Objective To investigate the risk factors for hospital-acquired infection in patients with stroke and to analyze the distribution of pathogens and characteristics of infection sites.Methods A retrospective cohort study was conducted,enrolling 393 patients with stroke hospitalized at Beijing Tiantan Hospital,Capital Medical University,from January 2024 to July 2025.Among them,184 patients were assigned to the infection group and 209 to the non-infection group.Multivariable logistic regression analysis was used to identify risk factors for hospital-acquired infection,and a nomogram prediction model was constructed.Results Multivariable logistic regression analysis identified cerebral infarction(odds ratio=25.09,95%confidence interval:5.38-117.10),no history of alcohol consumption(odds ratio=4.47,95%confidence interval:1.51-13.18),no history of cerebrovascular disease(odds ratio=5.04,95%confidence interval:1.35-18.76),elevated neutrophil count(odds ratio=1.29,95%confidence interval:1.08-1.55),and elevated C-reactive protein(odds ratio=1.03,95%confidence interval:1.01-1.06)as independent risk factors for hospital-acquired infection in patients with stroke.Absence of nasogastric tube feeding(odds ratio=0.09,95%confidence interval:0.03-0.31),no indwelling urinary catheterization(odds ratio=0.21,95%confidence interval:0.06-0.77),and absence of postoperative coma(odds ratio=0.07,95%confidence interval:0.01-0.36)were identified as protective factors.The nomogram model achieved an area under the curve of 0.96(95%confidence interval:0.94-0.98)in the training set and 0.94(95%confidence interval:0.90-0.99)in the validation set,with good calibration.Gram-negative bacteria were the predominant pathogens(70.2%),and the respiratory tract was the most common infection site(92.9%).Endotracheal intubation and impaired consciousness were identified as common risk factors for both pulmonary and Gram-negative bacterial infections.Conclusion This study identified independent risk factors for hospital-acquired infection in patients with stroke,developed a nomogram model with good predictive performance,and preliminarily characterized the risk profiles associated with different infection types and sites.These findings provide a reference for early identification of high-risk patients and the formulation of targeted prevention and control strategies.

BACKGROUND:Despite effective control of low-density lipoprotein cholesterol, the residual risk of atherosclerotic cardiovascular disease (ASCVD) remains substantial, underscoring the urgent need to identify novel targets to further reduce ASCVD risk. This study aimed to investigate the association between apolipoprotein C-III (APOC3) levels and ASCVD, and further explore the potential impact of APOC3 intervention for reducing ASCVD risk. METHODS:We leveraged the 20-year longitudinal data from the Chinese Multi-provincial Cohort Study-Proteomics Project, obtained totaling 5308 APOC3 measurements from 2550 participants, with up to four repeated measurements per participant. The intensity model was employed to estimate the association between time-varying APOC3 and ASCVD, accounting for time-varying potential confounders. The target trial emulation framework was used to emulate the effectiveness of various APOC3-targeted hypothetical interventions on ASCVD risk, with a guideline-directed low-density lipoprotein cholesterol-lowering strategy serving as a positive control. RESULTS:Of 2550 participants aged 57.5 ± 7.9 years at baseline, and 56% of participants were females. The median level of APOC3 was 5554.8 (interquartile range: 3936.5-7913.8) Relative Fluorescence Units. The level of time-varying APOC3 level were associated with an increased risk of incident ASCVD, and a stronger association was observed in populations with metabolic abnormalities. Furthermore, more intensive reductions in APOC3 produced progressively larger decreases in ASCVD risk, with a maximum estimated reduction of 9.3% observed at a 90% APOC3 reduction. CONCLUSIONS:Our findings suggest that APOC3 may play an important role in ASCVD incidence and that targeting APOC3 may offer additional cardiovascular benefits beyond conventional lipid-lowering strategies.

