Model

模型
  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fpubh.2023.1136939。].
    [This corrects the article DOI: 10.3389/fpubh.2023.1136939.].
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  • 文章类型: Journal Article
    EUS干预在肝胆胰疾病的治疗中具有越来越重要的作用。然而,程序本身不经常执行,需要专业知识,并且有很高的并发症风险。有了这些限制,动手实践模式对于内镜医师进行EUS干预培训非常重要。EUS干预有各种实践模型,从活体猪模型到全合成模型。尽管生活模型提供了现实的感觉,准备工作很复杂,增加了对人畜共患问题的关注。全合成模型更容易准备和存储,但不现实,仍然需要改进的空间。杂交离体模型是更广泛可用的,并且提供各种训练程序,但仍需要针对猪组织的特殊制备。
    EUS interventions have an increasing role in the treatment for hepatobiliary-pancreatic diseases. However, the procedure itself is not frequently performed, needs expertise, and carries a high risk of complications. With these limitations, the hands-on practice model is very important for the endoscopist in training for EUS intervention. There have been various hands-on models for EUS interventions, ranging from in vivo living pig model to all-synthetic model. Although a living model provides realistic sensation, the preparation is complex and increases concerns for zoonotic issues. All-synthetic models are easier to prepare and store but not realistic and still need the room for improvement. Hybrid ex vivo model is more widely available and provides various training procedures but still needs special preparation for the porcine tissue.
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  • 文章类型: Journal Article
    这篇综述的目的是总结当前宫腔镜训练模型的特点和应用。
    我们对PubMed进行了系统搜索,Embase,和Cochrane图书馆在2024年3月之前发表的合格研究。还进行了参考的手动筛选和引用跟踪。
    报告的宫腔镜训练模型包括虚拟现实模拟器,非生物材料模型,植物组织模型,动物组织模型,和人体组织模型。没有训练模式在现实主义方面明显优越,触觉反馈,操作标准化评分的可用性,准备难度,外科手术的可重用性,和价格。利用任何类型的模型进行宫腔镜模拟培训可以帮助受训者增强相关知识,技能,自信,和舒适,但是虚拟现实模型在训练能力上有优势。
    每种宫腔镜训练模型都有其优缺点。需要适当的培训课程来有效地利用不同模型的优点。需要使用严格设计的研究和标准评估工具来比较各种培训模型的真实性和培训有效性。
    UNASSIGNED: The purpose of this review is to summarize the characteristics and applications of current hysteroscopic training models.
    UNASSIGNED: We conducted a systematic search of PubMed, Embase, and Cochrane Library for eligible studies published before March 2024. Manual screening of references and citation tracking were also performed.
    UNASSIGNED: Reported hysteroscopic training models included virtual reality simulators, non-biological material models, plant tissue models, animal tissue models, and human tissue models. No training model was distinctly superior in terms of realism, haptic feedback, availability of standardized scoring of operations, preparation difficulty, reusability of surgical procedure, and prices. Utilizing any type of models for hysteroscopy simulation training could assist trainees in enhancing relevant knowledge, skills, self-confidence, and comfort, but virtual reality models had an advantage in training capacity.
    UNASSIGNED: Each hysteroscopic training model has its advantages and disadvantages. An appropriate training curriculum is needed to efficiently leverage the merits of different models. The realism and training effectiveness of various training models need to be compared using rigorously designed studies and standard evaluation tools.
