Background and Objective: Machine learning (ML) has excelled after being introduced into the medical field. Ensemble ML models were able to integrate the advantages of several different ML models. European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was a preoperative risk evaluation model for cardiac operations that was widely used in clinical practice. This study compares the ensemble ML model’s and EuroSCORE II’s performance predicting in-hospital mortality in patients undergoing coronary artery bypass grafting surgery. Methods: 4,764 patients from three heart centers in East China were included in the study. Of these, 3812 patients were assigned to the modeling group, and 952 patients were assigned to the internal test group. Patients from another heart center in East China and a heart center in Northwest China (1733 and 415 cases, respectively) constituted the external test group. The modeling set data are trained using each of the three ML strategies (XGBoost, CatBoost, and LightGBM), and the new model (XCL model) is constructed using an ensemble ML strategy. Performance of different models in the three test groups comparative assessments were performed by calibration, discriminant, decision curve analysis (DCA), net reclassification index (NRI), integrated discriminant improvement (IDI), and Bland-Altman analysis.Results: In terms of discrimination, the XCL model performed the best with an impressive AUC value of 0.914 in the internal validation group. The XCL model continued to perform best in both external test groups. Only the LightGBM model was poorly calibrated among the internal test groups with a P-value equal to 0.005. In the two external test groups, the calibration of all models was fair. EuroSCORE II and the four ML models performed relatively well in agreement among the different test groups. The DCA curves showed that EuroSCORE II performed the worst in the range of 0 to Within a threshold probability of 5%. EuroSCORE II generally performed among the three test groups. The NRI and IDI suggested that the ML model showed positive improvements in all three test groups compared to EuroSCORE II.Conclusions: ML models, especially the ensemble ML model, were no worse than or better than traditional EuroSCORE II in calibration accuracy, discrimination, clinical applicability, and model improvement.
Abstract Background: Osteoarthritis (OA) is a debilitating disease that inflicts intractable pain, a major problem that humanity faces, especially in aging populations. Stem cells have been used in the treatment of many chronic diseases, including OA. Cartilage progenitor cells (CPCs) are a type of stem cells with the ability to self- renew and differentiate. They hold a promising future for the understanding of the progression of OA and for its treatment. Previous studies have reported the relationship between mitochondrial dynamics and mesenchymal stem cell (MSC) proliferation, differentiation and aging. Mitochondrial dynamic and morphology change during stem cell differentiation. Methods: This study was performed to access the relationship between mitochondrial dynamics and chondrogenic differentiation of CPCs. Mitochondrial fusion and fission levels were measured during the chondrogenic differentiation process of CPCs. After that, we used mitochondrial fusion promoter to induce fusion in CPCs and then the chondrogenic markers were measured. Using Transmission Elecron Microscopy (TEM) and confocal microscopy to capture the mass and fusion status of mitochondria. Lentiviruses were used to detect the role of mitofusin 2 (MFN2) in CPC chondrogenic differentiation. In vivo , MNF2 was over-expressed in sheets of rCPCs, which were then injected intra-articularly into the knees of rats. Results: Mitochondrial fusion markers were upregulated during the chondrogenic induction process of CPCs. The mass of mitochondria was higher in differentiated CPC and the fusion status was obvious relative to un-differentiated CPC. Chondrogenesis of CPCs was upregulated with the induction by mitochondrial fusion promoter. MFN2 over-expression significantly increased chondrocyte-specific gene expression and reversed OA through Notch2 signal pathway. Conclusions: Our study demonstrated that the mitochondrial fusion promotes chondrogenesis differentiation of CPCs. MFN2 accelerates the chondrogenesis differentiation of CPCs through Notch2. In vivo , MNF2-OE in sheets of rCPCs ameliorated OA in the rat model.
