1.The value of a nomogram based on multi-parameter MRI for predicting the risk of postoperative recurrence in hormone receptor positive breast cancer
Di KANG ; Lihua ZHANG ; Weixia TANG ; Jinfeng QIAN ; Tianle WANG ; Meihong SHENG
Chinese Journal of Radiology 2025;59(10):1155-1162
Objective:To investigate the value of a multi-parameter MRI nomogram model in evaluating the recurrence risk of hormone receptor (HR)-positive breast cancer.Methods:This study was a retrospective cross-sectional study. A retrospective analysis was conducted on the clinicopathological data (age, menopausal status, axillary lymph node metastasis, etc.) and imaging data of 220 patients with HR-positive breast cancer who underwent breast MRI examination and were pathologically confirmed at the Second Affiliated Hospital of Nantong University from January 2018 to December 2023. All patients underwent preoperative MRI examinations. Their MRI features were analyzed, and the maximum diameter of the lesion and the apparent diffusion coefficient (ADC) value were measured. Finally, the clinical treatment score (CTS5 score) after 5 years was calculated, and all patients were divided into a low recurrence risk (CTS5 score 3.13 points) and a medium to high recurrence risk (CTS5 score≥3.13 points) group. The patients were followed up through the electronic medical record system or by phone until December 31, 2024 to determine recurrence status. The patients were divided into the recurrence group and the non-recurrence group. The differences in clinicopathological data, MRI features and CTS5 scores between the recurrence group and the non-recurrence group were compared using independent sample t-tests, Mann-Whitney U tests or χ2 tests. Indicators with P0.05 in the univariate analysis were included in the multivariate logistic regression to screen the independent risk factors for predicting the recurrence of HR receptor-positive breast cancer, and a nomogram was constructed to establish the nomogram model. The receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate the efficacy of the nomogram model in predicting the postoperative recurrence risk of patients with HR-positive breast cancer. The variance inflation factor (VIF) was used to evaluate the multicollinearity among independent variables. Calibration curves and decision curve analysis (DCA) were used to assess the fit and net clinical benefit of the nomogram model. Results:Among 220 patients with HR-positive breast cancer, 196 cases were in the non-recurrence group and 24 cases were in the recurrence group. There were statistically significant differences in the maximum diameter of the lesion, axillary lymph node metastasis, ADC value, CTS5 grouping, and CTS5 score between the recurrence group and the non-recurrence group ( P0.05). Multivariate logistic regression analysis showed that the maximum diameter of the lesion ( OR=1.110, 95% CI 1.169-1.503, P0.001), ADC value ( OR=0.993, 95% CI 0.993?0.989, P0.001), and axillary lymph node metastasis ( OR=8.842; 95% CI 2.120?36.884, P=0.003) were independent factors influencing postoperative recurrence in patients with HR-positive breast cancer, and a nomogram model was constructed based on this. VIF analysis showed that no significant multicollinearity was detected among the variables (VIF5). The AUC value of the nomogram model for predicting postoperative recurrence in patients with HR-positive breast cancer was 0.868 (95% CI 0.794-0.942), the sensitivity was 0.875, and the specificity was 0.781. The calibration curve showed that the prediction curve of this model for predicting postoperative recurrence in HR-positive breast cancer patients was basically consistent with the ideal curve trend. DCA showed that this model had a relatively high clinical benefit within the threshold probability range of 0.01% to 90.00%. Conclusion:The nomogram constructed based on multi-parameter MRI features can predict the postoperative recurrence risk of HR-positive breast cancer patients, with good consistency and predictive ability.
