ObjectiveCurrently, simple triage and rapid transport (START) is widely used as a method to evaluate the severity of mass casualty events in a disaster. Modified physiological triage tool (MPTT) and modified physiological triage tool-24 (MPTT-24) are newly introduced triage methodologies that may offer improvements over START. However, the feasibility and accuracy of these two methods cannot be adequately assessed without sufficient data support, whether in earthquakes or other disasters. Our study aimed to analyze the value of the three triage methodologies in mass casualty events due to earthquakes.MethodsA total of 36 604 injured patients from the West China Hospital database were evaluated using START, MPTT and MPTT-24, respectively. The triage methodologies were then evaluated based on death and ICU acceptance, using the area under the receiver-operator curve (AUC). The sensitivity and specificity of the three methodologies were compared under different standards and correlations with the injury severity score (ISS) were analyzed. ResultsFor deaths, the AUCs for the triage methodologies were 0.711, 0.775 and 0.686 for START, MPTT, and MPTT-24, respectively. For ICU acceptance, the AUCs of the triage methodologies after correction for bias were 0.579, 0.618 and 0.603. The correlation coefficients of the triage methodologies and ISS score were 0.041, 0.087, and 0.115.ConclusionsMPTT is superior to START and MPTT-24 in the evaluation of critically ill patients in mass casualty events caused by earthquakes.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP. MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing. Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance. ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.
Objective To investigate the value of fibrinogen to albumin ratio (FAR) combined with pulmonary embolism severity index (PESI) in the assessment of severity and prognosis of patients with acute pulmonary thromboembolism (APTE). Methods A retrospective study of hospitalized patients with confirmed APTE admitted to the Affiliated Hospital of Southwest Medical University from September 2013 to August 2021, divided into low-risk, intermediate-risk, and high-risk groups according to the Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism, and divided into survival groups and death groups according to the 30-day prognosis. The general data of all patients and relevant blood laboratory tests within 2 hours after admission were collected to calculate PESI and FAR. FAR and PESI levels were compared in APTE patients with different severity of disease and different prognosis. Independent risk factors for 30-day mortality in APTE patients were analyzed using logistic regression. Subject working characteristic curves were drawn to assess the differences in sensitivity, specificity and area under the curve of FAR, PESI and FAR combined with PESI in predicting 30-day death. Results Total of 235 APTE patients were included, divided into 85 in the low-risk group, 110 in the intermediate-risk group, and 40 in the high-risk group; 192 in the survival group and 43 in the death group according to 30-day survival. The differences in age, albumin (ALB), high-sensitivity troponin, D-dimer, fibrinogen (FIB), FAR, and PESI of APTE patients with different disease severity were statistically significant (P<0.05). FAR increased progressively with increasing severity of disease (P<0.05), and correlation analysis showed a positive correlation between FAR and PESI (r=0.614, P<0.05). Elevated FIB, FAR, PESI and decreased ALB were independent risk factors for 30-day death in patients with APTE (P<0.05). FAR, PESI, and FAR combined with PESI all had predictive value for 30-day death in APTE patients, and FAR combined with PESI predicted the largest area under the 30-day death curve. Conclusions FAR correlated with the severity and prognosis of APTE patients. FAR combined with PESI was more valuable in assessing the 30-day prognosis of APTE patients than FAR alone or PESI alone.
ObjectiveTo investigate the relationship between the red blood cell distribution width (RDW) and the severity of acute exacerbation of bronchiectasis in elderly patients.MethodsThe clinical data of 216 elderly patients with acute exacerbation of bronchiectasis admitted from January 2015 to October of 2018 were analyzed retrospectively. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by bronchiectasis severity index (BSI) score. Meanwhile, 50 elderly people receiving qualified medical examination were collected as a healthy control group in the same period. The distributions of BSI score, RDW, procalcitonin (PCT), neutrophil percentage (NEU%) and C-reactive protein (CRP) were described in the patients with different risk degree. The severity of acute exacerbation of bronchiectasis in the elderly was evaluated by BSI. The patients were divided into three groups by BSI score: a low risk group, a middle risk group, and a high risk group. The indexes were described including the distribution of stratified BSI score, RDW, PCT, NEU%, CRP at different risk levels. The correlation of each index was analyzed by Spearman correlation. The threshold value of RDW was calculated by general linear regression, and the influencing factors of BSI score were analyzed by multivariate linear regression analysis.ResultsThe higher the risk stratification, the higher the BSI score, RDW, PCT, NEU% and CRP were. RDW was positively correlated with PCT, NEU% and CRP (r values were 0.425, 0.311, 0.177, respectively, P<0.05). BSI score was positively correlated with RDW, PCT, NEU%, and CRP (r values were 0.425, 0.394, 0.650, 0.578, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.425, P<0.05). The thresholds of RDW were 11.45% and 14.03%. Multiple linear regression showed that RDW, PCT, NEU% and CRP were all influential factors of BSI score and explained 52.3% of the total mutation rate.ConclusionRDW is related to the severity of acute exacerbation of bronchiectasis in the elderly, and can predict the severity of acute exacerbation of bronchiectasis in the elderly.
