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Combating medical misinformation and rebuilding trust in the USA 在美国打击医疗误导,重建信任。
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-10-07 DOI: 10.1016/S2589-7500(24)00197-3
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引用次数: 0
Emotional competence self-help mobile phone app versus cognitive behavioural self-help app versus self-monitoring app to promote mental wellbeing in healthy young adults (ECoWeB PROMOTE): an international, multicentre, parallel, open-label, randomised controlled trial. 情绪能力自助手机应用与认知行为自助应用和自我监控应用对比,以促进健康年轻人的心理健康(ECoWeB PROMOTE):一项国际、多中心、平行、开放标签、随机对照试验。
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-10-04 DOI: 10.1016/S2589-7500(24)00149-3
Edward R Watkins, Fiona C Warren, Alexandra Newbold, Claire Hulme, Timothy Cranston, Benjamin Aas, Holly Bear, Cristina Botella, Felix Burkhardt, Thomas Ehring, Mina Fazel, Johnny R J Fontaine, Mads Frost, Azucena Garcia-Palacios, Ellen Greimel, Christiane Hößle, Arpine Hovasapian, Veerle E I Huyghe, Kostas Karpouzis, Johanna Löchner, Guadalupe Molinari, Reinhard Pekrun, Belinda Platt, Tabea Rosenkranz, Klaus R Scherer, Katja Schlegel, Bjorn W Schuller, Gerd Schulte-Korne, Carlos Suso-Ribera, Varinka Voigt, Maria Voß, Rod S Taylor
<p><strong>Background: </strong>Based on evidence that mental health is more than an absence of mental disorders, there have been calls to find ways to promote flourishing at a population level, especially in young people, which requires effective and scalable interventions. Despite their potential for scalability, few mental wellbeing apps have been rigorously tested in high-powered trials, derived from models of healthy emotional functioning, or tailored to individual profiles. We aimed to test a personalised emotional competence self-help app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to promote mental wellbeing in healthy young people.</p><p><strong>Methods: </strong>This international, multicentre, parallel, open-label, randomised controlled trial within a cohort multiple randomised trial (including a parallel trial of depression prevention) was done at four university trial sites in four countries (the UK, Germany, Spain, and Belgium). Participants were recruited from schools and universities and via social media from the four respective countries. Eligible participants were aged 16-22 years with well adjusted emotional competence profiles and no current or past diagnosis of major depression. Participants were randomised (1:1:1) to usual practice plus either the emotional competence app, the CBT app or the self-monitoring app, by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. The primary outcome was mental wellbeing (indexed by the Warwick-Edinburgh Mental Well Being Scale [WEMWBS]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. Outcome assessors were masked to group allocation. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed.</p><p><strong>Findings: </strong>Between Oct 15, 2020, and Aug 3, 2021, 2532 participants were enrolled, and 847 were randomly assigned to the emotional competence app, 841 to the CBT app, and 844 to the self-monitoring app. Mean age was 19·2 years (SD 1·8). Of 2532 participants self-reporting gender, 1896 (74·9%) were female, 613 (24·2%) were male, 16 (0·6%) were neither, and seven (0·3%) were both. 425 participants in the emotional competence app group, 443 in the CT app group, and 447 in the self-monitoring app group completed the follow-up assessment at 3 months. There was no difference in mental wellbeing between the groups at 3 months (global p=0·47). The emotional competence app did not differ from the CBT app (mean difference in WEMWBS -0·21 [95% CI -1·08 to 0·66]) or the self-monitoring app (0·32 [-0·54 to 1·19]) and the CBT app did not differ from the self-monitoring app (0·53 [-0·33 to 1·39]). 14 of 1315 participants were admitted to or treated in hospital (or both) for mental health-related reasons, which were considered unrelated to the interventions (five participants in the emotional competence
背景:有证据表明,心理健康不仅仅是没有精神障碍,因此,人们一直呼吁找到促进人群(尤其是年轻人)心理健康的方法,这需要有效且可扩展的干预措施。尽管心理健康应用程序具有可扩展性的潜力,但很少有心理健康应用程序经过高功率试验的严格测试,这些应用程序源自健康的情绪功能模型,或根据个人情况量身定制。我们旨在测试个性化情绪能力自助应用程序与认知行为疗法(CBT)自助应用程序和自我监控应用程序的对比,以促进健康年轻人的心理健康:在四个国家(英国、德国、西班牙和比利时)的四所大学的试验点进行了这项国际多中心、平行、开放标签、随机对照试验(包括一项预防抑郁症的平行试验)。参与者从四个国家的学校、大学以及社交媒体招募。符合条件的参与者年龄在 16-22 岁之间,具有良好的情绪能力,目前或过去未被诊断出患有重度抑郁症。参与者通过一个独立的计算机系统被随机分配(1:1:1)到通常做法加情绪能力应用程序、CBT 应用程序或自我监控应用程序,最小化国家、年龄和自我报告的性别,并在随机分配后随访 12 个月。主要结果是3个月随访时的心理健康(以沃里克-爱丁堡心理健康量表[WEMWBS]为指标),对完成3个月随访评估的参与者进行分析。结果评估人员对组别分配进行了屏蔽。该研究已在 ClinicalTrials.gov 注册,编号为 NCT04148508,现已结束:2020年10月15日至2021年8月3日期间,共有2532名参与者注册,其中847人被随机分配到情绪能力应用程序,841人被随机分配到CBT应用程序,844人被随机分配到自我监控应用程序。平均年龄为 19-2 岁(SD 1-8)。在 2532 名自我报告性别的参与者中,1896 人(74-9%)为女性,613 人(24-2%)为男性,16 人(0-6%)两者都不是,7 人(0-3%)两者都是。情绪能力应用程序组有 425 人、CT 应用程序组有 443 人、自我监控应用程序组有 447 人完成了 3 个月的跟踪评估。在 3 个月时,各组之间的心理健康状况没有差异(总体 p=0-47)。情绪能力应用程序与 CBT 应用程序(WEMWBS 平均差异-0-21 [95% CI -1-08 to 0-66])或自我监控应用程序(0-32 [-0-54 to 1-19])无差异,CBT 应用程序与自我监控应用程序(0-53 [-0-33 to 1-39])无差异。1315名参与者中有14人因精神健康相关原因入院或住院治疗(或两者兼有),这些原因被认为与干预措施无关(情绪能力应用程序组5人,CBT应用程序组8人,自我监控应用程序组1人)。没有人死亡:解释:情绪能力应用程序和 CBT 应用程序在促进健康青少年心理健康方面的益处有限。这一发现可能反映了这些干预措施的强度较低,以及在低风险人群中通过普及数字干预措施改善心理健康的难度:欧盟委员会。
