Comparison of artificial neural network and logistic regression models for predicting mortality in elderly patients with hip fracture

Purpose

Older patients with hip fracture have a mortality rate one year after surgery of 20-30%. The purpose of this study is to establish a predictive model to assess the outcome of surgical treatment in older patients with hip fracture.

Methods

A database of information from 286 consecutive cases of surgery for hip fracture from the Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, was utilised for model building and testing. Both logistic regression and artificial neural network (ANN) models were developed. Cases were randomly assigned to training and testing datasets. A testing dataset was utilised to test the accuracy of both models (n = 89).

Results

The areas under the receiver operator characteristic curves of both models were utilised to compare predictability and accuracy. The logistic regression training and testing datasets had an area of 0.938 (95% CI: 0.904, 0.972) and 0.784 (95% CI: 0.669, 0.899), respectively, below the 0.998 (95% CI: 0.995, 1.000) and 0.949 (95% CI: 0.857, 1.000) of the final ANN model.

Conclusion

Overall, ANNs have higher predictive ability than logistic regression, perhaps because they are not affected by interactions between factors. They may assist in complex decision making in the clinical setting.     

利用胎儿纤连蛋白、宫颈Bishop评分及宫颈超声预测足月妊娠分娩时间研究

目的对胎儿纤连蛋白、Bishop宫颈评分及宫颈超声三种预测宫颈成熟和分娩时间的方法进行比较,旨在寻找一种简便、快捷、客观、有效的预测方法。方法选取37～41周无明显剖宫产指征及合并症的孕妇60例,取宫颈阴道分泌物,运用酶联免疫吸附法（ELISA）测定胎儿纤连蛋白（FFN）的浓度。后行阴道超声测量其宫颈长度,最后行宫颈指检,行Bishop宫颈评分。若常规检查及胎儿生物物理评分无异常,则待其自然临产。观察取样及自然临产的间隔时间、产程时间、分娩方式等。结果宫颈阴道分泌物中的FFN浓度、Bishop宫颈评分、阴道超声与临产时间显著相关,且均能预测1周内临产。其中FFN浓度预测1周内临产的敏感性、特异性、阳性预测值和阴性预测值分别为92％、71％、86％、85％,阴道超声预测1周内临产的敏感性,特异度、阳性预测值和阴性预测值分别为88％、67％、76％、81％,Bishop宫颈评分预测1周内临产的敏感性,特异度、阳性预测值和阴性预测值分别为60％、60％、67％、53％。多因素分析显示,FFN预测价值优于阴道超声,而阴道超声优于Bishop宫颈评分。结论FFN、阴道超声、Bishop评分均能预测分娩时间,FFN是宫颈成熟,分娩启动的客观指标,其预测价值最高,如果将FFN,Bishop宫颈评分,宫颈超声三者结合,将大大提高分娩预测的准确性。     

新辅助化疗对ⅢA期非小细胞肺癌细胞增殖的影响

目的分析新辅助化疗对ⅢA期非小细胞肺癌（non—smallcelllungcancer,NSCLC）肿瘤细胞增殖活性的影响,探讨增殖细胞核抗体（ProliferatingCellNuclearAntigen,PCNA）作为以铂类为基础的化疗方案对NSCLC敏感性的预测指标的可行性。方法采用免疫组织化学SP法,检测78例术前接受过以铂类为基础的新辅助化疗的ⅢA期非小细胞肺癌患者的癌组织中PCNA表达情况,从中筛选出PCNA阳性表达的病例,进一步检测其手术切除组织中PCNA表达情况,计算平均增殖细胞指数（PCNA-labelingindex,PCNA—LI）,比较PCNA（＋）病例新辅助化疗前后平均PCNA—LI的差异;同时观察新辅助化疗的疗效,比较新辅助化疗对PCNA（＋）病例与PCNA（-）病例疾病控制率的差异。结果78例NSCLC病例中,48例PCNA（＋）,30例PCNA（-）;48例PCNA（＋）病例中,新辅助化疗前后其平均PCNA—LI分别为（66．81±6．46）％和（59．71士6．58）％,两者相比,差异无统计学意义（t=5．069,P=0．120）;新辅助化疗对78例NSCLC的疾病控制率为38．5％（30／78）,其中对48例PCNA（＋）病例的疾病控制率为39．6％（19／48）,对30例PCNA（-）病例的疾病控制率为36．7％（11／30）,两者相比,差异无统计学意义（x2=0．066,P=0．816）;在新辅助化疗有效的19例PCNA（＋）病例中,化疗前后其平均PCNA—L1分别为（69．69±5．37）％和（54．79±6．34）％,差异有统计学意义（t=7．582,P=0．032）。结论以铂类为基础的新辅助化疗对化疗敏感的NSCLC的肿瘤细胞增殖活性具有明显的抑制作用,PCNA不能作为NSCLC以铂类为基础的化疗敏感性的预测指标。     

Plasma phospho-tau181 increases with Alzheimer's disease clinical severity and is associated with tau- and amyloid-positron emission tomography

Introduction

We examined and compared plasma phospho-tau181 (pTau181) and total tau: (1) across the Alzheimer's disease (AD) clinical spectrum; (2) in relation to brain amyloid β (Aβ) positron emission tomography (PET), tau PET, and cortical thickness; and (3) as a screening tool for elevated brain Aβ.