Background: To compare the safety and efficacy of debulking devices, including directional atherectomy (DA) and excimer laser atherectomy (ELA), when combined with drug-coated balloons (DCBs) for treating de novo femoropopliteal atherosclerotic obliterans (ASO). Additionally, to evaluate the long-term outcomes and application status of these different debulking devices. Methods: Clinical data were collected from patients with femoropopliteal ASO who underwent combined debulking and DCBs at the Vascular Surgery Department of Xuanwu Hospital, Capital Medical University, China, between January 2018 and January 2023. In accordance with the different atherectomy devices used during the surgery, patients were divided into the DA group and the excimer laser group. Patient baseline characteristics, Rutherford classification, lesion length, stenosis degree, TASC II classification, calcification degree, and surgical-related data were recorded. Follow-up data over 36 months were collected to obtain efficacy indicators such as primary patency rate and freedom from clinically driven target lesion revascularization rate (fCD-TLR), and so on. Results: A total of 167 primary femoropopliteal lesions were treated with debulking combined with DCB intervention, with a technical success rate of 100%. The DA combined with DCB group included 90 cases, while the ELA combined with DCB group included 77 cases. Both groups showed significant improvement in postoperative Rutherford classification compared to preoperative. The primary patency rates at 12, 24, and 36 months for the DA and ELA groups were 88.89% vs. 81.74% (P = 0.15), 74.66% vs. 74.01% (P = 0.99), and 63.37% vs. 67.24% (P = 0.84), respectively. The fCD-TLR rates were 94.44% vs. 92.15% (P = 0.53); 83.82% vs. 80.87% (P = 0.42); and 68.47% vs. 72.87% (P = 0.22), with no significant statistical differences. Notably, there were certain intergroup differences. Patients in the DA group had more comorbidities but lighter Rutherford classification compared to the ELA group. In the ELA group, the average lesion length was significantly longer than that in the DA group (140 mm vs. 108 mm, P = 0.007), and 75.3% of the lesions were occlusive. In contrast, only 24.4% of the lesions in the DA group were occlusive (P < 0.001). Additionally, the use of embolic protection devices was more common in the DA group (78.9% vs. 49.4%, P < 0.001), while the ELA group had a higher incidence of dissection and a higher rate of bailout stent implantation. Subgroup analysis showed that for severe stenotic lesions, the primary patency rate in the DA group was higher than that in the ELA group (P = 0.04), whereas for occlusive lesions, the ELA group had a better primary patency rate (P = 0.002). Independent risk factors for restenosis included smoking history, hypertension, coronary artery disease, and severe calcified lesions. Conclusion: Both DA and ELA can treat femoropopliteal ASO effectively and improved clinical symptoms with few perioperative complications. However, the specific applications and longterm outcomes of the 2 debulking devices are influenced by the characteristics of the lesions. Additionally, there are certain differences in the use of bailout stenting and distal protection devices. Severe calcified lesions were an independent risk factor for reduced primary patency rate, warranting further in-depth research on the treatment of highly calcified lesions.

Background:To investigate the selection of enteral nutrition (EN) formulas for critically ill sepsis patients with acute gastrointestinal injury (AGI) grade I-II. Methods:We conducted a retrospective cohort study on critically ill sepsis patients with AGI grades I-II. The primary outcomes were EN caloric adequacy on day 7, calories and protein gain from EN within 3-7 days, and the incidence of gastric retention and diarrhea after EN administration. We performed a subgroup analysis based on whether patients initiated EN within 48 h. Results:In the early EN subgroup, caloric adequacy, calories and protein gain of EN on day 7 of the short-peptide group was higher than that of the standard-polymeric group (59.1% vs. 27.3%, p = 0.001; 624[0, 936] vs. 0[-360, 480], p = 0.001; 24[0, 38] vs. 0[-14.4, 19.2], p = 0.003, respectively), and the incidence of gastric retention (18.2% vs. 36.4%, p = 0.03) and diarrhea (9.1% vs. 25.5%, p = 0.02) were lower in the short-peptide group than in the standard-polymeric group. However, in the delayed EN subgroup, the caloric adequacy of EN on day 7 of the short-peptide group was lower than that of the standard-polymeric group (28.6% vs. 43.5%, p = 0.02), calories and protein gain from EN were lower in the short-peptide group than in the standard-polymeric group (960[480, 1,200] vs. 1,080[720, 1,440], p = 0.04; 38.4[19.2, 50.4] vs. 43.2[28.8, 57.6], p = 0.04, respectively). Conclusion:In sepsis patients with AGI grades I-II, short-peptide formulas may be considered for early EN initiation (≤48 h), while standard-polymer formulas may be an option for late EN initiation (>48 h). Exploratory results need to be interpreted with caution and await verification of these findings through high-quality research.

