Objective To explore predictive value of radiological indexes for hemorrhage in patients with portal hypertension. Methods The clinical data and radiological data of patients with portal hypertension accompanied with hepatitis B from June 2008 to June 2014 in the Nanjing Drum Tower Hospital were analyzed retrospectively. Patients with hepatocellular carcinoma, portal vein thrombosis, or portal hypertension due to other causes, such as autoimmune hepatitis, pancreatitis, or hematological diseases were excluded. Results Ninety-eight patients were studied and subsequently divided into a hemorrhage group (n=57) and a non-hemorrhage group (n=41). There were no statistical differences in the clinical indexes such as the age, prothrombin time, serum albumin, serum creatinine, serum sodium, white blood cell count, and blood platelet count (P>0.05). However, the differences were statistically significant in the serum total bilirubin, hemoglobin, and liver function with theP values of 0.023, 0.000, and 0.039, respectively. For the radiological indexes, the hemorrhage was correlated with the diameter of posterior gastric vein (P=0.028 3) or grading of esophageal varices (P=0.022 1). Logistic procedure was used to construct the model with stepwise selection and finally the diameter of inferior mesenteric vein, diameter of posterior gastric vein, grading of esophageal varices, and diameter of short gastric vein were enrolled into this model. These indexes were scored, the risk of bleeding increased with increasing the points. Then the model was validated with 26 patients with portal hypertension from July 2014 to December 2014, the area under the receiver operating characteristic curve was 0.884 9 by this radiological model. Conclusions A radiological scoring model is constructed including diameter of inferior mesenteric vein, grading of esophageal varices, diameter of posterior gastric vein, and diameter of short gastric vein, which might predict risk of hemorrhage in patients with portal hypertension. However, further protective study of large sample is needed to validate this model.
Acute pulmonary embolism (PE) is a common disorder with significant morbidity and mortality in patients who underwent pulmonary ground-glass nodules (GGN) resection. We should make efforts to increase surgeons' awareness of risk factors of PE and their understanding of the effectiveness of prevention strategies. Using the optimal risk assessment model to identify high-risk patients and give them the individualized prophylaxis. Early diagnosis and accurate risk stratification is mandatory to reduce the rates of PE, to decrease health care costs and shorten the length of stay. This article summarizes the risk factors, diagnostic process, risk assessment models, prophylaxis and therapy for the PE patients who underwent GGN resection.
Surgical operation is the first choice for most patients who suffer from early non-small cell lung cancer. The risk of ordinary thoracic surgery is between intermediate and high risk. Due to the high incidence of postoperative pulmonary complications after thoracic surgery, preoperative cardiopulmonary reserve assessment is extremely necessary and important. In recent years, lots of assessment tools are clinically used, including pulmonary function tests, arterial blood gas analysis, breath-holding test and 6-minute walk test. In addition, cardiopulmonary exercise test is used extensively. This article reviews the current status of preoperative cardiopulmonary reserve assessment in thoracic surgery to guide clinical decisions, reduce postoperative complications and improve outcomes.
Breast cancer, the most common malignancy in the world, also causes the most death cases of women among malignancies. Breast cancer risk reduction guidelines (version 2023) was updated by National Comprehensive Cancer Network (NCCN). Based on high-level evidences from evidence-based medicine and the latest research progress, the guidelines provided standardized guidance for breast cancer risk assessment and risk reduction strategies for individuals without a history of invasive breast cancer or ductal carcinoma in situ, which has attracted widespread attention from clinicians worldwide. Breast cancer is also the most common malignancy in Chinese women, and the number of newly diagnosed breast cancer cases each year in China ranks first in the world due to the large population, so the breast cancer prevention has become a major public health challenge in China. Aimed to provide reference for breast cancer prevention in China, this article interpreted the guidelines (the new version) based on the characteristics of breast structure in Asian women and the epidemiological characteristics of breast cancer in China.
Objective To explore the application of artificial intelligence in the risk assessment and diagnosis of pancreatic cancer, and to point out its limitations and future suggestions, so as to promote the further application of artificial intelligence in the future. Method The related literatures on the application of artificial intelligence in the risk assessment and diagnosis of pancreatic cancer at home and abroad in recent years were reviewed. Results The usage of artificial intelligence models to assess high-risk patients was beneficial to the diagnosis of pancreatic cancer, although more data were needed to support its role in pancreatic cancer screening. In terms of early diagnosis, artificial intelligence technology could rapidly locate high-risk groups through medical imaging, pathological examination, biomarkers, and so on, and then detected pancreatic cancer at an early stage. Conclusion Despite some limitations, artificial intelligence will play an important role in the early diagnosis and risk prediction of pancreatic cancer in the future due to its powerful computational power.