2.Immuneprotective efficacy of superoxide dismutase of Toxocarai canis
Tianle WU ; Yining YOU ; Lei WANG ; Bingnan WANG ; Xue SUN ; Rongqiong ZHOU
Chinese Journal of Veterinary Science 2025;45(1):66-73
To investigate the immune protective effect induced by superoxide dismutase(SOD)of the Toxocara canis(T.canis)in mice,in this experiment,seventy-five Kunming mice of six-week-age were randomly divided into 5 groups for the immune protection experiment,the mice were subcutaneously immunized with 50,75 and 125 mg/L Tc-SOD(0.1 mL)on days 0,14 and 28,re-spectively.In the blank group,mice did not receive any treatment,while the PBS group was injected with equal amounts of sterility PBS.A total of three immunizations and each immunization interval of 14 days.14 days after the third immunization,the 3 000 infected worm eggs were given orally in all groups.Before each immunization,14 days after the third immunization,and after the T.canis attack on the 7th day,the blood was sampled from the tail vein and sera were separated,while the IgG levels in serum were detected by indirect ELISA.The proliferation ability of splenic lympho-cytes and the mRNA expression levels of Th1(IFN-γ,IL-2)and Th2 cytokines(IL-4,IL-10)were analyzed with CCK-8 and qRT-PCR.The larvae reduction rates were calculated on the 7th day after the T.canis attack,and the pathological changes in the livers and lungs were observed using H&E staining.The results showed that compared with the PBS group,the serum IgG antibody levels increased with the frequency and duration of Tc-SOD immunization.It remained at a high level af-ter the T.canis attack,and the differences were very significant(P<0.001).The mRNA expres-sion levels of IFN-γ,IL-2,IL-4,and IL-10 were dramatically increased(P<0.01),while IL-4 andIL-10 were significantly higher than IFN-γ and IL-2 on the 14th day after the third immunization(P<0.05),showing the Th2 type predominant immune response.And induce the proliferation of spleen lymphocytes in vitro(P<0.01).The reduction rates of larvae of 50,75 and 125 mg/L Tc-SOD immune groups were 18.7%,24.9%and 37.6%,respectively,with significant differences in the 125 mg/L Tc-SOD group(P<0.05),and had better immune protection effect.Moreover,the H&E staining results indicated that three Tc-SOD immune groups reduce the inflammatory cell infiltration(neutrophils,eosinophils,and macrophages)and hemorrhagic lesions in the livers and lungs of mice.The above results indicated that Tc-SOD could induce humoral and cellular immune responses in mice,mainly Th2 immune response,and provide immune protection against T.canis infection.
3.Treatment of depression based on the theory of " liver disease affecting to the spleen"
Siyi WANG ; Jingchun LI ; Shaozhen JI ; Shuaihang HU ; Tianle ZHENG ; Fei WANG ; Qianqi WANG ; Jiaxiu LI ; Rongjuan GUO
Journal of Beijing University of Traditional Chinese Medicine 2025;48(2):216-222
The " liver disease affecting to the spleen" theory first appeared in Nanjing and was further elaborated in Jingui Yaolue. This theory encapsulates the traditional Chinese medicine principles of the " unity of the five viscera" and the " preventive treatment of disease" . The theory emphasizes that the spleen is the pivotal point where depression may progress from a functional disorder to an organic disease. The liver governs the emotions and qi flow, whereas the spleen is responsible for qi, blood, and body. In the early stages of the disease, emotional disorders and qi flow disorders primarily affect the liver, manifesting as depression or low mood. As the condition progresses, the liver (Wood) overacts on the spleen (Earth), disrupting liver and spleen functions and causing qi and blood disharmony. This stage is marked by fatigue and psychomotor retardation. Prolonged illness depletes qi and blood, eventually involving all five viscera, disrupting the harmony of the five spirits, and affecting both body and spirit. At this advanced phase, intense emotional distress or agitation often arises, accompanied by a heightened risk of suicide. The disease progression follows a dynamic " qi-blood-spirit" pattern, in which depression begins in the liver, characterized by qi stagnation, then affects the spleen, involving blood disharmony. In later stages, the disease eventually affects all viscera, with profound effects on both physical and mental health. Treatment strategies should align with the disease stage. Early intervention should focus on regulating the flow of qi, treating the liver, and strengthening the spleen. In the middle stages, qi and blood should be harmonized while promoting the harmonized functions of the liver and spleen. In the later stages, treatment should harmonize the five viscera to restore balance between body and spirit. Guided by this theory, integrating modern medical understanding of the progression of depression from emotional to somatic symptoms and adopting a stage-based approach to treatment in clinical practice can yield effective therapeutic outcomes for managing depression and related disorders.