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  • 文章类型: Journal Article
    背景:理论,模型和框架(TMF)在实现时很有用,评估和维持医疗保健循证干预措施。然而,为实施项目确定合适的TMF可能具有挑战性。我们开发并测试了在线工具的可用性,以帮助正在进行或支持实施实践活动的个人识别适当的模型和/或框架,以告知他们的工作。
    方法:我们在实施科学和以用户为中心的设计中使用了以模型和证据为指导的方法。工具开发的阶段包括应用对TMF进行范围审查的结果,并与24名研究人员/实施者进行访谈,了解识别和选择TMF的障碍和促进者。根据采访结果,我们按目标对TMF进行了分类,实施阶段,和目标级别的变化,以通知工具的算法。然后,我们对10个最终用户进行了访谈,以测试原型工具的可用性,并管理了系统可用性量表(SUS)。解决了可用性问题并将其纳入该工具。
    结果:我们开发了FindTMF,一个在线工具,由3-4个关于用户实施项目的问题组成。该工具的算法与用户项目的关键特征(目标,舞台,目标更改级别)具有不同TMF的特征,并呈现候选模型/框架列表。来自加拿大或澳大利亚的10个人参加了可用性测试(平均SUS评分84.5,标准差11.4)。总的来说,参与者发现工具很简单,易于使用和视觉上的吸引力与候选模型/框架的有用输出考虑一个实施项目。用户希望获得有关该工具的期望以及如何使用输出表中的信息的其他说明和指导。工具改进包括包含概述工具步骤和输出的概述图,在单个页面上显示工具问题,并阐明结果页面的可用功能,包括添加到词汇表和补充工具的直接链接。
    结论:FindTMF是一种易于使用的在线工具,通过使大量模型和框架更易于访问,可以使支持实施实践活动的个人受益。同时还支持识别和选择相关TMF的一致方法。
    BACKGROUND: Theories, models and frameworks (TMFs) are useful when implementing, evaluating and sustaining healthcare evidence-based interventions. Yet it can be challenging to identify an appropriate TMF for an implementation project. We developed and tested the usability of an online tool to help individuals who are doing or supporting implementation practice activities to identify appropriate models and/or frameworks to inform their work.
    METHODS: We used methods guided by models and evidence on implementation science and user-centered design. Phases of tool development included applying findings from a scoping review of TMFs and interviews with 24 researchers/implementers on barriers and facilitators to identifying and selecting TMFs. Based on interview findings, we categorized the TMFs by aim, stage of implementation, and target level of change to inform the tool\'s algorithm. We then conducted interviews with 10 end-users to test the usability of the prototype tool and administered the System Usability Scale (SUS). Usability issues were addressed and incorporated into the tool.
    RESULTS: We developed Find TMF, an online tool consisting of 3-4 questions about the user\'s implementation project. The tool\'s algorithm matches key characteristics of the user\'s project (aim, stage, target change level) with characteristics of different TMFs and presents a list of candidate models/frameworks. Ten individuals from Canada or Australia participated in usability testing (mean SUS score 84.5, standard deviation 11.4). Overall, participants found the tool to be simple, easy to use and visually appealing with a useful output of candidate models/frameworks to consider for an implementation project. Users wanted additional instruction and guidance on what to expect from the tool and how to use the information in the output table. Tool improvements included incorporating an overview figure outlining the tool steps and output, displaying the tool questions on a single page, and clarifying the available functions of the results page, including adding direct links to the glossary and to complementary tools.
    CONCLUSIONS: Find TMF is an easy-to-use online tool that may benefit individuals who support implementation practice activities by making the vast number of models and frameworks more accessible, while also supporting a consistent approach to identifying and selecting relevant TMFs.
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  • 文章类型: Journal Article
    背景:急诊科拥挤继续威胁患者的安全并导致患者预后不良。先前设计用于预测住院的模型存在偏见。成功估计患者入院概率的预测模型将有助于减少或预防急诊科“登机”和医院“出口障碍”,并通过提前入院和避免旷日持久的床位采购流程来减少急诊科的拥挤。
    目的:通过利用现有的临床描述符,开发一种模型来预测即将从急诊科住院的成年患者在患者就诊早期(即,患者生物标志物)在分诊时常规收集并记录在医院的电子病历中。生物标志物有利于建模,因为它们在分诊时的早期和常规收集;瞬时可用性;标准化定义,测量,和解释;以及他们摆脱患者病史的限制(即,他们不会受到不准确的病史患者报告的影响,不可用的报告,或延迟报告检索)。
    方法:这项回顾性队列研究评估了急诊科成年患者1年的连续数据事件,并开发了一种算法来预测哪些患者需要即将入院。评估了八个预测变量在患者急诊科就诊结果中的作用。采用Logistic回归对研究数据进行建模。
    结果:8预测模型包括以下生物标志物:年龄,收缩压,舒张压,心率,呼吸频率,温度,性别,和敏锐度水平。该模型使用这些生物标志物来识别需要住院的急诊科患者。我们的模型表现很好,观察到的和预测的录取之间有很好的一致性,这表明了一个很好的拟合和校准良好的模型,显示出很好的能力来区分谁会入院和不会入院。
    结论:这个基于主要数据的预测模型确定了急诊科患者入院风险增加。这些可操作的信息可用于改善患者护理和医院运营,特别是通过预测分诊后哪些患者可能入院,从而减少急诊科的拥挤,从而提供所需的信息,以在护理连续体中更早地启动复杂的入院和床位分配过程。
    BACKGROUND: Emergency department crowding continues to threaten patient safety and cause poor patient outcomes. Prior models designed to predict hospital admission have had biases. Predictive models that successfully estimate the probability of patient hospital admission would be useful in reducing or preventing emergency department \"boarding\" and hospital \"exit block\" and would reduce emergency department crowding by initiating earlier hospital admission and avoiding protracted bed procurement processes.
