Complicated relationships exist in both occurrence and progression of surgical complications,which are difficult to account for using a separate quantitative method such as prediction or grading.Data of 51,030 surgica...Complicated relationships exist in both occurrence and progression of surgical complications,which are difficult to account for using a separate quantitative method such as prediction or grading.Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China.The relationship between preoperative factors,22 common complications,and death was analyzed.With input from 54 senior clinicians and following a Bayesian network approach,a complication grading,cluster-visualization,and prediction(GCP)system was designed to model pathways between grades of complication and preoperative risk factor clusters.In the GCP system,there were 11 nodes representing six grades of complication and five preoperative risk factor clusters,and 32 arcs representing a direct association.Several critical targets were pinpointed on the pathway.Malnourished status was a fundamental cause widely associated(7/32 arcs)with other risk factor clusters and complications.American Society of Anesthesiologists(ASA)score≥3 was directly dependent on all other risk factor clusters and influenced all severe complications.Grade III complications(mainly pneumonia)were directly dependent on4/5 risk factor clusters and affected all other grades of complication.Irrespective of grade,complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters.展开更多
Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-inco...Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.展开更多
文摘酰胺质子转移(amide proton transfer,APT)成像基础为细胞内游离蛋白及多肽酰胺质子与自由水中的氢质子发生交换,肿瘤恶性程度越高,细胞内游离蛋白质及多肽含量越多,APT信号增高。本文汇总APT成像诊断直肠癌的国内外相关文献,希望将APT成像用于直肠癌临床早期诊断及疗效评估,提高直肠癌患者生存率。国内外文献研究APT成像诊断直肠癌主要集中在以下几个方面:评估直肠癌组织学分级,预测直肠癌化疗疗效,预测大鼠肉瘤病毒癌(Kirsten rat sarcoma,KRAS)基因是否突变,预测直肠癌侵袭性。与常规MRI序列相比,APT成像可以无创性预测直肠癌侵袭性,进一步观察分子生物学改变。APT成像目前最常用于脑部肿瘤,空腔脏器所含成分复杂,因此临床应用受限,故本文汇总相关文献,探索人为均匀磁场方法,将APT成像这一反映蛋白质代谢的分子生物学检查方法用于直肠癌,开辟APT成像临床应用新领域。
基金supported by the National Health and Family Planning Commission of China(201402017)。
文摘Complicated relationships exist in both occurrence and progression of surgical complications,which are difficult to account for using a separate quantitative method such as prediction or grading.Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China.The relationship between preoperative factors,22 common complications,and death was analyzed.With input from 54 senior clinicians and following a Bayesian network approach,a complication grading,cluster-visualization,and prediction(GCP)system was designed to model pathways between grades of complication and preoperative risk factor clusters.In the GCP system,there were 11 nodes representing six grades of complication and five preoperative risk factor clusters,and 32 arcs representing a direct association.Several critical targets were pinpointed on the pathway.Malnourished status was a fundamental cause widely associated(7/32 arcs)with other risk factor clusters and complications.American Society of Anesthesiologists(ASA)score≥3 was directly dependent on all other risk factor clusters and influenced all severe complications.Grade III complications(mainly pneumonia)were directly dependent on4/5 risk factor clusters and affected all other grades of complication.Irrespective of grade,complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters.
文摘Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.