ObjectiveThis Bayesian network meta-analysis sought to evaluate the efficacy of different endovascular treatments for femoropopliteal in-stent restenosis (FP-ISR).MethodsPubMed, Embase, Cochrane Central Register of Controlled Trials and Web of science for clinical trials from database inception to 31 March 2023, with no language restrictions to retrieve randomized controlled trials (RCTs) or cohort studies evaluating the impact of any kind of endovascular treatments for FP-ISR. Pair-wise meta-analysis and Bayesian network meta-analysis were performed to pool the outcome estimates different endovascular treatments. The primary endpoints under consideration were primary patency rates at both 6- and 12-month follow up.ResultsA total of 15 studies with 1424 patients were ultimately enrolled to be analyzed, 7 types of endovascular treatment were identified for comparison. In terms of primary patency and freedom from target lesion revascularization (F-TLR) at 6-,12-month follow-up, the direct meta-analysis findings showed that drug coated balloons (DCB) and CS are considerably superior to plain old balloon angioplasty (POBA), Excimer laser atherectomy (ELA)+DCB is significantly better than DCB. According to the meta-analysis based on Bayesian theory, during the 6-,12-months follow-up, we couldn’t find significant difference between the different treatments in terms of the primary patency and the freedom from TLR, based on the surface values under the cumulative ranking curve (SUCRA), CS was considered the best treatment in terms of primary patency(6 months SUCRA=85.2; 12 months SUCRA=78.9) and freedom from TLR(6 months SUCRA=84.9; 12 months SUCRA=70.9); directional atherectomy (DA)+POBA may lead to higher survival rate at 12 months(SUCRA=89.1) than others treatments; in addition, both ELA+POBA and ELA+DCB have higher limb salvage than POBA.ConclusionThe findings of this network meta-analysis suggest that CS showed positive encouraging results in primary patency and TLR in femoropopliteal ISR at 6, 12 months. However, due to the potential influence of certain confounding factors, the long-term results necessitate validation through numerous RCTs.

ABSTRACT:Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.

Objective: Observational studies show the correlation between COVID-19 and venous thromboembolism (VTE) risk. However, the causal effects remain uncertain. We aimed to explore the potential causal association between COVID-19 and VTE using Mendelian randomization (MR) design. Methods: Two-sample MR was used to evaluate the potential causality between COVID-19 and VTE by selecting single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from genome-wide association studies (GWAS). The weighted median, MR-Egger, simple mode, and weighted mode were employed as supplementary methods for MR estimations, with the inverse-variance weighted (IVW) method serving as the principal analysis. In addition, we took sensitivity analyses, including Cochran's test, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO), and leave-one-out analysis to ensure that we obtained stable and reliable results. Results: Our study selected 26 COVID-19 severity, 31 COVID-19 hospitalization, and 13 COVID-19 susceptibility SNPs as instrumental variables. The IVW analysis results revealed that there was no causal relationship between COVID-19 severity, hospitalization, or susceptibility and VTE, with odds ratios of 0.974 (95%CI: 0.936-1.013, p = 0.19), 0.976 (95%CI: 0.918-1.039, p = 0.447), and 0.908 (95%CI: 0.775-1.065, p = 0.235), respectively. The IVW approach yielded consistent results with MR-Egger, Weighted Median simple mode, and weighted mode. MR-PRESSO and sensitivity analysis further confirmed the stability and consistency of the MR results. Conclusions: This study did not find evidence to support a causal relationship between COVID-19 and VTE at the genetic level. Further investigation is warranted to determine if the significant association reported in previous observational studies between the two is due to confounding factors.

Abstract Background Giant cell arteritis (GCA) is a low-incidence systemic vasculitis in Asian populations. It is considered a rare cause of cerebral venous sinus thrombosis (CVST). This case report presents a rare case of an Asian patient with GCA accompanied by CVST. Case Presentation: A 67-year-old man who had been experiencing varicose veins in the bilateral temporal region for four years and complete loss of vision in the right eye for four months sought medical attention in our emergency department due to loss of vision in the left eye for two weeks and fever for three days. On admission, this patient had a recurrent fever, and no source of infection was identified. Conventional anti-infective treatment was ineffective. Based on the clinical presentation, a diagnosis of GCA combined with CVST was made, and hormone therapy was administered. The patient was discharged with normal body temperature, clear consciousness, recovery of vision in both eyes, and improved clinical parameters. Conclusions This case report presents a distinct manifestation of both GCA and CVST. The coexistence of GCA and CVST is not solely attributed to increased blood viscosity, inflammation of the vascular wall, and abnormal coagulation. It also involves a complex immunological network. This case report may help clinicians make comprehensive clinical decisions in similar cases.