    OBJECTIVE: To develop a model to predict imminent adult patient hospital admission from the emergency department early in the patient visit by utilizing existing clinical descriptors (ie, patient biomarkers) that are routinely collected at triage and captured in the hospital\'s electronic medical records. Biomarkers are advantageous for modeling due to their early and routine collection at triage; instantaneous availability; standardized definition, measurement, and interpretation; and their freedom from the confines of patient histories (ie, they are not affected by inaccurate patient reports on medical history, unavailable reports, or delayed report retrieval).
    METHODS: This retrospective cohort study evaluated 1 year of consecutive data events among adult patients admitted to the emergency department and developed an algorithm that predicted which patients would require imminent hospital admission. Eight predictor variables were evaluated for their roles in the outcome of the patient emergency department visit. Logistic regression was used to model the study data.
    RESULTS: The 8-predictor model included the following biomarkers: age, systolic blood pressure, diastolic blood pressure, heart rate, respiration rate, temperature, gender, and acuity level. The model used these biomarkers to identify emergency department patients who required hospital admission. Our model performed well, with good agreement between observed and predicted admissions, indicating a well-fitting and well-calibrated model that showed good ability to discriminate between patients who would and would not be admitted.
    CONCLUSIONS: This prediction model based on primary data identified emergency department patients with an increased risk of hospital admission. This actionable information can be used to improve patient care and hospital operations, especially by reducing emergency department crowding by looking ahead to predict which patients are likely to be admitted following triage, thereby providing needed information to initiate the complex admission and bed assignment processes much earlier in the care continuum.
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  • 文章类型: Journal Article
    背景:在卫生系统中,医院是提供重要医疗服务的复杂机构。他们的复原能力在减轻灾害的社会影响方面发挥着至关重要的作用。医院必须具备抵御风险的能力,保持其基本结构和运作,并通过增强各种能力并迅速从潜在风险的影响中恢复来增强其准备。它使医院能够达到更高的准备水平。因此,本研究旨在开发一种为医院量身定制的复原力模型,以有效地应对危机和灾难.
    方法:这项混合方法研究于2023年进行了三个阶段:(1)确定影响医院组织韧性的因素,(2)专家小组对影响因素进行评价。(3)遵循标准化流程,我们给个人发放了371份问卷,如大学职员经理和主管,护理经理,和研究单位经理。通过将组分乘以10,得到360(10*36)来确定样品大小。因此,我们选取了371名参与者的样本量.结构方程模型(SEM)被用来检验变量之间的因果关系。使用SPSS25.0和AMOS22软件进行这些步骤。最后,我们确定并提出了最终的模型。我们利用AMOS22,并应用SEM来评估变量之间的相关性,显著性水平为0.05。
    结果:研究结果表明,适当的建模确定了包含36个组件的五个维度。这些维度包括脆弱性,准备,支持管理,响应性和适应性,灾难后的恢复。该模型表现出很好的拟合,如X2/d指数所示,其值为2.202,拟合优度指数(GFI)为0.832,估计均方根误差(RMSEA)为0.057,调整后的比较拟合指数(CFI)为0.931,平滑拟合指数(NFI)为0.901。
    结论:增强医院的复原力对于有效防范和应对事故和灾难至关重要。开发用于测量弹性的本地化工具可以帮助识别漏洞,确保服务连续性,并告知康复计划。所提出的模型是评估医院弹性的合适框架。关键因素包括人力资源稀缺,医院专业化,和创伤中心能力。医院应优先考虑有效的资源分配,信息技术基础设施,在职培训,废物管理,和一个积极的组织框架来建立弹性。通过采用这种方法,医院可以更好地应对危机和灾难,最终减少伤亡,提高整体准备。
    BACKGROUND: In the health system, hospitals are intricate establishments that offer vital medical services. Their resilience plays a crucial role in mitigating the societal repercussions of disasters. A hospital must possess the capacity to withstand risks, preserve its fundamental structure and operations, and enhance its preparedness by augmenting various capabilities and promptly recovering from the impacts of potential risks. It enables the hospital to attain a heightened level of readiness. Therefore, this study aimed to develop a resilience model tailored for hospitals to navigate crises and disasters effectively.
