Imaging Changes in Liver After Chemotherapy for Colon Cancer: A Case Report.

BACKGROUND: Colon cancer with liver metastasis is a common occurrence in clinical practice. The presence of liver metastasis has a significant impact on the treatment strategy of patients, so the first step is to diagnose whether it is liver metastasis. Imaging is one of the auxiliary methods for diagnosing liver metastases, but due to the presence of different diseases with the same shadow, we need to be cautious when using imaging methods for the diagnosis of liver metastases. CASE PRESENTATION: We report a 53-year-old female patient with sigmoid colon cancer and perforation who underwent a surgical operation. Three years after the operation, reexamination of the liver through computed tomography and magnetic resonance imagery scanning revealed multiple progressive liver lesions. However, the liver biopsy did not show malignant changes. Repeated analysis of the patient's liver magnetic resonance imaging revealed that multiple liver nodules were significantly enhanced in the arterial phase and that the portal vein density/signal ratio was higher than that of the liver parenchyma. The coincidence of doughnut-shaped nodules and high signal in the hepatobiliary phase, combined with the results of pathological liver puncture examination, led to nodular regenerative hyperplasia being considered as a possible diagnosis. CONCLUSION: A review of the relevant literature showed that following oxaliplatin chemotherapy for colorectal cancer, it is not uncommon for doughnut-shaped nodules with obvious enhancement in the middle hepatic artery phase and high signal intensity in the hepatobiliary phase to develop. Such changes should be paid sufficient attention by radiologists.

One-stop procedure of "Atrial fibrillation radiofrequency ablation + left atrial appendage closure" guided by 3D printing technology: A case report.

Left atrial appendage occlusion (LAAO) in the treatment of atrial fibrillation (AF) has become a hot topic in clinical research in recent years. We report a 68-year-old female with a 3-year history of paroxysmal atrial fibrillation refractory to antiarrhythmic therapy and unable to tolerate anticoagulation therapy who underwent successful atrial fibrillation radiofrequency ablation combined with left atrial appendage occlusion guided by 3D printing technology. There was no recurrence of her atrial fibrillation and there was continued complete occlusion of her left atrial appendage at 3-month and 1-year follow-ups.This case supports the potential advantage of 3D printing technology to guide a "one-stop combined AF radiofrequency ablation and left atrial appendage occlusion procedure." But whether it can improve the prognosis and quality of life of patients, further multi-center research and large data statistics are required.

Relationship between Prothrombin time and All-cause Mortality in Heart Failure.

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Association between PT, PT-INR, and in-hospital mortality in critically ill patients with tumors: A retrospective cohort study.

Objectives: Prothrombin time (PT) and PT-INR are independent predictors of mortality in patients with cancer. The PT and PT-INR of cancer patients are independent predictive variables of mortality. However, whether the PT or PT-INR is related to in-hospital mortality in severely ill patients with tumors remains unknown. Design: This was a case-control study based on a multicenter public database. Settings: This study is a secondary analysis of data extracted from 2014 to 2015 from the Electronic Intensive Care Unit Collaborative Research Database. Participants: The data relevant to seriously ill patients with tumors were obtained from 208 hospitals spread throughout the USA. This research included a total of 200,859 participants. After the samples were screened for patients with combination malignancies and prolonged PT-INR or PT, the remaining 1745 and 1764 participants, respectively, were included in the final data analysis. Primary and secondary outcome measures: The key evaluation methodology was the PT count and PT-INR, and the main outcome was the in-hospital mortality rate. Results: After controlling for confounding variables, we found a curvilinear connection between PT-INR and in-hospital mortality (p < 0.001), and the inflection point was 2.5. When PT-INR was less than 2.5, an increase in PT-INR was positively associated with in-hospital mortality (OR 1.62, 95% CI 1.24 to 2.13), whereas when PT-INR was greater than 2.5, in-hospital mortality was relatively stable and higher than the baseline before the inflection point. Similarly, our study indicated that the PT exhibited a curvilinear connection with in-hospital mortality. On the left side of the inflection point (PT <22), a rise in the PT was positively linked with in-hospital mortality (OR 1.08, 95% CI 1.04 to 1.13, p < 0.001). On the right side of the inflection point, the baseline PT was above 22, and the in-hospital mortality was stable and higher than the PT count in the prior range (OR 1.01, 95% CI 0.97 to 1.04, 0.7056). Conclusion: Our findings revealed that there is a curved rather than a linear link between the PT or PT-INR and in-hospital mortality in critically ill cancer patients. When these two laboratory results are below the inflection point, comprehensive therapy should be employed to reduce the count; when these two laboratory results are above the inflection point, every effort should be made to reduce the numerical value to a value below the inflection point.

