1.The value of coagulation function and inflammatory response biomarkers in predicting postoperative recurrence of non-muscle-invasive bladder cancer
Huafeng LI ; Zhenlong WANG ; Yao DONG ; Zihe PENG ; Haibin ZHOU
Chinese Journal of Postgraduates of Medicine 2025;48(1):60-66
Objective:To investigate the predictive value of preoperative coagulation function and inflammation response biomarkers for postoperative recurrence of non-muscle-invasive bladder cancer (NMIBC) patients.Methods:The clinical data of 390 NMIBC patients underwent surgical treatment from May 2014 to May 2021 in the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. The baseline characteristics coagulation function, inflammation response indexes and tumor characteristics were recorded. The baseline characteristics included gender, age and smoking history; the coagulation function included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer; the inflammation response indexes included neutrophil count, lymphocyte count, platelet count and monocyte count, and the systemic inflammatory response index (SIRI) and systemic immune-inflammation index (SII) were calculated; tumor characteristics included TNM stage, pathological grade, tumor length, tumor amount and postoperative instillation drugs. The patients were followed up until May 2022, with recurrence records and grouping. The "pROC" package was used to draw the receiver operating characteristic (ROC) curve, and calculate the optimal cutoff values of biomarkers. Multivariate Cox regression analysis was used to analyze the independent risk factors of recurrence in patients with NMIBC (variables were selected with P<0.1). The nomogram and its calibration curve were drawn by the "survival" and "rms" packages, and the area under the curve (AUC) was calculated with the "pROC" package for assessing the predictive ability of the model. The "caret" package was used for ten-fold cross-validation to evaluate the external applicability of the nomogram. Results:The ROC curve analysis result showed that the optimal cutoff values of PT, APTT, FIB, D-dimer, SIRI and SII were 11.95 s, 17.65 s, 0.233 mg/L, 565 ng/L, 0.62 and 291.5, respectively. The 390 patients with NMIBC were followed up 29 to 71 months, with a median follow-up time of 49 months. Among them, 113 patients experienced postoperative recurrence (recurrence group), and the recurrence rate was 29.0%; while 277 patients did not experience recurrence (non-recurrence group). The rate of FIB≥0.233 mg/L, D-dimmer ≥565 ng/L, SIRI≥0.62 and SII≥291.5, T 1 stage, high-grade tumor, tumor length ≥2.3 cm and multiple tumor in recurrence group were significantly higher than those in non-recurrence group: 90.3% (102/113) vs. 71.5% (198/277), 33.6% (38/113) vs. 23.5% (65/277), 74.3% (84/113) vs. 56.7% (157/277), 84.1% (95/113) vs. 60.6% (168/277), 77.9% (88/113) vs. 38.6% (107/277), 25.7% (29/113) vs. 8.3% (23/277), 49.6% (56/113) vs. 32.1% (89/277) and 41.6% (47/113) vs. 19.9% (55/277), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in gender ratio, age, smoking history, PT, APTT and postoperative instillation drugs between the two groups ( P>0.05). Multivariate Cox regression analysis result showed that FIB≥0.233 mg/L, SII≥291.5, T 1 stage, high pathological grade, tumor length≥2.3 cm and multiple tumor were independent risk factors of postoperative recurrence in patients with NMIBC ( HR = 2.186, 1.627, 3.182, 1.675, 1.775 and 2.052; 95% CI 1.149 to 4.159, 0.913 to 2.902, 1.988 to 5.095, 1.067 to 2.630, 1.208 to 2.608 and 1.388 to 3.033; P<0.1). A nomogram model was constructed to predict postoperative 1-, 3- and 5-year non-recurrence based on FIB, SII, T stage, tumor length, pathological grade and tumor amount. The calibration curve analysis result showed that the nomogram model predicted good consistency between the postoperative 1-, 3-, 5-year non-recurrence rates and the actual incidence rate in patients with NMIBC. ROC curve analysis result showed that the AUC of the nomogram model for predicting postoperative 1-, 3- and 5-year non-recurrence in patients with NMIBC were 0.746, 0.789 and 0.835 (95% CI 0.695 to 0.832, 0.703 to 0.875 and 0.756 to 0.915). The ten-fold cross-validation result showed that the nomogram model had good external applicability for predicting postoperative 1-, 3- and 5-year non-recurrence in patients with NMIBC, with AUC of 0.754, 0.781 and 0.832 (95% CI 0.689 to 0.817, 0.724 to 0.832 and 0.778 to 0.879). Conclusions:The nomogram model based on FIB, SII, T stage, tumor length, pathological grade and tumor amount can accurately predict the postoperative 1-, 3- and 5-year recurrence risks in patients with NMIBC. The model helps clinical doctors early identify high-risk recurrent NMIBC patients, and provides reference for the development of individualized treatment plans.
