Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical ch...Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical characteristics within 24 hours of admission for IPN prediction.Methods We conducted a retrospective,multicentre cohort study including 3005 patients with AP from eight hospitals in China.Clinical variables collected within 24 hours after admission were analysed using least absolute shrinkage and selection operator regression(10 cross-validations)for variable selection,followed by multivariate logistic regression to develop an IPN prediction model.Internal cross-validation of the development set and validation of the validation set were performed to ensure robustness.Decision curve analysis was used to evaluate its clinical utility.Results IPN occurred in 176 patients(176/3005,5.9%).The final model included temperature,respiratory rate,plasma calcium ion concentration,serum urea nitrogen and serum glucose.The area under the receiver operating characteristics curve(AUC)was 0.85(95%CI 0.81 to 0.89),outperforming widely used severity scoring systems.The model demonstrated robust performance on the internal validation cohort(mean AUC:0.84)and external validation cohort(AUC:0.82,95%CI 0.77 to 0.87).Conclusion We developed a simple and robust model for predicting IPN in patients with AP,demonstrating strong predictive performance and clinical utility.展开更多
Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including o...Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.展开更多
Patients with extensive or complicated Crohn's disease(CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines.In patients with localized and uncompli...Patients with extensive or complicated Crohn's disease(CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines.In patients with localized and uncomplicated CD at diagnosis,early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact.In this context,there is a need for predictors of benign or unfavourable subsequent clinical course,in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions.At diagnosis,an age below 40 years,the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course.The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts.Consequently,the use of these predictors can be integrated into the elements that influence individual decisions.In the CD postoperative context,keeping smoking and history of prior resection are the stron-gest predictors of disease symptomatic recurrence.However,these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice.In ulcerative colitis(UC),extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease,and also with long-term colectomy and colorectal inflammation-associated colorectal cancer.In patients with extensive UC at diagnosis,a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered.At the moment,no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.展开更多
Objective The purpose of the study was to investigate effective surgical procedure for perirolandic epilepsy and the predictor for good outcomes. Methods We collected 21 subjects who underwent epilepsy surgeries conse...Objective The purpose of the study was to investigate effective surgical procedure for perirolandic epilepsy and the predictor for good outcomes. Methods We collected 21 subjects who underwent epilepsy surgeries consecutively in Beijing Institute of Functional展开更多
While therapeutic strategies able to change the natural history of the disease are developing,it is of major importance to have available predictive factors for aggressive disease to try and target these therapeutic s...While therapeutic strategies able to change the natural history of the disease are developing,it is of major importance to have available predictive factors for aggressive disease to try and target these therapeutic strategies.Clinical predictors have probably been the most broadly studied.In both Crohn's disease(CD) and ulcerative colitis(UC),age at diagnosis,disease location and smoking habit are currently the strongest predictors of disease course.A younger age at onset is associated with more aggressive disease both in CD and UC.Disease location in CD is associated with different types of complications:surgery and recurrence in upper gastrointestinal and proximal small bowel disease;and surgery in distal small bowel disease and peri-anal lesions in rectal disease.In UC,extensive colitis is clearly been associated with more severe disease.Finally,active smoking globally increases disease severity in CD but decreases it in UC.Besides these important factors,others may predispose to some specific disease evolution and complications,and are also reviewed in the present paper.展开更多
Purpose:To construct a symptoms-based prediction tool to assess the likelihood of superior canal dehiscence(SSCD)on high-resolution CT.Materials and methods:Mathematical modeling was employed to predict radiologic evi...Purpose:To construct a symptoms-based prediction tool to assess the likelihood of superior canal dehiscence(SSCD)on high-resolution CT.Materials and methods:Mathematical modeling was employed to predict radiologic evidence of SSCD at a tertiary neurotology referral center.Results:A total of 168 patients were included,of which 118 had imaging-confirmed SSCD.On univariate analysis significant predictors of SSCD presence were:sound/pressure-induced vertigo(p?0.006),disequilibrium(p?0.008),hyperacusis(p?0.008),and autophony(p?0.034).Multivariate analysis enabled a 14-point symptom-weighted tool to be developed,wherein a score of6 raised the suspicion of SSCD(70%likelihood of being present),R2?0.853.Conclusions:The likelihood of SSCD on CT scan can be determined with a high degree of certainty based on symptoms recorded at presentation.Using the evidenced-based diagnostic tool validated herein,a score6 with any symptom combination justifies ordering a CT scan.展开更多
基金supported by National High Level Hospital Clinical Research Funding(grant number 2022-PUMCH-B-023)National Key Clinical Specialty Construction Project(grant number ZK108000)+1 种基金Chinese Natural Science Foundation(grant number 32170788)the Beijing Natural Science Foundation(grant number 7232123).
