Abstract： Diseases prognosis is often influenced by multiple factors, and some intricate non-linear relationships exist among those factors. Artificial neural network （ANN）, an artificial intelligence model, simulates the work mode of biological neurons and has a b capability to analyze multi-factor non-linear relationships. In recent years, ANN is increasingly applied in clinical medical fields, especially for the prediction of disease prognosis. This article focuses on the basic principles of ANN and its application in disease prognosis research.
Objective To assess the value of vascular endothelial growth factor (VEGF) expression in the prognosis of esophageal cancer. Methods PubMed and EMbase were searched for collecting retrospective cohort studies on the correlation between VEGF expression and prognosis of esophageal cancer, and relevant articles were also retrieved from inception to June, 2012. Two reviewers independently screened the literature, extracted the data, and evaluated the quality. Then the meta-analysis was performed by using RevMan5.0 software, and the publication bias of literature was evaluated by means of Begg’s funnel plot and Egger’s method. Results Finally 10 cohort studies involving 811 patients were included. The meta-analysis showed that, patients with high level of VEGF had poor overall survival (HR=1.55, 95%CI 1.25 to 1.91). The results of subgroup analyses including VEGF subtype, critical value of VEGF and source of patient showed that: a) there was no correlation between patient’s prognosis and high level of VEGF-C; b) The high level of VEGF subtype in cancer tissue indicated a higher risk of death when the critical value was 10%, while it was not related to the prognosis when the critical value was 30%; and c) The high level of VEGF in cancer tissue was more valuable to predict the prognosis of esophageal cancer for Chinese patients rather than non-Chinese patients. Conclusion The level of VEGF’s expression in cancer tissue is valuable to predict the prognosis of esophageal cancer.
Objective Application of auditory brainstem response (ABR) in the study on the relationship of neonates with hypoxic-ischemic encephalopathy (HIE) and the children with hearing loss and auxiliary determine the prognosis of encephalopathy. Methods We prospectively selected neonates diagnosed as HIE in the department of neonatology of the Chengdu Women and Children Central Hospital from January, 2006 to June, 2008. Neonatal ABR was tested and the prognosis of neonates were observed through 3-year followed up in order to analyze the relationship between HIE severity and the severity of hearing handicap and the relationship between the severity of hearing handicap and prognosis. Statistical analysis was performed using SPSS 18.0. χ2 test was used to compare the rate between groups. Results 40 cases involving 80 ears were included, of which 33 cases accomplished the 3-year follow-up for prognosis. The results showed that, 86.3% HIE neonates had hearing handicap (mainly mild hearing loss, 40.0%). Medium-severe HIE groups had more serious hearing handicap than Mild HIE group with a statistical significance (continuity correction χ2=7.383, P=0.007). ABR results showed that, mild HIE is mainly manifested as I wave PL prolonged or poorly differentiated, accounting for 78.1%; medium - severe HIE are mainly manifested as III and V wave PL prolonged central segment abnormalities, accounting for 95.8%; the hearing threshold no more than 60 dB group had better prognosis than the hearing threshold more than 60 dB group prognosis (Fisher exact probability P=0.001). Conclusion ABR reflects that HIE severity and was positively related to the severity of hearing handicap. The more serious hearing loss in neonates is, the worse prognosis the neonates have. ABR can be used to assist the assessment of the prognosis of neonatal HIE.
Objective To assess the appropriateness of Barthel Index (BI) and Modified Rankin Scales (MRS) used as long-term outcome measures in a stroke data register and to investigate the correlation between cutoff points of the two scales in different stroke patients with and without disability. Methods Nine hundred and twelve patients were registered prospectively. BI and MRS were evaluated at the end of 1, 3, 6 and 12 months after stroke onset. The distribution, ceiling effects and floor effects of the two scales were evaluated. A logistic regression model was established to investigate correlation of cutoff points of BI and MRS. Results There were a total of 2 829 evaluation points of BI and MRS. The percentages of patients reaching the maximum scores of BI at the end of 3, 6 and 12 months (54.8％, 62.2％ and 68.3％, respectively) were higher than those of MRS. There was significant correlation between the two scales (Spearman’s correlation coefficient 0.887, P＜0.05), when MRS scores of ≤1 and ≤2 were taken as cutoff points, the corresponding cutoff points of BI score were ≥90 and ≥85, respectively. Conclusions BI has significant ceiling effects when used as long-term outcome measurement in a stroke data register. There was significant correlation between BI and MRS scores. In future clinical studies, an MRS score ≤2 or BI score ≥85 could be used as cutoff points in predicting stroke patients with and without disability.
Objective To evaluate the prognostic value of the level of serum neurone specific enolase (NSE) in patients with small cell lung cancer (SCLC). Methods We searched MEDLINE, EMbase, CBMdisc, and The Cochrane Central Register of Controlled Trials (1950 to December 2007). Studies meeting the eligibility criteria were retrieved and their bibliographies were checked for other relevant publications. The quality of included studies was evaluated by 2 reviewers independently. Meta-analyses were performed for the results of homogeneous studies using STATA 7.0 software. Results Nine studies involving 2 021 SCLC patients were included. About 66.0% of patients had high serum levels of NSE, according to the cut-off value defined by the authors. The hazard ratio (HR) of high levels of NSE for overall survival (OS) was 1.27 times of that of low levels of NSE for OS in SCLC patients (95% CI 1.19 to 1.35, P=0.281). Conclusion Patients with high levels of NSE appear to have a poorer OS compared with those with low levels of NSE, thus the level of NSE has a prognostic value in SCLC patients. Due to the potential publication bias, selection bias, and measurement bias among these studies, the conclusion should be interpreted carefully. More high-quality homogeneous studies are required to accurately evaluate the prognostic value of NSE.