Lipoprotein (a) [Lp (a)] is a complex polymorphic lipoprotein consisting of one low-density lipoprotein particle with one molecule of apolipoprotein B100 and another apolipoprotein (a) linked by a disulfide bond. In recent years, due to its causal role in premature atherosclerotic cardiovascular diseases and calcified aortic stenosis, Lp (a) has attracted more and more attention. Our study aimed to illustrate the trend of Lp (a) research in atherosclerosis (AS) through bibliometric analysis. The Science Citation Index-Expanded was used to locate Lp (a) and AS studies published between December 1, 2012 and December 1, 2022. VOSviewer and CiteSpace bibliometric software packages were used to analyze literature information. LP (a) has seen an overall increase in annual publications. The United States had the highest number of publications worldwide, with 192 publications. The University of California, San Diego, has contributed significantly to Lp (a) with 29 publications and led research collaboration. In the past few decades, there has been close collaboration between countries or regions, institutions, and authors. In addition, the European Heart Journal was the most cited, followed by the Journal of Lipid Research and AS with 2033, 1096, and 806 citations, respectively. Recent studies were on genes and lipid-lowering therapies. Our study comprehensively evaluated the research status and trends of Lp (a) in AS worldwide for the first time and provided a valuable reference for clinical researchers.

Common carotid artery (CCA) pseudoaneurysm is a rare clinical disorder. CCA pseudoaneurysm that occurs with a carotid-esophageal fistula and causes massive upper gastrointestinal bleeding is especially uncommon but can be life-threatening. Accurate diagnosis and prompt managements are essential to save lives. Here, we report a case of a 58-year-old female who presented with dysphagia and throat pain after accidental ingestion of a chicken bone. The patient presented with active upper gastrointestinal bleeding which quickly developed into hemorrhage shock. Imaging studies confirmed a diagnosis of right CCA pseudoaneurysm and carotid-esophageal fistula. The patient had a satisfactory recovery after a right CCA balloon occlusion, right CCA pseudoaneurysm excision, and right CCA and esophageal repairs. We present and discuss this case here to remind physicians to rule out rare causes of upper gastrointestinal bleeding. A multidisciplinary approach is commonly required to achieve satisfactory outcomes in these cases.

BACKGROUND:Bacteremia, which is a major cause of mortality in patients with acute cholangitis, induces hyperactive immune response and mitochondrial dysfunction. Presepsin is responsible for pathogen recognition by innate immunity. Acylcarnitines are established mitochondrial biomarkers.AIM:To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage.METHODS:Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018. Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry, respectively.RESULTS:The concentrations of presepsin, procalcitonin, short- and medium-chain acylcarnitines increased, while long-chain acylcarnitines decreased with the severity of acute cholangitis. The areas under the receiver operating characteristic curves (AUC) of presepsin for diagnosing moderate/severe and severe cholangitis (0.823 and 0.801, respectively) were greater than those of conventional markers. The combination of presepsin, direct bilirubin, alanine aminotransferase, temperature, and butyryl-L-carnitine showed good predictive ability for biliary drainage (AUC: 0.723). Presepsin, procalcitonin, acetyl-L-carnitine, hydroxydodecenoyl-L-carnitine, and temperature were independent predictors of bloodstream infection. After adjusting for severity classification, acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality (hazard ratio 14.396; P < 0.001) (AUC: 0.880). Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine.CONCLUSION:Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage. Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis. Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.