One-stop procedure of "atrial fibrillation radiofrequency ablation + left atrial appendage closure + coronary artery fistula embolization": A case report.

BACKGROUND: Through a case of atrial fibrillation (AF) combined with coronary artery fistula, a one-stop interventional operation treatment of "AF radiofrequency ablation + left atrial appendage closure (LAAC) + coronary artery fistula (CAF) embolization" was performed. We have checked the relevant literature, and there is no similar report, which may help clinicians deal with similar situations. CASE PRESENTATION: The patient had a 6-year history of paroxysmal AF, and had experienced negative effects of the drug treatment. She had suffered many years of repeated hemoptysis due to bronchiectasis, and could not tolerate anticoagulation therapy. After in-depth clinical discussion, a one-stop interventional operation including AF radiofrequency ablation, LAAC, and CAF embolization, was formulated according to the patient's situation. The patient recovered and was discharged smoothly. CONCLUSIONS: In patients with AF combined with coronary artery-bronchial artery fistula, a one-stop interventional operation treatment of "AF radiofrequency ablation + LAAC+ CAF embolization" was performed. It can effectively improve the anticoagulation-worsened haemoptysis in patients with AF.

Electrocardiogram of a patient with mushroom poisoning-induced myocarditis.

A patient presented to our hospital with myocarditis caused by mushroom poisoning. The early ECG changes in this patient were very similar to the ECG of hyperacute ST-segment elevation myocardial infarction or hyperkalemia, but further tests eliminated these options. The patient was fully treated by timely hemodialysis treatment, confirming the diagnosis of mushroom poisoning-induced myocarditis. Although not specific to mushroom poisoning myocarditis, our experience shows that the observed ECG changes. Our findings have the potential to help diagnose and manage this potentially fatal disease in the future.

Fishbone-induced Pericardial Hemorrhage Resulting in a Misdiagnosis of Acute Myocardial Infarction.

Fishbone intake is a common clinical event; but serious complications resulting from the ingestion of fishbones, such as perforations in the stomach, diaphragm, and pericardium and heart lacerations, are rare. Here, we present a case of fishbone-induced pericardial hemorrhage that led to a misdiagnosis of acute myocardial infarction (AMI) since the emergency coronary angiogram showed normal coronaries. However, the patient's circulatory status was not good and an echocardiogram revealed pericardial effusion. A contrast-enhanced computed tomography (CT) of the chest and abdomen showed a foreign body in the upper abdomen. Therefore, an urgent exploratory thoracotomy was performed, and it was discovered that the pericardial hemorrhage was caused by the fishbone puncturing the pericardium and myocardium of the right ventricle. The fishbone was removed, damaged vessels were repaired, and the pericardium was closed with a drain. The patient was discharged in good clinical condition. In order to avoid unnecessary damage and suffering, the possibility of a foreign body in the esophagus or heart must be considered when patients have chest pain, and careful reporting of histories and corresponding examinations are necessary.    Key Words: Acute myocardial infarction, Fishbone, Pericardial effusion.

Acute Myocardial Infarction (AMI) as the Effect Modifiers to Modify the Association Between Red Blood Cell Distribution Width (RDW) and Mortality in Critically Ill Patients With Stroke.

