In this paper, we have considered some properties of quasi-umbilical hypersurfaces of a Riemannian space and obtained a characteristic of Riemannian spaces admitting quasi-concircular transformation.
In the mid-1980’s researchers at Cleveland State University made a startling discovery. They conducted an experiment by creating two fictitious job candidates—David and John.Thecandidates had identical resumes and l...In the mid-1980’s researchers at Cleveland State University made a startling discovery. They conducted an experiment by creating two fictitious job candidates—David and John.Thecandidates had identical resumes and letters of reference.The only difference was that John’s letterincluded the sentence“Sometimes,John can be difficult to get along with.”They showed the re-展开更多
Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right up...Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right upper quadrant pain,hepatomegaly,jaundice,and peripheral blood eosinophilia.By contrast,chronic liver fluke infection is asymptomatic in its early stage,but can easily progress to cirrhosis,cancer,or bile duct cancer initslaterstages.The diagnosis of clonorchiasis is particularly challenging in non-endemic areas.We herein report an unusual case of liver fluke infection in a patient who presented with FUO and eosinophilia.A 38-year-old male was admitted to our hospital with a history of intermittent and recurrent fever for over 10 d and a history of sudden abdominal pain for1 h.He had no other medical history.More than 10d ago,he visited our emergency department because of FUO,with his body temperature reaching 39.7℃,and he had no other symptoms at that time.Laboratory and radiological examinations revealed:white blood cell(WBC)counts,10.9×10^(9)/L;neutrophil percentage,84.5%;eosinophil percentage,3.1%;C-reactive protein(CRP),141 mg/L;liver and kidney function,normal;influenza virus,negative;urine and stool tests,normal;and chest computed tomography(CT)findings,normal.The fever subsided after 1 week of anti-infective treatment with moxifloxacin.Subsequent tests revealed the following results:WBC,15.0×10^(9)/L;neutrophil percentage,70.0%;eosinophil percentage,16.8%;and CRP,122 mg/L.The antimicrobial treatment was then discontinued.展开更多
Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture pr...Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.展开更多
BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevatio...BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.展开更多
BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services...BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.展开更多
OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected...OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.展开更多
OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Ch...OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.展开更多
Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern ...Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern in society.As the brand-new medical and health model created by the modern biomedical technology revolution and the information technology revolution,mobile health has been used more and more widely in the field of medical health with the characteristics of convenience,rapidity and generalisability.With the general use of the social software WeChat,it is feasible to implement mobile health on the WeChat platform.Aim We aimed to explore the clinical effect of WeChat platform used in the cognitive behavioural therapy(CBT)on the maintenance period of alcohol dependence and addiction.Methods Seventy alcohol-dependent patients in the withdrawal maintenance stage admitted into our hospital were randomly divided into the CBT on WeChat platform group(the experiment group,n=35)and the general clinical treatment using sertraline group(the control group,n=35)with block randomisation grouping.They were evaluated with the Severity of Alcohol Dependence Questionnaire(SADQ-C)before the treatment,at the end of the fourth week,at the end of the eighth week and at the end of the twelfth week of treatment.In addition,Zung's Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were employed to evaluate the degree of anxiety and depression of the two groups.Results The SADQ-C,SAS and SDS scores of the two groups after treatment decreased markedly compared with those before treatments,and the differences were statistically significant.Between-group comparison:the SADQ-C scores of the experiment group at the end of the fourth,eighth and twelfth weeks were lower than those of the control group,and the difference was statistically significant,which indicated that the score reduction in the experiment group was larger than that in the control group.The SAS and SDS scores of the experiment group at these time points were not significantly different from those of the control group,which indicated that these two treatment methods were comparable in treating patients1 anxiety and depression.Conclusion The CBT in tervention using WeChat may improve the subjectively reported severity of alcohol dependence of patients who had completed detoxification.It is conducive to prevention of relapse,and is convenient for patients.It is worthy of clinical application and further study.展开更多
To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by...To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by malignant melanomain a展开更多
Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had ...Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had been advised rest for two months because of left ankle sprain, leading to less activity. At admission, the patient was unconscious,with facial cyanosis, and his limbs were cold.展开更多
Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreat...Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.A 76-year-old male patient had intermittent abdominal pain for 2 days,which was aggravated for 1 day.He was admitted to the Emergency Department on August 29,2017.The patient developed paroxysmal abdominal pain after consuming greasy foods,accompanied by nausea.The physical examination revealed the following:temperature 37.0°C,pulse 76 bpm,respiratory rate 19 per minute,blood pressure 164/77 mmHg;no jaundice;abdominal distention;and mild total abdominal tenderness,mainly located in the left upper abdomen.Murphy’s sign was positive.Urgent abdominal ultrasound showed postprandial gallbladder emptying,gallbladder stones,unclear gallbladder cavity,and focal hepatic lesions.Hemangioma was suggested.The intrahepatic bile duct was mildly dilated,and the abdominal and pelvic cavity showed no obvious accumulation of fluid.The laboratory findings were as follows:serum amylase 922.1 U/L,white blood cell count 18.2×109/L(neutrophils,83.4%),and hemoglobin 13.8 g/dL.展开更多
OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI)...OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.展开更多
Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventila...Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.展开更多
Dear editor,The incidence of renal infarction in patients admitted to the emergency department(ED) is approximately 0.004%.[1]Among patients with renal infarction, bilateral renal involvement has been reported in 28.6...Dear editor,The incidence of renal infarction in patients admitted to the emergency department(ED) is approximately 0.004%.[1]Among patients with renal infarction, bilateral renal involvement has been reported in 28.6% of patients.[2]However, there are very few cases of bilateral renal infarction after a traumatic injury.展开更多
Traumatic injuries range from simple to complicated multiple injuries.The identification of patients with critical injuries and disrupted organ perfusion is essential to prevent tissue hypoxia.A study estimated that a...Traumatic injuries range from simple to complicated multiple injuries.The identification of patients with critical injuries and disrupted organ perfusion is essential to prevent tissue hypoxia.A study estimated that a fast and accurate response to thoracic trauma should reduce the mortality by 30%.[1]The tissue perfusion value is an essential indicator of mortality and morbidity for patients admitted to the hospital with thoracic trauma.Thus,this study aimed to show the role of the perfusion index(PI)in predicting the prognosis of patients admitted to the emergency department for thoracic trauma.展开更多
INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]T...INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.展开更多
BACKGROUND Fractional flow reserve(FFR)is the invasive gold standard for evaluating coronary arterial stenosis.However,there have been a few non-invasive methods such as computational fluid dynamics FFR(CFD-FFR)with c...BACKGROUND Fractional flow reserve(FFR)is the invasive gold standard for evaluating coronary arterial stenosis.However,there have been a few non-invasive methods such as computational fluid dynamics FFR(CFD-FFR)with coronary CT angiography(CCTA)images that can perform FFR assessment.This study aims to develop a new method based on the principle of static first-pass of CT perfusion imaging technique(SF-FFR)and evaluate the efficacy in direct comparisons between CFD-FFR and the invasive FFR.METHODS A total of 91 patients(105 coronary artery vessels)who were admitted from January 2015 to March 2019 were enrolled in this study,retrospectively.All patients underwent CCTA and invasive FFR.64 patients(75 coronary artery vessels)were successfully analyzed.The correlation and diagnostic performance of SF-FFR method on per-vessel basis were analyzed,using invasive FFR as the gold standard.As a comparison,we also evaluated the correlation and diagnostic performance of CFD-FFR.RESULTS The SF-FFR showed a good Pearson correlation(r=0.70,P<0.001)and intra-class correlation(r=0.67,P<0.001)with the gold standard.The Bland-Altman analysis showed that the average difference between the SF-FFR and invasive FFR was 0.03(0.11–0.16);between CFD-FFR and invasive FFR was 0.04(-0.10–0.19).Diagnostic accuracy and area under the ROC curve on a per-vessel level were 0.89,0.94 for SF-FFR,and 0.87,0.89 for CFD-FFR,respectively.The SF-FFR calculation time was about 2.5 s per case while CFD calculation was about 2 min on an Nvidia Tesla V100 graphic card.CONCLUSIONS The SF-FFR method is feasible and shows high correlation compared to the gold standard.This method could simplify the calculation procedure and save time compared to the CFD method.展开更多
During the COVID-19 epidemic,Wuhan city had the hardest hit in China.The treatment capacity of the local medical system exceeded due to the rapid growth of COVID-19 cases.As a result,a considerable part of diagnosed p...During the COVID-19 epidemic,Wuhan city had the hardest hit in China.The treatment capacity of the local medical system exceeded due to the rapid growth of COVID-19 cases.As a result,a considerable part of diagnosed patients could not be admitted to hospitals for isolation and treatment in time,causing the risk of spreading in the community.To effectively achieve the goals of controlling the source of infection by cutting off the transmission route,increasing the cure rate and reducing the mortality rate,Wuhan has reconstructed several makeshift hospitals based on large public places.展开更多
文摘In this paper, we have considered some properties of quasi-umbilical hypersurfaces of a Riemannian space and obtained a characteristic of Riemannian spaces admitting quasi-concircular transformation.