2.Prediction of Multifunctional Parameters of SPECT Gated Myocardial Perfusion Imaging for Major Adverse Cardiovascular Events in Chronic Kidney Disease
Ying ZHANG ; Zhi CHANG ; Xu HAN ; Jian JIAO ; Zihe YANG ; Quan LI ; Wei DONG ; Hongzhi MI
Chinese Journal of Medical Imaging 2025;33(7):751-757
Purpose To evaluate the predictive value of multifunctional parameters of single photon emission computed tomography gated myocardial perfusion imaging(SPECT G-MPI)for major adverse cardiovascular events(MACE)in chronic kidney disease(CKD)with abnormal stress myocardial perfusion.Materials and Methods A total of 99 patients diagnosed with CKD from June 2017 to March 2024 who underwent stress and rest G-MPI indicating abnormal myocardial perfusion in Beijing Anzhen Hospital,Capital Medical University.The American Heart Association 17-segment 5-point method and PHASE software were used to obtain the left ventricular myocardial perfusion,functional and synchronization parameters.According to the occurrence of MACE,the patients were divided into MACE group and non-MACE group.Cox regression was used to analyze the predictors related to MACE.The receiver operator characteristic curve was used to analyze the performance of predictors,the survival curves were obtained by the Kaplan-Meier method,Log-rank test was used to compare the differences in different groups.Results Finally,we enrolled 99 CKD patients with abnormal stress myocardial perfusion.35 patients(35.35%)developed MACE during the follow-up period.Cox regression analysis showed that stress phase bandwidth(SPBW)(HR=1.015,95%CI 1.002-1.028)and sum difference score(SDS)(HR=1.105,95%CI 1.008-1.211)were independent risk factors for predicting MACE(both P<0.05).The optimal cut-off value of SPBW and SDS for predicting MACE were 69° and 6 points,the area under the curve was 0.801 and 0.778,respectively.The incidence of MACE in the SPBW≥69° group and SDS≥6 points group was higher than that in SPBW<69° group and SDS<6 points group(66.6%vs.13.2%,53.3%vs.20.4%,both P<0.05).Conclusion SPECT G-MPI multifunctional parameters can be used to predict the prognosis of CKD patients with abnormal stress myocardial perfusion.SPBW and SDS are independent risk factors for MACE in these patients.
3.Feature extraction and genetic association validation study for complex facial morphology phenotypes
Xin SHI ; Wei ZHAO ; Zihe JIANG ; Xinyu HOU ; Hong FAN ; Caixia LI ; Wenting ZHAO
Chinese Journal of Forensic Medicine 2025;40(2):172-180
Objective Human facial morphology is an appearance phenotype with high heritability,high diversity,and complexity.Traditional facial morphological genetic analysis is mostly based on facial landmark measurements,using linear regression for genome-wide association studies,but this method extracts limited facial morphological feature information.This study established an extraction method for multidimensional facial representations and validated the correlation between 473 single-nucleotide polymorphisms(SNPs)previously reported to be significantly associated with facial features and facial representations in the Han Chinese population.Methods After acquiring facial 3D images,3D morphable face models and HR-net network were used to align and quantify the 3D images,obtaining high-density 3D facial point cloud data.After unsupervised clustering of the point cloud,principal component analysis was applied to reduce dimensionality and extract multidimensional morphological phenotypes for each facial region.Based on these multidimensional phenotypes,partial least squares regression(PLSR)and canonical correlation analysis(CCA)were used for genetic association analysis.Results A total of 10 SNPs were validated to be significantly associated with facial morphology in Han Chinese,of which 7 SNPs were validated by the PLSR method,2 SNPs were validated by the CCA method,and 1 SNP was validated by both methods.Conclusion Among the 10 significantly associated SNP sites,9 related facial morphological regions were consistent with previous reports in other populations,indicating that genes affecting complex facial morphology have cross-population effects.
