clinical factors

临床因素
  • 文章类型: Journal Article
    脑胶质瘤的准确预测和分级在评估脑肿瘤的进展中起着至关重要的作用。评估总体预后,和治疗计划。除了神经成像技术,确定可以指导诊断的分子生物标志物,对治疗反应的预测和预测引起了研究人员对它们与机器学习和深度学习模型一起使用的兴趣。该领域的大部分研究都是以模型为中心,这意味着它是基于找到性能更好的算法。然而,在实践中,提高数据质量可以产生更好的模型。这项研究调查了一种以数据为中心的机器学习方法,以确定它们在预测神经胶质瘤等级方面的潜在益处。我们报告了六个性能指标,以提供模型性能的完整图景。实验结果表明,标准化和过度调整少数类增加了四个流行的机器学习模型和两个分类器集成应用于由临床因素和分子生物标记组成的低不平衡数据集的预测性能。实验还表明,两个分类器集成的性能明显优于四个标准预测模型中的三个。此外,我们对神经胶质瘤数据集进行全面的描述性分析,以识别相关的统计特征,并使用四种特征排序算法发现信息最丰富的属性。
    Accurate prediction and grading of gliomas play a crucial role in evaluating brain tumor progression, assessing overall prognosis, and treatment planning. In addition to neuroimaging techniques, identifying molecular biomarkers that can guide the diagnosis, prognosis and prediction of the response to therapy has aroused the interest of researchers in their use together with machine learning and deep learning models. Most of the research in this field has been model-centric, meaning it has been based on finding better performing algorithms. However, in practice, improving data quality can result in a better model. This study investigates a data-centric machine learning approach to determine their potential benefits in predicting glioma grades. We report six performance metrics to provide a complete picture of model performance. Experimental results indicate that standardization and oversizing the minority class increase the prediction performance of four popular machine learning models and two classifier ensembles applied on a low-imbalanced data set consisting of clinical factors and molecular biomarkers. The experiments also show that the two classifier ensembles significantly outperform three of the four standard prediction models. Furthermore, we conduct a comprehensive descriptive analysis of the glioma data set to identify relevant statistical characteristics and discover the most informative attributes using four feature ranking algorithms.
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  • 文章类型: Journal Article
    牙种植体骨折对长期治疗成功构成重大挑战。本系统综述旨在全面检查影响牙种植体骨折(IFs)的临床因素。此外,解决了选择正确类型的植入物和预防这种并发症的策略。在PubMed进行了系统的搜索,Scopus,和WebofScience数据库。符合条件的研究包括回顾性病例对照,前瞻性队列研究,和临床试验。最初的搜索产生了361篇文章,其中312项被排除在这些评论之外,病例报告,无关紧要,或用英语以外的其他语言写的。这留下了49篇文章,只有6人符合深入审查的资格标准。这些研究,所有回顾性病例对照,检查植入物特性,患者人口统计学,手术和假体变量,生物力学和功能因素,临床和程序变量,并发症和维护问题。使用ROBINS-I工具评估偏倚风险较低。主要研究结果表明,植入物直径和结构阻力之间存在相关性,更广泛的植入物显示骨折风险降低。此外,后部区域,尤其是磨牙和前磨牙,由于咀嚼力的增加,对IFs的敏感性更高。植入物的设计和材料可能会显著影响骨折风险,锥形植入物和螺钉保留假体显示出更高的脆弱性。生物力学过载,尤其是磨牙症患者,成为IFs的主要促成因素。假体类型显著影响骨折发生率,悬臂假体由于应力增加而带来更高的风险。种植体周围骨丢失与IFs密切相关,强调需要细致的术前评估和个性化管理策略。未来的研究应该优先考虑更大的和异质的群体与长期随访和标准化的方法,以提高结果的普遍性和可比性。在受控条件下进行随机对照试验和生物力学研究对于阐明导致IFs的复杂相互作用和制定有效的预防策略也至关重要。此外,整合患者报告的结局可以全面了解IFs对生活质量的影响.
    Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies included retrospective case-control, prospective cohort studies, and clinical trials. The initial search yielded 361 articles, of which 312 were excluded being these reviews, case reports, irrelevant, or written in languages other than English. This left 49 articles, with only 6 meeting the eligibility criteria for an in-depth review. These studies, all retrospective case-control, examine implant characteristics, patient demographics, surgical and prosthetic variables, biomechanical and functional factors, clinical and procedural variables, complications and maintenance issues. The risk of bias was assessed as low using the ROBINS-I tool. Key findings suggest a correlation between implant diameter and structural resistance, with wider implants demonstrating reduced fracture risk. Additionally, posterior regions, especially molars and premolars, exhibit higher susceptibility to IFs due to increased masticatory forces. Implant design and material may considerably influence fracture risk, with conical implants and screw-retained prostheses showing higher vulnerability. Biomechanical overload, particularly in patients with bruxism, emerges as a primary contributing factor to IFs. Prosthesis type significantly influences fracture incidence, with cantilever prostheses posing a higher risk due to increased stress. Peri-implant bone loss is strongly associated with IFs, emphasizing the need for meticulous preoperative assessments and individualized management strategies. Future research should prioritize larger and heterogeneous populations with long-term follow-up and standardized methodologies to enhance the generalizability and comparability of findings. Randomized controlled trials and biomechanical studies under controlled conditions are also essential to elucidate the complex interactions contributing to IFs and developing effective prevention strategies. Additionally, integrating patient-reported outcomes may offer a comprehensive understanding of the impact of IFs on quality of life.
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  • 文章类型: Journal Article
    背景:具体的日常行为(例如,目标设定,有意义的活动)与心理健康有关。以更高的频率执行特定的日常动作与抑郁和焦虑的基线症状显着降低相关。以及对抑郁和焦虑的更好的心理治疗结果。
    目的:这项研究探讨了与心理健康相关的特定日常行为的频率在之前可能会有所不同,during,并根据人口统计学和临床特征进行治疗。
    方法:使用来自澳大利亚国家数字心理服务的448名患者的样本,我们根据人口统计学和临床亚组检查了每日行动频率的基线差异和数字心理治疗期间每日行动频率的变化.使用“你做的事情”问卷总共测量了5种特定类型的日常行为:健康的思维,有意义的活动,目标和计划,健康的习惯,和社会关系。
    结果:日常行为的频率根据就业状况(最大P=0.005)和教育水平(最大P=0.004)而有所不同。那些有更严重或慢性抑郁或焦虑症状的参与者的每日行动频率较低(最大P=.004)。参与者报告说,与治疗中期相比,从基线到中期治疗,他们进行这些日常活动的频率增加了更大。抑郁持续时间(P=0.01)和严重程度(P<.001)与治疗期间日常行动频率变化的差异相关。
    结论:这项研究的结果支持继续探索日常行为与心理健康之间关系的研究,这种关系在个体之间可能有什么不同,以及支持个人增加日常行动频率以改善心理健康的临床潜力。
    BACKGROUND: Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety.
    OBJECTIVE: This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics.
    METHODS: Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections.
    RESULTS: The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment.
    CONCLUSIONS: The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health.
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  • 文章类型: English Abstract
    OBJECTIVE: Our aims were to assess cognitive impairment in bipolar patients in remission compared with healthy controls, and to study its connection to clinical and therapeutic factors.
    METHODS: This was a case-control study of patients with bipolar disorder (BD) in remission and matched healthy controls. It was carried out at the Hédi Chaker University Hospital in Sfax, Tunisia. The Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to assess cognitive function in patients and controls. This scale comprises subtests for verbal learning with immediate (VLT-I) and delayed (VLT-D) recall, working memory (WMT), verbal fluency (VFT) and information processing speed (PST).
    RESULTS: We recruited 61 patients and 40 controls. Compared with controls, patients had significantly lower scores on the overall SCIP scale and on all SCIP subtests (p < 0.001 throughout) with moderate to high effects. In multivariate analysis, the presence of psychotic characteristics correlated with lower scores on the overall SCIP (p = 0.001), VLT-I (p = 0.001) and VLT-D (p = 0.007), WMT (p = 0.002) and PST (p = 0.008). Bipolar II correlated with lower LTV-I scores (p = 0.023). Age of onset and duration of the disorder were negatively correlated with PST scores (p < 10-3 and p = 0.007, respectively). Predominantly manic polarity correlated with lower VFT scores (p = 0.007).
