The value of systemic immune inflammation index in predicting the risk of hospital death in critically ill patients / 中华急诊医学杂志

Objective:To explore the predictive value of systemic immune inflammation index (SII) for the risk of hospital death in critically ill patients.Methods:The basic information and clinical data of critically ill patients were extracted from the Medical Information Mart for Intensive Care database-Ⅳ (MIMIC-IV) database, including demographic data, vital signs, blood routine, Logistic organ dysfunction score (Lods), Oxford acute severity of illness score (Oasis), simplified acute physiology score (Saps-Ⅱ), acute physiology score Ⅲ (APS-Ⅲ), sequential organ failure score (SOFA) and outcome. The main outcome was hospital death, and the secondary outcomes were length of hospital stay, continuous renal replacement therapy (CRRT), invasive ventilation and 1-year mortality. Patients were divided into two groups according to in-hospital death, and the differences between the groups were compared. According to the SII tripartite for inter-group comparison, the patients were further divided into three groups for comparison, and Logistic regression model was used to analyze the odd ratio ( OR) of the three groups. Results:A total of 32 450 critically ill patients were included in the study, of which 3765 died in hospital, with a mortality rate of 11.6%. ① Compared with the survival group, the SII in the death group were significantly higher ( P < 0.05). ② The mortality for the SII tripartite grouping (<817; 817~2 151; >2 151) were 8.4%, 10.2% and 16.3%, respectively, and the differences between groups were statistically significant. ③ Further, Logistic regression model analysis showed that the risk of death increased gradually with the increase of groups (the first group was the reference group, OR of the second group was 1.38, 95% CI 1.24-1.54, and OR of the third group was 2.03, 95% CI 1.83-2.24 ( P < 0.05). Conclusions:SII has a certain value in predicting hospital death in critically ill patients. It is easy to obtain and can be used for risk stratification of critically ill patients.

Predictive value of sequential organ failure assessment on 28-day mortality in patients with post-cardiac arrest syndrome / 中华危重病急救医学

Objective:To evaluate the predictive value of sequential organ failure assessment (SOFA) for 28-day mortality in patients with post-cardiac arrest syndrome (PCAS).Methods:Retrospective analysis of 125 patients with PCAS who were treated in Emergency Intensive Care Unit (EICU) of Wenzhou People's Hospital from July 2016 to July 2021. Clinical data were collected, including age, gender, underlying diseases, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), SOFA score on admission to EICU and 28-day mortality. Univariate and multivariate Logistic regression model was constructed to analyze the influencing factors of PCAS patients, which was used to examine the independent correlation between SOFA score and 28-day mortality. Receiver operator characteristic curve (ROC curve) was used to determine the best predictive value of SOFA score and 28-day mortality in PCAS patients.Results:Among the 125 PCAS patients, there were 91 males and 34 females with an average age of (58.7±15.1) years old, and 97 died and 28 survived within 28 days. The overall SOFA score ranged from 7 to 15 points, with an average of 10.9 (10.0, 12.0) points. The SOFA score of non-survival group was significantly higher than that of the survival group [points: 11.0 (10.0, 12.0) vs. 9.5 (9.0, 10.0), P < 0.05]. This difference between SOFA score mainly caused by the neurological and cardiovascular systems. After excluding neurological factors, the SOFA score of the non-survival group was still significantly higher than that of the survival group [points: 8.0 (6.0, 8.0) vs. 6.5 (6.0, 7.0), P < 0.05]. SOFA score was found to be an independent risk factor for 28-day mortality in PCAS patients by multifactorial Logistic regression analysis [odds ratio ( OR) = 1.97, 95% confidence interval (95% CI) was 1.24-3.04]. The correlation between neurological score and mortality was the highest in subgroups ( OR = 3.47, 95% CI was 1.04-11.52). The area under the ROC curve (AUC) predicted by SOFA score was 0.81 (95% CI was 0.73-0.89). When SOFA score cut-off value was 10.5 points (10 or 11 points), the sensitivity and specificity of SOFA score for predicting 28-day mortality in patients with PCAS were 67.0% and 82.1%, respectively. Conclusions:The SOFA score is quite accurate in predicting 28-day mortality in patients with PCAS.