4.Feature extraction and genetic association validation study for complex facial morphology phenotypes
Xin SHI ; Wei ZHAO ; Zihe JIANG ; Xinyu HOU ; Hong FAN ; Caixia LI ; Wenting ZHAO
Chinese Journal of Forensic Medicine 2025;40(2):172-180
Objective Human facial morphology is an appearance phenotype with high heritability,high diversity,and complexity.Traditional facial morphological genetic analysis is mostly based on facial landmark measurements,using linear regression for genome-wide association studies,but this method extracts limited facial morphological feature information.This study established an extraction method for multidimensional facial representations and validated the correlation between 473 single-nucleotide polymorphisms(SNPs)previously reported to be significantly associated with facial features and facial representations in the Han Chinese population.Methods After acquiring facial 3D images,3D morphable face models and HR-net network were used to align and quantify the 3D images,obtaining high-density 3D facial point cloud data.After unsupervised clustering of the point cloud,principal component analysis was applied to reduce dimensionality and extract multidimensional morphological phenotypes for each facial region.Based on these multidimensional phenotypes,partial least squares regression(PLSR)and canonical correlation analysis(CCA)were used for genetic association analysis.Results A total of 10 SNPs were validated to be significantly associated with facial morphology in Han Chinese,of which 7 SNPs were validated by the PLSR method,2 SNPs were validated by the CCA method,and 1 SNP was validated by both methods.Conclusion Among the 10 significantly associated SNP sites,9 related facial morphological regions were consistent with previous reports in other populations,indicating that genes affecting complex facial morphology have cross-population effects.
5.The value of coagulation function and inflammatory response biomarkers in predicting postoperative recurrence of non-muscle-invasive bladder cancer
Huafeng LI ; Zhenlong WANG ; Yao DONG ; Zihe PENG ; Haibin ZHOU
Chinese Journal of Postgraduates of Medicine 2025;48(1):60-66
Objective:To investigate the predictive value of preoperative coagulation function and inflammation response biomarkers for postoperative recurrence of non-muscle-invasive bladder cancer (NMIBC) patients.Methods:The clinical data of 390 NMIBC patients underwent surgical treatment from May 2014 to May 2021 in the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. The baseline characteristics coagulation function, inflammation response indexes and tumor characteristics were recorded. The baseline characteristics included gender, age and smoking history; the coagulation function included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer; the inflammation response indexes included neutrophil count, lymphocyte count, platelet count and monocyte count, and the systemic inflammatory response index (SIRI) and systemic immune-inflammation index (SII) were calculated; tumor characteristics included TNM stage, pathological grade, tumor length, tumor amount and postoperative instillation drugs. The patients were followed up until May 2022, with recurrence records and grouping. The "pROC" package was used to draw the receiver operating characteristic (ROC) curve, and calculate the optimal cutoff values