论：积极防治高血压病,并降低老年EH患者的低密度脂蛋白胆固醇水平,可能是减少老年EH患者TRF排出的重要方法。     

中心静脉血氧饱和度监测在老年人急性左心衰病情评估中的应用研究

目的：探讨中心静脉血氧饱和度（ ScvO2）检测在老年人急性左心衰临床应用中是否可替代混合静脉血氧饱和度（ SvO2）监测。方法对42例老年急性左心衰患者进行监测,分析治疗前以及治疗后1 h、2 h、4 h的ScvO2、SvO2指标的参数变化情况,根据不同的预后结果对相关监测参数进行统计分析。结果无论患者是生存或是死亡,ScvO2与SvO2两者所代表的趋势是相同的。治疗前检测的ScvO2与SvO2差异无统计学意义（t＝0．867,P＞0．05）,治疗后4 h两者的变化趋势也有一致性,差异无统计学意义（t＝0．681,P＞0．05）。两者的相关系数r＝0．998,且为线性关系,证实两者监测具有相同的临床应用意义。结论综合考虑患者的创伤、并发症、费用等因素,可操作性更强的ScvO2可以用来替代SvO2对老年急性左心衰患者进行临床监测。     

老年高血压患者尿α_1-微球蛋白/肌酐相关因素的研究

目的通过分析老年高血压患者α1-微球蛋白/肌酐(alphal-microglobulin to creatinine ratio,α1-MG/Cr)的独立相关因素,来寻找减少老年高血压患者α1-MG排泄的方法。方法对1054例老年高血压患者进行动态血压检测、实验室检查、α1-MG和Cr检测,运用Logistic回归分析筛选老年高血压患者α1-MG/Cr的独立相关因素。结果老年高血压患者α1-MG/Cr的独立相关因素有24h脉压(β=0.07,P<0.01)、同型半胱氨酸(β=0.04,P<0.01),载脂蛋白AI(β=-1.10,P<0.01)和年龄(β=0.10,P<0.05)。结论降低24h脉压和同型半胱氨酸水平,提高载脂蛋白AI的水平,可能是减少老年高血压患者α1-MG排泄的重要方法。     

不同强度有氧运动对高血压病患者动态血压的影响

目的用平行对照试验比较两种不同强度的有氧运动训练对高血压病患者24h动态血压的影响。方法将28例久坐的高血压病患者随机分为2组，接受8周、强度分别为20%，和60％最大运动能力的有氧运动训练。在试验开始和结束时通过极量踏车运动试验测定运动能力的相关指标，试验开始和结束时分别进行24h动态血压监测。结果2组患者各项动态血压指标均有下降，血压昼夜节律基本一致。结论采用最大运动能力的20％和60％的强度进行有氧训练可以取得相似的降压效果。     

焦虑对妇科良性肿瘤术后康复的影响与护理对策

术后早期活动是预防手术并发症促进早日恢复自理的一项有效的护理措施.护理人员在实施健康教育的反馈评价过程中,发现针对术后早期活动的教育效果呈现出两种不同现象.     

单唾液酸四己糖神经节苷脂钠盐注射液（GM1）治疗椎-基底动脉供血不足疗效观察

目的观察单唾液酸四己糖神经节苷脂钠盐注射液,治疗椎-基底动脉供血不足综合症（VBI）临床疗效观察。方法对TCD显示椎-基底动脉供血不足患者给予单唾液酸四己糖神经节苷脂钠盐注射液药物进行干预性治疗及临床疗效观察,并采用经颅多普勒（TCD）检测治疗前后收缩峰血流速度（Vp）、舒张期末血流速度（Vd）平均血流速度（Vm）以及血管博动指数（PI）观察。结果采用单唾液酸四己糖神经节苷脂钠盐注射液注射液治疗后,46例VBI患者痊愈15.2%,好转78.3%,无效6.5%。左椎动脉（LVA）、右椎动脉（RVA）及基底动脉（BA）的Vp、Vd、Vm及PI治疗前后差异有显著性意义（P〈0.01）。结论单唾液酸四己糖神经节苷脂钠盐注射液对改善VBI患者的临床症状及椎-基底动脉的Vp、Vd、Vm、PI均有显著作用。     

Hepatic resection prolongs overall survival in the selected patients with nasopharyngeal carcinoma liver metastases

BackgroundThe role of surgery in nasopharyngeal carcinoma liver metastases (NCLM) remains elusive, and the current application is limited. We aim to investigate whether hepatic resection (HR) of NCLM improves survival compared with non-hepatic resection (NHR) treatment.MethodsOne hundred and thirty-three patients with NCLM from 2007 to 2017 were divided into two groups. Propensity score matching (PSM) analysis was used to compare the clinical outcomes.ResultsAfter PSM the median overall survival (OS) and the 1, 3 and 5-year OS rates in HR group were 32.60 months, 86.2%, 37.3% and 37.3%, respectively; while for NHR group these values were 19.57 months, 61.5%, 12.9% and 2.9%, respectively (P = 0.008). Multivariate analysis indicated hepatitis B virus infection (P = 0.029) and hepatic resection (P = 0.018) were independent prognostic factors.ConclusionOur study revealed that hepatectomy yields a survival benefit safely compared with systemic treatments, especially for patients with the size of largest metastasis < 5 cm, unilobar distribution of liver tumor and received unanatomical hepatectomy.