ObjectiveTo investigate predictive value of a new blood biochemical scoring system (CPWAG scoring system) on severity and mortality of acute pancreatitis (AP).MethodsThe AP patients who met the inclusion and exclusion criteria in our hospital from January 2017 to June 2019 were collected, then were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the latest Atlanta classification. The differences of clinical characteristics and related blood biochemical indicators between the SAP group and the non-SAP group were compared. Univariate logistic regression analysis was used to screen blood biochemical risk indicators related to SAP. The receiver operating characteristic (ROC) curve was used to obtain the best cut-off value corresponding to the maximum Youden index of statistical significant risk factors and was assigned as 0 or 1 point according to different situations. At the same time, the pleural effusion of the BISAP score was included and assigned as 0 (yes) or 1 (no) point, then the CPWAG score was obtained by adding the point of the above indexes.The areas under the ROC curve (AUC) of the CPWAG, BISAP, APACHEⅡ, CTSI, and Ranson scoring systems in predicting severity and death of AP patients were also compared.ResultsA total of 451 patients with AP were included in this study, including 85 patients with SAP and 366 patients with non-SAP. Compared with the non-SAP group, the etiology of AP was mainly biliary (P<0.05), with higher levels of white blood cell count (WBC), C reactive protein (CRP), procalcitonin (PCT), and glucose (P<0.05), greater red blood cell distribution width value (P<0.05), longer prothrombin time (PT) and hospital stay (P<0.05), lower albumin (ALB) and blood calcium levels (P<0.05), higher BISAP, APACHEⅡ, CTSI and Ranson points (P<0.05), and higher proportions of patients with pleural effusion, multiple organ dysfunction syndrome, and death (P<0.05) in the SAP group. The highest score of the CPWAG scoring system included CRP, PCT, WBC, ALB, glucose, blood calcium, and pleural effusion was 7. With the increase of CPWAG score, the proportion of SAP and death patients showed an increasing trend (P<0.001). The AUC of the CPWAG scoring system in predicting SAP was 0.866, which was higher than those of Ranson (AUC=0.722, Z=5.317, P<0.001), APACHEⅡ (AUC=0.706, Z=5.019, P<0.001), and CTSI (AUC=0.805, Z=1.962, P=0.005) scoring system, but which had no statistically significant difference as compared with the BISAP scoring system (AUC=0.819, Z=1.816, P=0.070). The AUC of the CPWAG scoring system in predicting death had a high ability (AUC=0.823), which had no significant differences as compared with the Ranson, APACHEⅡ, CTSI, and BISAP scoring systems (P>0.05).ConclusionThe CPWAG score is valuable in predicting the severity and mortality of AP patients, allowing accurate and early assessment of AP patients.
ObjectiveTo explore the risk factors which affect the severity of acute pancreatitis by using machine learning algorithms. MethodsA retrospective review was conducted of medical records from 262 patients hospitalized for acute pancreatitis at the Second Affiliated Hospital of Zhengzhou University between October 2022 and February 2024. Patients were classified according to the revised edition Atlanta Classification into mild cases (n=146) and non-mild cases (n=116). LASSO analysis was employed to identify predictors for non-mild acute pancreatitis. Six machine learning algorithms, including extreme gradient boosting, random forest, logistic regression, decision tree, support vector machine, and K-nearest neighbors were integrated to construct predictive models. Model performance was evaluated by comparing the following metrics: area under the curve (AUC), sensitivity, specificity, accuracy, F1 score, calibration curves, and decision curves. ResultsThrough LASSO regression analysis, six feature variables, including heart rate, white blood cell count, neutrophil count, C-reactive protein, albumin, and calcium ion were selected to train and test machine learning models. Results showed that extreme gradient boosting achieved the highest AUC value of 0.93 on the test set, making it the optimal model. The sensitivity, specificity, accuracy, Brier score, and F1 score of the extreme gradient boosting model were 0.97, 0.70, 0.85, 0.108, and 0.84. ConclusionThe prediction model developed using extreme gradient boosting has high clinical utility value, helps to predict the severity of acute pancreatitis at an early stage and is valuable in guiding clinical decision-making.
ObjectiveTo investigate correlation of bedside index for severity in acute pancreatitis (BISAP) and computed tomography severity index (CTSI) or modified CT severity index (MCTSI) in assessing severe acute pancreatitis (SAP).
MethodsThirty-eight patients confirmed SAP from July 2015 to October 2015 in West China Hospital of Sichuan University were prospectively included into this study. Contrast-enhanced multi-detector-row CT scan was performed for all the patients. The abnormal imaging features, such as pancreatic and peri-pancreatic inflammatory changes, involvement of other organs, and local complications, were observed and used to calculate by CTSI score and MCTSI score. The clinical data were also collected to calculate BISAP score and as compared with CTSI score and MCTSI score.