    CONCLUSIONS: Our study showed that bipolar patients in remission presented significantly more marked cognitive impairments, affecting various cognitive domains, than the controls. These cognitive impairments appear to be linked to clinical and therapeutic factors that are themselves considered to be factors of poor prognosis in BD.
    OBJECTIVE: Nos objectifs étaient d’évaluer les troubles cognitifs chez des patients bipolaires en rémission comparativement à des témoins sains et d’étudier leur rapport avec les facteurs cliniques et thérapeutiques.
    UNASSIGNED: Il s’agissait d’une étude cas-témoins, menée auprès de patients atteints de trouble bipolaire (TBP) en rémission et de témoins sains appariés. Elle a été réalisée au centre hospitalo-universitaire (CHU) Hédi Chaker de Sfax (Tunisie). L’échelle the Screen for cognitive impairment in psychiatry (SCIP) a été utilisée pour l’évaluation des fonctions cognitives chez les patients et les témoins. Cette échelle se compose des sous-échelles d’apprentissage verbal avec rappel immédiat (VLT-I) et différé (VLT-D), de la mémoire de travail (WMT), de la fluence verbale (VFT) et de la vitesse de traitement de l’information (PST).
    UNASSIGNED: Nous avons recruté 61 patients et 40 témoins. Comparés aux témoins, les cas avaient des scores totaux du SCIP et de toutes les sous-échelles du SCIP significativement plus bas (p < 0,001 partout) avec des tailles d’effet modérées à élevées. Dans l’analyse multivariée, la présence de caractéristiques psychotiques était corrélée à l’abaissement des scores du SCIP total (p = 0,001), du VLT-I (p = 0,001) et VLT-D (p = 0,007), du WMT (p = 0,002), et du PST (p = 0,008). Le TBP de type 2 était corrélé à l’abaissement du score de VLT-I (p = 0,023). L’âge de début et la durée d’évolution du trouble étaient corrélés négativement au score PST (p < 10−3 et p = 0,007 respectivement). La polarité maniaque prédominante était corrélée à l’abaissement du score VFT (p = 0,007).
    CONCLUSIONS: Notre étude a montré que les patients bipolaires en rémission présentaient des troubles cognitifs touchant différents domaines cognitifs, significativement plus marqués que chez les témoins. Ces troubles cognitifs semblent être liés à des facteurs cliniques et thérapeutiques considérés eux-mêmes comme des facteurs de mauvais pronostic de la maladie bipolaire.
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  • 文章类型: Journal Article
    自杀行为是充血性心力衰竭(CCF)的既定精神并发症,对自杀的发病率和死亡有显著的贡献。CCF患者自杀行为的严重程度和危险因素尚未公布,尤其是在尼日利亚等发展中国家。
    为了确定自杀行为的患病率和与自杀行为相关的危险因素,在尼日利亚CCF患者中。
    拉各斯州立大学教学医院心内科门诊,拉各斯,尼日利亚。
    在98名随机选择的诊断为CCF的患者中进行了一项横断面研究。通过社会人口统计学和临床因素问卷和贝克自杀意念量表对参与者进行评估。卡方检验,采用t检验和logistic回归分析。
    CCF患者中自杀意念和自杀企图的发生率分别为52%和1%,分别。没有社会人口统计学因素与自杀意念显着相关。与自杀意念相关的临床因素是诊断时的年龄(p=0.042),CCF的病因(p=0.001)和CCF的严重程度(p=0.032)。只有CCF的严重程度(比值比[OR]=20.557,p=0.014)可以预测CCF患者的自杀意念。
    自杀行为在门诊CCF人群中构成了巨大的负担。确定自杀意念的临床危险因素(诊断时的年龄,CCF的病因和严重程度)进一步阐明了CCF患者死亡的途径。
    这些发现为筛查自杀行为的必要性提供了声音,自杀预防方案,支持CCF患者心理健康的监测系统和政府政策。
    UNASSIGNED: Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria.