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引用次数: 0
Emotional competence self-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial. 情绪能力自助应用程序与认知行为自助应用程序和自我监控应用程序对比,以预防风险较高的年轻人患抑郁症(ECoWeB PREVENT):一项国际、多中心、平行、开放标签、随机对照试验。
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-10-04 DOI: 10.1016/S2589-7500(24)00148-1
Edward R Watkins, Fiona C Warren, Alexandra Newbold, Claire Hulme, Timothy Cranston, Benjamin Aas, Holly Bear, Cristina Botella, Felix Burkhardt, Thomas Ehring, Mina Fazel, Johnny R J Fontaine, Mads Frost, Azucena Garcia-Palacios, Ellen Greimel, Christiane Hößle, Arpine Hovasapian, Veerle E I Huyghe, Kostas Karpouzis, Johanna Löchner, Guadalupe Molinari, Reinhard Pekrun, Belinda Platt, Tabea Rosenkranz, Klaus R Scherer, Katja Schlegel, Bjorn W Schuller, Gerd Schulte-Korne, Carlos Suso-Ribera, Varinka Voigt, Maria Voß, Rod S Taylor
<p><strong>Background: </strong>Effective, scalable interventions are needed to prevent poor mental health in young people. Although mental health apps can provide scalable prevention, few have been rigorously tested in high-powered trials built on models of healthy emotional functioning or tailored to individual profiles. We aimed to test a personalised emotional competence app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to prevent an increase in depression symptoms in young people.</p><p><strong>Methods: </strong>This multicentre, parallel, open-label, randomised controlled trial, within a cohort multiple randomised trial (including a parallel trial of wellbeing promotion) was done at four university trial sites in the UK, Germany, Spain, and Belgium. Participants were recruited from schools, universities, and social media from the four respective countries. Eligible participants were aged 16-22 years with increased vulnerability indexed by baseline emotional competence profile, without current or past diagnosis of major depression. Participants were randomly assigned (1:1:1) to usual practice plus either the personalised emotional competence self-help app, the generic CBT self-help app, or the self-monitoring app by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. Outcome assessors were masked to group allocation. The primary outcome was depression symptoms (according to Patient Health Questionnaire-9 [PHQ-9]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed.</p><p><strong>Findings: </strong>Between Oct 15, 2020, and Aug 3, 2021, 1262 participants were enrolled, including 417 to the emotional competence app, 423 to the CBT app, and 422 to the self-monitoring app. Mean age was 18·8 years (SD 2·0). Of 1262 participants self-reporting gender, 984 (78·0%) were female, 253 (20·0%) were male, 15 (1·2%) were neither, and ten (0·8%) were both. 178 participants in the emotional competence app group, 191 in the CBT app group, and 199 in the self-monitoring app group completed the follow-up assessment at 3 months. At 3 months, depression symptoms were lower with the CBT app than the self-monitoring app (mean difference in PHQ-9 -1·18 [95% CI -2·01 to -0·34]; p=0·006), but depression symptoms did not differ between the emotional competence app and the CBT app (0·63 [-0·22 to 1·49]; p=0·15) or the self-monitoring app and emotional competence app (-0·54 [-1·39 to 0·31]; p=0·21). 31 of the 541 participants who completed any of the follow-up assessments received treatment in hospital or were admitted to hospital for mental health-related reasons considered unrelated to interventions (eight in the emotional competence app group, 15 in the CBT app group, and eight in the self-monitoring app group). No deaths o
背景:需要有效的、可扩展的干预措施来预防青少年的不良心理健康。虽然心理健康应用程序可以提供可扩展的预防措施,但很少有应用程序在建立在健康情绪功能模型基础上或根据个人情况量身定制的高功率试验中接受过严格测试。我们的目标是测试个性化情绪能力应用程序与认知行为疗法(CBT)自助应用程序和自我监控应用程序的对比,以防止青少年抑郁症状的增加:这项多中心、平行、开放标签、随机对照试验是在英国、德国、西班牙和比利时的四个大学试验点进行的,属于队列多重随机试验(包括一项促进健康的平行试验)的一部分。参与者分别从四个国家的学校、大学和社交媒体招募。符合条件的参与者年龄在 16-22 岁之间,根据基线情绪能力档案,他们的脆弱性有所提高,但目前或过去未被诊断出患有重度抑郁症。参与者通过一个独立的计算机系统被随机分配(1:1:1)到常规实践加个性化情绪能力自助应用程序、通用 CBT 自助应用程序或自我监控应用程序中,最小化国家、年龄和自我报告的性别,并在随机分配后随访 12 个月。结果评估人员对组别分配进行了屏蔽。主要结果是随访3个月时的抑郁症状(根据患者健康问卷-9 [PHQ-9]),对完成3个月随访评估的参与者进行分析。该研究已在 ClinicalTrials.gov 注册,编号为 NCT04148508,现已结束:2020年10月15日至2021年8月3日期间,共有1262名参与者注册,其中417人使用情绪能力应用程序,423人使用CBT应用程序,422人使用自我监控应用程序。平均年龄为 18-8 岁(SD 2-0)。在 1262 名自我报告性别的参与者中,984 人(78-0%)为女性,253 人(20-0%)为男性,15 人(1-2%)两者都不是,10 人(0-8%)两者都是。情绪能力应用程序组的 178 名参与者、CBT 应用程序组的 191 名参与者和自我监控应用程序组的 199 名参与者完成了 3 个月的跟踪评估。3 个月时,CBT 应用程序的抑郁症状低于自我监控应用程序(PHQ-9 的平均差异为 -1-18 [95% CI -2-01 to -0-34];p=0-006),但情绪能力应用程序与 CBT 应用程序(0-63 [-0-22 to 1-49];p=0-15)或自我监控应用程序与情绪能力应用程序(-0-54 [-1-39 to 0-31];p=0-21)之间的抑郁症状没有差异。在完成任何一项后续评估的 541 名参与者中,有 31 人接受了住院治疗,或因与干预无关的精神健康相关原因入院治疗(情绪能力应用程序组 8 人,CBT 应用程序组 15 人,自我监控应用程序组 8 人)。没有人死亡:与自我监控应用程序相比,CBT 应用程序延迟了高危青少年抑郁症状的增加,尽管这种益处在 12 个月后逐渐消失。与假设相反,情绪能力应用程序在减少抑郁症状方面并不比自我监控应用程序更有效。鉴于CBT自助应用程序的可扩展性、非消耗性和可负担性,它可能是针对年轻人的有价值的公共心理健康干预措施:欧盟委员会。