4.Aromatic Substances and Their Clinical Application: A Review
Yundan GUO ; Lulu WANG ; Zhili ZHANG ; Chen GUO ; Zhihong PI ; Wei GONG ; Zongping WU ; Dayu WANG ; Tianle GAO ; Cai TIE ; Yuan LIN ; Jiandong JIANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(22):264-272
Aromatherapy refers to the method of using the aromatic components of plants in appropriate forms to act on the entire body or a specific area to prevent and treat diseases. Essential oils used in aromatherapy are hydrophobic liquids containing volatile aromatic molecules, such as limonene, linalool, linalool acetate, geraniol, and citronellol. These chemicals have been extensively studied and shown to have a variety of functions, including reducing anxiety, relieving depression, promoting sleep, and providing pain relief. Terpenoids are a class of organic molecules with relatively low lipid solubility. After being inhaled, they can pass through the nasal mucosa for transfer or penetrate the skin and enter the bloodstream upon local application. Some of these substances also have the ability to cross the blood-brain barrier, thereby exerting effects on the central nervous system. Currently, the academic community generally agrees that products such as essential oils and aromatherapy from aromatic plants have certain health benefits. However, the process of extracting a single component from it and successfully developing it into a drug still faces many challenges. Its safety and efficacy still need to be further verified through more rigorous and systematic experiments. This article systematically elaborated on the efficacy of aromatic substances, including plant extracts and natural small molecule compounds, in antibacterial and antiviral fields and the regulation of nervous system activity. As a result, a deeper understanding of aromatherapy was achieved. At the same time, the potential of these aromatic substances for drug development was thoroughly explored, providing important references and insights for possible future drug research and application.
5.Comparative efficacy of different warming measures during the perioperative period of robotic-assisted total hip arthroplasty for femoral neck fracture in elderly patients
Ru GU ; Lei LEI ; Xu XU ; Wen WANG ; Geng ZHANG ; Tianle FAN ; Shuixia LI
Chinese Journal of Trauma 2025;41(9):852-857
Objective:To compare the efficacy of active warming versus conventional warming during the perioperative period of robotic-assisted total hip arthroplasty (THA) for femoral neck fracture in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 312 elderly patients with femoral neck fracture who underwent robot-assisted THA at Second Affiliated Hospital of Xi ′an Jiaotong University from January 2024 to January 2025, including 196 males and 116 females, aged 65-89 years [(77.0±7.3)years]. Among them, 156 patients received standardized thermal management (active warming group), involving the administration of pre-warmed intravenous fluids and use of an inflatable warming blanket preoperatively, combined application of a forced-air warming system and warmed fluids intraoperatively, and transfer to a temperature-controlled ward combined with a foot circulatory compression device postoperatively. The other 156 patients received conventional warming with cotton quilts (conventional warming group), involving no administration of pre-warmed intravenous fluids preoperatively, use of warmed fluids intraoperatively, and transfer to a standard ward without the use of a foot circulatory compression device postoperatively. Core body temperature was compared between the two groups at 30 minutes preoperatively, 30 minutes intraoperatively, immediately postoperatively, and at 1 hour, 1 day, 5 days, and 7 days postoperatively. Changes in the coagulation function, including prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and the inflammatory marker C-reactive protein (CRP) were assessed at 1 day preoperatively and at 1, 5, and 7 days postoperatively. Length of hospital stay and incidence of postoperative complications (incision infection, deep vein thrombosis, cardiac complications, and unplanned reoperations) were also recorded. Results:The core body temperature at 30 minutes intraoperatively, immediately postoperatively and at 1 hour postoperatively was (36.77±0.17)℃, (36.29±0.14)℃, and (36.35±0.14)℃ in the active warming group, significantly higher than (36.12±0.27)℃, (35.49±0.25)℃, and (35.67±0.29)℃ in the conventional warming group ( P<0.01). No significant differences in body temperature were observed between the two groups at 30 minutes preoperatively, at 1, 5, or 7 days postoperatively ( P>0.05). At 1 day postoperatively, the PT, TT and APTT were (8.5±1.3)seconds, (10.0±0.9)seconds and (24.8±2.3)seconds, significantly lower than (9.7±1.3)seconds, (12.1±1.5)seconds and (29.2±2.7)seconds in the conventional warming group ( P<0.01). There were no significant differences in PT, TT, APTT or CRP levels between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The CRP level at 1 day postoperatively was (8.0±3.0)mg/L in the active warming group, significantly lower than (13.5±3.2)mg/L in the conventional warming group ( P<0.05). There were no significant differences in CRP between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The average length of hospital stay was (12.2±1.4)days in the active warming group, significantly shorter than (14.9±1.4)days in the conventional warming group ( P<0.01). The perioperative complication rate was 6.4% (10/156) in the active warming group, significantly lower than 17.9% (28/156) in the conventional warming group ( P<0.01). Conclusion:For elderly patients with femoral neck fracture operated via robot-assisted THA, active warming during the perioperative period can more effectively maintain intraoperative normothermia, improve early postoperative coagulation function, reduce inflammatory response, shorten the length of hospital stay, and decrease complication rate when compared with conventional warming.