    UNASSIGNED: To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria.
    UNASSIGNED: Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria.
    UNASSIGNED: A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data.
    UNASSIGNED: The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF.
    UNASSIGNED: Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF.
    UNASSIGNED: The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.
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  • 文章类型: Journal Article
    马黑色素瘤是灰马的常见肿瘤。然而,关于它们随时间发展的科学知识相当缺乏。一些业主和兽医仍然认为,早期干预是没有必要的,指出肿瘤进化非常缓慢,干预可能会使动物的病情恶化。这项工作旨在确定不同切除间隔(肿瘤检测和手术切除之间的时间)的马黑色素瘤之间可能存在的临床和组织学差异。本研究包括来自34匹马的总共42个肿瘤(13个良性和29个恶性)。切除间隔与肿瘤大小之间存在统计学上的显着关联(p=0.038),切除后的肿瘤明显大于切除后的肿瘤。切除间隔也与肿瘤数量有统计学关联(p=0.011),因为携带肿瘤时间更长的马似乎容易患有多种肿瘤。此外,切除间隔与恶性肿瘤之间存在关联(p=0.035),后来切除的肿瘤是恶性的可能性的五倍。这项研究提供了延迟切除对马黑色素瘤进展的影响的证据。此外,它加强了早期切除这些肿瘤的重要性。
    Equine melanomas are a common neoplasm in gray horses. However, scientific knowledge about their progression over time is quite scarce. Some owners and veterinarians still believe that early intervention is not necessary, stating that tumors evolve very slowly and intervention could worsen the animal\'s condition. This work aims to identify clinical and histological differences that may exist between equine melanomas with different excision intervals (time between tumor detection and surgical excision). A total of 42 tumors (13 benign and 29 malignant) from 34 horses were included in this study. There was a statistically significant association between excision interval and tumor size (p = 0.038), with tumors excised later being significantly larger than the ones excised sooner. The excision interval was also statistically associated with the number of tumors (p = 0.011), since the horses that carried a tumor for longer seemed to be prone to have multiple tumors. Furthermore, there was an association between excision interval and malignancy (p = 0.035), with tumor excised later being fives times more likely to be malignant. This study provides evidence of delayed excision\'s effect on the progression of equine melanomas. Additionally, it reinforces the importance of the early excision of these tumors.
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  • 文章类型: Journal Article
    背景:这项对日本两项临床试验的分析评估了间歇性偏头痛(EM)和慢性偏头痛(CM)患者停用galcanezumab(GMB)后的疗效和安全性。
    方法:数据来自6个月,随机化,双盲,安慰剂[PBO]对照的主要试验(EM患者)和12个月开放标签延伸试验(EM/CM患者).患者接受GMB120mg(GMB120)加240mg负荷剂量或240mg(GMB240)的6个月(主要)或12/18个月(延长)治疗,治疗后随访4个月。疗效评估为治疗后每月偏头痛的天数。通过治疗后紧急不良事件(PTEAE)评估安全性。
    结果:分析人群包括186名来自初级试验的患者(PBON=93;GMB120N=45;GMB240N=48),来自扩展试验的220例EM患者(PBO/GMB120N=57;PBO/GMB240N=55;GMB120/GMB120N=55;GMB240/GMB240N=53),55例CM患者(GMB120N=28;GMB240N=27)。在接受6个月GMB120的EM患者中,平均标准偏差(SD)每月偏头痛天数从治疗结束时的5.69(4.64)增加到随访结束时的6.24(4.37),但没有恢复到治疗前的水平(8.80[2.96])。在延期审判中,接受GMB120的EM患者在12个月后平均每月偏头痛天数为4.13(3.85),随访结束时平均为4.45(3.78),18个月后的3.59(3.48)和随访结束时的3.91(3.57)。CM患者(12个月GMB120)的每月偏头痛天数在治疗结束时为10.71(4.61),在随访结束时为11.17(5.64)(治疗前20.15[4.65])。对于接受GMB240的患者也观察到类似的结果。GMB停药后观察最多的PTEAE是鼻咽炎。
    结论:Galcanezumab在患有EM和CM的日本患者中显示了长达4个月的治疗后疗效。没有观察到意外的安全信号。
    背景:ClinicalTrials.gov,NCT02959177和NCT02959190。
    BACKGROUND: This analysis of two Japanese clinical trials evaluated efficacy and safety after galcanezumab (GMB) discontinuation in patients with episodic migraine (EM) and chronic migraine (CM).