Identifying sarcopenia in advanced non-small cell lung cancer patients using skeletal muscle CT radiomics and machine learning.

BACKGROUND: Sarcopenia has been confirmed as a poor prognostic indicator of lung cancer. However, the lack of abdominal computed tomography (CT) hindered the application to assess the status of sarcopenia. The purpose of this study was to assess the ability of chest CT radiomics combined with machine learning classifiers to identify sarcopenia in advanced non-small cell lung cancer (NSCLC) patients. METHODS: This study retrospectively analyzed CT images of 99 patients with NSCLC. Skeletal muscle radiomics were extracted from a single axial slice of the chest CT scan at the 12th thoracic vertebrae level. In total, 854 radiomic and clinical features were obtained from each patient. Feature selection was conducted with FeatureSelector module, optimal key features were fed into the lightGBM classifier for model construction, and Bayesian optimization was adopted to tune hyperparameters. The model's performance was evaluated by specificity, sensitivity, accuracy, precision, F1-score, Matthew's correlation coefficient (MCC), Cohen's kappa coefficient (Kappa), and AUC. RESULTS: A total of 40 patients were found to have sarcopenia. Five optimal features were selected. In the base lightGBM model, the specificity, sensitivity, accuracy, precision, F1-score, AUC, MCC, Kappa of validation set were 0.889, 0.750, 0.833, 0.818, 0.783, 0.819, 0.649, 0.648, respectively. After Bayesian hyperparameter tuning, the optimized lightGBM model achieved better prediction performance, and the corresponding values were 0.944, 0.833, 0.900, 0.909, 0.870, 0.889, 0.791, 0.789, respectively. CONCLUSIONS: Chest CT-based radiomics has the potential to identify sarcopenia in NSCLC patients with the lightGBM classifier, and the optimal lightGBM model via Bayesian hyperparameter tuning demonstrated better performance. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: Our study demonstrates that chest CT-based radiomics combined with lightGBM classifier has the ability to identify sarcopenia in NSCLC patients. WHAT THIS STUDY ADDS: Skeletal muscle radiomics would be a potential biomarker for sarcopenia identity in NSCLC patients.

Comparing the analgesic effect of intravenous paracetamol with morphine on patients with renal colic pain: A meta-analysis of randomized controlled studies.

INTRODUCTION: The choice of intravenous paracetamol or morphine for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to compare the analgesic efficacy and safety of intravenous paracetamol with morphine for renal colic pain. METHODS: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2019 for randomized controlled trials (RCTs) assessing the analgesic efficacy and safety of intravenous paracetamol versus morphine for renal colic pain. This meta-analysis is performed using the random-effect model. RESULTS: Five RCTs are included in the meta-analysis. Intravenous paracetamol can lead to significantly lower pain scores at 30 min (standard mean difference (Std. MD) = -0.40; 95% confidence interval (CI) = -0.68 to -0.12; P = 0.005) and incidence of dizziness (risk ratio (RR) = 0.06; 95% CI = 0.01 to 0.48; P = 0.007) than morphine for renal colic pain. There is no statistical difference of pain scores at 15 min (Std. MD = -0.80; 95% CI = -1.84 to 0.24; P = 0.13), analgesic rescue (RR = 0.73; 95% CI = 0.45 to 1.19; P = 0.21), the incidence of adverse events (RR = 0.60; 95% CI = 0.35 to 1.03; P = 0.06), nausea or vomiting (RR = 0.61; 95% CI = 0.20 to 1.87; P = 0.38) between two groups. CONCLUSIONS: Intravenous paracetamol may result in lower pain scores at 30 min than morphine for renal colic pain, and more studies should be conducted to compare their analgesic efficacy.

