1.Treatment Principles and Paradigm of Diabetic Microvascular Complications Responding Specifically to Traditional Chinese Medicine
Anzhu WANG ; Xing HANG ; Lili ZHANG ; Xiaorong ZHU ; Dantao PENG ; Ying FAN ; Min ZHANG ; Wenliang LYU ; Guoliang ZHANG ; Xiai WU ; Jia MI ; Jiaxing TIAN ; Wei ZHANG ; Han WANG ; Yuan XU ; .LI PINGPING ; Zhenyu WANG ; Ying ZHANG ; Dongmei SUN ; Yi HE ; Mei MO ; Xiaoxiao ZHANG ; Linhua ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):272-279
To explore the advantages of traditional Chinese medicine (TCM) and integrative TCM-Western medicine approaches in the treatment of diabetic microvascular complications (DMC), refine key pathophysiological insights and treatment principles, and promote academic innovation and strategic research planning in the prevention and treatment of DMC. The 38th session of the Expert Salon on Diseases Responding Specifically to Traditional Chinese Medicine, hosted by the China Association of Chinese Medicine, was held in Beijing, 2024. Experts in TCM, Western medicine, and interdisciplinary fields convened to conduct a systematic discussion on the pathogenesis, diagnostic and treatment challenges, and mechanism research related to DMC, ultimately forming a consensus on key directions. Four major research recommendations were proposed. The first is addressing clinical bottlenecks in the prevention and control of DMC by optimizing TCM-based evidence evaluation systems. The second is refining TCM core pathogenesis across DMC stages and establishing corresponding "disease-pattern-time" framework. The third is innovating mechanism research strategies to facilitate a shift from holistic regulation to targeted intervention in TCM. The fourth is advancing interdisciplinary collaboration to enhance the role of TCM in new drug development, research prioritization, and guideline formulation. TCM and integrative approaches offer distinct advantages in managing DMC. With a focus on the diseases responding specifically to TCM, strengthening evidence-based support and mechanism interpretation and promoting the integration of clinical care and research innovation will provide strong momentum for the modernization of TCM and the advancement of national health strategies.
2.Effectiveness of modified single patellar tunnel medial patella femoral ligament reconstruction for recurrent patellar dislocation.
Guoliang WANG ; Li LI ; Fan WANG ; Yixiang DAI ; Hua LI ; Qinglü SHI
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(1):20-25
OBJECTIVE:
To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament (MPFL) reconstruction in the treatment of recurrent patellar dislocation.
METHODS:
Between January 2023 and June 2023, a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method. In the patellar anchor group, 31 patients were treated with MPFL reconstruction with double medial patellar anchors, and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel. The femoral ends of both groups were fixed with absorbable compression screws. There was no significant difference in baseline data such as gender, age, side, tibial tubercle-trochlear groove (TT-TG), Q angle, Caton-Deschamps index, number of dislocation, and preoperative Kujala score, preoperative patellar inclination angle ( P>0.05). Patellar tunnel, patellar anchor position, patellar reduction, and the patellar inclination angle were measured by CT scan after operation. Kujala score was used to evaluate the function of knee joint before operation, at 2 weeks and 1, 3, 6, 12 months after operation. Incision aesthetic satisfaction score was performed at 3 months after operation. The signal-to-noise quotient (SNQ) of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups.
RESULTS:
There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy. There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation ( P>0.05). All patients were followed up 12-14 months (mean, 12.8 months). There was 1 case of patellar anchor suture rejection in patellar anchor group, and the wound healed after debridement and dressing change. During the follow-up, there was no complication such as recurrence of patellar dislocation, infection and postoperative stiffness. The Kujala scores of the two groups significantly improved at each time point after 1 month of operation when compared with those before operation ( P<0.05), and the Kujala scores of the two groups returned to normal levels at 3 months after operation. The Kujala score in the patellar tunnel group was significantly higher than that in the patellar anchor group in the very early stage (2 weeks) ( P<0.05), and there was no significant difference between the two groups at other time points ( P>0.05). Patients in the patellar tunnel group were significantly better than those in the patellar anchor group in the score of incision aesthetic satisfaction at 3 months after operation and the SNQ at 12 months after operation ( P<0.05).