INTRODUCTION: Alzheimer's disease (AD) involves neurodegeneration, metabolic dysfunction, and proteostasis failure. While amyloid and tau pathology are well studied, the role of metabolic dysregulation as an upstream driver remains unclear. METHODS:We used Drosophila AD models expressing APP and BACE1 under the neuron-specific driver, applying quantitative mass spectrometry (MS) to analyze C99-induced proteomic changes and metabolic disruption. Additional biochemical and imaging analyses were performed to assess mitochondrial function and autophagy. RESULTS: C99 disrupted mitochondrial proteostasis, impairing TCA cycle enzymes, fatty acid oxidation, and lysosomal clearance. Immunoprecipitation confirmed C99's interaction with proteostasis regulators, leading to neurodegenerative stress. DISCUSSION: Our findings extend previous models of AD pathogenesis by demonstrating that C99 impairs lipid metabolism, disrupting ketone availability and neuronal energy balance.
The early diagnosis of laryngeal cancer (LCA) is crucial for prognosis, driving our search for an accurate, precise, and sensitive deep learning model to assist in LCA detection.
Objective To evaluate the quality of clinical literatures related with treatment of lung cancer with combined use of chemotherapy and Chinese herbs in respect of the scientific research design adapted. Methods According to the Scale for Quality and Information Evaluation of TCM Clinical Research Literature formulated by the group of methodology of this article, the literatures related with lung cancer published between 1979 to 2000 were evaluated in respect of the randomization and controlling of the trial. Results The method of randomization was not described in 93.7% of the literatures; problems or mistakes of randomized allocation existed in 2.5%, with no record about the state of dropped out or absconded cases in follow-up study in 29.1%, also no record about case screening was found in all the literatures. Besides, the blind trial method was seldom used, also some problems of key links concerning samples homogeneity and conclusion reasoning presented. All these bugs could influence quality of the randomized control trial. Conclusion Randomized control trial has been applied progressively in TCM clinical researches of lung cancer, however, there are still problems such as insufficiency of samples, and improving of the reliability and quality of the trial is needed.
Pulmonary involvement is a common feature of MPA. Although alveolar hemorrhage is the most common pulmonary manifestation of MPA, a few recent studies have described instances of MPA patients with pulmonary fibrosis. Pulmonary fibrosis was seen to predate, be concomitant with, or occur after the diagnosis of MPA. The goal of this study was to describe the clinical features and prognosis of microscopic polyangiitis (MPA) patients whose initial respiratory presentation was pulmonary fibrosis.We conducted a retrospective analysis of 19 MPA patients who presented with pulmonary fibrosis at Peking Union Medical College Hospital between 1990 and 2012.Of 67 total MPA cases, 19 patients presented with pulmonary fibrosis. There were 8 males and 11 females, with a median age of 63.6 years. Common clinical manifestations included fever (89.5%), cough (84.2%), dyspnea (78.9%) and velcro rales (84.2%). Eleven patients experienced weight loss, several had kidney involvement, and most had an increased erythrocyte sedimentation rate and C-reactive protein. All were positive for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA), with 6 patients being positive at the time of their initial diagnosis of pulmonary fibrosis. Every patient had typical features of usual interstitial pneumonia on High-resolution CT. All were treated with corticosteroids and cyclophosphamide, which lead to an improvement in twelve cases. One of the remaining patients progressed slowly, whereas six died.Patients with MPA, who also presented with pulmonary fibrosis in our cohort, were more likely to be older, female, and have extrapulmonic involvement. Most patients had a delayed positive ANCA. Corticosteroids plus cyclophosphamide was the remission-induction treatment scheme for all cases. The current prognosis for MPA patients with pulmonary fibrosis appears to be poor, suggesting that they may be candidates for new therapies.
The main structures of proximal femur, such as femoral calcar and lesser trochanter, play an important role in anti-flexion and anti-varus. As the proximal femur is rich in blood supply and its fracture rarely leads to nonunion after treatment, surgical treatment has become the first choice for orthopaedists to deal with such fractures. The key to a successful surgery for proximal femoral fracture is to restore the continuity of medial cortex. However, it is still a great challenge how to restore the medial continuity of the proximal femur and its supporting role as well. This article reviews the current progress in research on the proximal femoral medial wall and its supporting fixation in order to provide clinical guidance for orthopaedists treating proximal femoral fractures.
Key words:
Femur; Fractures, bone; Fracture fixation, internal
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)