6.Immuneprotective efficacy of superoxide dismutase of Toxocarai canis
Tianle WU ; Yining YOU ; Lei WANG ; Bingnan WANG ; Xue SUN ; Rongqiong ZHOU
Chinese Journal of Veterinary Science 2025;45(1):66-73
To investigate the immune protective effect induced by superoxide dismutase(SOD)of the Toxocara canis(T.canis)in mice,in this experiment,seventy-five Kunming mice of six-week-age were randomly divided into 5 groups for the immune protection experiment,the mice were subcutaneously immunized with 50,75 and 125 mg/L Tc-SOD(0.1 mL)on days 0,14 and 28,re-spectively.In the blank group,mice did not receive any treatment,while the PBS group was injected with equal amounts of sterility PBS.A total of three immunizations and each immunization interval of 14 days.14 days after the third immunization,the 3 000 infected worm eggs were given orally in all groups.Before each immunization,14 days after the third immunization,and after the T.canis attack on the 7th day,the blood was sampled from the tail vein and sera were separated,while the IgG levels in serum were detected by indirect ELISA.The proliferation ability of splenic lympho-cytes and the mRNA expression levels of Th1(IFN-γ,IL-2)and Th2 cytokines(IL-4,IL-10)were analyzed with CCK-8 and qRT-PCR.The larvae reduction rates were calculated on the 7th day after the T.canis attack,and the pathological changes in the livers and lungs were observed using H&E staining.The results showed that compared with the PBS group,the serum IgG antibody levels increased with the frequency and duration of Tc-SOD immunization.It remained at a high level af-ter the T.canis attack,and the differences were very significant(P<0.001).The mRNA expres-sion levels of IFN-γ,IL-2,IL-4,and IL-10 were dramatically increased(P<0.01),while IL-4 andIL-10 were significantly higher than IFN-γ and IL-2 on the 14th day after the third immunization(P<0.05),showing the Th2 type predominant immune response.And induce the proliferation of spleen lymphocytes in vitro(P<0.01).The reduction rates of larvae of 50,75 and 125 mg/L Tc-SOD immune groups were 18.7%,24.9%and 37.6%,respectively,with significant differences in the 125 mg/L Tc-SOD group(P<0.05),and had better immune protection effect.Moreover,the H&E staining results indicated that three Tc-SOD immune groups reduce the inflammatory cell infiltration(neutrophils,eosinophils,and macrophages)and hemorrhagic lesions in the livers and lungs of mice.The above results indicated that Tc-SOD could induce humoral and cellular immune responses in mice,mainly Th2 immune response,and provide immune protection against T.canis infection.