CONCLUSION
Modified single patellar tunnel MPFL reconstruction was used to treat patients with recurrent patellar dislocation without pathological TT-TG. The slide-fixation structure formed by single patellar tunnel positioning provides a variable degree of freedom for the reconstructed MPFL, which shows good effectiveness in the very early stage of the rehabilitation process.
Humans
;
Patellar Dislocation/surgery*
;
Male
;
Female
;
Plastic Surgery Procedures/methods*
;
Adult
;
Patellar Ligament/surgery*
;
Recurrence
;
Treatment Outcome
;
Young Adult
;
Adolescent
;
Patella/surgery*
;
Suture Anchors
;
Hamstring Tendons/transplantation*
;
Knee Joint/surgery*
;
Transplantation, Autologous
3.Impact of mean perfusion pressure on the risk of sepsis-associated acute kidney injury.
Linshan YANG ; Wei ZHOU ; Shuyue SHENG ; Guoliang FAN ; Shaolin MA ; Feng ZHU
Chinese Critical Care Medicine 2025;37(4):367-373
OBJECTIVE:
To investigate the relationship between mean perfusion pressure (MPP) and the risk of sepsis-associated acute kidney injury (SA-AKI) and its prognosis, and to determine the optimal cut-off value of MPP for predicting SA-AKI.
METHODS:
A retrospective cohort study was conducted. The clinical data of adult patients with sepsis were collected from the Medical Information Mart for Intensive Care-IV 2.2 (MIMIC-IV 2.2) database. The patients were divided into two groups based on the occurrence of SA-AKI. Baseline characteristics, vital signs, comorbidities, laboratory indicators within 24 hours of intensive care unit (ICU) admission, and clinical outcome indicators were collected. Mean MPP was calculated using the average values of mean arterial pressure (MAP) and central venous pressure (CVP), MPP = MAP-CVP. Cox regression models were constructed, relevant confounding factors were adjusted, and multivariate Logistic regression analysis was used to investigate the associations between MPP and the risk of SA-AKI as well as ICU death. The predictive value of MPP for SA-AKI was evaluated using receiver operator characteristic curve (ROC curve) analysis, and the optimal cut-off value was determined.
RESULTS:
A total of 6 009 patients were ultimately enrolled in the analysis. Among them, SA-AKI occurred in 4 755 patients (79.13%), while 1 254 patients (20.87%) did not develop SA-AKI. Compared with the non-SA-AKI group, the MPP in the SA-AKI group was significantly lowered [mmHg (1 mmHg≈0.133 kPa): 62.00 (57.00, 68.00) vs. 65.00 (60.00, 70.00), P < 0.01], and the ICU mortality was significantly increased [11.82% (562/4 755) vs. 1.59% (20/1 254), P < 0.01]. Three Cox regression models were constructed: model 1 was unadjusted; model 2 was adjusted for gender, age, height, weight and race; model 3 was adjusted for gender, age, height, weight, race, heart rate, respiratory rate, body temperature, hemoglobin, platelet count, white blood cell count, anion gap, HCO3-, blood urea nitrogen, serum creatinine, Cl-, Na+, K+, fibrinogen, international normalized ratio, blood lactic acid, pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, sequential organ failure assessment score, Charlson comorbidity index score, use of vasopressors, mechanical ventilation, and urine output. Multivariate Logistic regression analysis showed that when MPP was treated as a continuous variable, there was a negative correlation between MPP and the risk of SA-AKI in model 1 and model 2 [model 1: odds ratio (OR) = 0.967, 95% confidence interval (95%CI) was 0.961-0.974, P < 0.001; model 2: OR = 0.981, 95%CI was 0.974-0.988, P < 0.001], and also a negative correlation between MPP and the risk of ICU death (model 1: OR = 0.955, 95%CI was 0.945-0.965, P < 0.001; model 2: OR = 0.956, 95%CI was 0.946-0.966, P < 0.001). However, in model 3, there was no significant correlation between MPP and either SA-AKI risk or ICU death risk. when MPP was used as a multi-categorical variable, in model 1 and model 2, referring to MPP ≤ 58 mmHg, when 59 mmHg ≤ MPP ≤ 68 mmHg, as MPP increased, the risk of SA-AKI progressively decreased (OR value was 0.411-0.638, all P < 0.001), and the risk of ICU death also gradually decreased (OR value was 0.334-0.477, all P < 0.001). ROC curve showed that MPP had a certain predictive value for SA-AKI occurrence [area under the ROC curve (AUC) = 0.598, 95%CI was 0.404-0.746], and the optimal cut-off value was 60.5 mmHg.