Background and Objectives: Few studies have evaluated the impact of red blood cell distribution width (RDW) on prognosis for critically ill patients with acute stroke according to recent studies. The aim of this study was to investigate the association between RDW and mortality in these patients. Methods: Clinical data were extracted from the eICU Collaborative Research Database (eICU-CRD) and analyzed. The exposure of interest was RDW measured at admission. The primary outcome was in-hospital mortality. Binary logistic regression models and interaction testing were performed to examine the RDW-mortality relationship and effect modification by acute myocardial infarction and hypertension (HP). Results: Data from 10,022 patients were analyzed. In binary logistic regression analysis, after adjusting for potential confounders, RDW was found to be independently associated with in-hospital mortality {odds ratio (OR) 1.07, [95% confidence interval (CI) 1.03 to 1.11]; p = 0.001}. Higher RDW linked to an increase in mortality (OR, 1.07; 95% CI, 1.03 to 1.11; P for trend < 0.0001). Subgroup analysis showed that, in patients combined with AMI and without HP (both P-interaction <0.05), the correlation between RDW and in-hospital mortality is stronger (AMI group: OR, 1.30; 95% CI, 1.07 to 1.58, not the AMI group: OR, 1.06; 95% CI, 1.02, 1.10; the HP group: OR,.98; 95% CI,.91 to 1.07, not the HP group: OR, 1.09; 95% CI, 1.05 to 1.14). Conclusions: A higher baseline RDW is independently correlated with prognosis in critically ill patients with acute stroke, and the correlation can be modified by AMI and HP duration.

Association between platelets and in-hospital mortality in critically ill patients with tumours: a retrospective cohort study.

OBJECTIVES: Platelet count is an independent predictor of mortality in patients with cancer. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours. DESIGN: A retrospective study based on a dataset from a multicentre cohort. SETTING: This was a secondary analysis of data from one Electronic Intensive Care Unit Collaborative Research Database survey cycle (2014-2015). PARTICIPANTS: The data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the USA. This study initially a total of 200 859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The main measure was the platelet count, and the main outcome was in-hospital mortality. RESULTS: After adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (p<0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤184 'x10ˆ9/L), an increase of 10 in the platelet count was negatively associated with in-hospital mortality (OR 0.92, 95% CI 0.89 to 0.95, p<0.001). The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality (OR 1.13, 95% CI 1.00 to 1.28, p=0.0454). The baseline platelet count was in the range of 184 'x10ˆ9/L-445 'x10ˆ9/L(p=0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges. CONCLUSIONS: The relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 'x10ˆ9/Land 445 'x10ˆ9/L. This indicates that both high and low platelet count should receive attention in clinical practice.

Association between basal platelet count and all-cause mortality in critically ill patients with acute respiratory failure: a secondary analysis from the eICU collaborative research database.

BACKGROUND: Evidence regarding the correlation between platelet count and all-cause mortality in critically ill patients with acute respiratory failure (ARF) is limited. Therefore, the aim of the study was to evaluate whether platelet count was associated with all-cause mortality in critical patients with ARF by using the electronic intensive care unit (eICU) Collaborative Research Database (eICU-CRD). METHODS: In this retrospective multicenter cohort study, the data of 26961 patients with ARF hospitalized in ICUs between 2014 and 2015 were collected. The independent variable was log2 basal platelet count, and the dependent variables were all-cause in-hospital and ICU mortality. Covariates including demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, supportive treatment, and comorbidities were collected. RESULTS: In the fully adjusted model, log2 basal platelet count was negatively associated with all-cause mortality both in hospital [RR: 0.87, 95% CI: 0.84-0.91] and in ICU [RR: 0.87, 95% CI: 0.83-0.92]. A non-linear relationship between log2 basal platelet count and all-cause in-hospital and ICU mortality was identified by the nonlinearity test. The inflection points we got were 6.83 and 6.86 respectively (after inverse log2 logarithmic conversion, the platelet counts were 114×109/L and 116×109/L, respectively). On the right side of the inflection point, however, no association was observed between blood platelets and all-cause in-hospital (RR: 0.96, 95% CI: 0.88-1.03) and ICU mortality (RR: 0.97, 95% CI: 0.91-1.04). CONCLUSIONS: For patients with ARF in ICU, platelet count was negatively associated with all-cause in-hospital and ICU mortality when the platelet count was less than 114×109/L and 116×109/L respectively, but when the platelet count was higher, we failed to observe a correlation between them. The safe ranges of platelet count for hospital stay and ICU stay were 78×109/L-145×109/L and 89×109/L-147×109/L respectively.

