Establishment and Validation of an Early Predictive Model for Severe Acute Pancreatitis.

Objective: The purpose of this study is to establishment and validation of an early predictive model for severe acute pancreatitis (SAP). Methods: From January 2015 to August 2022, 2986 AP patients admitted to Changsha Central Hospital were enrolled in this study. They were randomly divided into a modeling group (n = 2112) and a validation group (n = 874). In the modeling group, identify risk factors through logistic regression models and draw column charts. Use internal validation method to verify the accuracy of column chart prediction. Apply calibration curves to evaluate the consistency between nomograms and ideal observations. Draw a DCA curve to evaluate the net benefits of the prediction model. Results: Nine variables including respiratory rate, heart rate, WBC, PDW, PT, SCR, AMY, CK, and TG are the risk factors for SAP. The column chart risk prediction model which was constructed based on these 9 independent factors has high prediction accuracy (modeling group AUC = 0.788, validation group AUC = 7.789). The calibration curve analysis shows that the prediction probabilities of the modeling and validation groups are consistent with the observation probabilities. By drawing a DCA curve, it shows that the model has a wide threshold range (0.01-0.88). Conclusion: The study developed an intuitive nomogram containing readily available laboratory parameters to predict the incidence rate of SAP.

Early predicting 30-day mortality in sepsis in MIMIC-III by an artificial neural networks model.

OBJECTIVE: Early identifying sepsis patients who had higher risk of poor prognosis was extremely important. The aim of this study was to develop an artificial neural networks (ANN) model for early predicting clinical outcomes in sepsis. METHODS: This study was a retrospective design. Sepsis patients from the Medical Information Mart for Intensive Care-III (MIMIC-III) database were enrolled. A predictive model for predicting 30-day morality in sepsis was performed based on the ANN approach. RESULTS: A total of 2874 patients with sepsis were included and 30-day mortality was 29.8%. The study population was categorized into the training set (n = 1698) and validation set (n = 1176) based on the ratio of 6:4. 11 variables which showed significant differences between survivor group and nonsurvivor group in training set were selected for constructing the ANN model. In training set, the predictive performance based on the area under the receiver-operating characteristic curve (AUC) were 0.873 for ANN model, 0.720 for logistic regression, 0.629 for APACHEII score and 0.619 for SOFA score. In validation set, the AUCs of ANN, logistic regression, APAHCEII score, and SOFA score were 0.811, 0.752, 0.607, and 0.628, respectively. CONCLUSION: An ANN model for predicting 30-day mortality in sepsis was performed. Our predictive model can be beneficial for early detection of patients with higher risk of poor prognosis.

Uric acid and blood pressure in NHANES dated from 2009 to 2018: A cross-sectional research.

BACKGROUND AND AIM: This study aimed to explore the association between uric acid (UA) and blood pressure (BP), included systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). METHODS AND RESULTS: A cross-sectional study with 22,478 individuals aged from 12 to 80 years (11,443 males and 11,035 females) from the National Health and Nutrition Examination Survey (NHANES) was performed. Multiple linear regression analysis was applied to explore the relationship between UA and BP, Stratified analysis and interaction were performed based on gender, race, age, body mass index (BMI), and alcohol consumption. Significantly positively associations were presented in SBP(ß, 0.84 [95% CI, 0.67, 1.00]), DBP(ß, 0.23 [95% CI, 0.11, 0.36]), and MAP (ß, 0.43 [95% CI, 0.31, 0.55]). The associations were much more stronger between UA and SBP in females (ß, 1.04 [95% CI, 0.78, 1.30], p for interaction 0.0003), black group (ß, 1.17 [95% CI, 0.77, 1.56], p for interaction 0.0296), age (≥45) group (ß, 1.03 [95% CI, 0.68, 1.39], p for interaction <0.0001) and drinking group (ß, 0.98 [95% CI, 0.75, 1.21], p for interaction <0.0001). The significant interactions were found between UA and DBP in gender and alcohol consumption (all p for interaction <0.05). In terms of MAP, the significant interactions were found in race, age, and alcohol consumption (all p for interaction <0.05). CONCLUSIONS: A significantly positively association was found between UA and BP, including SBP, DBP, and MAP.

Red cell distribution width and in-hospital mortality in septic shock: A public database research.