CONCLUSION
MPP was significantly associated with the risk of SA-AKI, with an optimal cut-off value of 60.5 mmHg, and also demonstrated a significant correlation with the risk of ICU death.
Humans
;
Acute Kidney Injury/physiopathology*
;
Retrospective Studies
;
Sepsis/physiopathology*
;
Middle Aged
;
Prognosis
;
Male
;
Female
;
Aged
;
Risk Factors
;
Intensive Care Units
;
Adult
;
Logistic Models
;
Proportional Hazards Models
4.The value of five scoring systems in evaluating the prognosis of perioperative aortic dissection
Chen LI ; Xingping LYU ; Yezhou SHEN ; Xiaobin LIU ; Wei ZHOU ; Guoliang FAN ; Feng ZHU
Chinese Journal of Thoracic and Cardiovascular Surgery 2025;41(2):91-97
Objective:To determine the best scoring system for assessing the severity of perioperative aortic dissection.Methods:All data were obtained from the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ) database in the United States. The predictive value of the Acute Physiology Score Ⅲ(APS Ⅲ), Oxford Acute Severity of Illness Score (OASIS), Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ), and Charlson Comorbidity Index (CCI) scoring systems were evaluated using the receiver operating characteristic ( ROC) curve. The area under the curve ( AUC) was used to determine the best predictive score, and the ideal cutoff value of the score was calculated based on the Youden index. Patients were divided into high and low groups according to the cutoff value. The Kaplan- Meier curve was used to show the impact on the survival rate of patients with aortic dissection. Results:ROC curve analysis showed that APS Ⅲ( AUC: 0.803, 95% CI: 0.721-0.885) was superior to SAPS Ⅱ( AUC: 0.767, 95% CI: 0.654-0.880), OASIS( AUC: 0.760, 95% CI: 0.635-0.885), SOFA( AUC: 0.753, 95% CI: 0.649-0.857), and CCI( AUC: 0.670, 95% CI: 0.524-0.817) in assessing in-hospital mortality. Based on the ROC curve and the Youden index calculation, the ideal cutoff value of the APS Ⅲ score was 57.5. Kaplan- Meier survival analysis showed that patients in the high group of APS Ⅲ had a shorter 28-day survival time. Patients in the high group of APS Ⅲ had a higher incidence of postoperative complications, and correlation analysis showed that patients in the high group of APS Ⅲ had a longer hospital stay. Conclusion:The APS Ⅲ scoring system is more valuable in predicting the 28-day mortality and prognosis of patients with aortic dissection.