of biomarkers. Multivariate Cox regression analysis was used to analyze the independent risk factors of recurrence in patients with NMIBC (variables were selected with P<0.1). The nomogram and its calibration curve were drawn by the "survival" and "rms" packages, and the area under the curve (AUC) was calculated with the "pROC" package for assessing the predictive ability of the model. The "caret" package was used for ten-fold cross-validation to evaluate the external applicability of the nomogram. Results:The ROC curve analysis result showed that the optimal cutoff values of PT, APTT, FIB, D-dimer, SIRI and SII were 11.95 s, 17.65 s, 0.233 mg/L, 565 ng/L, 0.62 and 291.5, respectively. The 390 patients with NMIBC were followed up 29 to 71 months, with a median follow-up time of 49 months. Among them, 113 patients experienced postoperative recurrence (recurrence group), and the recurrence rate was 29.0%; while 277 patients did not experience recurrence (non-recurrence group). The rate of FIB≥0.233 mg/L, D-dimmer ≥565 ng/L, SIRI≥0.62 and SII≥291.5, T 1 stage, high-grade tumor, tumor length ≥2.3 cm and multiple tumor in recurrence group were significantly higher than those in non-recurrence group: 90.3% (102/113) vs. 71.5% (198/277), 33.6% (38/113) vs. 23.5% (65/277), 74.3% (84/113) vs. 56.7% (157/277), 84.1% (95/113) vs. 60.6% (168/277), 77.9% (88/113) vs. 38.6% (107/277), 25.7% (29/113) vs. 8.3% (23/277), 49.6% (56/113) vs. 32.1% (89/277) and 41.6% (47/113) vs. 19.9% (55/277), and there were statistical differences ( P<0.01 or <0.05); there were no statistical differences in gender ratio, age, smoking history, PT, APTT and postoperative instillation drugs between the two groups ( P>0.05). Multivariate Cox regression analysis result showed that FIB≥0.233 mg/L, SII≥291.5, T 1 stage, high pathological grade, tumor length≥2.3 cm and multiple tumor were independent risk factors of postoperative recurrence in patients with NMIBC ( HR = 2.186, 1.627, 3.182, 1.675, 1.775 and 2.052; 95% CI 1.149 to 4.159, 0.913 to 2.902, 1.988 to 5.095, 1.067 to 2.630, 1.208 to 2.608 and 1.388 to 3.033; P<0.1). A nomogram model was constructed to predict postoperative 1-, 3- and 5-year non-recurrence based on FIB, SII, T stage, tumor length, pathological grade and tumor amount. The calibration curve analysis result showed that the nomogram model predicted good consistency between the postoperative 1-, 3-, 5-year non-recurrence rates and the actual incidence rate in patients with NMIBC. ROC curve analysis result showed that the AUC of the nomogram model for predicting postoperative 1-, 3- and 5-year non-recurrence in patients with NMIBC were 0.746, 0.789 and 0.835 (95% CI 0.695 to 0.832, 0.703 to 0.875 and 0.756 to 0.915). The ten-fold cross-validation result showed that the nomogram model had good external applicability for predicting postoperative 1-, 3- and 5-year non-recurrence in patients with NMIBC, with AUC of 0.754, 0.781 and 0.832 (95% CI 0.689 to 0.817, 0.724 to 0.832 and 0.778 to 0.879). Conclusions:The nomogram model based on FIB, SII, T stage, tumor length, pathological grade and tumor amount can accurately predict the postoperative 1-, 3- and 5-year recurrence risks in patients with NMIBC. The model helps clinical doctors early identify high-risk recurrent NMIBC patients, and provides reference for the development of individualized treatment plans.