    METHODS: Data were from a 6-month, randomized, double-blind, placebo [PBO]-controlled primary trial (patients with EM) and a 12-month open-label extension trial (patients with EM/CM). Patients received 6 months\' (primary) or 12/18 months\' (extension) treatment with GMB 120 mg (GMB120) plus 240-mg loading dose or 240 mg (GMB240) with 4 months\' post-treatment follow-up. Efficacy was assessed as number of monthly migraine headache days during post-treatment. Safety was assessed via post-treatment-emergent adverse events (PTEAEs).
    RESULTS: The analysis population included 186 patients from the primary trial (PBO N = 93; GMB120 N = 45; GMB240 N = 48), 220 patients with EM from the extension trial (PBO/GMB120 N = 57; PBO/GMB240 N = 55; GMB120/GMB120 N = 55; GMB240/GMB240 N = 53), and 55 patients with CM (GMB120 N = 28; GMB240 N = 27). In patients with EM receiving 6 months\' GMB120, mean standard deviation (SD) monthly migraine headache days increased from 5.69 (4.64) at treatment end to 6.24 (4.37) at end of follow-up but did not return to pre-treatment levels (8.80 [2.96]). In the extension trial, mean monthly migraine headache days in patients with EM receiving GMB120 were 4.13 (3.85) after 12 months and 4.45 (3.78) at end of follow-up, and 3.59 (3.48) after 18 months and 3.91 (3.57) at end of follow-up. Monthly migraine headache days in patients with CM (12 months\' GMB120) were 10.71 (4.61) at treatment end and 11.17 (5.64) at end of follow-up (pre-treatment 20.15 [4.65]). Similar results were seen for patients receiving GMB240. The most observed PTEAE after GMB discontinuation was nasopharyngitis.
    CONCLUSIONS: Galcanezumab exhibited post-treatment efficacy for up to 4 months in Japanese patients with EM and with CM. No unexpected safety signals were observed.
    BACKGROUND: ClinicalTrials.gov, NCT02959177 and NCT02959190.
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  • 文章类型: Systematic Review
    乳腺癌是全球女性癌症相关死亡的主要原因。传统的筛查和风险预测模型主要依靠人口统计学和患者临床病史来制定政策和估计可能性。然而,人工智能(AI)技术的最新进展,特别是深度学习(DL),在开发个性化风险模型方面表现出了希望。这些模型利用从医学成像和相关报告获得的个体患者信息。在这次系统审查中,我们彻底调查了现有的关于DL在数字乳腺X线摄影中应用的文献,影像组学,基因组学,和乳腺癌风险评估的临床信息。我们批判性地分析了这些研究并讨论了他们的发现,强调DL技术预测乳腺癌风险的前景。此外,我们探索了正在进行的研究计划和AI驱动方法的潜在未来应用,以进一步提高乳腺癌风险预测,从而促进更有效的筛选和个性化的风险管理策略。
    本研究全面概述了使用传统和AI模型进行乳腺癌风险预测的成像和非成像特征。这项研究中回顾的特征包括影像学,影像组学,基因组学,和临床特征。此外,这项调查系统地介绍了用于乳腺癌风险预测的DL方法,旨在对初学者和高级研究人员都有用。
    总共确定了600篇文章,其中20个符合设定的标准并被选中。DL模型的并行基准测试,随着自然语言处理(NLP)应用于成像和非成像特征,可以使临床医生和研究人员在考虑临床部署或开发新模型时获得更大的认识。这篇综述为了解使用AI进行乳腺癌风险评估的现状提供了全面的指导。
    这项研究为研究人员提供了一个不同的观点,即使用人工智能进行乳腺癌风险预测。结合了许多成像和非成像特征。
    UNASSIGNED: Breast cancer is the leading cause of cancer-related fatalities among women worldwide. Conventional screening and risk prediction models primarily rely on demographic and patient clinical history to devise policies and estimate likelihood. However, recent advancements in artificial intelligence (AI) techniques, particularly deep learning (DL), have shown promise in the development of personalized risk models. These models leverage individual patient information obtained from medical imaging and associated reports. In this systematic review, we thoroughly investigated the existing literature on the application of DL to digital mammography, radiomics, genomics, and clinical information for breast cancer risk assessment. We critically analyzed these studies and discussed their findings, highlighting the promising prospects of DL techniques for breast cancer risk prediction. Additionally, we explored ongoing research initiatives and potential future applications of AI-driven approaches to further improve breast cancer risk prediction, thereby facilitating more effective screening and personalized risk management strategies.