Relationship Between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Ischemic Stroke Patients with Atrial Fibrillation: An Analysis from the MIMIC-IV Database.

AIM: To investigate the association between the hemoglobin-to-red cell distribution width (RDW) ratio (HRR) and all-cause mortality in ischemic stroke patients with atrial fibrillation (AF). DESIGN: This study was a retrospective cohort analysis. In total, 1018 ischemic stroke patients with AF were enrolled using the Medical Information Mart for Intensive Care database, (MIMIC)-IV. The patients were divided into four groups according to the HRR values. The primary outcome was 180-day all-cause mortality. METHODS: Multivariate Cox proportional risk regression models were used to examine the association between HRR and all-cause mortality. The non-linear relationship between HRR and all-cause mortality was confirmed using a Cox proportional risk regression model fitted by cubic spline function and smooth curve fitting. RESULTS: A total of 246/1018 patients (24.17%) died. The serum HRR values were negatively associated with 180-day all-cause mortality (hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.68-0.94). A two-piecewise regression model was used to obtain a threshold inflection point value of 9.74. The HR and the 95% CI on the left inflection point were 0.73 and 0.61-0.87 (p = 0.0005); on the right inflection point they were 1.06 and 0.82-1.38 (p = 0.6383). CONCLUSION: The relationship between all-cause mortality and the HRR values was non-linear in ischemic stroke patients with AF. All-cause mortality and HRR values were negatively correlated when the HRR value was ≤9.74.

Non-linear relationship between basal serum albumin concentration and cardiac arrest in critically ill patients with end-stage renal disease: a cross-sectional study.

OBJECTIVES: The aim of our study was to investigate the association between serum albumin concentration and the risk of cardiac arrest in critically ill patients with end-stage renal disease in the intensive care unit (ICU). DESIGN: This was a secondary analysis. SETTING: The Phillip electronic-ICU collaborative database from 2014 to 2015. PARTICIPANTS: This study included 4990 critically ill patients diagnosed with end-stage renal disease. PRIMARY AND SECONDARY OUTCOME MEASURES: The exposure of interest was serum albumin concentration. The outcome variable was cardiac arrest. RESULTS: A non-linear relationship was observed between serum albumin concentration and risk of cardiac arrest, with an inflection point of 3.26 g/dL after adjusting for potential confounders. The effect sizes and the CIs on the left and right sides of the inflection point were 0.88 (0.65 to 1.19) and 0.32 (0.16 to 0.64), respectively. CONCLUSIONS: Within an albumin range of 3.26-5.6 g/dL, each 1 g/dL increase in serum levels is associated with a 68% decrease of the risk of cardiac arrest in critically ill patients with end-stage renal disease.

NT-proBNP and Major Adverse Cardiovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Primary Percutaneous Coronary Intervention: A Prospective Cohort Study.

