Prediction of futile recanalisation after endovascular treatment in acute ischaemic stroke: development and validation of a hybrid machine learning model.

BACKGROUND: Identification of futile recanalisation following endovascular therapy (EVT) in patients with acute ischaemic stroke is both crucial and challenging. Here, we present a novel risk stratification system based on hybrid machine learning method for predicting futile recanalisation. METHODS: Hybrid machine learning models were developed to address six clinical scenarios within the EVT and perioperative management workflow. These models were trained on a prospective database using hybrid feature selection technique to predict futile recanalisation following EVT. The optimal model was validated and compared with existing models and scoring systems in a multicentre prospective cohort to develop a hybrid machine learning-based risk stratification system for futile recanalisation prediction. RESULTS: Using a hybrid feature selection approach, we trained and tested multiple classifiers on two independent patient cohorts (n=1122) to develop a hybrid machine learning-based prediction model. The model demonstrated superior discriminative ability compared with other models and scoring systems (area under the curve=0.80, 95% CI 0.73 to 0.87) and was transformed into a web application (RESCUE-FR Index) that provides a risk stratification system for individual prediction (accessible online at fr-index.biomind.cn/RESCUE-FR/). CONCLUSIONS: The proposed hybrid machine learning approach could be used as an individualised risk prediction model to facilitate adherence to clinical practice guidelines and shared decision-making for optimal candidate selection and prognosis assessment in patients undergoing EVT.

[Progress in Diagnosis and Treatment of Lung Cancer Associated with Cystic Airspaces].

Lung cancer associated with cystic airspaces (LCCA) is a type of lung cancer characterized by the presence of cystic cavities in or around the tumor on imaging. Due to its high potential for misdiagnosis or underdiagnosis, the prognosis of LCCA patients is poor, necessitating further large-scale clinical studies to elucidate its characteristics. Currently, four imaging classification systems exist, and there has been a progressive increase in attention towards LCCA, particularly with regard to the study of its imaging features. The results indicate a correlation between the pathological features and imaging findings of LCCA; however, research on driver gene mutations and molecular subtyping associated with lung cancer remains insufficient. Due to the challenges associated with early diagnosis and the poorer prognosis compared to general types of lung cancer, this paper comprehensively reviews the research progress on LCCA, including its definition, etiology, pathogenesis, imaging features, histological and pathological features, treatment, and prognosis, aiming to serve as a valuable resource for clinical decision-making.
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Quality assessment of the guidelines for the management of malignant pleural effusions and ascites.

OBJECTIVES: To fully assess the quality of the guidelines for the management of malignant pleural effusions (MPE) and ascites and reveal the heterogeneity of recommendations and possible reasons among guidelines. METHODS: A systematic search was performed in the database to obtain guidelines for the management of MPE and ascites. The AGREE IIGtool was used to assess the quality of these guidelines. The Measurement Scale of Rate of Agreement (MSRA) was introduced to assess the scientific agreement of formulated recommendations for the management of MPE and ascites among guidelines, and evidence supporting these recommendations was extracted and analyzed. RESULTS: Nine guidelines were identified. Only 4 guidelines scored more than 60% and are worth recommending. Recommendations were also heterogeneous among guidelines for the management of MPE, and the main reasons were the different emphases of the recommendations for the treatment of MPE, the contradictions in recommendations, and the unreasonably cited evidence for MPE. CONCLUSIONS: The quality of the management guidelines for patients with MPE and malignant ascites was highly variable. Specific improvement of the factors leading to the heterogeneity of recommendations will be a reasonable and effective way for developers to upgrade the recommendations in the guidelines for MPE.

Application of a glycaemic control optimization programme in patients with stress hyperglycaemia.

BACKGROUND: Stress-induced hyperglycaemia (SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy (CIIT) tends to induce hypoglycaemia and glucose variability. AIMS: This study investigated the clinical effects of a blood glycaemic control optimization programme (BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. DESIGN: This study is a randomized, controlled, prospective clinical observation. METHODS: Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. RESULTS: Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly (p = 0·000). The high glycaemic index (p = 0·000), incidence of hypoglycaemia (p = 0·011), and other adverse events as well as the incidence of abdominal infection (p = 0·026), incision infection (p = 0·044), and lung infection (p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. CONCLUSION: BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. RELEVANCE TO CLINICAL PRACTICE: This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery.

Prevalence of stress hyperglycemia among hepatopancreatobiliary postoperative patients.

OBJECTIVE: The aim of this study was to determine the prevalence of stress hyperglycemia and its association with mortality among hepatopancreatobiliary postoperative patients admitted. METHODS: Retrospectively analysis was made on 706 cases of the hepatopancreatobiliary postoperative patients from three Grade A hospitals in Hunan province from November 2011 to June 2012, including the incidence and risk factors of patients with stress hyperglycemia. RESULTS: The incidence of stress hyperglycemia of pancreatic postoperative patients was 34.28%. The incidence of pancreatic surgery, simple cholecystectomy and biliary tract and liver surgery in patients with stress hyperglycemia was 63.08%, 20.83% and 32.21%, respectively. Stress hyperglycemia was associated with the first postoperative glucose values, duration of surgery, whether the anemia and the presence or absence of hypoproteinemia (P<0.05), but was no related with sex, weight and previous history (P>0.05). CONCLUSION: Stress hyperglycemia is common among emergency admissions and these patients have significantly higher mortality rate compared to other patients (P=0.001). Postoperative first blood glucose levels, duration of surgery, whether the anemia and the presence or absence of hypoproteinemia were stress hyperglycemia risk factors for patients.