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Aim: The currently recommended exercise methods for patients with diabetes require strict physical fitness and are not suitable for all diabetic patients. This study aims to explore the best exercise combination for diabetic patients and to provide scientific and practical personalized exercise guidance for diabetic patients. Subject and methods: Basic information about participants was obtained through questionnaires, physical measurements were performed, and fasting blood samples were collected. Polar area diagrams were used to analyze the relationship between different exercise habits and each index. The polar area graph showed the exercise duration with the best expected effect under a particular frequency and intensity. Two-sample Mendelian randomization (MR) was used to test whether there was a direct causal relationship between exercise and diabetes. Results: Polar area diagrams showed that diabetes patients who engaged in moderate- to vigorous-intensity exercise > 60 minutes five times per week had better health indicators. The polar area graph showed that low-intensity exercise once or twice a week required more than 30 minutes to achieve the desired effect. There was no significant difference in any indicators among elderly diabetic patients with different exercise intensities. Conclusion: Moderate- to vigorous-intensity exercise for more than 30 minutes five times a week was the most beneficial combination of exercise for diabetes. Low frequency needs to be matched with longer exercise time to achieve the desired effect at low intensity. The relationship between low frequency and long duration weakened when the exercise intensity increased. The levels of all indicators in elderly diabetic patients were unrelated to exercise intensity. [ABSTRACT FROM AUTHOR]

Axillary staging is commonly performed via sentinel lymph node biopsy for patients with early breast cancer (EBC) presenting with clinically negative axillary lymph nodes (cN0). The present study aimed to investigate the association between axillary lymph node metastasis (ALNM), clinicopathological characteristics of tumors and results from axillary ultrasound (US) scanning. Moreover, a nomogram model was developed to predict the risk for ALNM based on relevant factors. Data from 998 patients who met the inclusion criteria were retrospectively reviewed. These patients were then randomly divided into a training and validation group in a 7:3 ratio. In the training group, receiver operating characteristic curve analysis was used to identify the cutoff values for continuous measurement data. R software was used to identify independent ALNM risk variables in the training group using univariate and multivariate logistic regression analysis. The selected independent risk factors were incorporated into a nomogram. The model differentiation was assessed using the area under the curve (AUC), while calibration was evaluated through calibration charts and the Hosmer-Lemeshow test. To assess clinical applicability, a decision curve analysis (DCA) was conducted. Internal verification was performed via 1000 rounds of bootstrap resampling. Among the 998 patients with EBC, 228 (22.84%) developed ALNM. Multivariate logistic analysis identified lymphovascular invasion, axillary US findings, maximum diameter and molecular subtype as independent risk factors for ALNM. The Akaike Information Criterion served as the basis for both nomogram development and model selection. Robust differentiation was shown by the AUC values of 0.855 (95% CI, 0.817–0.892) and 0.793 (95% CI, 0.725–0.857) for the training and validation groups, respectively. The Hosmer-Lemeshow test yielded P-values of 0.869 and 0.847 for the training and validation groups, respectively, and the calibration chart aligned closely with the ideal curve, affirming excellent calibration. DCA showed that the net benefit from the nomogram significantly outweighed both the 'no intervention' and the 'full intervention' approaches, falling within the threshold probability interval of 12–97% for the training group and 17–82% for the validation group. This underscores the robust clinical utility of the model. A nomogram model was successfully constructed and validated to predict the risk of ALNM in patients with EBC and cN0 status. The model demonstrated favorable differentiation, calibration and clinical applicability, offering valuable guidance for assessing axillary lymph node status in this population. [ABSTRACT FROM AUTHOR]

Objective: This study aims to develop an interpretable machine learning (ML) model to accurately predict the probability of achieving total pathological complete response (tpCR) in patients with locally advanced breast cancer (LABC) following neoadjuvant chemotherapy (NAC). Methods: This multi-center retrospective study included pre-NAC clinical pathology data from 698 LABC patients. Post-operative pathological outcomes divided patients into tpCR and non-tpCR groups. Data from 586 patients at Shanghai Ruijin Hospital were randomly assigned to a training set (80%) and a test set (20%). In comparison, data from our hospital's remaining 112 patients were used for external validation. Variable selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis. Predictive models were constructed using six ML algorithms: decision trees, K-nearest neighbors (KNN), support vector machine, light gradient boosting machine, and extreme gradient boosting. Model efficacy was assessed through various metrics, including receiver operating characteristic (ROC) curves, precision-recall (PR) curves, confusion matrices, calibration plots, and decision curve analysis (DCA). The best-performing model was selected by comparing the performance of different algorithms. Moreover, variable relevance was ranked using the SHapley Additive exPlanations (SHAP) technique to improve the interpretability of the model and solve the "black box" problem. Results: A total of 191 patients (32.59%) achieved tpCR following NAC. Through LASSO regression analysis, five variables were identified as predictive factors for model construction, including tumor size, Ki-67, molecular subtype, targeted therapy, and chemotherapy regimen. The KNN model outperformed the other five classifier algorithms, achieving area under the curve (AUC) values of 0.847 (95% CI: 0.809-0.883) in the training set, 0.763 (95% CI: 0.670-0.856) in the test set, and 0.665 (95% CI: 0.555-0.776) in the external validation set. DCA demonstrated that the KNN model yielded the highest net advantage through a wide range of threshold probabilities in both the training and test sets. Furthermore, the analysis of the KNN model utilizing SHAP technology demonstrated that targeted therapy is the most crucial factor in predicting tpCR. Conclusion: An ML prediction model using clinical and pathological data collected before NAC was developed and verified. This model accurately predicted the probability of achieving a tpCR in patients with LABC after receiving NAC. SHAP technology enhanced the interpretability of the model and assisted in clinical decision-making and therapy optimization., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)