Acute pancreatitis(AP)is a prevalent gastrointestinal disease necessitating hospitalization globally,with an annual incidence ranging from 13 to 45 per 100,000 individuals[1]and a mortality rate of 5%-10%.[2]While mos...Acute pancreatitis(AP)is a prevalent gastrointestinal disease necessitating hospitalization globally,with an annual incidence ranging from 13 to 45 per 100,000 individuals[1]and a mortality rate of 5%-10%.[2]While most cases follow a self-limiting course,approximately 20%-30%of cases progress to severe acute pancreatitis(SAP),characterized by pancreatic necrosis and multiorgan failure,with the mortality rate increasing to 36%-50%.展开更多
Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU...Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.展开更多
BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HA...BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Respiratory infections are associated with high morbidity and mortality and are a major global health problem[1].Acute respiratory infections are caused by multiple respiratory pathogens,including viruses and bacteria...Respiratory infections are associated with high morbidity and mortality and are a major global health problem[1].Acute respiratory infections are caused by multiple respiratory pathogens,including viruses and bacteria.Viral-bacterial co-infections,which have become increasingly common and a global concern,can lead to substantial complications,causing higher morbidity and adverse prognosis[2].Previous studies have reported low positive detection rates of targeted pathogens related to acute respiratory infections,owing to the limited number of detected pathogens and variations in the sensitivity of diagnostic methods[3-4].Low positive detection rates may impede our understanding of respiratory pathogen characteristics and hamper the development of precise treatment and prevention strategies.展开更多
Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone...Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.展开更多
BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to ev...BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.展开更多
BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited....BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.展开更多
Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2...Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).展开更多
Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be cau...Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be caused by coronavirus disease 2019(COVID-19)causing exaggerated immune response leading to muscle damage.Acute kidney injury(AKI),when presented with RM,leads to increased mortality.Examining RM-related AKI and its comparison to other AKI types in COVID-19 patients could improve the management of viral infections developing RM and AKI.RM potentially complicated COVID-19 infection course and is a major etiology of AKI.RM-related AKI had higher severity and mortality than other AKI types,with increased hypercoagulopathy and inflammatory markers.Findings also express procalcitonin use in follow-ups with severe COVID-19 patients.Study limitations include small sample size,absence of kidney biopsies,and focus on the first wave of the pandemic,which should be addressed in future research to generate accurate and relevant findings.展开更多
BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admi...BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admissions,imposing the substantial economic burden.Acute kidney injury(AKI)complicates take up approximately 15%of AP cases,with an associated mortality rate of 74.7%-81%.AIM To evaluate the efficacy of estimated plasma volume status(ePVS)in forecasting AKI in patients with AP.METHODS In this retrospective cohort study,AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023.Electronic medical records were adopted for data extrac-tion,including demographic data and clinical characteristics.The association between ePVS and AKI was analyzed using multivariate logistic regression models,with potential confounders being adjusted.Nonlinear relationship was examined with smooth curve fitting,and infection points were calculated.Further analyses were performed on stratified subgroups and interaction tests were conducted.RESULTS Among the 1508 AP patients,251(16.6%)developed AKI.ePVS was calculated using Duarte(D-ePVS)and Kaplan-Hakim(KH-ePVS)formulas.After adjusting for covariates,the AKI risk exhibited 46%[odds ratio(OR)=1.46,95%confidence interval(CI):0.96-2.24]and 11%(OR=1.11,95%CI:0.72-1.72)increases in the low tertile(T1)of D-ePVS and KH-ePVS,respectively,and 101%(OR=2.01,95%CI:1.31-3.05)and 51%(OR=1.51,95%CI:1.00-2.29)increases in the high tertile(T3)relative to the reference tertile(T2).Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS,with inflection points at 4.3 dL/g and-2.8%,res-pectively.Significant interactions were not observed in age,gender,hypertension,diabetes mellitus,sequential organ failure assessment score,or AP severity(all P for interaction>0.05).CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients.A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula,and a J-shaped curve at-2.8%for the Kaplan-Hakim formula.展开更多
