1.Clinical analysis of 61 cases of imported malaria
Jixiang ZHANG ; Xiaohua DUAN ; Chengze ZHENG ; Jin CHENG ; Chongxin WANG
Chinese Journal of General Practitioners 2011;10(2):126-128
Clinical data of 61 cases of imported malaria were analyzed retrospectively.Patients with malaria were divided into three groups,asymptomatic tertian (vivax) malaria,symptomatic tertian malaria and pernicious (falciparum) malaria.Only mild hepatic damage occurred in some patients with asymptomatic tertian malaria,compared with other groups Symptomatic tertian malaria and pernicious malaria were misdiagnosed in 6 of 20 and three of six,respectively before hospitalization,and 16 of 20 and four of six patients complicated with thrombocytopenia,respectively,and both of them had increased serum level of C-reactive protein (CRP).Platelet count negatively correlated with their serum level of CRP significantly in patients with symptomatic tertian malaria (r =-0.555,P < 0.05).Routine anti-malaria therapy was used in imported malaria,blackwater fever occurred in two patients and acute renal failure occurred in one with falciparum malaria.It is suggested plasmodium exam ination in peripheral blood should be performed in all persons returned from countries prevalent with malaria,thrombocytopenia is an indicator of acute malaria,and more severe complications usually tend to occur in falciparum malaria.
2.Apoptotic Effects of MicroRNA-1 on Hypoxemic Cardiomyocytes
Junyi ZHENG ; Jixiang WANG ; Jianyong XIAO ; Hongliang CONG
Tianjin Medical Journal 2014;(7):641-644
Objective To investigate the apoptotic effect of microRNA-1 (miR-1) on hypoxemic cardiomyocytes. Methods The cultured H9C2 cells were divided into 5 groups:normal control group, negative control group, H2O2 group, miR-1 group and H2O2+miR-1 group. After verified the success of transfection by real time PCR, MTT and flow cytometry methods were used to test the cell vitality and apoptotic rate, while the mRNA and protein expression level of Bcl-2 were de-tected by real time PCR and Western blot methods. Results Compared with normal control group, there were no significant differences in all indexes in negative control group. The application of H2O2 and miR-1 respectively or together significantly increased the miR-1 level and apoptotic rate, and reduced the cell vitality and Bcl-2 expression level. Conclusion mi-croRNA-1 can induce cardiomyocyte apoptosis by downregulating anti-apoptosis factor Bcl-2.
3.The correlation study of cerebral vascular hemo -dynamic index with blood pressure,body mass index etc.in 28 616 outpatients
Xianwen WEI ; Shaoyong LIU ; Zhuangying LUO ; Chengzhi XING ; Changyong DAO ; Jixiang ZHENG
Chinese Journal of Primary Medicine and Pharmacy 2017;24(5):645-650
Objective To explore the correlation study of cerebral vascular hemo -dynamic index(CVHI) with blood pressure,body mass index (BMI)etc.in outpatients.Methods Participants were outpatients with non -invasive CVHI test,who were selected as study subjects.Height,weight,blood pressure and other general information were investigated and the distribution characteristics of blood pressure,BMI and CVHI were compared in different age and gender groups.Results A total of 28 616 subjects were included in the study.The age range was 11 -99 years. Means of CVHI integral score in males and females were (77.78 ±28.44)points and (79.18 ±27.8)points(t =4.275,P <0.01),and abnormality rates of the score(<75 points)were 30.1% and 28.1%(χ2 =13.444,P <0.01),the differences were statistically significant.CVHI score was decreased and the abnormal rate was increased with aging.Systolic blood pressure was elevated with aging and diastolic blood pressure was higher in middle age subjects (40 -65 years).The proportions of over weighted and obesity in male were 37.5% and 15.4%,which in female were 33.2% and 14.9%(χ2 =70.661,P <0.01).It was especially higher in middle age subjects.Conclusion Degree of injury of cerebrovascular function and level of systolic blood pressure are along with aging.Means of BMI and diastolic blood pressure is higher in middle age population.The rate of high risk individuals in outpatients is about 30%.