7.Comparative efficacy of different warming measures during the perioperative period of robotic-assisted total hip arthroplasty for femoral neck fracture in elderly patients
Ru GU ; Lei LEI ; Xu XU ; Wen WANG ; Geng ZHANG ; Tianle FAN ; Shuixia LI
Chinese Journal of Trauma 2025;41(9):852-857
Objective:To compare the efficacy of active warming versus conventional warming during the perioperative period of robotic-assisted total hip arthroplasty (THA) for femoral neck fracture in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 312 elderly patients with femoral neck fracture who underwent robot-assisted THA at Second Affiliated Hospital of Xi ′an Jiaotong University from January 2024 to January 2025, including 196 males and 116 females, aged 65-89 years [(77.0±7.3)years]. Among them, 156 patients received standardized thermal management (active warming group), involving the administration of pre-warmed intravenous fluids and use of an inflatable warming blanket preoperatively, combined application of a forced-air warming system and warmed fluids intraoperatively, and transfer to a temperature-controlled ward combined with a foot circulatory compression device postoperatively. The other 156 patients received conventional warming with cotton quilts (conventional warming group), involving no administration of pre-warmed intravenous fluids preoperatively, use of warmed fluids intraoperatively, and transfer to a standard ward without the use of a foot circulatory compression device postoperatively. Core body temperature was compared between the two groups at 30 minutes preoperatively, 30 minutes intraoperatively, immediately postoperatively, and at 1 hour, 1 day, 5 days, and 7 days postoperatively. Changes in the coagulation function, including prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and the inflammatory marker C-reactive protein (CRP) were assessed at 1 day preoperatively and at 1, 5, and 7 days postoperatively. Length of hospital stay and incidence of postoperative complications (incision infection, deep vein thrombosis, cardiac complications, and unplanned reoperations) were also recorded. Results:The core body temperature at 30 minutes intraoperatively, immediately postoperatively and at 1 hour postoperatively was (36.77±0.17)℃, (36.29±0.14)℃, and (36.35±0.14)℃ in the active warming group, significantly higher than (36.12±0.27)℃, (35.49±0.25)℃, and (35.67±0.29)℃ in the conventional warming group ( P<0.01). No significant differences in body temperature were observed between the two groups at 30 minutes preoperatively, at 1, 5, or 7 days postoperatively ( P>0.05). At 1 day postoperatively, the PT, TT and APTT were (8.5±1.3)seconds, (10.0±0.9)seconds and (24.8±2.3)seconds, significantly lower than (9.7±1.3)seconds, (12.1±1.5)seconds and (29.2±2.7)seconds in the conventional warming group ( P<0.01). There were no significant differences in PT, TT, APTT or CRP levels between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The CRP level at 1 day postoperatively was (8.0±3.0)mg/L in the active warming group, significantly lower than (13.5±3.2)mg/L in the conventional warming group ( P<0.05). There were no significant differences in CRP between the two groups at 1 day preoperatively or at 5 and 7 days postoperatively ( P>0.05). The average length of hospital stay was (12.2±1.4)days in the active warming group, significantly shorter than (14.9±1.4)days in the conventional warming group ( P<0.01). The perioperative complication rate was 6.4% (10/156) in the active warming group, significantly lower than 17.9% (28/156) in the conventional warming group ( P<0.01). Conclusion:For elderly patients with femoral neck fracture operated via robot-assisted THA, active warming during the perioperative period can more effectively maintain intraoperative normothermia, improve early postoperative coagulation function, reduce inflammatory response, shorten the length of hospital stay, and decrease complication rate when compared with conventional warming.