文摘Background Infected pancreatic necrosis(IPN)exacerbates complications in patients with acute pancreatitis(AP),increasing mortality rates if not treated promptly.We aimed to evaluate the predictive value of clinical characteristics within 24 hours of admission for IPN prediction.Methods We conducted a retrospective,multicentre cohort study including 3005 patients with AP from eight hospitals in China.Clinical variables collected within 24 hours after admission were analysed using least absolute shrinkage and selection operator regression(10 cross-validations)for variable selection,followed by multivariate logistic regression to develop an IPN prediction model.Internal cross-validation of the development set and validation of the validation set were performed to ensure robustness.Decision curve analysis was used to evaluate its clinical utility.Results IPN occurred in 176 patients(176/3005,5.9%).The final model included temperature,respiratory rate,plasma calcium ion concentration,serum urea nitrogen and serum glucose.The area under the receiver operating characteristics curve(AUC)was 0.85(95%CI 0.81 to 0.89),outperforming widely used severity scoring systems.The model demonstrated robust performance on the internal validation cohort(mean AUC:0.84)and external validation cohort(AUC:0.82,95%CI 0.77 to 0.87).Conclusion We developed a simple and robust model for predicting IPN in patients with AP,demonstrating strong predictive performance and clinical utility.
文摘Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.
文摘Patients with extensive or complicated Crohn's disease(CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines.In patients with localized and uncomplicated CD at diagnosis,early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact.In this context,there is a need for predictors of benign or unfavourable subsequent clinical course,in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions.At diagnosis,an age below 40 years,the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course.The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts.Consequently,the use of these predictors can be integrated into the elements that influence individual decisions.In the CD postoperative context,keeping smoking and history of prior resection are the stron-gest predictors of disease symptomatic recurrence.However,these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice.In ulcerative colitis(UC),extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease,and also with long-term colectomy and colorectal inflammation-associated colorectal cancer.In patients with extensive UC at diagnosis,a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered.At the moment,no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.
文摘Objective The purpose of the study was to investigate effective surgical procedure for perirolandic epilepsy and the predictor for good outcomes. Methods We collected 21 subjects who underwent epilepsy surgeries consecutively in Beijing Institute of Functional
文摘While therapeutic strategies able to change the natural history of the disease are developing,it is of major importance to have available predictive factors for aggressive disease to try and target these therapeutic strategies.Clinical predictors have probably been the most broadly studied.In both Crohn's disease(CD) and ulcerative colitis(UC),age at diagnosis,disease location and smoking habit are currently the strongest predictors of disease course.A younger age at onset is associated with more aggressive disease both in CD and UC.Disease location in CD is associated with different types of complications:surgery and recurrence in upper gastrointestinal and proximal small bowel disease;and surgery in distal small bowel disease and peri-anal lesions in rectal disease.In UC,extensive colitis is clearly been associated with more severe disease.Finally,active smoking globally increases disease severity in CD but decreases it in UC.Besides these important factors,others may predispose to some specific disease evolution and complications,and are also reviewed in the present paper.
文摘Purpose:To construct a symptoms-based prediction tool to assess the likelihood of superior canal dehiscence(SSCD)on high-resolution CT.Materials and methods:Mathematical modeling was employed to predict radiologic evidence of SSCD at a tertiary neurotology referral center.Results:A total of 168 patients were included,of which 118 had imaging-confirmed SSCD.On univariate analysis significant predictors of SSCD presence were:sound/pressure-induced vertigo(p?0.006),disequilibrium(p?0.008),hyperacusis(p?0.008),and autophony(p?0.034).Multivariate analysis enabled a 14-point symptom-weighted tool to be developed,wherein a score of6 raised the suspicion of SSCD(70%likelihood of being present),R2?0.853.Conclusions:The likelihood of SSCD on CT scan can be determined with a high degree of certainty based on symptoms recorded at presentation.Using the evidenced-based diagnostic tool validated herein,a score6 with any symptom combination justifies ordering a CT scan.
