目的:全球冠心病(coronary artery heart disease,CHD)发病率居高不下,给公共卫生系统带来了极大的负担和挑战。有效预防和早期诊断CHD成为减轻这一负担的关键策略。本研究致力于探索运用先进的机器学习技术来提高CHD早期筛查和风险评估的准确性。方法:纳入美国国家卫生和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库1999至2018年49490名研究对象,将数据集按7꞉3划分为训练集和测试集。以研究对象是否被告知患有CHD为因变量(输出变量),并以此为依据分为CHD组和非CHD组。通过查阅CHD相关危险因素的文献,最终纳入68个自变量。分析研究对象的变量特征,并比较其在CHD组与非CHD组之间差异。采用机器学习算法随机森林(randomForest_4.7-1.1)和XGBoost(xgboost_1.7.7.1)进行变量选择。综合分析这2种算法识别出的重要性排名前10的变量,选取这2个算法共同认定的变量。使用广义线性模型来分析变量与CHD之间的关系,采用经典的逻辑回归构建CHD风险预测模型。使用受试者操作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)评估模型在区分CHD和非CHD个体方面的能力;采用Hosmer-Lemeshow拟合优度检验进行校准测量,评估预测值与实际CHD比例之间的一致性;应用决策曲线评估模型风险预测的临床益处;采用诺谟图直观展示最终模型风险评分。结果:总人群的年龄为(49.53±18.31)岁,男性占51.8%。与非CHD组相比,CHD组患者的年龄较大[(69.05±11.32)岁vs(48.67±18.07)岁,P<0.001],女性比例更高(67.1%vs 47.4%,P<0.001),且在体重指数、收缩压、舒张压和吸烟等经典心血管危险因素上的差异均有统计学意义(均P<0.001)。此外,CHD组与非CHD组在能量摄入量、维生素E、维生素K、钙、磷、镁、锌、铜、钠、钾、硒等非经典心血管影响因素上的差异也均有统计学意义(均P<0.05)。最终确定了6个与CHD发生最相关的关键变量。并构建CHD风险预测模型如下:logit(p)=−7.783+0.074×年龄+0.003×肌酐−0.003×血小板+0.257×糖化血糖蛋白+0.003×尿酸+0.101×红细胞体积分布宽度变异系数。模型在预测CHD方面表现出优异的判别能力,其准确度为0.712,AUC值为0.841。校准曲线显示在训练集和测试集中,预测概率与实际值之间有良好的一致性,表明模型稳定、可靠。决策曲线表明该模型在不同阈值概率范围内提供了净效益,支持其在临床决策中的应用潜力。结论:本研究利用机器学习技术识别可能的CHD风险因素,并成功开发了一个简洁且实用的临床预测模型。未来需要进一步前瞻性临床队列研究验证其在临床应用中的潜力,使其能够在实际医疗环境中提供有效的心血管疾病预防和干预策略。
作为一种新型的治疗手段,纳秒脉冲电场(Nanosecond Pulse Electric Field,nsPEF)在黑色素瘤治疗中显示出了良好的应用前景。本文综述了nsPEF治疗黑色素瘤在细胞实验、动物实验与人体实验方面的研究进展,指出了nsPEF可通过多种机制诱导...
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作为一种新型的治疗手段,纳秒脉冲电场(Nanosecond Pulse Electric Field,nsPEF)在黑色素瘤治疗中显示出了良好的应用前景。本文综述了nsPEF治疗黑色素瘤在细胞实验、动物实验与人体实验方面的研究进展,指出了nsPEF可通过多种机制诱导黑色素瘤消融,并产生长期抗肿瘤记忆抑制其复发转移,同时具有高度靶向效果,不产生额外热损伤。这些独特优势对于黑色素瘤治疗具有广阔的临床应用前景,为临床治疗黑色素瘤提供了新的思路。
Background:Programmed cell death protein-1(PD-1) inhibitors combination therapy is used as a first-line treatment for advanced cholangiocarcinoma(CCA) in the real ***,whether this works and is safe remains to be *** s...
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Background:Programmed cell death protein-1(PD-1) inhibitors combination therapy is used as a first-line treatment for advanced cholangiocarcinoma(CCA) in the real ***,whether this works and is safe remains to be *** study aims to assess the impact of this treatment on survival of these ***:Patients with advanced CCA receiving first-line PD-1 inhibitors combination therapy at our hospital from September 2020 to April 2022 were enrolled,and October 2022 was cut-off date for the ***-Meier method was used to plot the survival *** Log-Rank method was used for comparison of differences in progression-free survival(PFS) and overall survival(OS) between ***:In all,54 patients with advanced CCA were *** objective response rate(ORR) and disease control rate(DCR) were 16.7% and 79.6%,*** PFS and OS were 6.6(95% CI:3.0-9.3) months and 13.9(95% CI:10.0-17.8) months,respectively.48 patients(88.9%) experienced at least one adverse event(AE) and grade≥3 AEs occurred in 20 patients(37.0%).The most common AEs with a grade of≥3 were neutropenia(n=6,11.1%),anemia(n=6,11.1%),and thrombocytopenia(n=6,11.1%).28 patients(51.9%)developed at least one immune-related adverse event(irAE),the most common of which were hypothyroidism(n=11,20.4%),rash(n=12,22.2%),and pruritus(n=5,9.3%).Four patients(7.4%) developed grade≥3 irAEs,including rash(n=1,1.9%),pruritus(n=1,1.9%),colitis(n=1,1.9%),and pancreatitis(n=1,1.9%).In addition,we found that patients with CEA≤5 ng/ml prior to PD-1 inhibitors combination therapy had longer median PFS(9.0 months vs 4.5 months,P=0.016) and median OS(17.5 months vs 11.3 months,P=0.014) than those with CEA>5 ng/***:In the real world,PD-1 inhibitors combination therapy has shown promising effectiveness with manageable AEs as a first-line treatment for advanced CCA.
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