8.The value of a nomogram based on multi-parameter MRI for predicting the risk of postoperative recurrence in hormone receptor positive breast cancer
Di KANG ; Lihua ZHANG ; Weixia TANG ; Jinfeng QIAN ; Tianle WANG ; Meihong SHENG
Chinese Journal of Radiology 2025;59(10):1155-1162
Objective:To investigate the value of a multi-parameter MRI nomogram model in evaluating the recurrence risk of hormone receptor (HR)-positive breast cancer.Methods:This study was a retrospective cross-sectional study. A retrospective analysis was conducted on the clinicopathological data (age, menopausal status, axillary lymph node metastasis, etc.) and imaging data of 220 patients with HR-positive breast cancer who underwent breast MRI examination and were pathologically confirmed at the Second Affiliated Hospital of Nantong University from January 2018 to December 2023. All patients underwent preoperative MRI examinations. Their MRI features were analyzed, and the maximum diameter of the lesion and the apparent diffusion coefficient (ADC) value were measured. Finally, the clinical treatment score (CTS5 score) after 5 years was calculated, and all patients were divided into a low recurrence risk (CTS5 score 3.13 points) and a medium to high recurrence risk (CTS5 score≥3.13 points) group. The patients were followed up through the electronic medical record system or by phone until December 31, 2024 to determine recurrence status. The patients were divided into the recurrence group and the non-recurrence group. The differences in clinicopathological data, MRI features and CTS5 scores between the recurrence group and the non-recurrence group were compared using independent sample t-tests, Mann-Whitney U tests or χ2 tests. Indicators with P0.05 in the univariate analysis were included in the multivariate logistic regression to screen the independent risk factors for predicting the recurrence of HR receptor-positive breast cancer, and a nomogram was constructed to establish the nomogram model. The receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate the efficacy of the nomogram model in predicting the postoperative recurrence risk of patients with HR-positive breast cancer. The variance inflation factor (VIF) was used to evaluate the multicollinearity among independent variables. Calibration curves and decision curve analysis (DCA) were used to assess the fit and net clinical benefit of the nomogram model. Results:Among 220 patients with HR-positive breast cancer, 196 cases were in the non-recurrence group and 24 cases were in the recurrence group. There were statistically significant differences in the maximum diameter of the lesion, axillary lymph node metastasis, ADC value, CTS5 grouping, and CTS5 score between the recurrence group and the non-recurrence group ( P0.05). Multivariate logistic regression analysis showed that the maximum diameter of the lesion ( OR=1.110, 95% CI 1.169-1.503, P0.001), ADC value ( OR=0.993, 95% CI 0.993?0.989, P0.001), and axillary lymph node metastasis ( OR=8.842; 95% CI 2.120?36.884, P=0.003) were independent factors influencing postoperative recurrence in patients with HR-positive breast cancer, and a nomogram model was constructed based on this. VIF analysis showed that no significant multicollinearity was detected among the variables (VIF5). The AUC value of the nomogram model for predicting postoperative recurrence in patients with HR-positive breast cancer was 0.868 (95% CI 0.794-0.942), the sensitivity was 0.875, and the specificity was 0.781. The calibration curve showed that the prediction curve of this model for predicting postoperative recurrence in HR-positive breast cancer patients was basically consistent with the ideal curve trend. DCA showed that this model had a relatively high clinical benefit within the threshold probability range of 0.01% to 90.00%. Conclusion:The nomogram constructed based on multi-parameter MRI features can predict the postoperative recurrence risk of HR-positive breast cancer patients, with good consistency and predictive ability.
9.Quantification of myocardial scar by dual-energy CT predicts risk of major cardiovascular events in patients with old myocardial infarction
Qian GUO ; Qi XU ; Hairong GU ; Yuanchao LIU ; Zhaoheng HUANG ; Koulong ZHENG ; Tianle WANG ; Shenchu GONG ; Rongxing QI
Chinese Journal of Radiology 2024;58(9):902-908