    METHODS: This mixed-method study was conducted in 2023 in three phases: (1) Identification of the factors influencing the organizational resilience of the hospital, (2) Evaluation of the influential factors by an expert panel. (3) Following the standardization process, we administered 371 questionnaires to individuals, such as university staff managers and supervisors, nursing managers, and research unit managers. The sample size was determined by multiplying the components by 10, resulting in 360 (10 * 36). Therefore, we selected a sample size of 371 participants. Structural Equation Modeling (SEM) was employed to examine the causal relationships between variables. These steps were performed using SPSS 25.0 and AMOS 22 software. Finally, we identified and presented the final model. We utilized AMOS 22 and applied the SEM to assess the correlation between the variables, with a significance level of 0.05.
    RESULTS: Findings indicate that the appropriate modeling identified five dimensions comprising 36 components. These dimensions include vulnerability, preparedness, support management, responsiveness and adaptability, and recovery after the disaster. The model demonstrates a good fit, as indicated by the X2/d indices with a value of 2.202, a goodness of fit index (GFI) of 0.832, a root mean square error of estimation (RMSEA) of 0.057, an adjusted comparative fit index (CFI) of 0.931, and a smoothed fit index (NFI) of 0.901.
    CONCLUSIONS: Enhancing hospital resilience is crucial for effective preparedness and response to accidents and disasters. Developing a localized tool for measuring resilience can help identify vulnerabilities, ensure service continuity, and inform rehabilitation programs. The proposed model is a suitable framework for assessing hospital resilience. Key factors include human resource scarcity, hospital specialization, and trauma center capacity. Hospitals should prioritize efficient resource allocation, information technology infrastructure, in-service training, waste management, and a proactive organizational framework to build resilience. By adopting this approach, hospitals can better respond to crises and disasters, ultimately reducing casualties and improving overall preparedness.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    颅骨修补术(CP)的时机已成为研究中广泛争论的话题,目前没有统一的标准。为此,我们建立了一个结局预测模型来探讨影响早期CP结局的因素。我们的目的是为去骨瓣减压术(DC)后颅骨缺损患者是否适合早期CP提供理论和实践依据。
    回顾性收集了2020年1月至2021年12月的90例DC后早期CP患者作为训练组,收集2022年1月至2023年3月的另外52例DC术后早期CP患者作为验证组.通过最小绝对收缩分析和选择算子(LASSO)回归和Logistic回归分析,建立列线图以探索影响早期CP结果的预测因素。采用受试者工作特征(ROC)曲线评价预测模型的区别性。用校正曲线评价数据拟合的准确性,并利用决策曲线分析(DCA)图来评价使用该模型的效益。
    年龄,术前GCS,术前NIHSS,缺陷区域,和从DC到CP的间隔时间是颅骨缺损患者早期CP风险预测模型的预测因子。训练组ROC曲线下面积(AUC)为0.924(95CI:0.867-0.980),验证组的AUC为0.918(95CI,0.842-0.993).Hosmer-Lemeshow拟合测试表明,平均绝对误差很小,而且贴合度很好。决策风险曲线的概率阈值较宽,具有实用价值。
    考虑年龄的预测模型,术前GCS,术前NIHSS,缺陷区域,和间隔时间从DC具有良好的预测能力。
    UNASSIGNED: The timing of cranioplasty (CP) has become a widely debated topic in research, there is currently no unified standard. To this end, we established a outcome prediction model to explore the factors influencing the outcome of early CP. Our aim is to provide theoretical and practical basis for whether patients with skull defects after decompressive craniectomy (DC) are suitable for early CP.