Abstract Background There were limited studies investigating treatments of septic cardiomyopathy (SCM), which is a common complication during sepsis. A septic rat model created by cecal ligation and puncture (CLP) was used to investigate the effects of diminazene aceturate (DIZE) in SCM. Methods A total of 151 Wistar rats were randomly assigned into the sham, CLP, or CLP + DIZE group. Data evaluated postoperatively at 6, 12, 24, and 48 hours included: cardiac function; plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6, angiotensin-(1–7) [Ang-(1–7)], angiotensin II (AngII), troponin I, and brain natriuretic peptide; expression levels of myocardial Ang-(1–7), angiotensin-converting enzyme (ACE), ACE2, and angiotensin type 1 and Mas receptors; and histological changes. Results We found that the CLP + DIZE group had a lower mortality compared to the CLP group (38.5% versus 61.5%) within 48 h postoperatively, although without statistical significance. In contrast to the sham group, the CLP group had decreased cardiac functions, increased myocardial injuries, and higher TNF-α levels, which were ameliorated in the CLP + DIZE group. Furthermore, administration of DIZE could reverse the decreases of myocardial Ang-(1–7) and ACE2 expressions in the CLP group, which finally minimized the myocardial microstructure disruptions. Conclusions It was concluded that DIZE could mitigate the development of SCM and preserve cardiac function during sepsis possibly by interfering with the renin-angiotensin system through promoting myocardial ACE2 expression and restoring local Ang-(1–7) levels.

目的 评价在慢性肾病(CKD)患者运动康复中应用医护一体化健康教育模式的干预效果.方法 选取2019年1月至2021年1月首都医科大学附属北京友谊医院收治的228例CKD患者作为研究对象,采用随机数表法将患者分为观察组和对照组各114例.两组患者均接受为期12周的有氧运动和抗阻运动康复锻炼,对照组采用传统健康教育模式,医生制定医嘱,护士进行常规护理宣教,观察组采用医护一体化健康教育模式干预,比较两组患者的干预效果.结果 干预后,观察组eGFR、VO2 peak分别为(70.45±12.58)mL/min/1.73m2、(2.41±0.62)L/min,高于对照组(65.17±12.64)mL/min/1.73m2、(2.18±0.55)L/min,观察组SCr、SBUN、TG、TC、LDL-C、SBP及DBP指标分别为(140.84±18.57)μmol/L、(8.01±1.29)mmol/L、(2.16±0.71)mmol/L、(3.42±1.18)mmol/L、(2.04±0.45)mmol/L、(122.46±14.11)mmHg和(73.45±7.56)mmHg,低于对照组(147.75±18.42)μmol/L、(8.55±1.40)mmol/L、(2.57±0.79)mmol/L、(3.82±1.27)mmol/L、(2.23±0.49)mmol/L、(128.33±14.29)mm-Hg、(78.09±7.64)mmHg,观察组疾病知识、科学锻炼、自我护理和用药规范得分分别为(8.04±1.35)分、(8.78±0.93)分、(8.27±1.14)分和(7.72±1.48)分,高于对照组(7.26±1.48)分、(8.26±1.07)分、(7.74±1.50)分和(7.28±1.31)分,差异均有统计学意义(P<0.05).结论 在CKD患者运动康复中应用医护一体化健康教育模式,可有效降低患者血脂,改善患者肾脏及心肺功能,较传统健康教育模式效果更佳,值得临床推广应用.

Background: Comparing to anterior cruciate ligament reconstructions (ACLR) with free hamstring tendon (FHT), ACLR with preserved tibial-insertion hamstring tendon (HT-PTI) could ensure the blood supply of the graft and avoid graft necrosis. Yet, whether HT-PTI could protect the cartilage and clinical outcomes in mid-long period after ACLR was still unclear. Purpose: To compare the cartilage change and clinical results between the HT-PTI and FHT in 5 years after ACLR. Study design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 45 patients who underwent isolated ACLR with the autograft of hamstring tendons were enrolled and randomized into 2 groups. The study group undertook ACLR with HT-PTI, whereas the control group had FHT. At pre-operation, and 6, 12, 24, and 60 months post-operation, all cases underwent evaluation with Knee Injury and Osteoarthritis Outcome Score (KOOS), and MR examination. The knee cartilage was divided into 8 sub-regions of which the T2 value and cartilage volume on MRI were measured and documented. The data of two groups were compared and their correlations were analyzed. Results: A total of 18 patients in the HT-PTI group and 19 patients in the FHT group completed the follow-up. The KOOS scores were improved at each follow-up time point (p < 0.001), reached the most superior at 12 months and maintained until 60 months but had no significant difference between the two groups. At 60 months, the cartilage in most subregions in FHT group had higher T2 values than those of pre-operation (p < 0.05) and also higher than HT-PTI group; The cartilage volume changes (CV%) are positive at 6 months and negative from 12 to 60 months in the FHT group, while being negative at all time points in the HT-PTI group. The values of absolute CV% in most subregions in FHT group were significantly higher than those in the HT-PTI group at 6 and 60 months (p < 0.05). Conclusion: The improvement of KOOS score peaked at 12 months in all cases and had no difference between the two groups. The cartilage in the FHT group had more volume loss, earlier and wider damage than that in the HT-PTI group within 5 years. No significant correlation was found among KOOS score, CV%, and T2 value.