天津港国际航行船舶携带医学媒介生物风险分析及预测模型的建立

〔目的〕通过对天津港2006年全年和2007年上半年所有入境船舶资料进行分析,找出导致船舶携带医学媒介生物的危险因素,并建立数学模型,指导在入境船舶上对医学媒介生物的检查,有效防止媒介生物传入我国。〔方法〕利用多种单因素和多因素分析方法对资料进行分析,应用风险分析的理论建立数学模型。〔结果〕研究发现起航港是否疫区、船舶国籍、船舶装载货物类型、航舶到港时间、船舶类型、船舶吨位、船舶船龄7个危险因素,并据此建立了数学模型。〔结论〕本研究建立的国际航行船舶医学媒介生物风险预测模型具有较强的预测能力,分析结果准确可靠,能较好地指导入境船舶媒介生物检疫查验工作。     

Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases

Percutaneous cervical discectomy (PCD) has been developed as an effective treatment option for soft cervical disc herniation. However, no prognostic study of this procedure has yet been made. The purpose of this study was to evaluate the surgical outcome of PCD and to determine the factors predicting excellent outcome. A retrospective review was performed of 111 consecutive patients who underwent PCD with a mean follow-up period of 49.4 months (range, 29–64 months). Under local anesthesia, a percutaneous anterior approach was followed by discectomy with microforceps and endoscopic Ho:YAG laser. The surgical outcomes of the 111 patients based on the Macnab criteria were excellent in 52 patients (46.9%), good in 37 (33.3%), fair in 9 (8.1%), and poor in 13 (11.7%), thereby indicating a symptomatic improvement in 88.3% of the patients. In this study, the two major factors predicting an excellent long-term outcome were the symptom of radiating arm pain (P=0.02) and the location of lateral disc herniation (P<0.02). Proper patient selection remains critical for the success of this minimally invasive procedure.No funds were provided by any commercial source to support this work.     

肌钙蛋白I对非ST段抬高急性冠状动脉综合征低分子肝素抗凝疗效预测价值

目的观察肌钙蛋白I(TnI)对非ST段抬高急性冠状动脉综合征(NSTEACS)低分子肝素抗凝疗效的预测价值。方法起病后24h内就诊住院的160例NSTEACS患者,TnI阳性者或阴性者分别随机分为治疗组和对照组,治疗组予以常规治疗加低分子肝素钙,对照组仅接受常规治疗。随访30d和6个月,观察终点为心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复心绞痛发作住院)发生率。结果随访30d和6个月时分别与对照组比较,TnI阳性治疗组患者因反复心绞痛住院及复合心血管事件发生率均显著降低(P<0.05)。而TnI阴性患者中治疗组与对照组无显著性差异。结论早期低分子肝素干预治疗能减少TnI阳性NSTEACS患者随访期内心血管事件的发生,但不能使TnI阴性患者从中受益。     

c-erbB2、nm23-H1在妊娠滋养细胞疾病中的表达及其临床意义

目的 :探讨癌基因c erbB2和抑癌基因nm2 3 H1在妊娠滋养细胞肿瘤的临床分期及临床主要预后因素不同的情况下表达的差异 ,以期达到对妊娠滋养细胞疾病转归的预测。方法 :采用针对两种基因表达产物的单克隆抗体进行SABC免疫组织化学染色 ,回顾性检测分析 30例不同妊娠期正常胎盘、2 1例葡萄胎、2 1例侵蚀性葡萄胎及 2 0例绒癌中两种基因产物的表达情况。结果 :c erbB2基因在侵蚀性葡萄胎和绒癌中的表达明显高于葡萄胎及妊娠中晚期正常胎盘 ,而nm2 3 H1的表达明显低于葡萄胎及妊娠中晚期正常胎盘 (P <0 0 5 ) ;c erbB2基因在临床Ⅲ、Ⅳ期患者中的表达高于Ⅰ、Ⅱ期患者 ,但差异无统计学意义 ;nm2 3 H1基因产物的高表达与WHO预后评分系统的好的预后因素相一致。结论 :c erbB2的高表达及nm2 3 H1的低表达与葡萄胎恶变紧密相关 ,对于妊娠滋养细胞肿瘤的早期诊断、早期治疗及预后评估具有重要的临床意义。     

Predicting individual risk for medial tibial stress syndrome in navy recruits

Objectives

Quantifying individual risk for medial tibial stress syndrome (MTSS) is valuable due to the high prevalence, substantial financial and service costs, and lengthy recovery time of the condition. Identification of those at risk is a key first step in prevention of the condition. This study aimed to test a suite of best evidence risk factors in a cohort of Navy recruits and to develop a predictive model for individuals at risk of MTSS.

A new episode of low back pain: Who relies on bed rest?

Bed rest has been shown to be an ineffective treatment for non‐specific low back pain (LBP). Despite this, during a new episode of pain some patients still rely on bed rest. Which patients choose bed rest is however unknown. The objectives of the present study were, firstly, to assess characteristics of patients choosing bed rest in (sub)acute pain and secondly to study whether prolonged bed rest in the (sub)acute phase of pain will result in long term disability. A prospective longitudinal cohort study included 282 patients with non‐specific LBP for less than 7 weeks. Main outcome measures were duration of bed rest (in three categories) and disability. Results showed that 33% of patients with (sub)acute LBP had bed rest, but only 8% stayed in bed for more than four days. An ordinal regression analysis revealed that behavioural factors (catastrophizing (OR=1.05 per bed rest category p<0.01)) and fear of injury (OR=1.05 per category p<0.01) rather than specific pain related factors (pain history (OR=0.61 per category p=0.16) and pain intensity (OR=1.00 per category p=0.63)) were associated with bed rest. Patients with prolonged bed rest in an early phase of pain were still more disabled after one year (p<0.01). Based on these results we conclude that prolonged bed rest in the early phase of pain is associated with a higher long term disability level. In preventing low back disability, GP screening for catastrophizing and fear of injury in LBP patients who had prolonged bed rest merits consideration.