A Restless Stone.

Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus usually presents on elderly patients with multiple underlying diseases. Typically, the way of gallstone migration to small bowel is through biliary-enteric flstula, which is a rare complication of chronic cholecystitis. Patients present with diffuse abdominal pain and vomiting when the gallstone lodges in distal small bowel. The goals of surgical intervention include release of the bowel obstruction and closure of biliary-enteric flstula.

Real-time AI prediction for major adverse cardiac events in emergency department patients with chest pain.

BACKGROUND: A big-data-driven and artificial intelligence (AI) with machine learning (ML) approach has never been integrated with the hospital information system (HIS) for predicting major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED). Therefore, we conducted the present study to clarify it. METHODS: In total, 85,254 ED patients with chest pain in three hospitals between 2009 and 2018 were identified. We randomized the patients into a 70%/30% split for ML model training and testing. We used 14 clinical variables from their electronic health records to construct a random forest model with the synthetic minority oversampling technique preprocessing algorithm to predict acute myocardial infarction (AMI) < 1 month and all-cause mortality < 1 month. Comparisons of the predictive accuracies among random forest, logistic regression, support-vector clustering (SVC), and K-nearest neighbor (KNN) models were also performed. RESULTS: Predicting MACE using the random forest model produced areas under the curves (AUC) of 0.915 for AMI < 1 month and 0.999 for all-cause mortality < 1 month. The random forest model had better predictive accuracy than logistic regression, SVC, and KNN. We further integrated the AI prediction model with the HIS to assist physicians with decision-making in real time. Validation of the AI prediction model by new patients showed AUCs of 0.907 for AMI < 1 month and 0.888 for all-cause mortality < 1 month. CONCLUSIONS: An AI real-time prediction model is a promising method for assisting physicians in predicting MACE in ED patients with chest pain. Further studies to evaluate the impact on clinical practice are warranted.

Clinical Image: Leriche Syndrome.

Lower extremity weakness is a neurological symptom that can be caused by several factors, including cerebrovascular accident, spinal cord disease, peripheral nerve disease, neuromuscular junction disease, muscle disease, or other metabolic conditions, such as hypoglycemia and hypokalemia. However, vascular occlusive disease may exhibit neurological symptoms. Here, we present a case of aortoiliac artery total occlusion, Leriche syndrome.