In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnan...In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.展开更多
Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-t...Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.展开更多
BACKGROUND Painless acute pancreatitis(PAP)is a slowly progressive disease that involves inflammation,scarring,and thickening of pancreatic cells,which can happen due to either alcohol,idiopathic,or genetic.Clinicians...BACKGROUND Painless acute pancreatitis(PAP)is a slowly progressive disease that involves inflammation,scarring,and thickening of pancreatic cells,which can happen due to either alcohol,idiopathic,or genetic.Clinicians usually miss PAP due to lack of pain and additional symptoms of hypotension and fever can lead to an infectious work-up instead.In this case report,we discuss the importance of the rapid discovery of this condition to prevent devastating complications like diabetes,necrotizing pancreatitis,or even death.CASE SUMMARY A 47-years old male with past medical history of hypotension and alcohol abuse presented for loss of consciousness.Patient was found with pinpoint pupils,hypoglycemia,and hypotensive.He received Narcan,dextrose,and IV fluids and became responsive.In the emergency department,the patient was hypotensive and the physical exam was only significant for diaphoresis.Patient denied abdominal or radiating pain.Labs significant for elevated lipase,metabolic acidosis,and hyponatremia with imaging positive for AP without chronic inflammation.Based on imaging,lipase and absence of pain,PAP was diagnosed.Patient had multiple episodes of hypoglycemia and remained hypotensive requiring pressor support and intubation.After intubation,he had pulseless electrical activity cardiac arrest.Return of spontaneous circulation achieved but the patient had worsening acidosis,acute kidney injury,liver injury,and bandemia.Empiric antibiotics started,dexamethasone,and maxed on five pressors and transferred to the medical intensive care unit for management of severe AP(SAP).CONCLUSION This case report featured PAP without chronic inflammation which is an even rarer disease than PAP which progressed to SAP.展开更多
In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published ...In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades,there is still a lack of evidence-based protocol for individual and population disparities.This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia.Nevertheless,there is still a need for further investigation at a high level regarding this topic.展开更多
BACKGROUND:Patients suffering from hemorrhagic shock(HS)complicated by severe trauma are at high risk of developing acute lung injury(ALI)and acute respiratory distress syndrome(ARDS).The underlying pathophysiology is...BACKGROUND:Patients suffering from hemorrhagic shock(HS)complicated by severe trauma are at high risk of developing acute lung injury(ALI)and acute respiratory distress syndrome(ARDS).The underlying pathophysiology is complex,and the lack of targeted therapeutic strategies remains a major clinical challenge.METHODS:In this narrative review,a literature search was conducted in the PubMed to identify articles published from 2006 to August 2025 concerning trauma,HS,traumatic HS(THS),biomarkers related to ALI,ARDS and HS,as well as their treatment.Through its multifactorial pathogenesis,we discuss the diagnostic and prognostic values of biomarkers,their potential role in treatment,and therapeutic advancements and perspectives.RESULTS:ALI and ARDS are serious complications in severe trauma patients with HS.Hypoperfusion,hypoxia,endothelial cell activation,inflammation,ischemia/reperfusion injury and the intestinal response,as well as chest trauma and transfusion-related events are potential causes of lung injury.The pulmonary epithelial biomarkers soluble receptor for advanced glycation end products(sRAGE)and surfactant protein-D provide indicators for evaluating the severity of lung contusion and injury,whereas Clara cell protein 16 may have clinical value for trauma patients with ALI complicated by pneumonia.Elevated endothelial biomarkers angiopoietin-2 and syndecan-1 are correlated with injury severity,transfusion,coagulopathy,the onset of ARDS,and patient outcomes.The role of biomarkers in therapeutic benefit is reviewed.CONCLUSIONS:Preventive and therapeutic strategies for THS-induced ALI/ARDS rely on the implementation of multi-target,multi-mechanism interventions that address the complex pathophysiology.Targeted phenotypic therapy guided by biomarkers would be of interest for future research aimed at improving clinical outcomes.展开更多
Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-qua...Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.展开更多
BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients oft...BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients often experience bad moods,sleep disorders,and other health issues.Despite recognizing these factors,no studies have examined the correlation between inflammatory factors,lactic acid levels,ASF,mood disturbances,and sleep quality in critically ill patients.We hypothesize that higher levels of inflammatory factors and lactic acid are associated with more severe ASF and poorer mood and sleep quality,which may inform clinical treatment for septic shock and ASF.AIM To explore the relationship between inflammatory factors,lactic acid levels,the severity of ASF,bad mood,and sleep quality.METHODS The retrospective study included 150 patients with septic shock from the Second Hospital of Dalian Medical University,categorized into ASF(n=35)or non-ASF groups(n=115).We compared the peripheral blood inflammatory factors,including tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),lactic acid levels,skin mottling score(SMS),modified early warning score(MEWS),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)scores.Pearson correlation analysis assessed relationships among these variables.RESULTS The ASF group had significantly higher levels of CRP(19.60±4.10 vs 15.30±2.96 mg/mL),IL-6(298.65±48.65 vs 268.66±33.66 pg/L),procalcitonin,lactic acid(8.42±2.32 vs 5.70±1.27 mmol/L),SMS[0(0,1)vs 3(2,3)],MEWS(9.34±1.92 vs 6.48±1.96),SAS(61.63±12.03 vs 53.71±12.48),SDS(60.17±12.64 vs 52.27±12.64),and PSQI scores(14.23±3.94 vs 8.69±2.46)compared with the non-ASF group(all P<0.001).Pearson correlation analysis revealed that IL-6,CRP,TNF-α,and lactic acid were positively correlated with SMS,MEWS,SAS,SDS,and PSQI scores(P<0.05).CONCLUSION Peripheral blood levels of IL-6,CRP,TNF-α,and lactic acid correlate positively with SMS,MEWS,SAS,SDS,and PSQI in critically ill patients with ASF.展开更多
BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
基金supported by National Natural Science Foundation of China(81272737).
文摘Acute pancreatitis(AP)is a prevalent gastrointestinal disease necessitating hospitalization globally,with an annual incidence ranging from 13 to 45 per 100,000 individuals[1]and a mortality rate of 5%-10%.[2]While most cases follow a self-limiting course,approximately 20%-30%of cases progress to severe acute pancreatitis(SAP),characterized by pancreatic necrosis and multiorgan failure,with the mortality rate increasing to 36%-50%.
基金funded by the Hunan Provincial Natural Science Foundation of China(2024JJ2038,2024JJ9161)the Central Government Guides Local Science and Technology Development Fund Projects(2024ZYC031)+4 种基金the Hunan Health High-Level Talent Project(R2023073)the National Key Clinical Specialty Scientific Research Project(Z2023114)the Young Doctor Foundation of Hunan Provincial People’s Hospital(BSJJ202209)the Key Cultivation Project of Hunan Provincial People’s Hospital(RS2022A06)the Clinical Research Center for Emergency and Critical Care in Hunan Province(2021SK4011).
文摘Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.
文摘BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
基金supported by the Beijing Science and Technology Planning Project of the Beijing Science and Technology Commission(Z241100009024047)the High-Level Public Health Technical Talent Training Plan(lingjunrencai-01-02).
文摘Respiratory infections are associated with high morbidity and mortality and are a major global health problem[1].Acute respiratory infections are caused by multiple respiratory pathogens,including viruses and bacteria.Viral-bacterial co-infections,which have become increasingly common and a global concern,can lead to substantial complications,causing higher morbidity and adverse prognosis[2].Previous studies have reported low positive detection rates of targeted pathogens related to acute respiratory infections,owing to the limited number of detected pathogens and variations in the sensitivity of diagnostic methods[3-4].Low positive detection rates may impede our understanding of respiratory pathogen characteristics and hamper the development of precise treatment and prevention strategies.
文摘Acute compartment syndrome(ACoS)involves a complex pathological process in which rising pressures within an enclosed muscle space ultimately result in anoxia and cell death.The most common etiologies include long bone fractures,crush injuries,and burns.[1,2]While rare,ACoS can also occur in atraumatic settings following periods of prolonged limb compression,such as intoxication.[3]Atraumatic ACoS is easily overlooked,resulting in diagnostic delay and poor patient outcomes.Prompt recognition and surgical management is essential to prevent critical sequelae.