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引用次数: 0
Demographic reporting in biosignal datasets: a comprehensive analysis of the PhysioNet open access database 生物信号数据集的人口统计学报告:对开放存取的 PhysioNet 数据库的综合分析。
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-10-01 DOI: 10.1016/S2589-7500(24)00170-5
The PhysioNet open access database (PND) is one of the world's largest and most comprehensive repositories of biosignal data and is widely used by researchers to develop, train, and validate algorithms. To contextualise the results of such algorithms, understanding the underlying demographic distribution of the data is crucial—specifically, the race, ethnicity, sex or gender, and age of study participants. We sought to understand the underlying reporting patterns and characteristics of the demographic data of the datasets available on PND. Of the 181 unique datasets present in the PND as of July 6, 2023, 175 involved human participants, with less than 7% of studies reporting on all four of the key demographic variables. Furthermore, we found a higher rate of reporting sex or gender and age than race and ethnicity. In the studies that did include participant sex or gender, the samples were mostly male. Additionally, we found that most studies were done in North America, particularly in the USA. These imbalances and poor reporting of representation raise concerns regarding potential embedded biases in the algorithms that rely on these datasets. They also underscore the need for universal and comprehensive reporting practices to ensure equitable development and deployment of artificial intelligence and machine learning tools in medicine.
PhysioNet 开放存取数据库 (PND) 是世界上最大、最全面的生物信号数据存储库之一,被研究人员广泛用于开发、训练和验证算法。要使这些算法的结果符合实际情况,了解数据的基本人口分布至关重要,特别是研究参与者的种族、民族、性别和年龄。我们试图了解 PND 数据集人口统计数据的基本报告模式和特征。截至 2023 年 7 月 6 日,PND 上有 181 个独特的数据集,其中 175 个涉及人类参与者,只有不到 7% 的研究报告了所有四个关键人口统计学变量。此外,我们发现报告性别和年龄的比例高于报告种族和民族的比例。在包含参与者性别的研究中,样本大多为男性。此外,我们发现大多数研究都是在北美进行的,尤其是美国。这些不平衡和代表性报告的不足引起了人们对依赖于这些数据集的算法中潜在的嵌入式偏见的担忧。它们还强调了普遍和全面报告实践的必要性,以确保医学中人工智能和机器学习工具的公平开发和部署。
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引用次数: 0
Mobile phone interventions to improve health outcomes among patients with chronic diseases: an umbrella review and evidence synthesis from 34 meta-analyses 改善慢性病患者健康状况的手机干预措施:34 项元分析的总综述和证据综述。
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-26 DOI: 10.1016/S2589-7500(24)00119-5
This umbrella review of 34 meta-analyses, representing 235 randomised controlled trials done across 52 countries and 48 957 participants and ten chronic conditions, aimed to evaluate evidence on the efficacy of mobile phone interventions for populations with chronic diseases. We evaluated the strengths of evidence via the Fusar-Poli and Radua methodology. Compared with usual care, mobile apps had convincing effects on glycated haemoglobin reduction among adults with type 2 diabetes (d=0·44). Highly suggestive effects were found for both text messages and apps on various outcomes, including medication adherence (among patients with HIV in sub-Saharan Africa and people with cardiovascular disease), glucose management in type 2 diabetes, and blood pressure reduction in hypertension. Many effects (42%) were non-significant. Various gaps were identified, such as a scarcity of reporting on moderators and publication bias by meta-analyses, little research in low-income and lower-middle-income countries, and little reporting on adverse events.
本综述包括 34 项荟萃分析,涉及 52 个国家的 235 项随机对照试验、48 957 名参与者和 10 种慢性病,旨在评估手机干预对慢性病患者的疗效。我们通过 Fusar-Poli 和 Radua 方法评估了证据的优势。与常规护理相比,手机应用对降低成人 2 型糖尿病患者的糖化血红蛋白具有令人信服的效果(d=0-44)。短信和应用程序对各种结果都有高度提示性效果,包括坚持用药(撒哈拉以南非洲的艾滋病毒感染者和心血管疾病患者)、2 型糖尿病患者的血糖管理和高血压患者的血压降低。许多效果(42%)并不显著。研究还发现了许多不足之处,如缺乏关于调节因素和荟萃分析发表偏差的报告,对低收入和中低收入国家的研究很少,对不良事件的报告也很少。
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引用次数: 0
Deep learning assessment of senescence-associated nuclear morphologies in mammary tissue from healthy female donors to predict future risk of breast cancer: a retrospective cohort study 对健康女性捐献者乳腺组织中与衰老相关的核形态进行深度学习评估,以预测未来罹患乳腺癌的风险:一项回顾性队列研究
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-25 DOI: 10.1016/S2589-7500(24)00150-X