    UNASSIGNED: This study presents a comprehensive overview of imaging and non-imaging features used in breast cancer risk prediction using traditional and AI models. The features reviewed in this study included imaging, radiomics, genomics, and clinical features. Furthermore, this survey systematically presented DL methods developed for breast cancer risk prediction, aiming to be useful for both beginners and advanced-level researchers.
    UNASSIGNED: A total of 600 articles were identified, 20 of which met the set criteria and were selected. Parallel benchmarking of DL models, along with natural language processing (NLP) applied to imaging and non-imaging features, could allow clinicians and researchers to gain greater awareness as they consider the clinical deployment or development of new models. This review provides a comprehensive guide for understanding the current status of breast cancer risk assessment using AI.
    UNASSIGNED: This study offers investigators a different perspective on the use of AI for breast cancer risk prediction, incorporating numerous imaging and non-imaging features.
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  • 文章类型: Journal Article
    由于个体异质性,特发性膜性肾病(IMN)患者对免疫治疗的敏感性不同.本研究旨在使用深度学习训练建立并验证融合病理和临床特征的模型,以评估IMN患者对免疫抑制治疗的反应。
    将291名患者随机分为训练组(n=219)和验证组(n=72)。以弱监督方式进行补丁级卷积神经网络训练用于分析整个载玻片的组织病理学特征。我们开发了一个机器学习模型来评估与临床因素相比的病理特征的预测价值。在训练和验证测试中,使用受试者工作特征曲线下面积(AUC)评估模型的性能水平,并比较了免疫治疗反应模型的预测准确性。
    多因素分析表明,糖尿病和吸烟是影响IMN患者免疫治疗反应的独立危险因素。整合病理特征的模型对于确定IMN患者对免疫疗法的反应具有良好的预测价值。在培训和测试队列中使用时,AUC为0.85和0.77,分别。然而,当将临床特征纳入模型时,预测功效下降,训练和测试队列的AUC值较低,分别为0.75和0.62,分别。
    与临床因素的整合相比,结合病理学特征的模型显示出用于确定IMN患者对免疫抑制治疗的反应的优越预测能力。
    UNASSIGNED: Owing to individual heterogeneity, patients with idiopathic membranous nephropathy (IMN) exhibit varying sensitivities to immunotherapy. This study aimed to establish and validate a model incorporating pathological and clinical features using deep learning training to evaluate the response of patients with IMN to immunosuppressive therapy.
    UNASSIGNED: The 291 patients were randomly categorized into training (n = 219) and validation (n = 72) cohorts. Patch-level convolutional neural network training in a weakly supervised manner was utilized to analyze whole-slide histopathological features. We developed a machine-learning model to assess the predictive value of pathological signatures compared to clinical factors. The performance levels of the models were evaluated using the area under the receiver operating characteristic curve (AUC) on the training and validation tests, and the prediction accuracies of the models for immunotherapy response were compared.
