Objective:Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors(GISTs).However,the laparoscopic approach for GISTs located in the esophagogastric junction(EGJ-GIST)is surgically challeng...Objective:Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors(GISTs).However,the laparoscopic approach for GISTs located in the esophagogastric junction(EGJ-GIST)is surgically challenging.This study compares the efficacy of laparoscopic surgery and the open procedure for EGJ-GIST through the propensity score weighting(PSW)method.Methods:Between April 2006 and April 2018,1,824 surgical patients were diagnosed with primary gastric GIST at four medical centers in South China.Of these patients,228 were identified as EGJ-GISTs and retrospectively reviewed clinicopathological characteristics,operative information,and long-term outcomes.PSW was used to create the balanced cohorts.Results:PSW was carried out in laparoscopic and open-surgery cohorts according to year of surgery,sex,age,body mass index(BMI),tumor size,mitotic rates and recurrence risk.After PSW,438 patients consisting of 213 laparoscopic(L group)and 225 open surgery(O group)patients were enrolled.After PSW,the following measures in the L group were superior to those in the O group:median operative time[interquartile range(IQR)]:100.0(64.5-141.5)vs.149.0(104.0-197.5)min,P<0.001;median blood loss(IQR):30.0(10.0-50.0)vs.50.0(20.0-100.0)mL,P=0.002;median time to liquid intake(IQR):3.0(2.0-4.0)vs.4.0(3.0-5.0)d,P<0.001;median hospital stay(IQR):6.0(4.0-8.0)vs.7.0(5.0-12.0)d,P<0.001;and postoperative complications(10.3%vs.22.7%,P=0.001).The median follow-up was 55(range,2-153)months in the entire cohort.No significant differences were detected in either relapse-free survival(RFS)[hazard ratio(HR):0.372,95%confidence interval(95%CI):0.072-1.910,P=0.236]or overall survival(OS)(HR:0.400,95%CI:0.119-1.343,P=0.138)between the two groups.Conclusions:Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time,reduced blood loss,shorter time to liquid intake,and shorter length of stay,all without compromising postoperative outcomes and long-term survival.展开更多
Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confo...Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.展开更多
目的探讨C反应蛋白/白蛋白比值(C-reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者出现心血管事件风险的相关性。方法选择2016年8月至2019年12月在广州医科大学附属第二医院血液净化中心进...目的探讨C反应蛋白/白蛋白比值(C-reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者出现心血管事件风险的相关性。方法选择2016年8月至2019年12月在广州医科大学附属第二医院血液净化中心进行治疗的MHD患者为研究对象,随访截止时间为2021年3月31日。收集符合研究纳入标准的患者的人口学资料、合并症、原发病因、规律透析治疗3个月后的生化指标及随访截止时间内心血管事件发生情况。采用Kaplan-Meier法估计MHD患者出现心血管事件的概率。基于广义倾向性得分加权(GPSW)的Cox比例风险回归模型评估CAR水平与MHD患者出现心血管事件风险的关联。结果共纳入符合标准的研究对象170例,其中64例患者出现心血管事件(占37.6%)。基于GPSW的Cox比例风险回归模型提示(HR_(CAR)=2.087,95%CI:1.085~4.015,P=0.028),说明MHD患者的CAR平均每增加一个单位,出现心血管事件的风险比为2.087。结论CAR与MHD患者的心血管事件风险存在显著的正相关关系,这将有助于临床工作者识别具有高心血管事件风险的MHD患者并及时干预。展开更多
本研究依托2018年中国老年社会追踪调查(China Longitudinal Aging Social Survey,CLASS)数据,在基准回归模型估计基础上,运用倾向值加权法,对多维照料类型(照料孙辈和照料父母)与照料强度(单一照料或双重照料)下的老年人生活满意度进...本研究依托2018年中国老年社会追踪调查(China Longitudinal Aging Social Survey,CLASS)数据,在基准回归模型估计基础上,运用倾向值加权法,对多维照料类型(照料孙辈和照料父母)与照料强度(单一照料或双重照料)下的老年人生活满意度进行分析,并基于“自主性”的角度和“进化论”的框架为此作出理论解释。结果显示,为孙辈和父母提供照料的老年人接近三成,照料工作总体上表现出显著的生活满意度增进效应;其中,超过八成的人照料孙辈,这方面照料工作的正向作用明显更加突出,而照料父母则基本不显示积极的影响;同时照料孙辈与父母也未能实现老年生活满意度的改善。展开更多