<div><h3>Background</h3><div>Cellular senescence has been associated with cancer as either a barrier mechanism restricting autonomous cell proliferation or a tumour-promoting microenvironmental mechanism that secretes proinflammatory paracrine factors. With most work done in non-human models and the heterogeneous nature of senescence, the precise role of senescent cells in the development of cancer in humans is not well understood. Furthermore, more than 1 million non-malignant breast biopsies are taken every year that could be a major resource for risk stratification. We aimed to explore the clinical relevance for breast cancer development of markers of senescence in mammary tissue from healthy female donors.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we applied single-cell deep learning senescence predictors, based on nuclear morphology, to histological images of haematoxylin and eosin-stained breast biopsy samples from healthy female donors at the Komen Tissue Bank (KTB) at the Indiana University Simon Cancer Center (Indianapolis, IN, USA). All KTB participants (aged ≥18 years) who underwent core biopsies for research purposes between 2009 and 2019 were eligible for the study. Senescence was predicted in the epithelial (terminal duct lobular units [TDLUs] and non-TDLU epithelium), stromal, and adipose tissue compartments using validated models, previously trained on cells induced to senescence by ionising radiation (IR), replicative exhaustion (or replicative senescence; RS), or antimycin A, atazanavir–ritonavir, and doxorubicin (AAD) exposures. To benchmark our senescence-based cancer prediction results, we generated 5-year Gail scores—the current clinical gold standard for breast cancer risk prediction—for participants aged 35 years and older on the basis of characteristics at the time of tissue donation. The primary outcome was estimated odds of breast cancer via logistic modelling for each tissue compartment based on predicted senescence scores in cases (participants who had been diagnosed with breast cancer as of data cutoff, July 31, 2022) and controls (those who had not been diagnosed with breast cancer).</div></div><div><h3>Findings</h3><div>4382 female donors (median age at donation 45 years [IQR 34–57]) were eligible for the study. As of data cutoff (median follow-up of 10 years [7–11]), 86 (2·0%) had developed breast cancer a mean of 4·8 years (SD 2·84) after date of donation and 4296 (98·0%) had not received a breast cancer diagnosis. Among the 86 cases, we found significant differences in adipose-specific IR and AAD senescence prediction scores compared with controls. Risk analysis showed that individuals in the upper half (above the median) of scores for the adipose tissue IR model had higher odds of developing breast cancer (odds ratio [OR] 1·71 [95% CI 1·10–2·68]; p=0·019), whereas the adipose AAD model revealed a reduced odds of developing breast cancer (OR 0·57 [0·36–0·88]; p=0·013). For the othe
背景细胞衰老与癌症有关,它既是限制细胞自主增殖的屏障机制,也是分泌促炎旁分泌因子的肿瘤促进微环境机制。由于大多数研究都是在非人类模型中完成的,而且衰老的性质多种多样,因此人们对衰老细胞在人类癌症发展中的确切作用还不是很了解。此外,每年有 100 多万例非恶性乳腺活检,这可能是进行风险分层的重要资源。在这项回顾性队列研究中,我们将基于核形态的单细胞深度学习衰老预测因子应用于印第安纳大学西蒙癌症中心(印第安纳波利斯,美国)科曼组织库(KTB)中健康女性捐献者的血苏木精和伊红染色乳腺活检样本的组织学图像。所有在2009年至2019年期间为研究目的接受核心活检的KTB参与者(年龄≥18岁)均符合研究条件。使用经过验证的模型预测上皮(末端导管小叶单位 [TDLUs] 和非 TDLU 上皮)、基质和脂肪组织区的衰老,这些模型以前曾在电离辐射(IR)、复制衰竭(或复制衰老;RS)或抗霉素 A、阿扎那韦-利托那韦和多柔比星(AAD)暴露诱导衰老的细胞上进行过训练。为了给我们基于衰老的癌症预测结果设定基准,我们根据组织捐献时的特征为 35 岁及以上的参与者生成了 5 年 Gail 评分--目前临床上预测乳腺癌风险的金标准。主要结果是根据病例(截至数据截止日 2022 年 7 月 31 日已确诊为乳腺癌的参与者)和对照组(未确诊为乳腺癌的参与者)的衰老预测得分,通过逻辑模型对每个组织区块进行估算,得出患乳腺癌的几率。截至数据截止日期(中位数随访时间为 10 年 [7-11]),86 例(2-0%)在捐献日期后平均 4-8 年(SD 2-84)患上乳腺癌,4296 例(98-0%)未确诊乳腺癌。在这 86 例病例中,我们发现脂肪特异性 IR 和 AAD 衰老预测得分与对照组相比存在显著差异。风险分析表明,脂肪组织IR模型得分处于上半部(高于中位数)的人患乳腺癌的几率更高(几率比[OR] 1-71 [95% CI 1-10-2-68];P=0-019),而脂肪AAD模型显示患乳腺癌的几率降低(OR 0-57 [0-36-0-88];P=0-013)。对于其他组织区划和 RS 模型,没有发现明显的关联(除了通过 IR 模型的基质组织,其患乳腺癌的几率更高 [OR 1-59, 1-03-2-49])。同时具有两种脂肪风险因素的个体的OR值为3-32(1-68-7-03;P=0-0009)。5年Gail评分高于中位数的参与者与评分低于中位数的参与者相比,患癌症的OR值为2-33(1-46-3-82;p=0-0012)。在将盖尔评分与我们的脂肪 AAD 风险模型相结合时,我们发现同时具有这两个预测因子的个体的 OR 值为 4-70 (2-29-10-90; p<0-0001)。当将盖尔评分与我们的脂肪 IR 模型相结合时,我们发现同时具有这两个预测因子的个体的 OR 值为 3-45 (1-77-7-24; p=0-0002)。与目前的临床基准 Gail 模型相比,多种模型的组合提高了对未来乳腺癌的预测能力。我们的研究结果表明,基于显微镜图像的深度学习模型在预测未来癌症发展方面发挥着重要作用。此类模型可纳入当前的乳腺癌风险评估和筛查方案。
{"title":"Deep learning assessment of senescence-associated nuclear morphologies in mammary tissue from healthy female donors to predict future risk of breast cancer: a retrospective cohort study","authors":"","doi":"10.1016/S2589-7500(24)00150-X","DOIUrl":"10.1016/S2589-7500(24)00150-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Cellular senescence has been associated with cancer as either a barrier mechanism restricting autonomous cell proliferation or a tumour-promoting microenvironmental mechanism that secretes proinflammatory paracrine factors. With most work done in non-human models and the heterogeneous nature of senescence, the precise role of senescent cells in the development of cancer in humans is not well understood. Furthermore, more than 1 million non-malignant breast biopsies are taken every year that could be a major resource for risk stratification. We aimed to explore the clinical relevance for breast cancer development of markers of senescence in mammary tissue from healthy female donors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this retrospective cohort study, we applied single-cell deep learning senescence predictors, based on nuclear morphology, to histological images of haematoxylin and eosin-stained breast biopsy samples from healthy female donors at the Komen Tissue Bank (KTB) at the Indiana