BACKGROUND:Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis (AC). Although early biliary drainage is recommended by the treatment guidelines for AC, the best time for performing this procedure is yet to be established. Furthermore, since the clinical outcomes of patients with severe AC vary dramatically, screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade criteria. AIM:To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction. METHODS:In this retrospective monocenter cohort analysis, we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December 2020. Demographic characteristics including age and sex, clinical and laboratory characteristics, and imaging findings of each patient were obtained from electronic medical records. We investigated the all-cause in-hospital mortality (IHM), hospital length of stay (LOS), and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors [age, white blood cell (WBC) count, total bilirubin, albumin, lactate, malignant obstruction, and Charlton comorbidity index (CCI)]. RESULTS:Biliary drainage within 24 or 48 h in Grade III AC patients could dramatically decrease IHM (3.9% vs 9.0%, P = 0.041; 4% vs 9.9%, P = 0.018, respectively), while increasing LOS and hospitalization costs. Multivariate logistic analysis revealed that neurological, respiratory, renal, and cardiovascular dysfunctions, hypoalbuminemia, and malignant obstruction were significantly associated with IHM (odds ratio = 5.32, 2.541, 6.356, 4.021, 5.655, and 7.522; P < 0.001, P = 0.016, P < 0.001, P = 0.012, P < 0.001, and P < 0.001; respectively). Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neurological dysfunction (0% vs 17.3%, P = 0.041) or with serum lactate > 2 mmol/L (0% vs 5.4%, P = 0.016). In the subgroup of AC patients with renal dysfunction, abnormal WBC count, hyperbilirubinemia, or hypoalbuminemia, early drainage (< 24 h) reduced the IHM (3.6% vs 33.3%, P = 0.004; 1.9% vs 5.8%, P = 0.031; 1.7% vs 5.0%, P = 0.019; 0% vs 27%, P = 0.026; respectively). The IHM was lower in patients with AC combined with hepatic dysfunction, malignant obstruction, or a CCI > 3 who had undergone biliary drainage within 48 h (2.6% vs 20.5%, P = 0.016; 3.0% vs 13.5%, P = 0.006; 3.4% vs 9.6%, P = 0.021; respectively). CONCLUSION:Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction, while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade III AC.

Objective:To summarize the clinical characteristics of patients with acute cholangitis and analyze the early warning factors of death.Methods:The clinical data of patients with acute cholangitis treated in the emergency department of Beijing Friendship Hospital from May 1, 2019 to December 5, 2020 were prospectively selected. The age, gender, vital signs, basic diseases, inflammatory indexes, organ function indexes, coagulation indexes, etiology, emergency drainage and prognosis of cholangitis were analyzed to understand the clinical characteristics of acute cholangitis and find out the strongest early warning factor of 28 day death.Results:A total of 274 patients with acute cholangitis attending the emergency department were examined, which included 265 survival patients (survival group) and 9 deaths (death group). In the death group, the proportion of diabetic patients, white blood cell counts, C-reactive protein, creatinine, international standardized ratio, D-dimer, lactate dehydrogenase, fibrinogen degradation products, Sequential Organ Failure Assessment (SOFA) score were significantly higher than those in the survival group, while the albumin level and Glasgow Coma Scale (GCS) score were significantly lower than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that GCS score, creatinine level, white blood cell counts and international standardized ratio were the risk factors of death in patients with acute cholangitis (all P<0.05). Conclusions:GCS score, creatinine level, white blood cell counts and international standardized ratio are early warning factors to judge the death of patients with acute cholangitis. GCS score is the strongest predictor of death in patients with cholangitis.