OBJECTIVE: This study aimed to explore the relationship between red cell distribution width (RDW) and in-hospital mortality in septic shock based on a large-scale public database. METHODS: All patients with septic shock in MIMIC-IV were enrolled. Based on RDW values, the general characteristics of different groups were compared. Different models were constructed for exploring the association of RDW and in-hospital mortality. To assess the predictive value of RDW, receiver operator characteristic (ROC) curve analysis was applied. RESULTS: A total of 3006 patients with septic shock were included and in-hospital mortality was 32.27% (n = 970). The results of the fully adjusted model demonstrated that RDW was positively associated with in-hospital mortality in septic shock patients after adjusting all confounders (OR = 1.12, 95% CI:1.08-1.17, p < .001). A linear relationship between RDW and in-hospital mortality was found. For predicting in-hospital mortality, the area under the ROC curve (AUC) of RDW was .602 and the best threshold of RDW was 17.25%. CONCLUSION: RDW was associated with in-hospital mortality in septic shock. It could be a useful marker for predicting clinical outcomes in septic shock.

Different clinical characteristics between recurrent and non-recurrent acute pancreatitis: A retrospective cohort study from a tertiary hospital.

Background: Acute pancreatitis (AP) is a common digestive disorder with different clinical outcomes, some of which develop into recurrent acute pancreatitis (RAP). This study aimed to explore the differences between AP and RAP. Methods: All patients with AP admitted to Changsha Central Hospital between January 2015 and December 2020 were included. Characteristics between RAP and non-RAP groups were compared. Independent factors associated with RAP were identified by multivariate logistic regression analyses. Results: This was a retrospective study. A total of 1567 patients, including 262 patients in the RAP group and 1305 patients in the non-RAP group, were enrolled. Compared to the non-RAP group, results indicated that the RAP group was younger (P < 0.001), had a male predominance (P < 0.001), and had higher incidences of diabetes (P < 0.001) and hypertriglyceridemia (HTG) (P < 0.001). Lower incidences of cholelithiasis (P < 0.001) and acute liver injury (P < 0.001) were also noted in the RAP group. Scores of Ranson, BISAP, SOFA, and APACHE II were significantly higher in the non-RAP group (P < 0.001 for all). Three independent factors associated with RAP, including male gender (P = 0.006), diabetes (P < 0.001), and HTG (P < 0.001), were identified by multivariate logistic regression. Conclusion: Compared to the non-RAP, the incidence of cholelithiasis and acute liver injury was lower in RAP. Three independent factors associated with RAP, namely male, diabetes, and HTG, were identified.

Factors associated with in-hospital mortality in adult sepsis with Escherichia coli infection.

BACKGROUND: Escherichia coli (E. coli) is an important pathogen in sepsis. This study aimed to explore the factors which were associated with in-hospital mortality in adult sepsis with E. coli infection based on a public database. METHODS: All sepsis patients with E. coli infection in MIMIC-III were included in this study. Clinical characteristics between the survivor and non-survivor groups were analyzed. Factors associated with in-hospital mortality were identified by multivariate logistic regression. RESULTS: A total of 199 patients were eventually included and divided into two groups: a survivor group (n = 167) and a non-survivor group (n = 32). RDW and HCT were identified as the factors with clinical outcomes. The area under the ROC curve (AUC) were 0.633 and 0.579, respectively. When combined RDW and HCT for predicting in-hospital mortality, the AUC was 0.772, which was significantly superior to SOFA and APACHEII scores. CONCLUSION: RDW and HCT were identified as factors associated with in-hospital mortality in adult sepsis patients with E. coli infection. Our findings will be of help in early and effective evaluation of clinical outcomes in those patients.

A Case Report of Scapulothoracic Dissociation and Literature Review.

BACKGROUND: Scapulothoracic dissociation (STD) is a rare, life-threatening injury, usually resulting from high energy and leading to poor clinical outcomes and high incidence of disability. This case and a review of the literature aimed to highlight the early diagnosis and management of STD. CASE PRESENTATION: A 61-year-old man was injured in a motorcycle accident, when he took a sudden turn and fell from his motorcycle. He was admitted to the emergency department of Changsha Central Hospital. Based on the computed tomography (CT) and digital subtraction angiogram (DSA) findings, the patient was diagnosed as follows: right scapulothoracic dislocation syndrome, right subclavian artery rupture, right subclavian vein rupture, right clavicular fracture, right multiple rib fractures, and right lung contusion and laceration. An expanded polytetrafluoroethylene interposition graft was implemented in the right subclavian artery to re-establish continuity of the subclavian artery. Surgery was performed to repair thoracic deformity, and active rehabilitation therapy also was implemented after surgery. The patient was discharged from the hospital and recovered well with grade 4 muscle strength in his right arm. CONCLUSIONS: Physicians should be vigilant for STD in all patients with shoulder girdle injury. DSA could be recommended for patients with unstable hemodynamics. Early diagnostic image tests and individualized management should be implemented, according to the patient's condition.