    UNASSIGNED: Multivariate analysis indicated that diabetes and smoking were independent risk factors affecting the response to immunotherapy in IMN patients. The model integrating pathologic features had a favorable predictive value for determining the response to immunotherapy in IMN patients, with AUCs of 0.85 and 0.77 when employed in the training and test cohorts, respectively. However, when incorporating clinical features into the model, the predictive efficacy diminishes, as evidenced by lower AUC values of 0.75 and 0.62 on the training and testing cohorts, respectively.
    UNASSIGNED: The model incorporating pathological signatures demonstrated a superior predictive ability for determining the response to immunosuppressive therapy in IMN patients compared to the integration of clinical factors.
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  • 文章类型: Journal Article
    目的:生存分析在医学领域对最佳治疗决策起着至关重要的作用。最近,基于深度学习(DL)方法的生存分析已经被提出,并证明了有希望的结果。然而,开发理想的预测模型需要跨多个机构集成大型数据集,这对医疗数据隐私提出了挑战。
    方法:在本文中,我们提议FedSurv,异步联合学习(FL)框架,旨在使用临床信息和基于正电子发射断层扫描(PET)的特征来预测生存时间。这项研究使用了两个数据集:来自癌症成像档案(RNSCLC)的非小细胞肺癌(NSCLC)的公共放射学数据集,和来自韩国忠南国立大学华顺医院(CNUHH)的内部数据集,由NSCLC患者的临床危险因素和F-18氟脱氧葡萄糖(FDG)PET图像组成。最初,每个数据集根据组织学属性分为多个客户,每个客户都使用提出的DL模型进行训练,以预测个体生存时间。FL框架从客户端收集权重和参数,然后被纳入全球模型。最后,全局模型汇总所有权重和参数,并将更新后的模型权重重新分配给每个客户端。我们评估了不同的框架,包括基于单客户的方法,集中学习和FL。
    结果:我们在两个独立的数据集上评估了我们的方法。首先,在RNSCLC数据集上,平均绝对误差(MAE)为490.80±22.95d,C指数为0.69±0.01。第二,在CNUHH数据集上,MAE为494.25±40.16d,C指数为0.71±0.01。FL方法在基于PET的生存时间预测中实现了集中式方法性能,并且优于基于单客户端的方法。
    结论:我们的结果证明了应用FL预测NSCLC患者个体生存的可行性和有效性。使用临床信息和基于PET的特征。
    OBJECTIVE: Survival analysis plays an essential role in the medical field for optimal treatment decision-making. Recently, survival analysis based on the deep learning (DL) approach has been proposed and is demonstrating promising results. However, developing an ideal prediction model requires integrating large datasets across multiple institutions, which poses challenges concerning medical data privacy.
    METHODS: In this paper, we propose FedSurv, an asynchronous federated learning (FL) framework designed to predict survival time using clinical information and positron emission tomography (PET)-based features. This study used two datasets: a public radiogenic dataset of non-small cell lung cancer (NSCLC) from the Cancer Imaging Archive (RNSCLC), and an in-house dataset from the Chonnam National University Hwasun Hospital (CNUHH) in South Korea, consisting of clinical risk factors and F-18 fluorodeoxyglucose (FDG) PET images in NSCLC patients. Initially, each dataset was divided into multiple clients according to histological attributes, and each client was trained using the proposed DL model to predict individual survival time. The FL framework collected weights and parameters from the clients, which were then incorporated into the global model. Finally, the global model aggregated all weights and parameters and redistributed the updated model weights to each client. We evaluated different frameworks including single-client-based approach, centralized learning and FL.
    RESULTS: We evaluated our method on two independent datasets. First, on the RNSCLC dataset, the mean absolute error (MAE) was 490.80±22.95 d and the C-Index was 0.69±0.01. Second, on the CNUHH dataset, the MAE was 494.25±40.16 d and the C-Index was 0.71±0.01. The FL approach achieved centralized method performance in PET-based survival time prediction and outperformed single-client-based approaches.
    CONCLUSIONS: Our results demonstrated the feasibility and effectiveness of employing FL for individual survival prediction in NSCLC patients, using clinical information and PET-based features.
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