5.Lactylation at K197 site of peroxiredoxin 1 promotes proliferation and migration of glioblastoma cells
Guoliang DUAN ; Qingliang HAN ; Shibing FAN
Chinese Journal of Pathophysiology 2025;41(2):219-229
AIM:To investigate the effects of lactylation at the K197 site of peroxiredoxin 1(PRDX1)on the proliferation and migration of glioblastoma cells.METHODS:(1)Immunofluorescence and lactylation pan-antibody techniques were adopted to compare the differences in PRDX1 lactylation modification level between glioblastoma tissues and adjacent normal tissues.High-throughput mass spectrometry and modificomics analysis were utilized to select PRDX1 protein and its K197 site as the focus.(2)Cell experiments were conducted using lactate(5,10 and 15 mmol/L),glu-cose(5,10 and 25 mmol/L)and glycolysis inhibitor 2-deoxy-D-glucose(2-DG;1,5,10 and 15 mmol/L)to treat human glioblastoma U87MG and LN229 cells.Cell proliferation was detected by EdU proliferation staining,and PRDX1 expres-sion was detected in U87MG,LN229 and glial cells via immunoprecipitation and Western blot.The PRDX1 expression and lactylation levels were further examined in 10 mmol/L lactic acid-treated and untreated cells using immunoprecipita-tion and Western blot.(3)The U87MG and LN229 cells were transfected with constructed lactate dehydrogenase A(LDHA)siRNA(si-LDHA)plasmids and negative control(si-Con)plasmids,and the lactylation level of PRDX1 was as-sessed by immunoprecipitation and Western blot.(4)Similarly,the U87MG and LN229 cells were transfected with PRDX1 shRNA(sh-PRDX1)plasmids and negative control(sh-Con)plasmids,and PRDX1 expression was determined by Western blot.(5)The PRDX1 K197R mutant and PRDX1 wild-type(WT)plasmids were constructed and transfected into U87MG and LN229 cells.The PRDX1 expression and lactylation levels were determined by immunoprecipitation and Western blot.The CCK-8 and EdU assays were used to measure cell viability and proliferation,and Transwell assay was performed to assess the migration of U87MG and LN229 cells transfected with PRDX1 K197R mutant and PRDX1 WT plasmids.(6)A tumor formation model in nude mice was established.The LN229 cells with or without PRDX1 K197R mutation were used in the tumor formation experiment with 6 nude mice per group.After 18 d,the nude mice were eutha-nized,and tumor tissues were harvested.Histological changes were observed by HE staining,the lactylation modification leve was detected by immunofluorescence,and immunohistochemistry method was adopted for checking Ki67,a prolifera-tion marker,in tumor tissues.RESULTS:The PRDX1 level in glioblastoma tissues was significantly higher than that in adjacent tissues(P<0.05).In cell experiments,the addition of lactate and glucose significantly promoted the proliferation and migration of glioblastoma cells and increased the lactylation level of PRDX1(P<0.05).In contrast,the glycolysis in-hibitor 2-DG inhibited these effects.The si-LDHA transfection experiment showed that knockdown of LDHA reduced the lactylation level of PRDX1(P<0.05).Importantly,the K197R point mutation in PRDX1 significantly decreased the lacty-lation level of PRDX1 and inhibited the proliferation and migration of glioblastoma cells(P<0.05).Nude mouse tumori-genesis experiments further confirmed that tumor growth in PRDX1 K197R group was significantly reduced,and the Ki67 proliferation index and lactylation level were decreased(P<0.05).CONCLUSION:Lactoylation at the K197 site of PRDX1 promotes the proliferation and migration of glioblastoma cells.
6.A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma
Zezhen ZHOU ; Liyuan GE ; Fan ZHANG ; Shaohui DENG ; Ye YAN ; Hongxian ZHANG ; Guoliang WANG ; Lei LIU ; Yi HUANG ; Shudong ZHANG
Journal of Peking University(Health Sciences) 2025;57(4):704-710
Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5%vs.15.2%)and segmental renal vein involvement(42.4%vs.20.8%),but lower rates of renal sinus invasion(RSI,21.2%vs.73.6%)and renal vein tumor thrombus(0%vs.15.2%)compared with the RN group(n=394,all P<0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P>0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P<0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P>0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P<0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.
7.A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma
Zezhen ZHOU ; Liyuan GE ; Fan ZHANG ; Shaohui DENG ; Ye YAN ; Hongxian ZHANG ; Guoliang WANG ; Lei LIU ; Yi HUANG ; Shudong ZHANG
Journal of Peking University(Health Sciences) 2025;57(4):704-710
Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5%vs.15.2%)and segmental renal vein involvement(42.4%vs.20.8%),but lower rates of renal sinus invasion(RSI,21.2%vs.73.6%)and renal vein tumor thrombus(0%vs.15.2%)compared with the RN group(n=394,all P<0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P>0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P<0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P>0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P<0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.