4.Separate vertical wiring combined with anchor suture for comminuted fractures of the inferior patellar pole
Xiang GAO ; Hui LIU ; Jixiang ZHENG ; Xinlu LI ; Pengfei LIU ; Baolong REN
Chinese Journal of Orthopaedic Trauma 2017;19(2):169-172
Objective To report surgical outcomes of managing comminuted fractures of the inferior patellar pole with separate vertical wiring plus anchor suture fixation.Methods From January 2010 to January 2015,37 patients with comminuted fractures of the inferior patellar pole were treated with separate vertical wiring and anchor suture fixation.They were 15 men and 22 women,from 32 to 76 years of age (average,55.1 years).The intervals from fracture to surgery ranged from 2 to 3 days (average,2.1 days).According to the AO classification,all the fractures were type 34-A1.The visual analogue scale (VAS) scores,ranges of motion (ROM) of the knee,Bostman scores and postoperative complications were recorded at 6 weeks,3,6 and 12 months and the final follow-up postoperatively.Results The follow-up time for the 37 patients averaged 16 months (range,from 12 to 23 months).The fracture union time averaged 10 weeks after surgery (range,from 8 to 13 weeks).At postoperative 6 weeks,3,6 and 12 months and the final follow-up,respectively,the average VAS scores were 2.5,1.1,0.3,0.2 and 0.2 points,the average ranges of motion 109.5°,123.7°,128.6°,129.1° and 132.5°,and the average Bostman scores 23.7,26.9,29.1,29.4 and 29.6 points.No patient reported delayed union,nonunion,loss of reduction,wire breakage,wound problem or irritation from the implant.Conclusion Separate vertical wiring combined with anchor suture fixation is a useful technique for comminuted fractures of the inferior patellar pole,for it is easy to perform,allows early functional exercise and leads to fine curative outcomes.
5.Effects of Electroacupuncture at Baihui (DU20) on Learning and Memory and Expression of Brain-derived Neu-rotrophic Factor in APP/PS1 Double-transgenic Mice
Jixiang CHEN ; Yunan WU ; Yaxuan ZHENG ; Peiyuan ZHUO ; Yingzheng ZHANG ; Lidian CHEN
Chinese Journal of Rehabilitation Theory and Practice 2015;21(6):642-647
Objective To explore the effects of electroacupuncture at Baihui (DU20) acupoint on learning and memory and its possible mechanism through the expression of brain-derived neurotrophic factor (BDNF) in APP/PS1 double-transgenic mice. Methods 30 female APP/PS1 double transgenic mice were randomly divided into model group, DU20 group and non-acupoint group, and 10 wild type mice con-sisted of wild group. DU20 group received electroacupuncture at Baihui and the non-acupoint group received electroacupuncture at non-acu-point for 28 days. Learning and memory was tested by Morris water maze. Deposition ofβ-amyloid (Aβ) peptide was determined by immu-nohistochemical staining. The expression of BDNF in cortex was examined by RT-PCR and Western blotting. Results Compared with the model group, DU20 group ameliorated the learning and memory ability of APP/PS1 double-transgenic mice (P<0.05), decreased the deposi-tion of Aβpeptide (P<0.05) and upregulated the gene and protein levels of BDNF (P<0.01). There was no significant difference between the model group and non-acupoint group (P>0.05). Conclusion Electroacupuncture at DU20 acupoint could ameliorate learning and memory in APP/PS1 double-transgenic mice. The mechanism may be related to increase the expression of BDNF and decrease the deposition of Aβ.