University Simon Cancer Center (Indianapolis, IN, USA). All KTB participants (aged ≥18 years) who underwent core biopsies for research purposes between 2009 and 2019 were eligible for the study. Senescence was predicted in the epithelial (terminal duct lobular units [TDLUs] and non-TDLU epithelium), stromal, and adipose tissue compartments using validated models, previously trained on cells induced to senescence by ionising radiation (IR), replicative exhaustion (or replicative senescence; RS), or antimycin A, atazanavir–ritonavir, and doxorubicin (AAD) exposures. To benchmark our senescence-based cancer prediction results, we generated 5-year Gail scores—the current clinical gold standard for breast cancer risk prediction—for participants aged 35 years and older on the basis of characteristics at the time of tissue donation. The primary outcome was estimated odds of breast cancer via logistic modelling for each tissue compartment based on predicted senescence scores in cases (participants who had been diagnosed with breast cancer as of data cutoff, July 31, 2022) and controls (those who had not been diagnosed with breast cancer).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;4382 female donors (median age at donation 45 years [IQR 34–57]) were eligible for the study. As of data cutoff (median follow-up of 10 years [7–11]), 86 (2·0%) had developed breast cancer a mean of 4·8 years (SD 2·84) after date of donation and 4296 (98·0%) had not received a breast cancer diagnosis. Among the 86 cases, we found significant differences in adipose-specific IR and AAD senescence prediction scores compared with controls. Risk analysis showed that individuals in the upper half (above the median) of scores for the adipose tissue IR model had higher odds of developing breast cancer (odds ratio [OR] 1·71 [95% CI 1·10–2·68]; p=0·019), whereas the adipose AAD model revealed a reduced odds of developing breast cancer (OR 0·57 [0·36–0·88]; p=0·013). For the othe","PeriodicalId":48534,"journal":{"name":"Lancet Digital Health","volume":null,"pages":null},"PeriodicalIF":23.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of the COVID-19 pandemic on health-care use among patients with cancer in England, UK: a comprehensive phase-by-phase time-series analysis across attendance types for 38 cancers COVID-19 大流行对英国英格兰癌症患者使用医疗服务的影响:对 38 种癌症的不同就诊类型进行逐阶段时间序列综合分析
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-25 DOI: 10.1016/S2589-7500(24)00152-3
<div><h3>Background</h3><div>The COVID-19 pandemic resulted in the widespread disruption of cancer health provision services across the entirety of the cancer care pathway in the UK, from screening to treatment. The potential long-term health implications, including increased mortality for individuals who missed diagnoses or appointments, are concerning. However, the precise impact of lockdown policies on national cancer health service provision across diagnostic groups is understudied. We aimed to systematically evaluate changes in patterns of attendance for groups of individuals diagnosed with cancer, including the changes in attendance volume and consultation rates, stratified by both time-based exposures and by patient-based exposures and to better understand the impact of such changes on cancer-specific mortality.</div></div><div><h3>Methods</h3><div>In this retrospective, cross-sectional, phase-by-phase time-series analysis, by using primary care records linked to hospitals and the death registry from Jan 1, 1998, to June 17, 2021, we conducted descriptive analyses to quantify attendance changes for groups stratified by patient-based exposures (Index of Multiple Deprivation, ethnicity, age, comorbidity count, practice region, diagnosis time, and cancer subtype) across different phases of the COVID-19 pandemic in England, UK. In this study, we defined the phases of the COVID-19 pandemic as: pre-pandemic period (Jan 1, 2018, to March 22, 2020), lockdown 1 (March 23 to June 21, 2020), minimal restrictions (June 22 to Sept 20, 2020), lockdown 2 (Sept 21, 2020, to Jan 3, 2021), lockdown 3 (Jan 4 to March 21, 2021), and lockdown restrictions lifted (March 22 to March 31, 2021). In the analyses we examined changes in both attendance volume and consultation rate. We further compared changes in attendance trends to cancer-specific mortality trends. Finally, we conducted an interrupted time-series analysis with the lockdown on March 23, 2020, as the intervention point using an autoregressive integrated moving average model.</div></div><div><h3>Findings</h3><div>From 561 611 eligible individuals, 7 964 685 attendances were recorded. During the first lockdown, the median attendance volume decreased (–35·30% [IQR –36·10 to –34·25]) compared with the preceding pre-pandemic period, followed by a median change of 4·38% (2·66 to 5·15) during minimal restrictions. More drastic reductions in attendance volume were seen in the second (–48·71% [–49·54 to –48·26]) and third (–71·62% [–72·23 to –70·97]) lockdowns. These reductions were followed by a 4·48% (3·45 to 7·10) increase in attendance when lockdown restrictions were lifted. The median consultation rate change during the first lockdown was 31·32% (25·10 to 33·60), followed by a median change of –0·25% (–1·38 to 1·68) during minimal restrictions. The median consultation rate decreased in the second (–33·89% [–34·64 to –33·18]) and third (–4·98% [–5·71 to –4·00]) lockdowns, followed by a 416·16% increase (40