Association between sleep duration on workdays and blood pressure in non-overweight/obese population in NHANES: a public database research.

This study aimed to explore the association between sleep duration on workdays and blood pressure (BP) including systolic blood pressure (SBP) and diastolic blood pressure (DBP) in non-overweight/obese population. A cross-sectional study composed of 2887 individuals from NHANES was conducted. Subjective sleep duration on workdays were evaluated by the questionnaire. Multiple linear regression analyses were done to explore the relationship between sleep duration and BP. Compared with sleep duration of 6-8 h, both sleep duration < 6 h and ≥ 8 h on workdays were significantly associated with increased SBP (ß, 3.58 [95% CI 1.60, 5.56] and 1.70 [95% CI 0.76, 2.64], respectively). However, the significant association was not founded in DBP. The stratified analyses showed that in females, sleep duration (< 6 h or ≥ 8 h) on workdays were associated with SBP (ß = 5.99 and 2.41, respectively, both P < 0.0005). In addition, the SBP levels were much higher among participants aged (≥ 60) with sleep duration < 6 h. The effect size was 7.23 (P = 0.0217). In the subgroup classified by race, a significantly positive association between sleep duration (< 6 h, ≥ 8 h) and SBP can be seen in the White population (ß = 6.64 (P = 0.0007) and 1.91 (P = 0.0215), respectively). In non-overweight/obese population, both short sleep duration (< 6 h) and long sleep duration (≥ 8 h) on workdays were correlated with higher level of SBP.

Nomogram for the Prediction of In-Hospital Incidence of Acute Respiratory Distress Syndrome in Patients with Acute Pancreatitis.

BACKGROUND: Acute respiratory distress syndrome (ARDS) associated with high mortality is the common complication in acute pancreatitis (AP). The aim of this study was to formulate and validate an individualized predictive nomogram for in-hospital incidence of ARDS in Patients with AP. METHODS: From January 2017 to December 2018, 779 individuals with AP were involved in this study. They were randomly distributed into primary cohort (n = 560) and validation cohort (n = 219). Based on the primary cohort, risk factors were identified by logistic regression model and a nomogram was performed. The nomogram was validated in the primary and validation cohort by the bootstrap validation method. The calibration curve was applied to evaluate the consistency between the nomogram and the ideal observation. RESULTS: There were 728 patients in the non-ARDS group and 51 in the ARDS group, with an incidence of about 6.55%. Five independent factors including white blood cell counts (WBC), prothrombin time (PT), albumin (ALB), serum creatinine (SCR) and triglyceride (TG) were associated with in-hospital incidence of ARDS in Patients with AP. A nomogram was constructed based on the five independent factors with primary cohort of AUC = 0.821 and validation cohort of AUC = 0.823. Calibration curve analysis indicated that the predicted probability was in accordance with the observed probability in both primary and validation cohorts. CONCLUSIONS: The study developed an intuitive nomogram with easily available laboratory parameters for the prediction of in-hospital incidence of ARDS in patients with AP. The incidence of ARDS for an individual patient can be fast and conveniently evaluated by our nomogram.

Air pollution and hospital admissions for critical illness in emergency department: a tertiary-center research in Changsha, China, 2016-2020.

We aimed to comprehensively investigate the associations of air pollutants with hospital admissions for critical illness in ED. Patients with critical illness including level 1 and level 2 of the Emergency Severity Index admitted in ED of Changsha Central Hospital from January 2016 to December 2020 were enrolled. Meteorological and air pollutants data source were collected from the National Meteorological Science Data Center. A Poisson generalized linear regression combined with a polynomial distributed lag model (PDLM) was utilized to explore the effect of air pollution on hospital admissions for critical illness in ED. Benchmarks as references (25th) were conducted for comparisons with high levels of pollutant concentrations (75th). At first, lagged effects of all different air pollutants were analyzed. Then, based on the most significant factor, analyses in subgroups were performed by gender (male and female), age (< 45, 45-65, and > 65), disorders (cardiovascular, neurological, respiratory), and seasons (spring, summer, autumn, and winter). A total of 47,290 patients with critical illness admitted in ED were included. The effects of air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) on critical illness ED visits were statistically significant. Strong collinearity between PM2.5 and PM10 (r = 0.862) was found. Both single-day lag and cumulative-day lag day models showed that PM2.5 had the strongest effects (lag 0, RR = 1.025, 95% CI 1.008-1.043, and lag 0-14, RR = 1.067, 95% CI 1.017-1.120, respectively). In both PM2.5 and PM10, the risks of critical illness in male, > 65 ages, respiratory diseases, and winter increased the most significant. Air pollutants, especially PM2.5 and PM10 exposure, could increase the risk of critical illness admission.