    UNASSIGNED: A total of 90 patients with early CP after DC from January 2020 to December 2021 were retrospectively collected as the training group, and another 52 patients with early CP after DC from January 2022 to March 2023 were collected as the validation group. The Nomogram was established to explore the predictive factors that affect the outcome of early CP by Least absolute shrinkage analysis and selection operator (LASSO) regression and Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the prediction model. Calibration curve was used to evaluate the accuracy of data fitting, and decision curve analysis (DCA) diagram was used to evaluate the benefit of using the model.
    UNASSIGNED: Age, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC to CP were the predictors of the risk prediction model of early CP in patients with skull defects. The area under ROC curve (AUC) of the training group was 0.924 (95%CI: 0.867-0.980), and the AUC of the validation group was 0.918 (95%CI, 0.842-0.993). Hosmer-Lemeshow fit test showed that the mean absolute error was small, and the fit degree was good. The probability threshold of decision risk curve was wide and had practical value.
    UNASSIGNED: The prediction model that considers the age, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC has good predictive ability.
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  • 文章类型: Journal Article
    分析多模态磁共振成像(MRI)图像中定量特征的诊断价值,以构建乳腺癌的放射组学模型。
    将2020年1月至2021年1月95例乳腺相关疾病患者根据病理结果分为良性组(57例)和恶性组(38例)。根据检查时间以7:3的比例将所有病例随机分为训练组(n=66)和验证组(n=29)。所有受试者均进行T1加权成像(T1WI)检查,T2加权成像(T2WI),弥散加权成像(DWI),动态对比度增强(DCE),和表观扩散系数(ADC)多模态MRI。将MRI表现与病理结果进行对比分析。建立了诊断乳腺癌影像组学模型。分析验证组模型的诊断效能,通过ROC曲线分析诊断效能。
    纤维腺瘤占乳腺良性疾病的49.12%,浸润性导管癌占乳腺恶性疾病的73.68%。T1WI的灵敏度,T2WI,DWI,ADC,诊断乳腺癌的DCE为61.14%,66.67%,73.30%,78.95%,85.96%,使用四折表法。T1WI的曲线下面积(AUCs),T2WI,DWI,ADC,诊断乳腺癌的DCE分别为0.715、0.769、0.785、0.835和0.792。普通扫描的AUC,弥漫,增强,平扫+弥漫性扫描,普通扫描+增强,增强+弥漫性,平扫+增强+弥漫性诊断乳腺癌分别为0.746、0.798、0.816、0.839、0.890、0.906和0.927。
    通过多模态MRI图像中的定量特征构建放射组学模型对乳腺癌的诊断具有重要价值。平扫+增强+弥漫性等放射组学模型在乳腺癌诊断中的价值高于其他模型,可广泛应用于临床。
    UNASSIGNED: To analyze the diagnostic value of quantitative features in multimodal magnetic resonance imaging (MRI) images to construct a radio-omics model for breast cancer.
    UNASSIGNED: Ninety-five patients with breast-related diseases from January 2020 to January 2021 were grouped into the benign group (n=57) and malignant group (n=38) according to the pathological findings. All cases were randomized as the training group (n=66) and validation group (n=29) in a 7:3 ratio based on the examination time. All subjects were examined by T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), dynamic contrast enhancement (DCE), and apparent diffusion coefficient (ADC) multimodality MRI. The MRI findings were analyzed against pathological findings. A diagnostic breast cancer radiomics model was constructed. The diagnostic efficacy of the model in the validation group was analyzed, and the diagnostic efficacy was analyzed via the ROC curve.