背景COVID-19 大流行导致英国从筛查到治疗的整个癌症治疗过程中癌症医疗服务的广泛中断。其潜在的长期健康影响令人担忧,包括因错过诊断或预约而增加的个人死亡率。然而,有关封锁政策对不同诊断组的国家癌症医疗服务提供的确切影响的研究还很不足。我们的目的是系统地评估被诊断为癌症的人群就诊模式的变化,包括就诊量和就诊率的变化,按基于时间的暴露和基于患者的暴露进行分层,并更好地了解这些变化对癌症特异性死亡率的影响。方法在这项回顾性、横断面、逐阶段的时间序列分析中,我们利用 1998 年 1 月 1 日至 2021 年 6 月 17 日期间与医院和死亡登记处相连接的初级保健记录,进行了描述性分析,以量化英国英格兰 COVID-19 大流行不同阶段按患者暴露(多重贫困指数、种族、年龄、合并症计数、执业地区、诊断时间和癌症亚型)分层的群体就诊量变化。在本研究中,我们将 COVID-19 大流行的阶段定义为:大流行前期(2018 年 1 月 1 日至 2020 年 3 月 22 日)、封锁 1 期(2020 年 3 月 23 日至 6 月 21 日)、最小限制期(2020 年 6 月 22 日至 9 月 20 日)、封锁 2 期(2020 年 9 月 21 日至 2021 年 1 月 3 日)、封锁 3 期(2021 年 1 月 4 日至 3 月 21 日)和封锁限制解除期(2021 年 3 月 22 日至 3 月 31 日)。在分析中,我们研究了就诊人数和就诊率的变化。我们还将就诊趋势的变化与癌症特定死亡率趋势进行了比较。最后,我们使用自回归综合移动平均模型,以 2020 年 3 月 23 日的封锁为干预点,进行了间断时间序列分析。与大流行前相比,在第一次封锁期间,就诊人数的中位数减少了(-35-30% [IQR -36-10 to -34-25]),随后在最小限制期间,就诊人数的中位数变化为 4-38%(2-66 to 5-15)。在第二次(-48-71% [-49-54至-48-26])和第三次(-71-62% [-72-23至-70-97])封锁期间,就诊人数的减少幅度更大。随后,在解除封锁限制后,就诊人数增加了 4-48%(3-45 至 7-10)。在第一次封锁期间,就诊率变化的中位数为 31-32%(25-10 到 33-60),随后在最小限制期间,就诊率变化的中位数为-0-25%(-1-38 到 1-68)。在第二次(-33-89%[-34-64 到 -33-18])和第三次(-4-98%[-5-71 到 -4-00])封锁期间,咨询率的中位数有所下降,而在解除封锁限制后,咨询率的中位数增加了 416-16%(409-77 到 429-77)。值得注意的是,在许多周内,每周就诊人数逐年减少的同时,癌症死亡率却逐年上升。总体而言,与大流行之前相比,大流行期间癌症患者的就诊人数出现了统计学意义上的显著减少(封锁 1 -24 070-19 人次,p<0-0001;最小限制 -19 194-89 人次,p<0-0001;封锁 2 -31 311-28 人次,p<0-0001;封锁 3 -43 843-38 人次,p<0-0001;取消封锁限制 -56 260-50 人次,p<0-0001)。解读英国 COVID-19 大流行封锁对癌症医疗服务的获取产生了负面影响。在大流行的各个阶段,许多癌症患者群体的就诊量和就诊率都有所下降。就诊人数的减少可能会导致癌症诊断、治疗和随访的延误,从而使这类人群面临更高的负面健康风险,如癌症特异性死亡率。我们讨论了解释服务提供趋势变化的潜在因素,并提供了见解,以帮助为高危人群的临床随访提供信息,同时为此类患者的护理提供潜在的未来政策变化。
{"title":"Impact of the COVID-19 pandemic on health-care use among patients with cancer in England, UK: a comprehensive phase-by-phase time-series analysis across attendance types for 38 cancers","authors":"","doi":"10.1016/S2589-7500(24)00152-3","DOIUrl":"10.1016/S2589-7500(24)00152-3","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The COVID-19 pandemic resulted in the widespread disruption of cancer health provision services across the entirety of the cancer care pathway in the UK, from screening to treatment. The potential long-term health implications, including increased mortality for individuals who missed diagnoses or appointments, are concerning. However, the precise impact of lockdown policies on national cancer health service provision across diagnostic groups is understudied. We aimed to systematically evaluate changes in patterns of attendance for groups of individuals diagnosed with cancer, including the changes in attendance volume and consultation rates, stratified by both time-based exposures and by patient-based exposures and to better understand the impact of such changes on cancer-specific mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this retrospective, cross-sectional, phase-by-phase time-series analysis, by using primary care records linked to hospitals and the death registry from Jan 1, 1998, to June 17, 2021, we conducted descriptive analyses to quantify attendance changes for groups stratified by patient-based exposures (Index of Multiple Deprivation, ethnicity, age, comorbidity count, practice region, diagnosis time, and cancer subtype) across different phases of the COVID-19 pandemic in England, UK. In this study, we defined the phases of the COVID-19 pandemic as: pre-pandemic period (Jan 1, 2018, to March 22, 2020), lockdown 1 (March 23 to June 21, 2020), minimal restrictions (June 22 to Sept 20, 2020), lockdown 2 (Sept 21, 2020, to Jan 3, 2021), lockdown 3 (Jan 4 to March 21, 2021), and lockdown restrictions lifted (March 22 to March 31, 2021). In the analyses we examined changes in both attendance volume and consultation rate. We further compared changes in attendance trends to cancer-specific mortality trends. Finally, we conducted an interrupted time-series analysis with the lockdown on March 23, 2020, as the intervention point using an autoregressive integrated moving average model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;From 561 611 eligible individuals, 7 964 685 attendances were recorded. During the first lockdown, the median attendance volume decreased (–35·30% [IQR –36·10 to –34·25]) compared with the preceding pre-pandemic period, followed by a median change of 4·38% (2·66 to 5·15) during minimal restrictions. More drastic reductions in attendance volume were seen in the second (–48·71% [–49·54 to –48·26]) and third (–71·62% [–72·23 to –70·97]) lockdowns. These reductions were followed by a 4·48% (3·45 to 7·10) increase in attendance when lockdown restrictions were lifted. The median consultation rate change during the first lockdown was 31·32% (25·10 to 33·60), followed by a median change of –0·25% (–1·38 to 1·68) during minimal restrictions. The median consultation rate decreased in the second (–33·89% [–34·64 to –33·18]) and third (–4·98% [–5·71 to –4·00]) lockdowns, followed by a 416·16% increase (40","PeriodicalId":48534,"journal":{"name":"Lancet Digital Health","volume":null,"pages":null},"PeriodicalIF":23.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Symptom trajectories in infancy for the prediction of subsequent wheeze and asthma in the BILD and PASTURE cohorts: a dynamic network analysis 婴儿期症状轨迹对 BILD 和 PASTURE 队列中后续喘息和哮喘的预测:动态网络分析