Risk Factors of Recurrence of Acute Pancreatitis: A Retrospective Research.

BACKGROUND: Acute pancreatitis (AP) was one of the most common disorders of acute hospital admission with significant morbidity and mortality. Some of the patients experienced recurrent attacks of AP, leading to recurrent acute pancreatitis (RAP) and poor clinical outcomes. The association of clinical and laboratory variables with recurrence of AP were analyzed to evaluate the risk of RAP. METHODS: All patients with AP admitted in the hospital between January 2017 and December 2019 were included in this study. Clinical and laboratory variables were analyzed and risk factors were identified by multivariate logistic regression. The receiver operating characteristic (ROC) analysis for predicting recurrence of AP was performed. RESULTS: A total of 834 AP patients, including 671 in the non-RAP group and 167 in the RAP group, were enrolled in the study. There were significant differences in age, sex, body mass index (BMI), history of biliary surgery, cholelithiasis, diabetes, triglyceride (TG), high-density lipoprotein, and cholesterol between the non-RAP group and the RAP group. Two independent variables were identified as risk factors for recurrence of AP: TG (P = .007, odds ratio [OR] = 1.101, 95% CI, 1.025-1.183), and BMI (P = .032, OR = 1.094, 95% CI, 1.009-1.086). The area under the curve of ROC analysis of TG and BMI were 0.702 (95% CI, 0.655-0.749) and 0.593 (95% CI, 0.538-0.647). The best threshold for TG and BMI to anticipate recurrence of AP were 5.9 (sensitivity0.763, specificity 0.595) and 28.24 (sensitivity 0.302, specificity 0.844). CONCLUSION: TG and BMI were identified as independent predictors for recurrence of AP. A TG level of 5.9 mmol/L could be a clinical guide for the target level of lowering TG therapy in AP patients with hypertriglyceridemia.

Factors Associated with Emergency Department Length of Stay in Critically Ill Patients: A Single-Center Retrospective Study.

BACKGROUND Length of stay (LOS) in the emergency department (ED) should be measured and evaluated comprehensively as an important indicator of hospital emergency service. In this study, we aimed to analyze clinical characteristics of critically ill patients admitted to the ED and identify the factors associated with LOS. MATERIAL AND METHODS All patients with level 1 and level 2 of the Emergency Severity Index who were admitted to the ED from January 2018 to December 2019 were included in this retrospective study. The patients were divided into 2 groups: LOS ≥4 h and LOS <4 h. Variables were comprehensively analyzed and compared between the 2 groups. RESULTS A total of 19 616 patients, including 7269 patients in the LOS ≥4 h group and 12 347 patients in the LOS <4 group, were included. Advanced age, admission in winter and during the night shift, and diseases excluding nervous system diseases, cardiovascular diseases, and trauma were associated with higher risk of LOS. Nervous system diseases, cardiovascular diseases, trauma, and procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis were associated with lower risk of LOS. CONCLUSIONS Prolonged LOS in the ED was associated with increased age and admission in winter and during the night shift, while shortened LOS was associated with nervous system diseases, cardiovascular diseases, and trauma, as well as with procedures including tracheal intubation, surgery, percutaneous coronary intervention, and thrombolysis. Our findings can serve as a guide for ED physicians to individually evaluate patient condition and allocate medical resources more effectively.

Clinical Characteristics of Aortic Aneurysm in MIMIC-III.

BACKGROUND: Aortic aneurysm (AA) is an aortic disorder prone to sudden, life-threatening aortic dissection or rupture, with poor clinical outcomes. In this study, we aimed to analyze the clinical characteristics of AA in MIMIC-III to explore implications for management. METHODS: All patients with AA, including abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA), in the MIMIC-III database were included. Clinical and laboratory variables were analyzed and compared in AAA and TAA. RESULTS: A total of 345 patients, including 183 patients with AAA and 162 patients with TAA, were enrolled in this study. The in-hospital mortality in AAA and TAA groups was 6.01% and 3.7%, respectively. In the nonsurvivor groups in both AAA and TAA, patients were older, and the incidence of surgery was lower. In the nonsurvivor group of AAA, the levels of alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatinine, lactate dehydrogenase (LDH), creatine kinase, anion gap, and lactate were significantly higher in the nonsurvivor group, whereas the level of albumin was lower. In the nonsurvivor group of TAA, the level of LDH significantly increased and the level of albumin decreased. In the nonsurgery group, in-hospital mortality was higher, and patients were older, with higher levels of glucose, total bilirubin, urea nitrogen, and creatinine and longer length of stay in ICU and hospital. CONCLUSION: Age, surgery, albumin, and LDH showed significant differences between survivor and nonsurvivor groups in both AAA and TAA. In the nonsurgery group, the mean age was older and disease severity was worse, with poorer clinical outcomes. Older AA patients without surgery and with lower levels of albumin and higher levels of LDH had higher risk of in-hospital mortality.