8.Lactylation at K197 site of peroxiredoxin 1 promotes proliferation and migration of glioblastoma cells
Guoliang DUAN ; Qingliang HAN ; Shibing FAN
Chinese Journal of Pathophysiology 2025;41(2):219-229
AIM:To investigate the effects of lactylation at the K197 site of peroxiredoxin 1(PRDX1)on the proliferation and migration of glioblastoma cells.METHODS:(1)Immunofluorescence and lactylation pan-antibody techniques were adopted to compare the differences in PRDX1 lactylation modification level between glioblastoma tissues and adjacent normal tissues.High-throughput mass spectrometry and modificomics analysis were utilized to select PRDX1 protein and its K197 site as the focus.(2)Cell experiments were conducted using lactate(5,10 and 15 mmol/L),glu-cose(5,10 and 25 mmol/L)and glycolysis inhibitor 2-deoxy-D-glucose(2-DG;1,5,10 and 15 mmol/L)to treat human glioblastoma U87MG and LN229 cells.Cell proliferation was detected by EdU proliferation staining,and PRDX1 expres-sion was detected in U87MG,LN229 and glial cells via immunoprecipitation and Western blot.The PRDX1 expression and lactylation levels were further examined in 10 mmol/L lactic acid-treated and untreated cells using immunoprecipita-tion and Western blot.(3)The U87MG and LN229 cells were transfected with constructed lactate dehydrogenase A(LDHA)siRNA(si-LDHA)plasmids and negative control(si-Con)plasmids,and the lactylation level of PRDX1 was as-sessed by immunoprecipitation and Western blot.(4)Similarly,the U87MG and LN229 cells were transfected with PRDX1 shRNA(sh-PRDX1)plasmids and negative control(sh-Con)plasmids,and PRDX1 expression was determined by Western blot.(5)The PRDX1 K197R mutant and PRDX1 wild-type(WT)plasmids were constructed and transfected into U87MG and LN229 cells.The PRDX1 expression and lactylation levels were determined by immunoprecipitation and Western blot.The CCK-8 and EdU assays were used to measure cell viability and proliferation,and Transwell assay was performed to assess the migration of U87MG and LN229 cells transfected with PRDX1 K197R mutant and PRDX1 WT plasmids.(6)A tumor formation model in nude mice was established.The LN229 cells with or without PRDX1 K197R mutation were used in the tumor formation experiment with 6 nude mice per group.After 18 d,the nude mice were eutha-nized,and tumor tissues were harvested.Histological changes were observed by HE staining,the lactylation modification leve was detected by immunofluorescence,and immunohistochemistry method was adopted for checking Ki67,a prolifera-tion marker,in tumor tissues.RESULTS:The PRDX1 level in glioblastoma tissues was significantly higher than that in adjacent tissues(P<0.05).In cell experiments,the addition of lactate and glucose significantly promoted the proliferation and migration of glioblastoma cells and increased the lactylation level of PRDX1(P<0.05).In contrast,the glycolysis in-hibitor 2-DG inhibited these effects.The si-LDHA transfection experiment showed that knockdown of LDHA reduced the lactylation level of PRDX1(P<0.05).Importantly,the K197R point mutation in PRDX1 significantly decreased the lacty-lation level of PRDX1 and inhibited the proliferation and migration of glioblastoma cells(P<0.05).Nude mouse tumori-genesis experiments further confirmed that tumor growth in PRDX1 K197R group was significantly reduced,and the Ki67 proliferation index and lactylation level were decreased(P<0.05).CONCLUSION:Lactoylation at the K197 site of PRDX1 promotes the proliferation and migration of glioblastoma cells.
9.The value of five scoring systems in evaluating the prognosis of perioperative aortic dissection
Chen LI ; Xingping LYU ; Yezhou SHEN ; Xiaobin LIU ; Wei ZHOU ; Guoliang FAN ; Feng ZHU
Chinese Journal of Thoracic and Cardiovascular Surgery 2025;41(2):91-97
Objective:To determine the best scoring system for assessing the severity of perioperative aortic dissection.Methods:All data were obtained from the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ) database in the United States. The predictive value of the Acute Physiology Score Ⅲ(APS Ⅲ), Oxford Acute Severity of Illness Score (OASIS), Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score Ⅱ(SAPS Ⅱ), and Charlson Comorbidity Index (CCI) scoring systems were evaluated using the receiver operating characteristic ( ROC) curve. The area under the curve ( AUC) was used to determine the best predictive score, and the ideal cutoff value of the score was calculated based on the Youden index. Patients were divided into high and low groups according to the cutoff value. The Kaplan- Meier curve was used to show the impact on the survival rate of patients with aortic dissection. Results:ROC curve analysis showed that APS Ⅲ( AUC: 0.803, 95% CI: 0.721-0.885) was superior to SAPS Ⅱ( AUC: 0.767, 95% CI: 0.654-0.880), OASIS( AUC: 0.760, 95% CI: 0.635-0.885), SOFA( AUC: 0.753, 95% CI: 0.649-0.857), and CCI( AUC: 0.670, 95% CI: 0.524-0.817) in assessing in-hospital mortality. Based on the ROC curve and the Youden index calculation, the ideal cutoff value of the APS Ⅲ score was 57.5. Kaplan- Meier survival analysis showed that patients in the high group of APS Ⅲ had a shorter 28-day survival time. Patients in the high group of APS Ⅲ had a higher incidence of postoperative complications, and correlation analysis showed that patients in the high group of APS Ⅲ had a longer hospital stay. Conclusion:The APS Ⅲ scoring system is more valuable in predicting the 28-day mortality and prognosis of patients with aortic dissection.