6.Construction of nomogram prediction model for knee joint cartilage injury in patients with anterior cruciate ligament rupture
Jianfeng NI ; Heyuan MENG ; Bao ZHANG ; Jixiang ZHENG
Chinese Journal of Postgraduates of Medicine 2024;47(5):427-433
Objective:To analyze the relevant factors of knee joint cartilage injury in patients with anterior cruciate ligament rupture and construct a nomogram prediction model.Methods:The clinical data of 160 patients with unilateral anterior cruciate ligament rupture who underwent surgical treatment from March 2020 to February 2023 at Tianjin 272 Hospital and the Ninety-Eighty-Third Hospital of the People′s Liberation Army Joint Logistics Support Force were retrospectively analyzed. The patients were divided into injured group (97 cases) and non injured group (63 cases) based on whether there was concurrent knee joint cartilage injury. The optimal cutoff values of each factor were analyzed by the receiver operating characteristic (ROC) curve. Using a multiple Logistic regression model to analyze the independent risk factors of knee joint cartilage injury in patients with anterior cruciate ligament rupture; construct a nomogram model for predicting knee joint cartilage injury in patients with anterior cruciate ligament rupture. The internal validation of the nomogram model was validated using calibration curves, and the predictive performance of the nomogram model is evaluated using decision curves.Results:The body mass index (BMI), rate of meniscus injury, number of sprains and injury time in injured group were significantly higher than those in non injured group: (24.15 ± 2.52) kg/m 2 vs. (22.84 ± 3.13) kg/m 2, 77.32% (75/97) vs. 17.46% (11/63), (2.64 ± 0.90) times vs. (1.17 ± 0.64) times, (19.15 ± 3.77) d vs. (12.92 ± 3.14) d, and there were statistical differences ( P<0.05). The ROC curve analysis results show that the optimal cutoff values for BMI, number of sprains and injury time were 22.9 kg/m 2, once and 16 d, respectively. BMI (>22.9 kg/m 2), meniscus injury (with), number of sprains (>1 time) and injury time (>16 d) were independent risk factors for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and they were also predictive factors for building nomogram model. The internal validation results show that the nomogram model predicts a C-index of 0.819 (95% CI 0.715 to 0.883) for patients with anterior cruciate ligament rupture complicated by knee cartilage injury. The consistency between the observed values and the predicted values was good. The nomogram model predicts a threshold of over 0.14 for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and the clinical net benefits provided by the column chart model were higher than BMI, meniscus injury, number of sprains and injury time. Conclusions:This study constructs a nomogram model based on BMI, meniscus injury, number of sprains, and injury time to predict knee joint cartilage injury in patients with anterior cruciate ligament rupture. The model has good predictive value for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and can be used to identify high-risk patients who are prone to knee joint cartilage injury in patients with anterior cruciate ligament rupture.
7.miR-148b-3p, miR-190b, and miR-429 Regulate Cell Progression and Act as Potential Biomarkers for Breast Cancer
Wenzhu DAI ; Jixiang HE ; Ling ZHENG ; Mingyu BI ; Fei HU ; Minju CHEN ; Heng NIU ; Jingyu YANG ; Ying LUO ; Wenru TANG ; Miaomiao SHENG
Journal of Breast Cancer 2019;22(2):219-236
PURPOSE: Breast cancer is the most frequently diagnosed malignancy in women worldwide. MicroRNAs (miRNAs) are thought to serve as potential biomarkers in various cancers, including breast cancer. METHODS: We evaluated the miRNA expression profiles in 1,083 breast cancer samples and 104 normal breast tissues from The Cancer Genome Atlas database. We used the edgeR package of R software to analyze the differentially expressed miRNAs in normal and cancer tissues, and screened survival-related miRNAs by Kaplan-Meier analysis. A receiver operating characteristic curve was generated to evaluate the accuracy of these miRNAs as molecular markers for breast cancer diagnosis. Furthermore, the functional role of these miRNAs was verified using cell experiments. Targets of candidate miRNAs were predicted using 9 online databases, and Gene Ontology (GO) functional annotation and pathway analyses were conducted using Database for Annotation, Visualization and Integrated Discovery online tool. RESULTS: A total of 68 miRNAs showed significantly different expression patterns between the groups (p < 0.001), and 13 of these miRNAs were significantly associated with poor survival (p < 0.05). Three miRNAs with high specificity and sensitivity, namely, miR-148b-3p, miR-190b, and miR-429, were selected. In vitro experiments showed that the overexpression of these 3 miRNAs significantly promoted the proliferation and migration of MDA-MB-468 and T47D cells and reduced the apoptosis of T47D cells. GO and pathway enrichment analyses revealed that the targets of these dysregulated miRNAs were involved in many critical cancer-related biological processes and pathways. CONCLUSION: The miR-148b-3p, miR-190b, and miR-429 may serve as potential diagnostic and prognostic markers for breast cancer. This study demonstrated the roles of these 3 miRNAs in the initiation and progression of breast cancer.