ResultsThe results of BISAP score were as follows:3 cases gradeⅠ(8.9%), 20 cases gradeⅡ(52.6%), 15 cases gradeⅢ(39.5%). The results of CTSI score were as follows:6 cases gradeⅠ(15.8%), 22 cases gradeⅡ(57.9%), 10 cases gradeⅢ(26.3%). The results of MCTSI score were as follows:2 cases gradeⅠ(5.3%), 19 cases gradeⅡ(50.0%), 17 cases gradeⅢ(44.7%). The results of interobserver agreement were good (BISAP:Kappa=1, P < 0.01; CTSI:Kappa=0.748, 95% CI 0.00-0.076, P < 0.01; MCTSI:Kappa=0.788, 95% CI 0.00-0.076, P < 0.01). There was a positive correlation between CTSI score (rs=0.385, P=0.001) or MCTSI score (rs=0.326, P=0.004) and BISAP score using the Spearman test.
ConclusionThere is a weak correlation between CTSI score or MCTSI score and BISAP score.
ObjectiveTo discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia.MethodsData of 80 patients with severe pneumonia admitted in our ICU were analyzed retrospectively, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, weight, Acute Physiology and Chronic Health EvaluationⅡscore, lactate, PSI score and LIPS score, etc. were collected. Statistical significance results were evaluated by multivariate logistic regression analysis after univariate analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the parameter for ARDS after severe pneumonia.ResultsForty patients with severe pneumonia progressed to ARDS, there were 4 moderate cases and 36 severe cases according to diagnostic criteria. Univariate analysis showed that procalcitonin (t=4.08, P<0.001), PSI score (t=10.67, P<0.001), LIPS score (t=5.14, P<0.001), shock (χ2=11.11, P<0.001), albumin level (t=3.34, P=0.001) were related to ARDS. Multivariate logistic regression analysis showed that LIPS ［odds ratio (OR) 0.226, 95%CI=4.62-5.53, P=0.013］ and PSI (OR=0.854, 95%CI=132.2-145.5, P=0.014) were independent risk factors for ARDS. The predictive value of LIPS and PSI in ARDS occurrence was significant. The area under ROC curve (AUC) of LIPS was 0.901, the cut-off value was 7.2, when LIPS ≥7.2, the sensitivity and specificity were both 85.0%. AUC of PSI was 0.947, the cut-off value was 150.5, when PSI score ≥150.5, the sensitivity and specificity were 87.5% and 90.0% respectively.ConclusionsPSI and LIPS are independent risk factors of ARDS in patients with severe pneumonia, which may be references for guiding clinicians to make an early diagnosis and treatment plan.
Objective To investigate the load distribution on the more painful and less painful limbs in patients with mild-to-moderate and severe bilateral knee osteoarthritis (KOA) and explore the compensatory mechanisms in both limbs among bilateral KOA patients with different severity levels. Methods A total of 113 participants were enrolled between July 2022 and September 2023. This cohort comprised 43 patients with mild-to-moderate bilateral KOA (Kellgren-Lawrence grade 2-3), 43 patients with severe bilateral KOA (Kellgren-Lawrence grade 4), and 27 healthy volunteers (healthy control group). The visual analogue scale (VAS) score for pain, the Hospital for Special Surgery (HSS) score, passive knee range of motion (ROM), and hip-knee-ankle angle (HKA) were used to assess walking pain intensity, joint function, and lower limb alignment in KOA patients, respectively. Motion trajectories of reflective markers and ground reaction force data during walking were captured using a gait analysis system. Musculoskeletal modeling was then employed to calculate biomechanical parameters, including the peak knee adduction moment (KAM), KAM impulse, peak joint contact force (JCF), and peak medial/lateral contact forces (MCF/LCF). Statistical analyses were performed to compare differences in clinical and gait parameters between bilateral limbs. Additionally, one-dimensional statistical parametric mapping was utilized to analyze temporal gait data. Results Mild-to-moderate KOA patients showed the significantly higher HSS score (67.7±7.9) than severe KOA patients (51.9±8.9; t=8.747, P<0.001). The more painful limb in all KOA patients exhibited significantly greater HKA and higher VAS scores compared to the less painful limb (P<0.05). While bilateral knee ROM did not differ significantly in mild-to-moderate KOA patients (P>0.05), the severe KOA patients had significantly reduced ROM in the more painful limb versus the less painful limb (P<0.05). Healthy controls showed no significant bilateral difference in any biomechanical parameters (P>0.05). All KOA patients demonstrated longer stance time on the less painful limb (P<0.05). Critically, severe KOA patients exhibited significantly higher peak KAM, KAM impulse, and peak MCF in the more painful limb (P<0.05), while mild-to-moderate KOA patients showed the opposite pattern with lower peak KAM and KAM impulse in the more painful limb (P<0.05) and a similar trend for peak MCF. Conclusion Patients with mild-to-moderate KOA effectively reduce load on the more painful limb through compensatory mechanisms in the less painful limb. Conversely, severe bilateral varus deformities in advanced KOA patients nullify compensatory capacity in the less painful limb, paradoxically increasing load on the more painful limb. This dichotomy necessitates personalized management strategies tailored to disease severity.