文摘In the mid-1980’s researchers at Cleveland State University made a startling discovery. They conducted an experiment by creating two fictitious job candidates—David and John.Thecandidates had identical resumes and letters of reference.The only difference was that John’s letterincluded the sentence“Sometimes,John can be difficult to get along with.”They showed the re-
文摘Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right upper quadrant pain,hepatomegaly,jaundice,and peripheral blood eosinophilia.By contrast,chronic liver fluke infection is asymptomatic in its early stage,but can easily progress to cirrhosis,cancer,or bile duct cancer initslaterstages.The diagnosis of clonorchiasis is particularly challenging in non-endemic areas.We herein report an unusual case of liver fluke infection in a patient who presented with FUO and eosinophilia.A 38-year-old male was admitted to our hospital with a history of intermittent and recurrent fever for over 10 d and a history of sudden abdominal pain for1 h.He had no other medical history.More than 10d ago,he visited our emergency department because of FUO,with his body temperature reaching 39.7℃,and he had no other symptoms at that time.Laboratory and radiological examinations revealed:white blood cell(WBC)counts,10.9×10^(9)/L;neutrophil percentage,84.5%;eosinophil percentage,3.1%;C-reactive protein(CRP),141 mg/L;liver and kidney function,normal;influenza virus,negative;urine and stool tests,normal;and chest computed tomography(CT)findings,normal.The fever subsided after 1 week of anti-infective treatment with moxifloxacin.Subsequent tests revealed the following results:WBC,15.0×10^(9)/L;neutrophil percentage,70.0%;eosinophil percentage,16.8%;and CRP,122 mg/L.The antimicrobial treatment was then discontinued.
文摘Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.
文摘BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.
文摘BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.
基金supported by the CCC-ACS Project(NCT02306616)which is a collaborative project of the American Heart Association and the Chinese Society of Cardiology.
文摘OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.
基金supported by the Key Project of Chinese Military Health Care Projects(No.18BJZ32)the Projects of International Cooperation and Exchanges NSFC(No.81820108019)+2 种基金the Technical Fund for the Foundation Strengthening Program of China(2021-JCJG-JJ-1079)the Chinese Military Innovation Project(CX19028)the Project of National Clinical Research Center for Geriatric Disease(NCRCG-PLAGH-2019024).
文摘OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.
文摘Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern in society.As the brand-new medical and health model created by the modern biomedical technology revolution and the information technology revolution,mobile health has been used more and more widely in the field of medical health with the characteristics of convenience,rapidity and generalisability.With the general use of the social software WeChat,it is feasible to implement mobile health on the WeChat platform.Aim We aimed to explore the clinical effect of WeChat platform used in the cognitive behavioural therapy(CBT)on the maintenance period of alcohol dependence and addiction.Methods Seventy alcohol-dependent patients in the withdrawal maintenance stage admitted into our hospital were randomly divided into the CBT on WeChat platform group(the experiment group,n=35)and the general clinical treatment using sertraline group(the control group,n=35)with block randomisation grouping.They were evaluated with the Severity of Alcohol Dependence Questionnaire(SADQ-C)before the treatment,at the end of the fourth week,at the end of the eighth week and at the end of the twelfth week of treatment.In addition,Zung's Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were employed to evaluate the degree of anxiety and depression of the two groups.Results The SADQ-C,SAS and SDS scores of the two groups after treatment decreased markedly compared with those before treatments,and the differences were statistically significant.Between-group comparison:the SADQ-C scores of the experiment group at the end of the fourth,eighth and twelfth weeks were lower than those of the control group,and the difference was statistically significant,which indicated that the score reduction in the experiment group was larger than that in the control group.The SAS and SDS scores of the experiment group at these time points were not significantly different from those of the control group,which indicated that these two treatment methods were comparable in treating patients1 anxiety and depression.Conclusion The CBT in tervention using WeChat may improve the subjectively reported severity of alcohol dependence of patients who had completed detoxification.It is conducive to prevention of relapse,and is convenient for patients.It is worthy of clinical application and further study.
文摘To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by malignant melanomain a
文摘Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had been advised rest for two months because of left ankle sprain, leading to less activity. At admission, the patient was unconscious,with facial cyanosis, and his limbs were cold.