文摘BACKGROUND Acute decompensated heart failure(ADHF)is one of the leading causes of mortality,highlighting the importance of early identification of high-risk patients.The fibrosis-5(FIB-5)index,traditionally used to evaluate hepatic fibrosis,may hold prognostic value in ADHF patients by reflecting systemic congestion,inflammation,and organ dysfunction.The hypothesis of this study is that the FIB-5 index is an independent predictor of 1-month mortality in patients with ADHF.METHODS This retrospective study included 155 patients diagnosed with ADHF between 2020 and 2024.Patients were divided into two groups based on their left ventricular ejection fraction(LVEF≤40%or LVEF>50%).Survival was monitored for one month,and clinical,biochemical,and echocardiographic parameters were compared between survivors and death.Logistic regression and receiver operating characteristic curve analyses were performed to assess the prognostic value of the FIB-5 index.RESULTS During the 1-month follow-up,66 patients(42.6%)died.The mean FIB-5 index was significantly lower in non-survivors(−10.46±6.93)compared to survivors(−8.10±6.67)(P=0.03).Multivariate regression analysis identified the FIB-5 index as an independent predictor of 1-month mortality(OR=1.089,95%CI:1.022–1.160,P=0.009).The receiver operating characteristic curve analysis demonstrated an area under the curve of 0.609(95%CI:0.51–0.699)with sensitivity of 59.6%and specificity of 63.4%.Kaplan-Meier survival analysis revealed significantly higher mortality rates among patients with lower FIB-5 values(log-rank:7.887,P=0.005).CONCLUSIONS The FIB-5 index is an independent predictor of 1-month mortality in ADHF patients.Its low cost,non-invasive nature,and ability to reflect systemic inflammation and congestion make it a promising tool for risk stratification.Prospective studies are needed to validate its utility in clinical practice and evaluate its role in guiding therapeutic decisions.
文摘BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.
文摘Acute mountain sickness(AMS) is an illness caused by hypoxia due to rapid ascent to altitudes above 2,500 m. Symptoms include headache,nausea, vomiting, and loss of appetite, all of which usually improve within 1 to 2 days. However,untreated AMS can progress to life-threatening conditions such as high-altitude cerebral and pulmonary edema(HACE and HAPE, respectively)^([1]).
文摘Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be caused by coronavirus disease 2019(COVID-19)causing exaggerated immune response leading to muscle damage.Acute kidney injury(AKI),when presented with RM,leads to increased mortality.Examining RM-related AKI and its comparison to other AKI types in COVID-19 patients could improve the management of viral infections developing RM and AKI.RM potentially complicated COVID-19 infection course and is a major etiology of AKI.RM-related AKI had higher severity and mortality than other AKI types,with increased hypercoagulopathy and inflammatory markers.Findings also express procalcitonin use in follow-ups with severe COVID-19 patients.Study limitations include small sample size,absence of kidney biopsies,and focus on the first wave of the pandemic,which should be addressed in future research to generate accurate and relevant findings.
文摘BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admissions,imposing the substantial economic burden.Acute kidney injury(AKI)complicates take up approximately 15%of AP cases,with an associated mortality rate of 74.7%-81%.AIM To evaluate the efficacy of estimated plasma volume status(ePVS)in forecasting AKI in patients with AP.METHODS In this retrospective cohort study,AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023.Electronic medical records were adopted for data extrac-tion,including demographic data and clinical characteristics.The association between ePVS and AKI was analyzed using multivariate logistic regression models,with potential confounders being adjusted.Nonlinear relationship was examined with smooth curve fitting,and infection points were calculated.Further analyses were performed on stratified subgroups and interaction tests were conducted.RESULTS Among the 1508 AP patients,251(16.6%)developed AKI.ePVS was calculated using Duarte(D-ePVS)and Kaplan-Hakim(KH-ePVS)formulas.After adjusting for covariates,the AKI risk exhibited 46%[odds ratio(OR)=1.46,95%confidence interval(CI):0.96-2.24]and 11%(OR=1.11,95%CI:0.72-1.72)increases in the low tertile(T1)of D-ePVS and KH-ePVS,respectively,and 101%(OR=2.01,95%CI:1.31-3.05)and 51%(OR=1.51,95%CI:1.00-2.29)increases in the high tertile(T3)relative to the reference tertile(T2).Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS,with inflection points at 4.3 dL/g and-2.8%,res-pectively.Significant interactions were not observed in age,gender,hypertension,diabetes mellitus,sequential organ failure assessment score,or AP severity(all P for interaction>0.05).CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients.A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula,and a J-shaped curve at-2.8%for the Kaplan-Hakim formula.