用户搜索时产生的点击数据分布,在不同的搜索场景下存在较大差异.现有算法如融合上下文的位置模型(contextual position based model,CPBM)往往只通过单个模型预测多种场景下的位置倾向性得分,不可避免地降低了模型在不同场景下的预测...用户搜索时产生的点击数据分布,在不同的搜索场景下存在较大差异.现有算法如融合上下文的位置模型(contextual position based model,CPBM)往往只通过单个模型预测多种场景下的位置倾向性得分,不可避免地降低了模型在不同场景下的预测准确性,影响去除位置偏置的效果.基于上述问题提出一种基于多任务学习的多门专家混合位置倾向性得分预测模型(multi-gate contextual position based model,MCPBM),在CPBM模型的基础上加入信息筛选结构,解决了多场景数据联合训练时预测准确性不佳的问题.同时,为了缓解不同任务收敛速度不一致的问题,提出了指数加权平均权重动态调整算法,在加速模型训练的同时提升了模型整体预测性能.实验结果表明提出的MCPBM模型在多场景数据联合训练时,预测准确性优于传统的CPBM;在使用MCPBM模型去除位置偏置后,基于生成的无偏数据训练得到的排序模型,在AvgRank排序指标上有1%~5%的提升.展开更多
目的:使用倾向评分匹配(propensity score matching,PSM)评估髋关节置换术中椎管内麻醉(intrathecal anesthesia,IA)与全身麻醉的效果。方法:回顾性选取2019年1月—2022年6月徐州民政医院收治的100例髋关节置换术患者。根据麻醉方式将...目的:使用倾向评分匹配(propensity score matching,PSM)评估髋关节置换术中椎管内麻醉(intrathecal anesthesia,IA)与全身麻醉的效果。方法:回顾性选取2019年1月—2022年6月徐州民政医院收治的100例髋关节置换术患者。根据麻醉方式将其分为IA组(61例)和全麻组(39例)。采用PSM对两组患者进行匹配,从而对两组混杂因素进行控制。IA组给予IA,全麻组给予全身麻醉。比较两组PSM法匹配前后基线资料。比较两组麻醉效果,术前及术后12 h、24 h、48 h认知功能,围手术期指标及并发症。结果:PSM匹配后,两组性别、年龄、体重指数(body mass index,BMI)、疾病类型、美国麻醉医师协会分级(American society of anesthesiologists,ASA)分级、高血压史、糖尿病史、PSM评分比较差异无统计学意义(P>0.05)。两组麻醉效果及麻醉优良率比较差异均无统计学意义(P>0.05)。重复测量方差分析显示,两组简易智力状态检查量表(mini mental state examination,MMSE)评分时点、组间、时点·组间比较差异均有统计学意义(P<0.05)。两组术后12 h、24 h的MMSE评分均低于术前,差异有统计学意义(P<0.05);术后48 h,两组MMSE评分与术前比较差异无统计学意义(P>0.05)。IA组术后12 h、24 h MMSE评分均高于全麻组,差异有统计学意义(P<0.05)。IA组术后留观时间、住院时间均短于全麻组,住院费用少于全麻组,差异有统计学意义(P<0.05)。IA组并发症发生率为5.71%,低于全麻组的22.86%,差异有统计学意义(P<0.05)。结论:经PSM处理后证实,与全麻相比,IA能更有效促进髋关节置换术患者术后认知功能的恢复,减少住院费用,降低并发症发生率。展开更多
文摘Objective:Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors(GISTs).However,the laparoscopic approach for GISTs located in the esophagogastric junction(EGJ-GIST)is surgically challenging.This study compares the efficacy of laparoscopic surgery and the open procedure for EGJ-GIST through the propensity score weighting(PSW)method.Methods:Between April 2006 and April 2018,1,824 surgical patients were diagnosed with primary gastric GIST at four medical centers in South China.Of these patients,228 were identified as EGJ-GISTs and retrospectively reviewed clinicopathological characteristics,operative information,and long-term outcomes.PSW was used to create the balanced cohorts.Results:PSW was carried out in laparoscopic and open-surgery cohorts according to year of surgery,sex,age,body mass index(BMI),tumor size,mitotic rates and recurrence risk.After PSW,438 patients consisting of 213 laparoscopic(L group)and 225 open surgery(O group)patients were enrolled.After PSW,the following measures in the L group were superior to those in the O group:median operative time[interquartile range(IQR)]:100.0(64.5-141.5)vs.149.0(104.0-197.5)min,P<0.001;median blood loss(IQR):30.0(10.0-50.0)vs.50.0(20.0-100.0)mL,P=0.002;median time to liquid intake(IQR):3.0(2.0-4.0)vs.4.0(3.0-5.0)d,P<0.001;median hospital stay(IQR):6.0(4.0-8.0)vs.7.0(5.0-12.0)d,P<0.001;and postoperative complications(10.3%vs.22.7%,P=0.001).The median follow-up was 55(range,2-153)months in the entire cohort.No significant differences were detected in either relapse-free survival(RFS)[hazard ratio(HR):0.372,95%confidence interval(95%CI):0.072-1.910,P=0.236]or overall survival(OS)(HR:0.400,95%CI:0.119-1.343,P=0.138)between the two groups.Conclusions:Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time,reduced blood loss,shorter time to liquid intake,and shorter length of stay,all without compromising postoperative outcomes and long-term survival.
