目的评估基于Kaiser评分的MRI影像特征列线图模型术前预测肿块型乳腺癌脉管侵犯的价值。方法回顾性分析经手术病理证实的345例肿块型浸润性乳腺癌患者临床、病理、影像学和Kaiser评分资料,按照7∶3随机分为训练集(n=242)和验证集(n=103...目的评估基于Kaiser评分的MRI影像特征列线图模型术前预测肿块型乳腺癌脉管侵犯的价值。方法回顾性分析经手术病理证实的345例肿块型浸润性乳腺癌患者临床、病理、影像学和Kaiser评分资料,按照7∶3随机分为训练集(n=242)和验证集(n=103)。应用单因素和多因素Logistic回归模型分析肿块型乳腺癌脉管侵犯的独立危险因素并构建列线图预测模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线评估模型效能。结果单因素Logistic回归分析发现,肿瘤最大直径、Kaiser评分、扩散加权成像信号、形状和相关受侵征象与肿块型乳腺癌脉管侵犯相关(均P<0.05);进一步的多因素Logistic回归分析显示,Kaiser评分≥6分、扩散加权成像高信号、形状不规则和存在相关受侵征象是肿块型乳腺癌脉管侵犯的独立危险因素(均P<0.05)。Kaiser评分联合扩散加权成像信号、形状和相关侵犯征象构建的肿块型乳腺癌脉管侵犯列线图预测模型在训练集和验证集中的ROC曲线下面积(area under the ROC curve,AUC)分别为0.899(95%CI:0.859~0.939)和0.827(95%CI:0.744~0.909);训练集中特异性为0.845,敏感性为0.840;验证集中的特异性为0.787,敏感性为0.750;校准曲线和Hosmer-Lemeshow拟合优度检验结果表明列线图模型一致性较好;临床决策曲线结果显示列线图预测肿块型乳腺癌脉管侵犯可获得较高收益。结论本研究构建的基于Kaiser评分的MRI影像特征列线图模型有助于术前预测肿块型乳腺癌脉管侵犯,并且该模型具有较高的预测效能,可为临床术前评估肿块型乳腺癌脉管侵犯提供参考依据。展开更多
There is increasing evidence that the gut microbiota affects the incidence and progression of central nervous system diseases via the brain-gut axis.The spinal cord is a vital important part of the central nervous sys...There is increasing evidence that the gut microbiota affects the incidence and progression of central nervous system diseases via the brain-gut axis.The spinal cord is a vital important part of the central nervous system;however,the underlying association between spinal cord injury and gut interactions remains unknown.Recent studies suggest that patients with spinal cord injury frequently experience intestinal dysfunction and gut dysbiosis.Alterations in the gut microbiota can cause disruption in the intestinal barrier and trigger neurogenic inflammatory responses which may impede recovery after spinal cord injury.This review summarizes existing clinical and basic research on the relationship between the gut microbiota and spinal cord injury.Our research identified three key points.First,the gut microbiota in patients with spinal cord injury presents a key characteristic and gut dysbiosis may profoundly influence multiple organs and systems in patients with spinal cord injury.Second,following spinal cord injury,weakened intestinal peristalsis,prolonged intestinal transport time,and immune dysfunction of the intestine caused by abnormal autonomic nerve function,as well as frequent antibiotic treatment,may induce gut dysbiosis.Third,the gut microbiota and associated metabolites may act on central neurons and affect recovery after spinal cord injury;cytokines and the Toll-like receptor ligand pathways have been identified as crucial mechanisms in the communication between the gut microbiota and central nervous system.Fecal microbiota transplantation,probiotics,dietary interventions,and other therapies have been shown to serve a neuroprotective role in spinal cord injury by modulating the gut microbiota.Therapies targeting the gut microbiota or associated metabolites are a promising approach to promote functional recovery and improve the complications of spinal cord injury.展开更多
文摘目的评估基于Kaiser评分的MRI影像特征列线图模型术前预测肿块型乳腺癌脉管侵犯的价值。方法回顾性分析经手术病理证实的345例肿块型浸润性乳腺癌患者临床、病理、影像学和Kaiser评分资料,按照7∶3随机分为训练集(n=242)和验证集(n=103)。应用单因素和多因素Logistic回归模型分析肿块型乳腺癌脉管侵犯的独立危险因素并构建列线图预测模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线评估模型效能。结果单因素Logistic回归分析发现,肿瘤最大直径、Kaiser评分、扩散加权成像信号、形状和相关受侵征象与肿块型乳腺癌脉管侵犯相关(均P<0.05);进一步的多因素Logistic回归分析显示,Kaiser评分≥6分、扩散加权成像高信号、形状不规则和存在相关受侵征象是肿块型乳腺癌脉管侵犯的独立危险因素(均P<0.05)。Kaiser评分联合扩散加权成像信号、形状和相关侵犯征象构建的肿块型乳腺癌脉管侵犯列线图预测模型在训练集和验证集中的ROC曲线下面积(area under the ROC curve,AUC)分别为0.899(95%CI:0.859~0.939)和0.827(95%CI:0.744~0.909);训练集中特异性为0.845,敏感性为0.840;验证集中的特异性为0.787,敏感性为0.750;校准曲线和Hosmer-Lemeshow拟合优度检验结果表明列线图模型一致性较好;临床决策曲线结果显示列线图预测肿块型乳腺癌脉管侵犯可获得较高收益。结论本研究构建的基于Kaiser评分的MRI影像特征列线图模型有助于术前预测肿块型乳腺癌脉管侵犯,并且该模型具有较高的预测效能,可为临床术前评估肿块型乳腺癌脉管侵犯提供参考依据。
基金supported by the National Natural Science Foundation of China,Nos.82105019(to YC),82271218(to CZ)Natural Science Foundation of Tianjin Municipality Foundation,No.20JCZDJC00540(to CZ).
文摘There is increasing evidence that the gut microbiota affects the incidence and progression of central nervous system diseases via the brain-gut axis.The spinal cord is a vital important part of the central nervous system;however,the underlying association between spinal cord injury and gut interactions remains unknown.Recent studies suggest that patients with spinal cord injury frequently experience intestinal dysfunction and gut dysbiosis.Alterations in the gut microbiota can cause disruption in the intestinal barrier and trigger neurogenic inflammatory responses which may impede recovery after spinal cord injury.This review summarizes existing clinical and basic research on the relationship between the gut microbiota and spinal cord injury.Our research identified three key points.First,the gut microbiota in patients with spinal cord injury presents a key characteristic and gut dysbiosis may profoundly influence multiple organs and systems in patients with spinal cord injury.Second,following spinal cord injury,weakened intestinal peristalsis,prolonged intestinal transport time,and immune dysfunction of the intestine caused by abnormal autonomic nerve function,as well as frequent antibiotic treatment,may induce gut dysbiosis.Third,the gut microbiota and associated metabolites may act on central neurons and affect recovery after spinal cord injury;cytokines and the Toll-like receptor ligand pathways have been identified as crucial mechanisms in the communication between the gut microbiota and central nervous system.Fecal microbiota transplantation,probiotics,dietary interventions,and other therapies have been shown to serve a neuroprotective role in spinal cord injury by modulating the gut microbiota.Therapies targeting the gut microbiota or associated metabolites are a promising approach to promote functional recovery and improve the complications of spinal cord injury.