6.Prediction of Multifunctional Parameters of SPECT Gated Myocardial Perfusion Imaging for Major Adverse Cardiovascular Events in Chronic Kidney Disease
Ying ZHANG ; Zhi CHANG ; Xu HAN ; Jian JIAO ; Zihe YANG ; Quan LI ; Wei DONG ; Hongzhi MI
Chinese Journal of Medical Imaging 2025;33(7):751-757
Purpose To evaluate the predictive value of multifunctional parameters of single photon emission computed tomography gated myocardial perfusion imaging(SPECT G-MPI)for major adverse cardiovascular events(MACE)in chronic kidney disease(CKD)with abnormal stress myocardial perfusion.Materials and Methods A total of 99 patients diagnosed with CKD from June 2017 to March 2024 who underwent stress and rest G-MPI indicating abnormal myocardial perfusion in Beijing Anzhen Hospital,Capital Medical University.The American Heart Association 17-segment 5-point method and PHASE software were used to obtain the left ventricular myocardial perfusion,functional and synchronization parameters.According to the occurrence of MACE,the patients were divided into MACE group and non-MACE group.Cox regression was used to analyze the predictors related to MACE.The receiver operator characteristic curve was used to analyze the performance of predictors,the survival curves were obtained by the Kaplan-Meier method,Log-rank test was used to compare the differences in different groups.Results Finally,we enrolled 99 CKD patients with abnormal stress myocardial perfusion.35 patients(35.35%)developed MACE during the follow-up period.Cox regression analysis showed that stress phase bandwidth(SPBW)(HR=1.015,95%CI 1.002-1.028)and sum difference score(SDS)(HR=1.105,95%CI 1.008-1.211)were independent risk factors for predicting MACE(both P<0.05).The optimal cut-off value of SPBW and SDS for predicting MACE were 69° and 6 points,the area under the curve was 0.801 and 0.778,respectively.The incidence of MACE in the SPBW≥69° group and SDS≥6 points group was higher than that in SPBW<69° group and SDS<6 points group(66.6%vs.13.2%,53.3%vs.20.4%,both P<0.05).Conclusion SPECT G-MPI multifunctional parameters can be used to predict the prognosis of CKD patients with abnormal stress myocardial perfusion.SPBW and SDS are independent risk factors for MACE in these patients.
7.Establishment of a prediction model for postoperative progression-free survival in patients with renal cell carcinoma
Huafeng LI ; Zhenlong WANG ; Hongyi ZHANG ; Zihe PENG ; Chenyue WANG ; Yao DONG ; Haibin ZHOU
Journal of Modern Urology 2024;29(10):892-897
[Objective] To analyze factors influencing the postoperative progression-free survival (PFS) in patients with renal cell carcinoma (RCC), construct a nomogram model for predicting PFS, and compare it with other predictive models. [Methods] A retrospective analysis was conducted on the general and clinical data of 263 RCC patients who underwent surgery at the Department of Urology, the Second Affiliated Hospital of Xi'an Jiaotong University, during Apr.2014 and Nov.2021.Patients were divided into the progression group (n=34) and non-progression group (n=229). The data of the two groups were analyzed to identify prognostic variables associated with PFS, and a nomogram model was constructed.The performance of this model was compared with that of the University of California, Los Angeles Integrated Staging System (UISS) score, tumor staging, tumor size, tumor pathological grade, and tumor necrosis scoring system (SSIGN score), and Leibovich score by plotting receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Calibration curve of the nomogram was used to validate the model's performance, and K-fold cross-validation was employed to assess its external validity. [Results] Multivariate Cox regression analysis revealed that age (HR=2.255, 95%CI: 1.032-4.926), T stage (HR=5.766, 95%CI: 2.351-14.142), pathological grade (HR=3.100, 95%CI: 1.445-6.651), and pathological necrosis (HR=2.656, 95%CI: 1.253-5.629) were independent risk factors of PFS (P<0.05). The nomogram model based on these four independent variables had AUCs (95%CI) of 0.750 (0.630-0.870), 0.803 (0.705-0.902), and 0.847 (0.757-0.937) for 1, 3, and 5 years, respectively, which were higher than those of UISS score, SSIGN score, and Leibovich score.The calibration curve of the nomogram showed good consistency between predicted and actual probabilities.In K-fold cross-validation, the average AUCs of the nomogram at 1, 3, and 5 years were 0.761, 0.808, and 0.842, indicating good external validity of the nomogram. [Conclusion] The nomogram based on age, T stage, pathological grade and pathological necrosis can accurately predict the risk of postoperative PFS in RCC patients at 1, 3, and 5 years, which can aid clinicians in the early identification of high-risk progression.
