Predictive value of red blood cell distribution width and platelet-to-lymphocyte ratio for acute kidney injury in critically ill patients.

OBJECTIVES: The purpose of this study was to explore the value of red blood cell distribution width (RDW) and platelet-to-lymphocyte ratio (PLR) in predicting the occurrence of acute kidney injury (AKI) in critically ill patients. MATERIALS AND METHODS: Among 1,500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. RESULTS: Overall, 615 (41%) patients were diagnosed with AKI. We divided the groups into two subgroups each; the high-RDW (≥ 14.045%) group had a high risk of developing AKI (OR = 5.189, 95% CI: 4.088 - 6.588), and the high-PLR (≥ 172.067) group had a risk of developing AKI too (OR = 9.11, 95% CI: 7.09 - 11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755 - 0.804) and 0.728 (95% CI: 0.702 - 0.754) (all p < 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190 - 3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95% CI: 1.179 - 1.995). CONCLUSION: A higher RDW was related to a higher risk of AKI occurrence and in-hospital mortality in the ICU.

Assisting Scalable Diagnosis Automatically via CT Images in the Combat against COVID-19

Introductory paragraphThe pandemic of coronavirus Disease 2019 (COVID-19) caused enormous loss of life globally. 1-3 Case identification is critical. The reference method is using real-time reverse transcription PCR (rRT-PCR) assays, with limitations that may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that application of deep learning (DL) to the 3D CT images could help identify COVID-19 infections. Using the data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 patients. COVIDNet achieved an accuracy rate of 94.3% and an area under the curve (AUC) of 0.98. Application of DL to CT images may improve both the efficiency and capacity of case detection and long-term surveillance.

Evaluation of iodixanol combined with low voltage in CT imaging quality of solitary pulmonary nodules / 实用医学杂志

Objective To explore the feasibility of low concentration contrast medium and low-voltage combined with adaptive statistical iterative reconstruction(ASRI)technique in enhanced CT imaging of solitary pulmonary nodules. Methods A total of 40 patients with solitary pulmonary nodules who underwent routine exam-inations and were pathologically confirmed from February 2015 to February 2017 were collected and divided into conventional group(conventional dose,high osmolar contrast,using filtered back projection reconstruction)and low dose group(low voltage,low concentration isotonic contrast,iterative reconstruction). Results Subjective scoring of conventional group(3.97 ± 0.57)and low dose group(4.01 ± 0.54)indicated no statistical significance (P > 0.05). No significant difference was found regarding to reconstructed image quality,SNR and CNR in both two groups.The dose length product(DLP)and effective dose(ED)in low dose group were lower than those in the conventional group[(283.52 ± 11.50)mGy/cm vs(370.74 ± 29.56)mGy/cm;(3.65 ± 0.32)mSV vs(5.11±0.25) mSV],and the difference was statistically significant(P < 0.05). Conclusions Low concentration isotonic con-trast agent(iodixanol 270 mgI/L)and low voltage(100 kV)combined with ASIR technology could satisfy the clini-cal need in enhanced CT imaging of solitary pulmonary nodule.

Transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization as a treatment option for cervical pregnancy.

PURPOSE: To assess the value of transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization (UAE) as a treatment option for cervical pregnancy. MATERIALS AND METHODS: Between January 2004 and June 2009, a prospective study was conducted in 20 consecutive patients with cervical pregnancy. The patients were treated with UAE with gelatin sponge particles (1-2 mm in size) to control active vaginal bleeding. Methotrexate was injected into the arteries before, during, and after UAE. RESULTS: Two of 20 patients (10%) had recurrent vaginal bleeding of approximately 50 mL daily after treatment; the other 18 (90%) had no significant vaginal bleeding after UAE. Fifteen cases (75%) were treated successfully by a single procedure and five (25%) required a subsequent curettage without blood transfusion. The degeneration of placenta was confirmed by light microscopy after curettage. The cervical gestational sac was eliminated at a mean of 41 days (range, 11-83 d). Increased serum beta-human chorionic gonadotrophin levels normalized by an average of 30 days (range, 7-49 d). The uterus was preserved and normal menses resumed within 2-4 months in all 20 women (100%). Of 16 women who attempted another pregnancy, eight (50%) achieved pregnancy: there were six term pregnancies with live births (38%) and two miscarriages (13%). No obvious complications related to treatment occurred, but a few mild side effects were observed in nine cases (45%). CONCLUSIONS: Based on this series of 20 patients, the conservative protocol of transcatheter intraarterial methotrexate infusion combined with UAE may be a feasible, effective, and safe option for cervical pregnancy.

Study progress of two-stage resection for primary hepatocellular carcinoma after transcatheter arterial chemoembolization / 中华肝胆外科杂志

The resection can be performed in about 20 percent of patients with primary hepatocellular carcinoma(PHC) in clinic. However, with the development of interventional treatment such as transcatheter arterial chemoembolization(TACE), better therapeutic effect has been achieved by two-stage resection such as TACE in patients with unresectable PHC. At present, surgical resection is still regarded as the first choice of PHC, and the principle of comprehensive therapeutic solutions around surgical operation has been established. The pretreatment of TACE is an important measure to improve the therapeutic effect in PHC.This paper discussed the mechanism, effect and value of TACE in pretreatment of unresectable PHC. The selection of operative opportunity, sign, and ways after TACE and the factors affecting prognosis of two-stage resection were also reviewed.

Bronchial artery embolization in hemoptysis / 中国介入影像与治疗学

Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.