BACKGROUND: The prognostic significance of the amino-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) has not been fully elucidated. Major adverse cardiovascular events (MACEs) are clinically viable indicators for the accurate, rapid, and safe evaluation of patients with STEMI. This study was designed to investigate the relationship between NT-proBNP levels and the occurrence of short-term MACEs in patients with STEMI who underwent emergency PCI. METHODS: This prospective cohort study included 405 patients with STEMI aged 20-90 years who underwent emergency PCI at the First People's Hospital of Changde City from April 6, 2017, to May 31, 2019. Stent thrombosis, reinfarction, congestive heart failure, unstable angina, and cardiac death were considered as MACEs in this study. The target-independent and -dependent variables were NT-proBNP at baseline and MACE, respectively. RESULTS: There were 28.25% of MACEs. Age, number of implanted stents, Killip class, infarction-related artery, applied intra-aortic balloon pump (IABP), creatine kinase (CK) peak value, CK-MB peak value, TnI peak value, and ST-segment resolution were independently associated with MACE (P < 0.05). In a multivariate model, after adjusting all potential covariates, Log2 NT-proBNP levels remained significantly associated with MACE, with an inflection point of 11.66. The effect sizes and confidence intervals of the left and right sides of the inflection point were 1.07 and 0.84-1.36 (P=0.5730) and 3.47 and 2.06-5.85 (P < 0.0001), respectively. CONCLUSIONS: In patients with STEMI who underwent PCI, Log2 NT-proBNP was positively correlated with MACE within 1 month when the Log2 NT-proBNP was >11.66 (NT-proBNP >3.236 pg/mL).

Relationship Between Red Blood Cell Distribution Width and All-Cause Mortality in Disseminated Intravascular Coagulation Patients: A Retrospective Analysis.

PURPOSE: Studies regarding death risk factors of disseminated intravascular coagulation (DIC) patients were limited. We conducted this study to investigate whether red blood cell distribution width (RDW) was independently related to all-cause mortality of DIC patients. METHODS: We used data from the Medical Information Mart for Intensive Care III version 1.4 (MIMIC-III v1.4). A total of 2098 patients with DIC were included. The main outcome was in-hospital all-cause mortality. RESULTS: After adjusting for potential covariates, the in-hospital all-cause mortality was positively correlated with RDW. The hazard ratio (HR), 95% confidence intervals (CI), and P-value were 1.08, (1.05, 1.12), and P<0.0001, respectively. The Kaplan-Meier curve found DIC patients with elevated RDW had a lower survival rate than patients with normal RDW (P<0.0001). A nonlinear relationship between RDW and mortality was found with the inflection point 19.2%. When RDW <19.2%, RDW was positively correlated with in-hospital all-cause mortality of DIC patients (HR (95% CI): 1.17 (1.11, 1.24), P<0.0001). An elevation in RDW greater than 19.2% did not result in an additional increased risk of mortality (HR=0.97, 95% CI: 0.91-1.04, P=0.4617). CONCLUSION: RDW is an independent predictor of all-cause mortality in DIC patients. Furthermore, there is a nonlinear association between RDW and all-cause mortality of DIC patients.

The Association Between Serum Anion Gap and All-Cause Mortality in Disseminated Intravascular Coagulation Patients: A Retrospective Analysis.

PURPOSE: Studies regarding death risk factors of disseminated intravascular coagulation (DIC) patients were limited. Therefore, we conducted this study to investigate whether the serum anion gap (AG) was independently related to all-cause mortality of DIC patients. METHODS: We used the data from Medical Information Mart for Intensive Care III version 1.4 (MIMIC-III v1.4). A total of 2,654 DIC patients were included. The main outcomes were in-hospital, 30-day, and 90-day all-cause mortality. The AG was measured upon ICU admission and its association with mortality was evaluated using the Cox proportional-hazards regression model. The generalized additive model and the smooth curve fitting were introduced to examine the non-linear association. RESULTS: After adjusting for potential covariates, the in-hospital, 30-day, and 90-day all-cause mortality were positively correlated with AG. The hazard ratio (HR), confidence intervals (CI), and P were 1.05 (1.04-1.07) <0.0001, 1.06 (1.04-1.07) <0.0001, and 1.05 (1.03-1.07) <0.0001, respectively. We did not find an obvious non-linear relationship between AG and in-hospital, 30-day, and 90-day mortality, which indicated that the association between AG and all-cause mortality of DIC patients was nearly linear. CONCLUSION: Serum AG is positively related with all-cause mortality in DIC patients.