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-25 DOI: 10.1016/S2589-7500(24)00147-X
<div><h3>Background</h3><div>Host and environment early-life risk factors are associated with progression of wheezing symptoms over time; however, their individual contribution is relatively small. We hypothesised that the dynamic interactions of these factors with an infant's developing respiratory system are the dominant factor for subsequent wheeze and asthma.</div></div><div><h3>Methods</h3><div>In this dynamic network analysis we used data from term healthy infants from the Basel-Bern Infant Lung Development (BILD) cohort (435 neonates aged 0–4 weeks recruited in Switzerland between Jan 1, 1999, and Dec 31, 2012) and replicated the findings in the Protection Against Allergy Study in Rural Environments (PASTURE) cohort (498 infants aged 0–12 months recruited in Germany, Switzerland, Austria, France, and Finland between Jan 1, 2002, and Oct 31, 2006). BILD exclusion criteria for the current study were prematurity (<37 weeks), major birth defects, perinatal disease of the neonate, and incomplete follow-up period. PASTURE exclusion criteria were women younger than 18 years, a multiple pregnancy, the sibling of a child was already included in the study, the family intended to move away from the area where the study was conducted, and the family had no telephone connection. Outcome groups were subsequent wheeze, asthma, and healthy. The first outcome was defined as ever wheezed between the age of 2 years and 6 years. Week-by-week correlations of the determining factors with cumulative symptom scores (CSS) were calculated from weeks 2 to 52 (BILD) and weeks 8 to 52 (PASTURE). The complex dynamic interaction between the determining factors and the CSS was assessed via dynamic host–environment correlation network, quantified by a simple descriptor: trajectory function <em>G(t)</em>. Wheeze outcomes at age 2–6 years were compared in 335 infants from BILD and 437 infants from PASTURE, and asthma outcomes were analysed at age 6 years in a merged cohort of 783 infants.</div></div><div><h3>Findings</h3><div>CSS was significantly different for wheeze and asthma outcomes and became increasingly important during infancy in direct comparison with all determining factors. Weekly symptoms were tracked for groups of infants, showing a non-linear increase with time. Using logistic regression classification, <em>G(t)</em> distinguished between the healthy group and wheeze or asthma groups (area under the curve>0·97, p<0·0001; sensitivity analysis confirmed significant CSS association with wheeze [BILD p=0·0002 and PASTURE p=0·068]) and <em>G(t)</em> was also able to distinguish between the farming and non-farming exposure groups (p<0·0001).</div></div><div><h3>Interpretation</h3><div>Similarly to other risk factors, CSS had weak sensitivity and specificity to identify risks at the individual level. At group level however, the dynamic host–environment correlation network properties (<em>G(t)</em>) showed excellent discriminative ability for identifying
背景早期生活中的宿主和环境风险因素与喘息症状随着时间的推移而加重有关;但是,这些因素的单独作用相对较小。我们假设,这些因素与婴儿呼吸系统发育过程中的动态相互作用是导致后续喘息和哮喘的主要因素。方法在这项动态网络分析中,我们使用了来自巴塞尔-伯尔尼婴儿肺发育(BILD)队列(1999 年 1 月 1 日至 2012 年 12 月 31 日期间在瑞士招募的 435 名 0-4 周大的新生儿)的足月健康婴儿的数据,并复制了农村环境中的抗过敏保护研究(PASTURE)队列(2002 年 1 月 1 日至 2006 年 10 月 31 日期间在德国、瑞士、奥地利、法国和芬兰招募的 498 名 0-12 个月大的婴儿)的研究结果。本次研究的 BILD 排除标准为早产(37 周)、重大出生缺陷、新生儿围产期疾病和随访时间不完整。PASTURE 的排除标准是:女性小于 18 岁、多胎妊娠、孩子的兄弟姐妹已被纳入研究、家庭打算搬离研究地区、家庭没有电话连接。结果分组为嗣后喘息、哮喘和健康。第一项结果定义为 2 岁至 6 岁期间曾经喘息。从第 2 周到第 52 周(BILD)和第 8 周到第 52 周(PASTURE),逐周计算决定因素与累积症状评分 (CSS) 的相关性。决定因素与 CSS 之间复杂的动态相互作用通过动态的宿主-环境相关网络进行评估,并通过简单的描述符进行量化:轨迹函数 G(t)。对来自 BILD 的 335 名婴儿和来自 PASTURE 的 437 名婴儿 2-6 岁时的喘息结果进行了比较,并对 783 名合并队列婴儿 6 岁时的哮喘结果进行了分析。对各组婴儿的每周症状进行了追踪,结果显示,随着时间的推移,症状呈非线性增加。通过逻辑回归分类,G(t)可区分健康组和喘息或哮喘组(曲线下面积>0-97,p<0-0001;敏感性分析证实 CSS 与喘息有显著关联 [BILD p=0-0002 和 PASTURE p=0-068]),G(t)还能区分养殖和非养殖暴露组(p<0-0001)。然而,在群体水平上,动态宿主-环境相关网络特性(G(t))在识别随后出现喘息和哮喘的婴儿群体方面表现出卓越的鉴别能力。这项研究的结果与2018年柳叶刀哮喘委员会的研究结果一致,后者强调了发育过程中风险因素之间动态相互作用的重要性,而不是风险因素本身的重要性。资金来源瑞士国家科学基金会、Kühne基金会、EFRAIM研究欧盟研究基金、FORALLVENT研究欧盟研究基金和莱布尼兹奖。
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引用次数: 0
In the era of digitalisation and biosignatures, is C-reactive protein still the one to beat? 在数字化和生物特征时代,C 反应蛋白是否仍然是最重要的指标?