10.Effect of AI-CAD assisting doctors with different seniority in CT image interpretation to predict the enlargement of hematoma in early stage of cerebral hemorrhage
Wei WEI ; Wenjing FAN ; Xin CHEN ; Zheming ZHANG ; Guoliang LI ; Dong CHEN
Chinese Journal of Arteriosclerosis 2024;32(5):429-436
Aim To investigate the effect of artificial intelligence(AI)assisting doctors with different seniority in predicting the enlargement of hematoma in the early stage of cerebral hemorrhage.Methods A total of 108 patients diagnosed with cerebral hemorrhage in Central Hospital Affiliated to Dalian University of Technology were retrospectively collected.CT images at admission and 24 hours after admission were collected.DICOM images obtained from plain CT scan were input into AI-CAD model developed by Biomind in collaboration with Temple of Heaven.A total of 9 doctors of different senior-level were selected in neurosurgery department of our hospital.Firstly,independent prediction was applied in the patients and then the study predicted whether patients would delelop hematoma enlargement within 24 hours combined with the results of auxiliary AI.The accuracy of independent prediction of doctors with different seniority and assisted AI prediction of aneurysm stability was calculated respectively.McNemar of paired samples was used to test the significance of difference between independent prediction coincidence rate and assisted AI prediction accuracy among differ-ent doctors.Results The accuracy of high,middle and low seniority doctors independently predicting the early expan-sion of cerebral hemorrhage was 58.95%,50.62%and 38.89%,respectively,and the accuracy of prediction was signifi-cantly improved after assisted AI(P<0.001),the highest increase rate was low seniority doctors(25.92%),followed by middle seniority doctors(19.75%)and high seniority doctors(11.73%).The ability of senior physicians to independ-ently predict the expansion of intracerebral hemorrhage was strongest in patients and non-patients,with sensitivity of 18.75%(95%CI:9.44%~33.10%)and specificity of 65.94%(95%CI:59.98%~71.45%).The sensitivity of middle seniority doctors was 16.67%(95%CI:7.97%~30.76%),the specificity was 56.52%(95%CI:50.44%~62.42%),and the sensitivity of low seniority doctors was 8.33%(95%CI:2.70%~20.87%),the specificity was 44.20%(95%CI:38.29%~50.28%).However,after AI assisted the prediction of senior doctors,the sensitivity and specificity of each seniority group of doctors increased.The sensitivity of high seniority doctors was 60.42%(95%CI:45.29%~73.88%),the specificity was 72.46%(95%CI:66.72%~77.57%),the sensitivity of middle seniority doc-tors was 64.58%(95%CI:49.40%~77.45%),the specificity was 71.38%(95%CI:65.59%~76.56%),and the sensitivity of low seniority doctors was 68.75%(95%CI:53.60%~80.91%),the specificity was 64.13%(95%CI:58.13%~69.73%).Conclusion AI-CAD assisted doctors with high,middle and low seniority can improve the ac-curacy of predicting the enlargement of hematoma in early stage of cerebral hemorrhage,especially the ability of doctors with low seniority to find patients can be significantly improved,which can make up for the lack of work experience of doc-tors with low seniority to a certain extent.

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