Advances in imaging technology of acute lymphoblastic leukemia related neurocognitive impairment / 中国医学影像技术

Acute lymphoblastic leukemia is the most common malignant tumor of children.Due to the application of individual chemotherapy,the cure rate of this disease is increasing.Because of the rapid development of brain in childhood,the chemotherapeutic drugs can affect the neurocognitive function of children in varying degrees.The progresses of pathophysiology,neurological function,MRI of acute lymphoblastic leukemia related neurocognitive impairment were reviewed in this article.

Imaging characterization and differential diagnosis of primary renal malignant fibrous histiocytoma / 实用放射学杂志

Objective To investigate CT and MRI findings of primary malignant fibrous histiocytoma (MFH)in the kidney. Methods The clinical data and imaging findings of 7 patients with primary renal MFH proved by histopathology were reviewed retrospectively.Results Tumors were unilateral in all patients,in which 5 cases were in the left kidney and 2 cases in the right kidney.The maximum diameter of the lesions ranged from 3.5 to 17.1 cm,with a mean of (8.7±3.9)cm.All the masses showed shallow lobulated or oval, with obscure boundary.On CT plain scan,heterogeneous isodensity/hypodensity were showed in 7 cases,necrosis occured in 7 cases, intratumoral hemorrhage in 2 cases and calcification in 3 cases.MRI also showed heterogeneous signal intensity.No obvious pseudocapsule was found in 6 cases.On dynamic contrast enhancement scan mild-moderate progressive enhancement was showed in corticomedullary and parenchymal phase in all 7 cases.In delay phase slightly decreased enhancement were showed in 5 cases,and similar or slightly higher enhancement corresponding to the parenchymal phase was showed in 2 cases.However,lower enhancement was showed in the tumors on all 3 phases than that in the renal cortex.Besides,the tumors invaded the renal vein (n=1)and the adjacent structure (n=3).Conclusion No specific imaging findings of primary renal MFH are found.The dynamic contrast enhancement might be helpful for its diagnosis to some extent,and clinical data should be integrated with imaging findings together to differentiate renal MFH from other renal neoplasms.The final diagnosis relies on pathology and immunohistochemistry examination.

Applied anatomy of free flap transplant with long superior genicular vessles in reconstruction of lower leg's smashed wound / 中华显微外科杂志

Objective Anatomical researches of two long superiror genicular vessels,the descending branch of lateral circumflex femoral artery (LCFA) and the descending genicular artery(DGA),were performed to discuss the feasibility of reconstruction in lower leg's destruction injury by free flaps transplant anastomoses with these two long superior genicular vessels.Methods Thirty embalmed lower limb specimens from adult cadavers perfused with red latex were used for this anatomical study.The superior of patella,anterior inferior iliac spine and adductor tubercle were used as observation landmark.Dissection started along the line that from the middle point of Inguinal Ligament to the middle point of superior line of patella,and dividedly turned over to posterior lateral part and posterior medial part.The followings were focused observed:①The external diameter at the beginning of the D-LCFA ; the 0.5 mm external diameter point of this artery,and its length to the beginning and superior of patella.②The external diameter at the beginning of DGA,the distance between the beginning of DGA and adductor tubercle.③Anastomoses relations of final branches of D-LCFA and DGA with other arteries around the knee.Results The external diameter of the beginning of D-LCFA was (2.73 ± 0.35) mm ; the 0.5 mm external diameter point of this artery's length to the beginning and to the superior of patella were (24.56 ± 0.92) cm and (6.09 ± 0.86) cm; both D-LCFA and DGA had sent out many perforator arteries on their ways; the final branch of D-LCFA and DGA had lots of anastomoses relations in perioseal deep fascia and superficial fascia with other genicular arteries.Conclusion Base on the anatomical researches,in theory,the two long superior genicular vessels (D-LCFA and DGA) have enough lengthes and blood supply to regress and anastomosis with free flaps transplant to repair lower leg's smashed wound.