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-25 DOI: 10.1016/S2589-7500(24)00177-8
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引用次数: 0
Highly sensitive detection platform-based diagnosis of oesophageal squamous cell carcinoma in China: a multicentre, case–control, diagnostic study 基于高灵敏检测平台的中国食管鳞状细胞癌诊断:一项多中心病例对照诊断研究
IF 23.8 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2024-09-25 DOI: 10.1016/S2589-7500(24)00153-5
<div><h3>Background</h3><div>Early detection and screening of oesophageal squamous cell carcinoma rely on upper gastrointestinal endoscopy, which is not feasible for population-wide implementation. Tumour marker-based blood tests offer a potential alternative. However, the sensitivity of current clinical protein detection technologies is inadequate for identifying low-abundance circulating tumour biomarkers, leading to poor discrimination between individuals with and without cancer. We aimed to develop a highly sensitive blood test tool to improve detection of oesophageal squamous cell carcinoma.</div></div><div><h3>Methods</h3><div>We designed a detection platform named SENSORS and validated its effectiveness by comparing its performance in detecting the selected serological biomarkers MMP13 and SCC against ELISA and electrochemiluminescence immunoassay (ECLIA). We then developed a SENSORS-based oesophageal squamous cell carcinoma adjunct diagnostic system (with potential applications in screening and triage under clinical supervision) to classify individuals with oesophageal squamous cell carcinoma and healthy controls in a retrospective study including participants (cohort I) from Sun Yat-sen University Cancer Center (SYSUCC; Guangzhou, China), Henan Cancer Hospital (HNCH; Zhengzhou, China), and Cancer Hospital of Shantou University Medical College (CHSUMC; Shantou, China). The inclusion criteria were age 18 years or older, pathologically confirmed primary oesophageal squamous cell carcinoma, and no cancer treatments before serum sample collection. Participants without oesophageal-related diseases were recruited from the health examination department as the control group. The SENSORS-based diagnostic system is based on a multivariable logistic regression model that uses the detection values of SENSORS as the input and outputs a risk score for the predicted likelihood of oesophageal squamous cell carcinoma. We further evaluated the clinical utility of the system in an independent prospective multicentre study with different participants selected from the same three institutions. Patients with newly diagnosed oesophageal-related diseases without previous cancer treatment were enrolled. The inclusion criteria for healthy controls were no obvious abnormalities in routine blood and tumour marker tests, no oesophageal-associated diseases, and no history of cancer. Finally, we assessed whether classification could be improved by integrating machine-learning algorithms with the system, which combined baseline clinical characteristics, epidemiological risk factors, and serological tumour marker concentrations. Retrospective SYSUCC cohort I (randomly assigned [7:3] to a training set and an internal validation set) and three prospective validation sets (SYSUCC cohort II [internal validation], HNCH cohort II [external validation], and CHSUMC cohort II [external validation]) were used in this step. Six machine-learning algorithms were compared (the least a
背景食道鳞状细胞癌的早期检测和筛查依赖于上消化道内窥镜检查,而这种检查在全民范围内并不可行。基于肿瘤标记物的血液检测提供了一种潜在的替代方法。然而,目前临床蛋白质检测技术的灵敏度不足以识别低丰度的循环肿瘤生物标记物,导致对癌症患者和非癌症患者的区分度较低。我们设计了一个名为 SENSORS 的检测平台,并通过比较其与 ELISA 和电化学发光免疫分析法(ECLIA)在检测所选血清生物标志物 MMP13 和 SCC 方面的性能,验证了其有效性。然后,我们开发了基于 SENSORS 的食管鳞状细胞癌辅助诊断系统(可应用于临床监督下的筛查和分流),在一项回顾性研究中对食管鳞状细胞癌患者和健康对照者进行分类,研究对象包括中山大学附属肿瘤医院(SYSUCC;中国广州)、河南省肿瘤医院(中国郑州)和汕头大学医学院附属肿瘤医院(中国汕头)的参与者(队列 I)。纳入标准为年龄在 18 岁或以上、病理证实为原发性食管鳞状细胞癌、血清样本采集前未接受过癌症治疗。对照组从健康体检部门招募没有食道相关疾病的参与者。基于 SENSORS 的诊断系统以多变量逻辑回归模型为基础,将 SENSORS 的检测值作为输入,并输出预测食管鳞状细胞癌可能性的风险评分。我们在一项独立的前瞻性多中心研究中进一步评估了该系统的临床实用性,该研究的参与者来自同三家机构。新诊断出患有食道相关疾病且未接受过癌症治疗的患者被纳入研究。健康对照组的纳入标准是常规血液和肿瘤标志物检测无明显异常、无食道相关疾病、无癌症病史。最后,我们结合基线临床特征、流行病学风险因素和血清学肿瘤标志物浓度,评估了将机器学习算法与系统集成是否能改进分类。在这一步骤中使用了回顾性 SYSUCC 队列 I(随机分配 [7:3] 到一个训练集和一个内部验证集)和三个前瞻性验证集(SYSUCC 队列 II [内部验证]、HNCH 队列 II [外部验证] 和 CHSUMC 队列 II [外部验证])。比较了六种机器学习算法(最小绝对收缩和选择算子回归、脊回归、随机森林、逻辑回归、支持向量机和神经网络),并选择表现最佳的算法作为最终预测模型。SENSORS 和基于 SENSORS 的诊断系统的性能主要通过准确性、灵敏度、特异性和接收器操作特征曲线下面积(AUC)进行评估。研究结果在 2017 年 10 月 1 日至 2020 年 4 月 30 日期间,1051 名参与者被纳入回顾性研究。在前瞻性诊断研究中,从 2022 年 4 月 2 日至 2023 年 2 月 2 日,共纳入了 924 名参与者。与 ELISA(108-90 pg/mL)和 ECLIA(41-79 pg/mL)相比,SENSORS(243-03 fg/mL)分别提高了 448 倍和 172 倍。在三个回顾性验证集中,基于 SENSORS 的诊断系统在 SYSUCC 内部验证集中的 AUC 值为 0-95(95% CI 0-90-0-99),在 HNCH 外部验证集中的 AUC 值为 0-93(0-89-0-97),在 CHSUMC 外部验证集中的 AUC 值为 0-98(0-97-1-00)、灵敏度分别为 87-1% (79-3-92-3)、98-6% (94-4-99-8) 和 93-5% (88-1-96-7),特异性分别为 88-9% (75-2-95-8)、74-6% (61-3-84-6) 和 92-1% (81-7-97-0),成功区分了食管鳞状细胞癌患者和健康对照组。此外,在三个前瞻性验证队列中,该算法对 SYSUCC 的灵敏度为 90-9%(95% CI 86-1-94-2),对 HNCH 的灵敏度为 84-8%(76-1-90-8),对 CHSUMC 的灵敏度为 95-2%(85-6-98-7)。在比较的六种机器学习算法中,随机森林模型表现最佳。
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