A 20-year-old female resident of Beijing intended to consume the eggs of the parasitic worm, Taenia saginata, for weight loss; however, she apparently inadvertently ingested Taenia solium (pork tapeworm) eggs, which resulted in disseminated cysticercosis. Cysticerci developed in the brain, tongue, muscles, liver, peritoneum, and subcutaneous tissues. She was administered oral albendazole and praziquantel. After four 10-day courses of treatment, most of the cysts disappeared and she recovered. After 3 years, the patient remains in good health.

Background: Presepsin is currently a promising biomarker for the early diagnosis and prognosis of acute bacterial infection. Acute cholangitis is caused by bacterial infection and has high morbidity and mortality. The study engaged to assess the grading and prognostic value of presepsin in patients with acute cholangitis. Methods: This study enrolled patients with acute cholangitis in the emergency department from May 1, 2019 to December 20, 2020. The patients were evaluated for severity by the 2018 Tokyo Guidelines for Acute Cholangitis. Patients’ baseline features and routine clinical data were collected. On admission, presepsin, procalcitonin (PCT) and systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores were determined; and blood cultures were performed. IBM SPSS software (version 22.0) was used. The comparation of values was performed by Pearson chi-square test or Fisher's exact test or Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC), multivariate logistic regression, and correlation analysis were used to analyze this importance of determining the presepsin levels on admission for acute cholangitis. Results: In total, 330 patients, including 109, 101, and 120 patients classified as having mild, moderate, and severe cholangitis, respectively, were examined. The AUCs of presepsin were 0.713 in predicting severe acute cholangitis, better than those of white blood cell (WBC 0.411), C-reactive protein (CRP 0.615), PCT 0.608, and total bilirubin (T-Bil 0.441) ( P <0.05). The AUC of presepsin in predicting 28-day mortality was higher than that of WBC, CRP, PCT, and T-Bil. The presepsin level in the positive blood culture group was higher than that in the negative blood culture group ( P =0.000). The P values for correlations of presepsin with SIRS and SOFA scores were 0.002 and 0.000, respectively. Conclusions: Presepsin levels on admission were correlated with SIRS and SOFA scores. Presepsin may predict positive blood culture and 28-day mortality in patients with acute cholangitis, and it is superior to WBC, CRP, PCT, and T-Bil in the risk stratification and prognostic assessment of severe cholangitis. Trial registration: Ethical code of this study is 2018-P2-063-01 and acquired on May, 22, 2018.

Objective:To evaluate direct bilirubin /total bilirubin(D/T), B-mode ultrasound(BUS), multislice spiral computed tomography (MSCT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the diagnosis of choledocholithiasis abdominal pain (CAP).Methods:We retrospectively analyzed the materials of patients who were diagnosed with choledocholithiasis abdominal pain by above imagines in the emergency department of Beijing Friendship Hospital during March 2016 to December 2018. The stones were taken out by endoscopic retrograde cholangiopancreatography or surgical operation as the golden standard.Results:Among 256 patients, 195 cases, 138 cases, 107 cases and 26 cases were diagnosed by EUS, MRCP, CT and BUS, respectively. The sensitivity were 0.86, 0.62, 0.45, 0.13, respectively. The specificity were 0.86, 0.81, 0.75, 0.87. The positive predictive value were 0.97, 0.96, 0.91, 0.83.The negative predictive value were 0.55, 0.19, 0.21, 0.16. The accuracy rate were 0.88, 0.64, 0.48, 0.30, respectively. The sensitivity of D/T and D/T combined with EUS in the diagnosis of CAP were 0.57 and 0.67, and the accuracy were 0.16 and 0.56, respectively.Conclusions:EUS has a high diagnostic value for CAP. MRCP is superior to CT in the value of diagnosis of CAP. BUS in imaging diagnosis of CAP value is relatively low, but D/T combined with BUS can improve the sensitivity and accuracy of diagnosis for CAP.

Nuclear medicine can not only display the anatomical structure of organs or lesions, but also provide the information of blood flow, function, metabolism and receptor density of organs and lesions in digestive system . It is not only complementary to computer tomography (CT) and magnetic resonance imaging (MRI) in organic diseases of digestive system, but aslo has unique clinical value in functional diseases of digestive system.