文摘In this article,we have commented on the article by Augustin et al.The authors presented a systematic review of the diagnosis,treatment,and outcomes of primary hyperparathyroidism-induced acute pancreatitis in pregnant women.Since acute pancreatitis during pregnancy could cause maternal as well as fetal adverse outcomes,understanding this pathology is essential.Although there are various etiologies of acute pancreatitis during pregnancy,primary hyperparathyroidism is one of the causes that complicate hypercalcemia.Along with conventional treatment for acute pancreatitis,parathyroidectomy can effectively normalize calcium levels and improve acute pancreatitis.Augustin et al have provided vital information that can enable physicians to understand and treat hyperparathyroidism-induced acute pancreatitis in pregnant women,which could contribute to better maternal and fetal outcomes.In addition,since primary hyperparathyroidism is associated with multiple endocrine neoplasia,further consideration regarding screening for multiple endocrine neoplasia might lead to better prognoses.
基金funded,in part,by the National Natural Science Fund (NSFC,China) under award number 81900382supported,in part,by the Yang talents Program of Beijing (QML20200302)Beijing Municipal Natural Science Foundation (7222072).
文摘Background Biomarkers-based prediction of long-term risk of acute coronary syndrome(ACS)is scarce.We aim to develop a risk score integrating clinical routine information(C)and plasma biomarkers(B)for predicting long-term risk of ACS patients.Methods We included 2729 ACS patients from the OCEA(Observation of cardiovascular events in ACS patients).The earlier admitted 1910 patients were enrolled as development cohort;and the subsequently admitted 819 subjects were treated as valida-tion cohort.We investigated 10-year risk of cardiovascular(CV)death,myocardial infarction(MI)and all cause death in these pa-tients.Potential variables contributing to risk of clinical events were assessed using Cox regression models and a score was de-rived using main part of these variables.Results During 16,110 person-years of follow-up,there were 238 CV death/MI in the development cohort.The 7 most import-ant predictors including in the final model were NT-proBNP,D-dimer,GDF-15,peripheral artery disease(PAD),Fibrinogen,ST-segment elevated MI(STEMI),left ventricular ejection fraction(LVEF),termed as CB-ACS score.C-index of the score for predica-tion of cardiovascular events was 0.79(95%CI:0.76-0.82)in development cohort and 0.77(95%CI:0.76-0.78)in the validation co-hort(5832 person-years of follow-up),which outperformed GRACE 2.0 and ABC-ACS risk score.The CB-ACS score was also well calibrated in development and validation cohort(Greenwood-Nam-D’Agostino:P=0.70 and P=0.07,respectively).Conclusions CB-ACS risk score provides a useful tool for long-term prediction of CV events in patients with ACS.This model outperforms GRACE 2.0 and ABC-ACS ischemic risk score.
文摘BACKGROUND Painless acute pancreatitis(PAP)is a slowly progressive disease that involves inflammation,scarring,and thickening of pancreatic cells,which can happen due to either alcohol,idiopathic,or genetic.Clinicians usually miss PAP due to lack of pain and additional symptoms of hypotension and fever can lead to an infectious work-up instead.In this case report,we discuss the importance of the rapid discovery of this condition to prevent devastating complications like diabetes,necrotizing pancreatitis,or even death.CASE SUMMARY A 47-years old male with past medical history of hypotension and alcohol abuse presented for loss of consciousness.Patient was found with pinpoint pupils,hypoglycemia,and hypotensive.He received Narcan,dextrose,and IV fluids and became responsive.In the emergency department,the patient was hypotensive and the physical exam was only significant for diaphoresis.Patient denied abdominal or radiating pain.Labs significant for elevated lipase,metabolic acidosis,and hyponatremia with imaging positive for AP without chronic inflammation.Based on imaging,lipase and absence of pain,PAP was diagnosed.Patient had multiple episodes of hypoglycemia and remained hypotensive requiring pressor support and intubation.After intubation,he had pulseless electrical activity cardiac arrest.Return of spontaneous circulation achieved but the patient had worsening acidosis,acute kidney injury,liver injury,and bandemia.Empiric antibiotics started,dexamethasone,and maxed on five pressors and transferred to the medical intensive care unit for management of severe AP(SAP).CONCLUSION This case report featured PAP without chronic inflammation which is an even rarer disease than PAP which progressed to SAP.