Case Report: Application of Thoracoscopic Clamp Radiofrequency Ablation on Atrial Tachycardia Originating From Right Atrial Appendage After Catheter Ablation Failure.

Atrial tachycardia originating from the right atrial appendage has a higher probability of failure of catheter ablation. Here we report a case of a 13-year-old boy with incessant tachycardia, complicated by heart enlargement, and heart failure. Electrophysiological examination showed that atrial tachycardia (AT) originated from the apex of the right atrial appendage, and endocardial catheter ablation was ineffective. After thoracoscopic approach, the right atrial appendage was successfully ablated with bipolar radiofrequency ablation forceps, atrial tachycardia was terminated and sinus rhythm was restored. Within 3 months since the patient was discharged from the hospital, no arrhythmia occurred and the heart structure returned to normal. Thus, thoracoscopic clamp radiofrequency ablation may be a reasonable choice for young patients with atrial tachycardia originated from the right atrial appendage when transendocardial ablation is not effective.

Association between red blood cell distribution width and in-hospital mortality in acute myocardial infarction.

ABSTRACT: Previous studies have shown an independent association between increased red cell distribution width (RDW) and mortality after acute myocardial infarction (AMI). However, evidence regarding the predictive significance of repeated measures of RDW in patients with AMI remains scarce. We aimed to investigate the association between the dynamic profile of RDW and in-hospital mortality in patients with AMI.This was a cross-sectional study. We extracted clinical data from the Medical Information Mart for Intensive Care IIIV1.4 database. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was in-hospital mortality. Cox proportional hazards models were used to evaluate the prognostic values of basic RDW, and the Kaplan-Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. The repeated-measures data were compared using a generalized additive mixed model.In total, 3101eligible patients were included. In multivariate analysis, adjusted for age, sex, and ethnicity, RDW was a significant risk predictor of in-hospital mortality. Furthermore, after adjusting for more confounding factors, RDW remained a significant predictor of in-hospital mortality (tertile 3 vs tertile 1: hazard ratio 2.3; 95% confidence interval 1.39-4.01; P for trend <.05). The Kaplan-Meier curve for tertiles of RDW indicated that survival rates were highest when RDW was ≤13.2% and lowest when RDW was ≥14.2% after adjustment for age, sex, and ethnicity. During the intensive care unit stay, the RDW of nonsurvivors progressively increased until death occurred.Our findings showed that a higher RDW was associated with an increased risk of in-hospital mortality in patients with AMI.

The Relationship Between the Serum Anion Gap and All-Cause Mortality in Acute Pancreatitis: An Analysis of the MIMIC-III Database.

PURPOSE: We aimed to investigate the relationship between the serum anion gap (AG) and all-cause mortality in patients with acute pancreatitis (AP) in intensive care units (ICUs). PATIENTS AND METHODS: In this retrospective cohort analysis, data of patients with AP were extracted from the Medical Information Mart for Intensive Care database (version III). We collected the maximum serum AG value within the first 24 hours of ICU admission. The main outcome was 90-day all-cause mortality. A multivariate Cox proportional hazard regression model was used to examine the association between the serum AG and mortality. The restricted cubic spline curve was used to confirm a non-linear relationship between serum AG values and mortality. RESULTS: Of the 279 patients included in the study, 87 (31.18%) died. The serum AG value was positively associated with 90-day all-cause mortality (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.02-1.14), after adjusting for age, sex, alcohol consumption, congestive heart failure, diabetes mellitus, hypertension, eGFR, albumin, and the SOFA score. There was a non-linear relationship between serum AG values and mortality after adjusting for potential confounders. We used a two-piecewise regression model to obtain a threshold inflection point value of 13.8 mmol/L. The HR and the 95% CI on the left inflection point were 0. 82 (0.61-1.09; p = 0.1719), and on the right inflection point were 1.15 (1.08-1.23; p < 0.0001). CONCLUSION: The relationship between all-cause mortality in patients with acute pancreatitis and serum AG values was non-linear. All-cause mortality and serum AG values were positively correlated when the serum AG value was >13.8 mmol/L.