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Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.
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@#AIM: To investigate the influence of orthokeratology on ocular surface and visual quality of intermittent exotropia with myopia. <p>METHODS: Totally 60 patients(120 eyes)with intermittent exotropia and spherical equivalent ranging from -0.75 to -5.50D were numbered and divided into study group and control group according to random number table, which included 30 cases(60 eyes)of patients in each group. Two groups patients were intervened by orthopaedic training with prism for at least half of a year. In addition, the study group matched the night wearing corneal plastic lenses through the standardization of corneal plastic matching process, and observed continuously for at least half of a year. The before and after treatment strabismus, naked eye vision, best corrected visual acuity, fluoresce-in staining tear film rupture time(FBUT), diopter and visual quality between the two groups were compared. The rate of adverse reactions and complications between the two groups was compared to evaluate the safety. <p>RESULTS: There was no significant difference in all before intervention indexes between the two groups(<i>P</i> > 0.05). Compared with that those of before intervention, in both groups, after treatment strabismus decreased, naked vision, best corrected vision and FBUT increased, diopter values reduced, and the proportion of patients with excellent visual quality increased. And the after treatment naked visual acuity, best corrected visual acuity, FBUT, diopter and visual quality in the study group were better than those in the control group(<i>P</i><0.05). There was no significant difference in therate of adverse reactions and complications such as orbital and orbital pain, eye distention, headache, palpebral conjunctival vascular congestion between the two groups(13% <i>vs</i> 10%, <i>P</i>=1.000). <p>CONCLUSION: On the basis of triangular prism orthophotic training, the wearing of orthopaedic keratoplasty lenses can improve the tear film, refraction and visual quality of intermittent exotropia patients, and its safety is good, which is worthy of clinical application.