文摘Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.
文摘目的探讨C反应蛋白/白蛋白比值(C-reactive protein to albumin ratio,CAR)与维持性血液透析(maintenance hemodialysis,MHD)患者出现心血管事件风险的相关性。方法选择2016年8月至2019年12月在广州医科大学附属第二医院血液净化中心进行治疗的MHD患者为研究对象,随访截止时间为2021年3月31日。收集符合研究纳入标准的患者的人口学资料、合并症、原发病因、规律透析治疗3个月后的生化指标及随访截止时间内心血管事件发生情况。采用Kaplan-Meier法估计MHD患者出现心血管事件的概率。基于广义倾向性得分加权(GPSW)的Cox比例风险回归模型评估CAR水平与MHD患者出现心血管事件风险的关联。结果共纳入符合标准的研究对象170例,其中64例患者出现心血管事件(占37.6%)。基于GPSW的Cox比例风险回归模型提示(HR_(CAR)=2.087,95%CI:1.085~4.015,P=0.028),说明MHD患者的CAR平均每增加一个单位,出现心血管事件的风险比为2.087。结论CAR与MHD患者的心血管事件风险存在显著的正相关关系,这将有助于临床工作者识别具有高心血管事件风险的MHD患者并及时干预。
文摘本研究依托2018年中国老年社会追踪调查(China Longitudinal Aging Social Survey,CLASS)数据,在基准回归模型估计基础上,运用倾向值加权法,对多维照料类型(照料孙辈和照料父母)与照料强度(单一照料或双重照料)下的老年人生活满意度进行分析,并基于“自主性”的角度和“进化论”的框架为此作出理论解释。结果显示,为孙辈和父母提供照料的老年人接近三成,照料工作总体上表现出显著的生活满意度增进效应;其中,超过八成的人照料孙辈,这方面照料工作的正向作用明显更加突出,而照料父母则基本不显示积极的影响;同时照料孙辈与父母也未能实现老年生活满意度的改善。
文摘用户搜索时产生的点击数据分布,在不同的搜索场景下存在较大差异.现有算法如融合上下文的位置模型(contextual position based model,CPBM)往往只通过单个模型预测多种场景下的位置倾向性得分,不可避免地降低了模型在不同场景下的预测准确性,影响去除位置偏置的效果.基于上述问题提出一种基于多任务学习的多门专家混合位置倾向性得分预测模型(multi-gate contextual position based model,MCPBM),在CPBM模型的基础上加入信息筛选结构,解决了多场景数据联合训练时预测准确性不佳的问题.同时,为了缓解不同任务收敛速度不一致的问题,提出了指数加权平均权重动态调整算法,在加速模型训练的同时提升了模型整体预测性能.实验结果表明提出的MCPBM模型在多场景数据联合训练时,预测准确性优于传统的CPBM;在使用MCPBM模型去除位置偏置后,基于生成的无偏数据训练得到的排序模型,在AvgRank排序指标上有1%~5%的提升.
文摘目的:使用倾向评分匹配(propensity score matching,PSM)评估髋关节置换术中椎管内麻醉(intrathecal anesthesia,IA)与全身麻醉的效果。方法:回顾性选取2019年1月—2022年6月徐州民政医院收治的100例髋关节置换术患者。根据麻醉方式将其分为IA组(61例)和全麻组(39例)。采用PSM对两组患者进行匹配,从而对两组混杂因素进行控制。IA组给予IA,全麻组给予全身麻醉。比较两组PSM法匹配前后基线资料。比较两组麻醉效果,术前及术后12 h、24 h、48 h认知功能,围手术期指标及并发症。结果:PSM匹配后,两组性别、年龄、体重指数(body mass index,BMI)、疾病类型、美国麻醉医师协会分级(American society of anesthesiologists,ASA)分级、高血压史、糖尿病史、PSM评分比较差异无统计学意义(P>0.05)。两组麻醉效果及麻醉优良率比较差异均无统计学意义(P>0.05)。重复测量方差分析显示,两组简易智力状态检查量表(mini mental state examination,MMSE)评分时点、组间、时点·组间比较差异均有统计学意义(P<0.05)。两组术后12 h、24 h的MMSE评分均低于术前,差异有统计学意义(P<0.05);术后48 h,两组MMSE评分与术前比较差异无统计学意义(P>0.05)。IA组术后12 h、24 h MMSE评分均高于全麻组,差异有统计学意义(P<0.05)。IA组术后留观时间、住院时间均短于全麻组,住院费用少于全麻组,差异有统计学意义(P<0.05)。IA组并发症发生率为5.71%,低于全麻组的22.86%,差异有统计学意义(P<0.05)。结论:经PSM处理后证实,与全麻相比,IA能更有效促进髋关节置换术患者术后认知功能的恢复,减少住院费用,降低并发症发生率。