基金Supported by Yuzhong District Natural Science Foundation of Chongqing,No.20240129。
文摘In this editorial,we comment on the article published in a recent issue of the World Journal of Orthopedics.Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades,there is still a lack of evidence-based protocol for individual and population disparities.This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia.Nevertheless,there is still a need for further investigation at a high level regarding this topic.
基金supported by grants from the Zhejiang Provincial Key Research and Development Program of China(2023C03085).
文摘BACKGROUND:Patients suffering from hemorrhagic shock(HS)complicated by severe trauma are at high risk of developing acute lung injury(ALI)and acute respiratory distress syndrome(ARDS).The underlying pathophysiology is complex,and the lack of targeted therapeutic strategies remains a major clinical challenge.METHODS:In this narrative review,a literature search was conducted in the PubMed to identify articles published from 2006 to August 2025 concerning trauma,HS,traumatic HS(THS),biomarkers related to ALI,ARDS and HS,as well as their treatment.Through its multifactorial pathogenesis,we discuss the diagnostic and prognostic values of biomarkers,their potential role in treatment,and therapeutic advancements and perspectives.RESULTS:ALI and ARDS are serious complications in severe trauma patients with HS.Hypoperfusion,hypoxia,endothelial cell activation,inflammation,ischemia/reperfusion injury and the intestinal response,as well as chest trauma and transfusion-related events are potential causes of lung injury.The pulmonary epithelial biomarkers soluble receptor for advanced glycation end products(sRAGE)and surfactant protein-D provide indicators for evaluating the severity of lung contusion and injury,whereas Clara cell protein 16 may have clinical value for trauma patients with ALI complicated by pneumonia.Elevated endothelial biomarkers angiopoietin-2 and syndecan-1 are correlated with injury severity,transfusion,coagulopathy,the onset of ARDS,and patient outcomes.The role of biomarkers in therapeutic benefit is reviewed.CONCLUSIONS:Preventive and therapeutic strategies for THS-induced ALI/ARDS rely on the implementation of multi-target,multi-mechanism interventions that address the complex pathophysiology.Targeted phenotypic therapy guided by biomarkers would be of interest for future research aimed at improving clinical outcomes.
文摘Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.
文摘BACKGROUND The central link between septic shock and acute skin failure(ASF)is the inflammatory response,which occurs throughout disease progression and can lead to systemic inflammatory response syndrome.Patients often experience bad moods,sleep disorders,and other health issues.Despite recognizing these factors,no studies have examined the correlation between inflammatory factors,lactic acid levels,ASF,mood disturbances,and sleep quality in critically ill patients.We hypothesize that higher levels of inflammatory factors and lactic acid are associated with more severe ASF and poorer mood and sleep quality,which may inform clinical treatment for septic shock and ASF.AIM To explore the relationship between inflammatory factors,lactic acid levels,the severity of ASF,bad mood,and sleep quality.METHODS The retrospective study included 150 patients with septic shock from the Second Hospital of Dalian Medical University,categorized into ASF(n=35)or non-ASF groups(n=115).We compared the peripheral blood inflammatory factors,including tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),lactic acid levels,skin mottling score(SMS),modified early warning score(MEWS),self-rating depression scale(SDS),self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)scores.Pearson correlation analysis assessed relationships among these variables.RESULTS The ASF group had significantly higher levels of CRP(19.60±4.10 vs 15.30±2.96 mg/mL),IL-6(298.65±48.65 vs 268.66±33.66 pg/L),procalcitonin,lactic acid(8.42±2.32 vs 5.70±1.27 mmol/L),SMS[0(0,1)vs 3(2,3)],MEWS(9.34±1.92 vs 6.48±1.96),SAS(61.63±12.03 vs 53.71±12.48),SDS(60.17±12.64 vs 52.27±12.64),and PSQI scores(14.23±3.94 vs 8.69±2.46)compared with the non-ASF group(all P<0.001).Pearson correlation analysis revealed that IL-6,CRP,TNF-α,and lactic acid were positively correlated with SMS,MEWS,SAS,SDS,and PSQI scores(P<0.05).CONCLUSION Peripheral blood levels of IL-6,CRP,TNF-α,and lactic acid correlate positively with SMS,MEWS,SAS,SDS,and PSQI in critically ill patients with ASF.
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