8.Clinical outcomes of 3D-printing stand-alone artificial vertebral body in anterior cer-vical surgeries
Panpan HU ; Yan LI ; Xiao LIU ; Yanchao TANG ; Zihe LI ; Zhongjun LIU
Journal of Peking University(Health Sciences) 2024;56(1):161-166
Objective:To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body(AVB)in the surgical procedure of anterior cervical corpectomy and fusion(ACCF).Methods:Following the proposal of IDEAL(idea,development,exploration,assessment,and long-term follow-up)framework,we designed and conducted this single-armed,retrospective cohort study.The patients with cervical spondylotic myelopathy were recruited,and these patients exclusively received the surgical procedure of single-level ACCF in our single center.After the process of corpectomy,the size was tailored using different trials and the most suitable stand-alone AVB was then implanted.This AVB was manufactured by the fashion of 3D-printing.Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies,to stabilize the AVB.The participants were regularly followed-up after the operation.Their clinical data were thoroughly reviewed.We assessed the neurological status according to Japanese Orthopedic Association(JOA)scale.We determined the fusion based on imaging examination six months after the operation.The recorded clinical data were analyzed using specific software and they presented in suitable styles.Paired t test was employed in comparison analysis.Results:In total,there were eleven patients being recruited eventually.The patients were all followed up over six months after the operation.The mean age of the cohort was(57.2±10.2)years.The mean operation time was(76.1±23.1)min and the median bleeding volume was 150(100,200)mL.The postoperative course was uneventful for all the cases.Dysphagia,emergent hematoma,and deterioration of neurological func-tion did not occur.Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up,which were significantly different(P<0.001).The mean recovery rate of neurological func-tion was 85.9%.By comparing the imaging examinations postoperatively and six months after the opera-tion,we found that the average subsidence length was(1.2±1.1)mm,and that there was only one ca-ses(9.1%)of the severe subsidence(>3 mm).We observed significant improvement of cervical lor-dosis after the operation(P=0.013).All the cases obtained solid fusion.Conclusion:3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study.The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.
9.Research progress on risk factors associated with postoperative complications of endovascular repair for abdominal aortic aneurysms
Yuzhu WANG ; Shuai ZHANG ; Yu ZHOU ; Yi JIN ; Zihe ZHAO ; Chaohui PAN ; Dongsheng FU ; Yuexue HAN ; Jianhang HU ; REYAGULI·KEYOUMU ; Zhao LIU ; Xiaoqiang LI
Chinese Journal of General Surgery 2024;33(12):2077-2082
Endovascular Aneurysm Repair (EVAR) has become an important treatment method for abdominal aortic aneurysms due to its advantages of shorter operative time,faster postoperative recovery,and lower early postoperative mortality. However,the incidence of complications and the postoperative reintervention rates are higher than those of open surgery. The main complications after EVAR include access vessel injury,post-implantation syndrome,stent migration,endoleaks,visceral branch artery occlusion,lower limb ischemia,and stent infection,which are also the primary causes of reintervention. In recent years,the causes and associated risk factors of various postoperative complications of EVAR have attracted widespread attention and discussion,which are of great significance for improving surgical techniques,enhancing postoperative monitoring,and improving patient outcomes. This paper provides a review of the current complications,associated risk factors,and management strategies after EVAR.
10.Research progress on risk factors associated with postoperative complications of endovascular repair for abdominal aortic aneurysms
Yuzhu WANG ; Shuai ZHANG ; Yu ZHOU ; Yi JIN ; Zihe ZHAO ; Chaohui PAN ; Dongsheng FU ; Yuexue HAN ; Jianhang HU ; REYAGULI·KEYOUMU ; Zhao LIU ; Xiaoqiang LI
Chinese Journal of General Surgery 2024;33(12):2077-2082
Endovascular Aneurysm Repair (EVAR) has become an important treatment method for abdominal aortic aneurysms due to its advantages of shorter operative time,faster postoperative recovery,and lower early postoperative mortality. However,the incidence of complications and the postoperative reintervention rates are higher than those of open surgery. The main complications after EVAR include access vessel injury,post-implantation syndrome,stent migration,endoleaks,visceral branch artery occlusion,lower limb ischemia,and stent infection,which are also the primary causes of reintervention. In recent years,the causes and associated risk factors of various postoperative complications of EVAR have attracted widespread attention and discussion,which are of great significance for improving surgical techniques,enhancing postoperative monitoring,and improving patient outcomes. This paper provides a review of the current complications,associated risk factors,and management strategies after EVAR.

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