Objective:To investigate the predictive value for major adverse cardiovascular events (MACE) occurring within 1 year in patients with old myocardial infarction(OMI) using characteristics of myocardial scar derive from dual-energy CT (DECT) post-processing technique.Methods:OMI patients who received coronary CT angiography following dual-energy CT with late iodine enhancement (LIE-DECT) in the Second Affiliated Hospital of Nantong University from November 2019 to October 2022 were continuously included, and the images of all enrolled patients were reconstructed using 40 keV monoenergetic plus (Mono+) map, LIE (representing myocardial scar) was quantified on left ventricular short-axis images, including the LIE segments, the LIE score, and the LIE degree. All enrolled patients were followed up for MACE, defined as hospitalization for heart failure, malignant arrhythmia, and cardiac death. Regression analysis was used to investigate the relationship between the quantified value of myocardial scar and the occurrence of MACE, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of quantified value of myocardial scar in predicting MACE. The area under the curve (AUC) was compared using the DeLong test.Results:Finally, 231 patients with OMI were included, and MACE occurred in 37 cases (16.0%) within 1 year after LIE-DECT examination. The LIE segments 5 (4, 7), the LIE score 27 (13, 49) and the LIE degree 9.4%(7.5%, 15.5%) in the MACE group were higher than those in the non-MACE group 3 (2, 5), 9 (6, 15) and 6.7%(6.3%, 7.9%) (all P<0.001). Multivariable logistic regression analysis showed that after adjusting for confounders, the LIE segments ( OR=2.118, P<0.001), the LIE score ( OR=3.168, P<0.001), and the LIE degree ( OR=3.092, P<0.001) remained risk factors for the development of MACE. On ROC analysis, AUC of LIE segments, LIE score and LIE degree were 0.715, 0.822 and 0.806 (all P<0.001), with sensitivities of 81.1%, 86.5%, and 91.9%, and specificities of 53.6%, 69.6%, and 60.8%, respectively. DeLong′s test showed that the predictive efficacy of LIE score and LIE degree was higher than that of LIE segments ( Z=2.63, P=0.008; Z=1.96, P=0.049), and there were no significant differences in the predictive efficacy of LIE score and LIE degree ( Z=0.60, P=0.551). Conclusion:The LIE segments, the LIE score and the LIE degree detected by LIE-DECT 40 keV Mono+maps are risk factors for the occurrence of MACE in patients with OMI and have good efficacy in predicting the occurrence of MACE, which can be used as important indicators for assessing the clinical prognosis of OMI.
10.The value of a combined model of clinical factors and non-contrast CT radiomics in predicting symptomatic hemorrhagic transformation after intravenous thrombolysis in patients with anterior circulation ischemic stroke
Dandan JI ; Tianle WANG ; Li ZHU ; Yu LU ; Xiwu RUAN
Chinese Journal of Radiology 2024;58(10):1021-1027
Objective:To investigate the efficacy of a combined model constructed by the radiomics features based on non-contrast CT (NCCT) combined with clinical risk factors in predicting the occurrence of symptomatic intracranial hemorrhagic transformation (sICH) after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with anterior circulation acute ischemic stroke (AIS).Methods:In this cross-sectional study, clinical and imaging data of 316 patients with anterior circulation AIS who received intravenous thrombolysis with rt-PA at Nantong First People′s Hospital from October 2018 to September 2022 were retrospectively analyzed. The cases were divided into a training set of 210 cases and a validation set of 106 cases by stratified random sampling at a ratio of 7∶3. Univariate and multivariate logistic regression analyses were performed to select the independent clinical risk factors for predicting sICH. The infarct area was delineated on the NCCT images and radiomics features were extracted. The extracted radiomics features were dimensionally reduced and selected using the inter-and intra-group correlation coefficients, maximum correlation and minimum redundancy, and the least absolute shrinkage and selection operator, and then the radiomics score was calculated. Finally, multivariate logistic analysis was performed and the clinical risk factors and radiomics scores were used to establish the clinical model, the radiomics model and the radiomics-clinical combined model. The predictive efficacy of each model was evaluated by the receiver operating characteristic curve and the area under the curve, and decision curve analysis (DCA) was used to calculate and quantify the net benefits of each predictive model.Results:In total eight radiomics features were selected to construct the radiomics model. Multivariate logistic analysis showed that hypertension ( OR=2.703, 95% CI 1.153-6.334, P=0.022), atrial fibrillation ( OR=3.023, 95% CI 1.290-7.085, P=0.011), and the National Institutes of Health Stroke Scale score at admission ( OR=1.078, 95% CI 1.017-1.143, P=0.012) were independent risk factors for sICH after rt-PA intravenous thrombolysis in patients with anterior circulation AIS. In the validation set, the area under the curve of the combined model for predicting sICH was 0.763 (95% CI 0.618-0.909), which was higher than that of the clinical model 0.710 (95% CI 0.552-0.868) and the radiomics model 0.708 (95% CI 0.568-0.848). DCA showed that the combined model could allow patients to obtain higher net benefits. Conclusion:The combined model constructed based on the radiomics of NCCT and clinical risk factors has a high diagnostic efficacy in predicting sICH after rt-PA intravenous thrombolysis in patients with anterior circulation AIS.


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