基金supported by a grant from the Science and Tech-nology Program of Suzhou City(SYS201539)
文摘Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.A 76-year-old male patient had intermittent abdominal pain for 2 days,which was aggravated for 1 day.He was admitted to the Emergency Department on August 29,2017.The patient developed paroxysmal abdominal pain after consuming greasy foods,accompanied by nausea.The physical examination revealed the following:temperature 37.0°C,pulse 76 bpm,respiratory rate 19 per minute,blood pressure 164/77 mmHg;no jaundice;abdominal distention;and mild total abdominal tenderness,mainly located in the left upper abdomen.Murphy’s sign was positive.Urgent abdominal ultrasound showed postprandial gallbladder emptying,gallbladder stones,unclear gallbladder cavity,and focal hepatic lesions.Hemangioma was suggested.The intrahepatic bile duct was mildly dilated,and the abdominal and pelvic cavity showed no obvious accumulation of fluid.The laboratory findings were as follows:serum amylase 922.1 U/L,white blood cell count 18.2×109/L(neutrophils,83.4%),and hemoglobin 13.8 g/dL.
基金supported by the Capital Health Development Fund[201614035],the CAMS Innovation Fund for Medical Sciences[2021-I2M-1-008]the National High-level Hospital Clinical Research Funding[2023-GSP-RC-09,2023-GSP-QN-8].
文摘OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.
文摘Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.
文摘Dear editor,The incidence of renal infarction in patients admitted to the emergency department(ED) is approximately 0.004%.[1]Among patients with renal infarction, bilateral renal involvement has been reported in 28.6% of patients.[2]However, there are very few cases of bilateral renal infarction after a traumatic injury.
基金Ethics committee approval was obtained(Accept no.20.478.486//01/15/2020).
文摘Traumatic injuries range from simple to complicated multiple injuries.The identification of patients with critical injuries and disrupted organ perfusion is essential to prevent tissue hypoxia.A study estimated that a fast and accurate response to thoracic trauma should reduce the mortality by 30%.[1]The tissue perfusion value is an essential indicator of mortality and morbidity for patients admitted to the hospital with thoracic trauma.Thus,this study aimed to show the role of the perfusion index(PI)in predicting the prognosis of patients admitted to the emergency department for thoracic trauma.
文摘INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.
基金supported by grants from the National Natural Science Foundation of China(U1908211)the Capital Medical Development Research Foundation of China(PXM2020_026272_000013)the National Key Research and Development Program of China(grant 2016YFC1300300)for Dr.Xu L.
文摘BACKGROUND Fractional flow reserve(FFR)is the invasive gold standard for evaluating coronary arterial stenosis.However,there have been a few non-invasive methods such as computational fluid dynamics FFR(CFD-FFR)with coronary CT angiography(CCTA)images that can perform FFR assessment.This study aims to develop a new method based on the principle of static first-pass of CT perfusion imaging technique(SF-FFR)and evaluate the efficacy in direct comparisons between CFD-FFR and the invasive FFR.METHODS A total of 91 patients(105 coronary artery vessels)who were admitted from January 2015 to March 2019 were enrolled in this study,retrospectively.All patients underwent CCTA and invasive FFR.64 patients(75 coronary artery vessels)were successfully analyzed.The correlation and diagnostic performance of SF-FFR method on per-vessel basis were analyzed,using invasive FFR as the gold standard.As a comparison,we also evaluated the correlation and diagnostic performance of CFD-FFR.RESULTS The SF-FFR showed a good Pearson correlation(r=0.70,P<0.001)and intra-class correlation(r=0.67,P<0.001)with the gold standard.The Bland-Altman analysis showed that the average difference between the SF-FFR and invasive FFR was 0.03(0.11–0.16);between CFD-FFR and invasive FFR was 0.04(-0.10–0.19).Diagnostic accuracy and area under the ROC curve on a per-vessel level were 0.89,0.94 for SF-FFR,and 0.87,0.89 for CFD-FFR,respectively.The SF-FFR calculation time was about 2.5 s per case while CFD calculation was about 2 min on an Nvidia Tesla V100 graphic card.CONCLUSIONS The SF-FFR method is feasible and shows high correlation compared to the gold standard.This method could simplify the calculation procedure and save time compared to the CFD method.
文摘During the COVID-19 epidemic,Wuhan city had the hardest hit in China.The treatment capacity of the local medical system exceeded due to the rapid growth of COVID-19 cases.As a result,a considerable part of diagnosed patients could not be admitted to hospitals for isolation and treatment in time,causing the risk of spreading in the community.To effectively achieve the goals of controlling the source of infection by cutting off the transmission route,increasing the cure rate and reducing the mortality rate,Wuhan has reconstructed several makeshift hospitals based on large public places.