目的 探讨颅脑损伤急性期血小板（PLT）参数与外伤性脑梗死（TCI）的关系。 方法 选取2010年9月－2012年1月符合纳入除标准的颅脑损伤患者191例。将伤后14 d内发生脑梗死的患者划入观察组，余为对照组。分别于伤后第24、48小时，第3、7、14天，采集肘静脉血对PLT计数、PLT平均体积（MPV）、PLT体积分布宽度（PDW）；伤后24 h行格拉斯哥昏迷评分（GCS），伤后6个月随访行格拉斯哥结果评分（GOS）。分别分析脑梗死与上述PLT参数的关系、PLT参数与颅脑损伤病情轻重的关系以及与预后的关系。 结果 观察组PLT计数降低、MPV升高、PDW升高；观察组患者GCS/GOS与PLT计数呈正相关，与MPV、PDW呈负相关。 结论 PLT计数、MPV、PDW均与TCI有关，三者中PLT最具临床意义。PLT计数越低、MPV和PDW越高，脑梗死可能性越大，颅脑损伤可能越严重，预后可能越差。
目的 探讨碘131（131I）治疗后Graves眼病（GO）预后与血清促甲状腺激素受体抗体（TRAb）水平变化之间的关系。 方法 选择2011年5月－12月初发Graves病患者238例，分为GO组124 例和非GO组114 例，分别检测131I治疗前及131I治疗后2、3、6个月甲状腺功能和TRAb，GO患者131I治疗前和治疗后6 个月进行临床活动度评分（CAS）。 结果 131I治疗前各组TRAb水平差异无统计学意义（P＞0.05），TRAb水平与GO CAS评分之间无相关；131I治疗后6个月所有患者TRAb水平显著增加；非GO组有5例新发GO，新发GO组与其他患者的TRAb水平分别为（58.7 ± 77.9）、（61.9 ± 81.1）U/L，差异无统计学意义（P＞0.05）；GO组又分为GO无变化29例，GO加重17例，GO缓解78例，三组患者TRAb水平分别为（53.5 ± 77.6）、（66.2 ± 89.9）、（66.8 ± 42.2）U/L，差异无统计学意义（P＞0.05）。 结论 131I治疗后患者TRAb水平显著增加，但TRAb水平的变化和GO预后无关，TRAb与GO的关系还需要进一步研究。
目的 研究美国国立卫生院脑卒中量表（NIHSS）评分、格拉斯哥昏迷评分（GCS）及指数记分法（BI）量表，预测脑梗死患者发病3个月后二便障碍预后的有效性。 方法 采取队列研究，登记2010年9月－2011年10月入院的脑梗死患者性别、年龄、婚姻、民族、职业，由脑卒中护士全面评定NIHSS评分、GCS评分、BI量表等指标。3个月后回访患者二便障碍恢复情况。 结果 分析显示NIHSS评分、GCS评分分值与脑梗死发病后3个月二便障碍恢复相关，BI量表评分分值与脑梗死发病后3个月二便障碍恢复无关。 结论 NIHSS评分、GCS评分分值可以预测脑梗死患者二便障碍恢复情况及预后情况，具有预测有效性。
【摘要】 目的 探讨葡萄糖转运蛋白Ⅰ型（glucose transporter 1，GLUT1）和肿瘤增殖细胞核抗原Ki-67在卵巢上皮性肿瘤组织中的表达及其临床意义。 方法 收集2000年1月-2008年6月不同卵巢上皮性肿瘤病变患者119例的组织标本，采用免疫组织化学SP二步法检测肿瘤组织中GLUT1和Ki-67的表达情况。 结果 卵巢交界性、恶性上皮性肿瘤灶性或广泛高表达GLUT1和Ki-67，其表达强度有差异。卵巢良性上皮性肿瘤不表达GLUT1和Ki-67。在卵巢癌中GLUT1及Ki-67的表达强度与病理分级、临床分期、预后有关。GLUT1表达强度与病理分型无关，Ki-67表达强度与病理分型有关。 结论 卵巢上皮性肿瘤组织中GLUT1和Ki-67的表达具有相关性，其表达强度与肿瘤的良恶性质和增殖状态有关，二者同时检测可以全面了解卵巢上皮性肿瘤的性质、卵巢癌恶性程度和生物学行为，对于判断肿瘤的性质和预后有一定价值。【Abstract】 Objective To investigate the expression and clinical significance of glucose transporter-1 (GLUT1) and tumor proliferating karyon antigen Ki-67 in epithelial ovarian tumor tissue. Methods Immunohistochemistry SP method was used to detect the expression of GLUT1 and Ki-67 protein in epithelial ovarian tumor tissues from 119 patients diagnosed in our hospital from January 2000 to June 2008. Results The expressions of GLUT1 and Ki-67 had local or abroad higher expressions in the borderline and malignant epithelial ovarian tumor, and the expressive intensity was different. In benign tumors, the expression was negative. The expressive intensity of GLUT1 and Ki-67 had correlation with the grade, stage, and prognosis in malignant tumors. The expressive intensity of GLUT1 had no correlation with the type of malignant tumors, while Ki-67 related to the pathological types. Conclusion The expressions of GLUT1 and Ki-67 have relativity. The expressive intensity of GLUT1 and Ki-67 relates to the character and proliferation of epithelial ovarian tumors. The combined detection GLUT1 and Ki-67 is helpful to know the character of epithelial ovarian tumors, the malignant degree and biologic behavior of ovarian carcinoma, which is useful in estimating the character and prognosis of epithelial ovarian tumors.