Objective To determine the prognostic biomarkers and new therapeutic targets of the lung adenocarcinoma (LUAD), based on which to establish a prediction model for the survival of LUAD. Methods An integrative analysis was conducted on gene expression and clinicopathologic data of LUAD, which was obtained from the UCSC database. Subsequently, various methods, including screening of differentially expressed genes (DEGs), GO analysis, KEGG analysis, and GSEA, to analyze the data were employed. Our objective was to establish a five-gene panel risk assessment model using Cox regression and LASSO regression. Based on this model, we constructed a Nomogram to predict the probable survival of LUAD patients at different time points (1-year, 2-year, 3-year, 5-year, and 10-year). Finally, we evaluated the predictive ability of our model using Kaplan-Meier survival curves, ROC curves, and time-dependent ROC curves. The validation group further verified the prognostic value of the model. Results The different-grade pathological subtypes' DEGs were mainly enriched in biological processes such as Metabolism of xenobiotics by cytochrome P450, Natural killer cell-mediated cytotoxicity, Antigen processing and presentation, and Regulation of enzyme activity, which were closely related to tumor development. Through Cox regression and LASSO regression, we constructed a reliable prediction model consisting of a five-gene panel (MELTF, MAGEA1, FGF19, DKK4, C14ORF105). The model demonstrated excellent specificity and sensitivity in ROC curves, with an area under the ROC curve (AUC) of 0.675, as well as in time-dependent ROC curves. The time-dependent ROC analysis revealed AUC values of 0.893, 0.713, and 0.632 for 1-year, 3-year, and 5-year survival, respectively. The advantage of the model was also verified in the validation group. Additionally, we developed a Nomogram that accurately predicted survival, as demonstrated by calibration curves and C-index. Conclusion We have developed a prognostic prediction model for LUAD consisting of five genes. This novel approach offers clinical practitioners a personalized tool for making informed decisions regarding the prognosis of their patients.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Objective To construct a multi-dimensional risk assessment system and scale for the prevention and control risk of respiratory infectious diseases in general hospitals, and make evaluation and early warning. Methods Through the collection of relevant literature on the prevention and control of respiratory infectious diseases during the period from January 1st, 2020 to December 31st, 2022, the articles related to the risk assessment of respiratory infectious diseases such as severe acute respiratory syndrome, COVID-19 and influenza A (H1N1) were screened, and the Delphi method was used to evaluate the articles and establish an indicator system. The normalized weight and combined weight of each item were calculated by analytic hierarchy process. The technique for order preference by similarity to the ideal solution method was used to calculate the risk composite index of 38 clinical departments in a tertiary general hospital in Jiangxi Province in December 2022. Results A total of 16 experts were included, including 4 with senior titles, 8 with associate senior titles, and 4 with intermediate titles. After two rounds of Delphi consult, a total of 4 first-level indicators, 11 second-level indicators, and 38 third-level indicators of risk assessment for the prevention and control of respiratory infectious diseases were determined. The reliability and validity of the scale were good. The top three items with the largest combined weights in the scale were spread by aerosol, spread by respiratory droplet, and commonly used instruments (inspection instruments and monitoring equipment). After a comprehensive analysis on the 38 departments, the top 10 departments in the risk index were the departments of medical imaging, pediatrics, ultrasound, cardiac and vascular surgery, infection, emergency, respiratory and critical care, general medicine, otolaryngology and neck surgery, stomatology, and obstetrics. Conclusions This study constructed the risk assessment scale of respiratory infectious diseases in general hospitals, and the scale has good reliability and validity. The use of this scale for risk assessment of general hospitals can provide a theoretical basis for the risk characteristics of prevention and control of respiratory infectious diseases in general hospitals.
Acute alcohol intoxication is one of the most common poisoning diseases in emergency departments. The main clinical manifestations are nervous system symptoms, with various comorbidities, hidden complications, and high risk of adverse events, and it often takes up more medical resources in emergency departments. This article summarizes the necessity, basis, and existing methods of clinical risk assessment for acute alcohol intoxication, in order to provide a reference for early identification of high-risk patients and optimization of management in emergency departments.