Apoptosis
;
Biological Phenomena
;
Biological Processes
;
Biomarkers
;
Breast Neoplasms
;
Breast
;
Diagnosis
;
Female
;
Gene Ontology
;
Genome
;
Humans
;
In Vitro Techniques
;
Kaplan-Meier Estimate
;
MicroRNAs
;
ROC Curve
;
Sensitivity and Specificity
8.Multivariate analysis and construction and validation of a nomogram model from data of 1610 patients with non-tumor-related anastomotic stenosis after rectal cancer surgery
Kemao QIU ; Wei JIAN ; Jixiang ZHENG ; Mingyuan FENG ; Xiumin LIU ; Dingshan LU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2024;27(6):600-607
Objective:To assess the risk factors affecting development of non-tumor- related anastomotic stenosis after rectal cancer and to construct a nomogram prediction model.Methods:This was a retrospective study of data of patients who had undergone excision with one-stage intestinal anastomosis for rectal cancer between January 2003 and September 2018 in Nanfang Hospital of Southern Medical University. The exclusion criteria were as follows: (1) pathological examination of the operative specimen revealed residual tumor on the incision margin of the anastomosis; (2) pathological examination of postoperative colonoscopy specimens revealed tumor recurrence at the anastomotic stenosis, or postoperative imaging evaluation and tumor marker monitoring indicated tumor recurrence; (3) follow-up time <3 months; and (4) simultaneous multiple primary cancers. Univariate analysis using the χ 2 or Fisher's exact test was performed to assess the study patients' baseline characteristics and variables such as tumor-related factors and surgical approach ( P<0.05). Multivariate analysis using binary logistic regression was then performed to identify independent risk factors for development of non-tumor-related anastomotic stenosis after rectal cancer. Finally, a nomogram model for predicting non-tumor-related anastomotic stenosis after rectal cancer surgery was constructed using R software. The reliability and accuracy of this prediction model was evaluated using internal validation and calculation of the area under the curve of the model's receiver characteristic curve (ROC). Results:The study cohort comprised 1,610 patients, including 1,008 men and 602 women of median age 59 (50, 67) years and median body mass index 22.4 (20.2, 24.5) kg/m2. Non-tumor-related anastomotic stenosis developed in 121 (7.5%) of these patients. The incidence of non-tumor-related anastomotic stenosis in patients who had undergone neoadjuvant chemotherapy, neoadjuvant radiotherapy, and surgery alone was 11.2% (10/89), 26.4% (47/178), and 4.8% (64/1,343), respectively. Neoadjuvant treatment (neoadjuvant chemotherapy: OR=2.455, 95%CI: 1.148–5.253, P=0.021; neoadjuvant chemoradiotherapy, OR=3.882, 95%CI: 2.425–6.216, P<0.001), anastomotic leakage (OR=7.960, 95%CI: 4.550–13.926, P<0.001), open laparotomy (OR=3.412, 95%CI: 1.772–6.571, P<0.001), and tumor location (distance of tumor from the anal verge 5–10 cm: OR=2.381, 95%CI:1.227–4.691, P<0.001; distance of tumor from the anal verge <5 cm: OR=5.985,95% CI: 3.039–11.787, P<0.001) were identified as independent risk factors for non-tumor-related anastomotic stenosis. Thereafter, a nomogram prediction model incorporating the four identified risk factors for development of anastomotic stenosis after rectal cancer was developed. The area under the curve of the model ROC was 0.815 (0.773–0.857, P<0.001), and the C-index of the predictive model was 0.815, indicating that the model's calibration curve fitted well with the ideal curve. Conclusion:Non-tumor-related anastomotic stenosis after rectal cancer surgery is significantly associated with neoadjuvant treatment, anastomotic leakage, surgical procedure, and tumor location. A nomogram based on these four factors demonstrated good discrimination and calibration, and would therefore be useful for screening individuals at risk of anastomotic stenosis after rectal cancer surgery.
9.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.
10.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.