    UNASSIGNED: Fibroadenoma accounted for 49.12% of benign breast diseases, and invasive ductal carcinoma accounted for 73.68% of malignant breast diseases. The sensitivity of T1WI, T2WI, DWI, ADC, and DCE in diagnosing breast cancer was 61.14%, 66.67%, 73.30%, 78.95%, and 85.96%, using the four-fold table method. The area under the curves (AUCs) of T1WI, T2WI, DWI, ADC, and DCE for diagnosing breast cancer were 0.715, 0.769, 0.785, 0.835, and 0.792, respectively. The AUCs of plain scan, diffuse, enhanced, plain scan + diffuse, plain scan + enhanced, enhanced + diffuse, and plain scan + enhanced + diffuse for diagnosing breast cancer were 0.746, 0.798, 0.816, 0.839, 0.890, 0.906, and 0.927, respectively.
    UNASSIGNED: The construction of a radio-omics model by quantitative features in multimodal MRI images was valuable in the diagnosis of breast cancer. The value of radio-omics models such as plain scan + enhanced + diffuse was higher than the other models in diagnosing breast cancer and could be widely applied in clinical practice.
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  • 文章类型: Journal Article
    背景:自噬对于控制结核病的表现至关重要。这项研究旨在通过基因表达谱分析发现自噬相关的分子簇作为识别儿童潜伏性结核病(LTBI)和活动性结核病(ATB)的生物标志物。
    方法:利用来自基因表达综合(GEO)集合(GSE39939和GSE39940)的公开数据集,在患有LTBI和ATB的儿科患者中检查了自噬调节剂的表达。
    结果:在训练数据集(GSE39939)中,LTBI和ATB患者表现出与其主动免疫反应相关的自噬相关基因的表达.鉴定了两个与自噬相关的分子簇。与簇1相比,簇2通过减少的适应性细胞免疫反应和增强的炎症激活来区分。根据单样本基因集富集分析(ssGSEA)。根据基因集变异的研究,簇2的差异表达基因(DEGs)在合成转移RNA中起作用,DNA修复和重组,和原发性免疫缺陷。峰值变化效率,均方根误差,在随机森林模型中,曲线下面积(AUC)(AUC=0.950)均降低。最后,使用CD247,MAN1C1,FAM84B,HSZFP36、SLC16A10、DTX3和SIRT4基因,它对验证数据集GSE139940(AUC=0.888)表现良好。列线图校准和判定曲线在从LTBI识别ATB方面表现良好。
    结论:总之,根据目前的调查,自噬与TB的免疫病理可能相关。此外,这项研究建立了一个令人信服的预测表达谱来测量自噬亚型发展风险,它可能被用作儿童区分ATB和LTBI的可能生物标志物。
    BACKGROUND: Autophagy is crucial for controlling the manifestation of tuberculosis. This study intends to discover autophagy-related molecular clusters as biomarkers for discriminating between latent tuberculosis (LTBI) and active tuberculosis (ATB) in children through gene expression profile analysis.
    METHODS: The expression of autophagy modulators was examined in pediatric patients with LTBI and ATB utilizing public datasets from the Gene Expression Omnibus (GEO) collection (GSE39939 and GSE39940).
    RESULTS: In a training dataset (GSE39939), patients with LTBI and ATB exhibited the expression of autophagy-related genes connected with their active immune responses. Two molecular clusters associated with autophagy were identified. Compared to Cluster 1, Cluster 2 was distinguished through decreased adaptive cellular immune response and enhanced inflammatory activation, according to single-sample gene set enrichment analysis (ssGSEA). Per the study of gene set variation, Cluster 2\'s differentially expressed genes (DEGs) played a role in synthesizing transfer RNA, DNA repair and recombination, and primary immunodeficiency. The peak variation efficiency, root mean square error, and area under the curve (AUC) (AUC = 0.950) were all lowered in random forest models. Finally, a seven-gene-dependent random forest profile was created utilizing the CD247, MAN1C1, FAM84B, HSZFP36, SLC16A10, DTX3, and SIRT4 genes, which performed well against the validation dataset GSE139940 (AUC = 0.888). The nomogram calibration and decision curves performed well in identifying ATB from LTBI.
    CONCLUSIONS: In summary, according to the present investigation, autophagy and the immunopathology of TB might be correlated. Furthermore, this investigation established a compelling prediction expression profile for measuring autophagy subtype development risks, which might be employed as possible biomarkers in children to differentiate ATB from LTBI.
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