An Artificial Neural Networks Model for Early Predicting In-Hospital Mortality in Acute Pancreatitis in MIMIC-III.

BACKGROUND: Early and accurate evaluation of severity and prognosis in acute pancreatitis (AP), especially at the time of admission is very significant. This study was aimed to develop an artificial neural networks (ANN) model for early prediction of in-hospital mortality in AP. METHODS: Patients with AP were identified from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. Clinical and laboratory data were utilized to perform a predictive model by back propagation ANN approach. RESULTS: A total of 337 patients with AP were analyzed in the study, and the in-hospital mortality rate was 11.2%. A total of 12 variables that differed between patients in survivor group and nonsurvivor group were applied to construct ANN model. Three independent variables were identified as risk factors associated with in-hospital mortality by multivariate logistic regression analysis. The predictive performance based on the area under the receiver operating characteristic curve (AUC) was 0.769 for ANN model, 0.607 for logistic regression, 0.652 for Ranson score, and 0.401 for SOFA score. CONCLUSION: An ANN predictive model for in-hospital mortality in patients with AP in MIMIC-III database was first performed. The patients with high risk of fatal outcome can be screened out easily in the early stage of AP by our model.

Association of clinical and laboratory variables with in-hospital incidence of deep vein thrombosis in patients after acute ischemic stroke: A retrospective study.

ABSTRACT: Deep vein thrombosis (DVT) is a serious complication in patients with acute ischemic stroke (AIS). Early prediction of DVT could enable physicians to perform a proper prevention strategy. We analyzed the association of clinical and laboratory variables with DVT to evaluate the risk of DVT in patients after AIS.AIS patients admitted to the Changsha Central Hospital between January 2017 and December 2019 with length of stay in hospital ≥7 days were included. Clinical and laboratory variables for DVT at baseline were collected, and the diagnosis of DVT was confirmed by ultrasonography. Independent factors were developed by Multivariate logistic regression analysis.A total of 101 patients were included in the study. The in-hospital incidence of DVT after AIS was 19.8%(20/101). The average level of D-dimer when DVT detected was significant increased around 4-fold than that on admission (P < .001). Pulmonary infection (odds ratio [OR] = 5.4, 95%CI:1.10-26.65, P = .037)) and increased muscle tone (OR = 0.11, 95%CI:0.02-0.58, P = .010) as independent relevant factors for DVT were confirmed.Pulmonary infection as a risk factor and increased muscle tone as a protective factor for DVT were identified in patients after AIS. The level of D-dimer which increased around 4-fold compared to the initial level could be an indicator for DVT occurrence.

Association Between Bedtime at Night and Systolic Blood Pressure in Adults in NHANES.

Objectives: This study aimed to explore the association between bedtime at night and systolic blood pressure (SBP) in adults. Methods: We conducted a cross-sectional study composed of 7,642 individuals from the National Health and Nutrition Examination Survey (NHANES). Bedtime was defined as the response to the question: "What time do you usually fall asleep on weekdays or workdays?" SBP was taken using the average of all measured values. Multiple linear regression analyses were done to explore the relationship between bedtime and SBP. Results: The bedtime was changed from categorical variable to continuous variable for data analysis, and a significantly negative association was identified between bedtime and SBP (ß, -0.23 [95% CI, -0.43, -0.02]). With the delay of bedtime, the SBP showed a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. The stratified analyses showed that in the female group, with the delay of bedtime, the range of SBP was decreased more obviously at 0:00. In the 18-45 year group, bedtime had little effect on SBP. Among ≥45 years old group, this trend was still the same. In the black group, an obvious downward trend was found at 22:00. Conclusion: With the delay of bedtime, the SBP had shown a gradual decrease trend, and it was dropped to the lowest at 0:00. After 0:00, the SBP was gradually increased with the delay of sleep time. Bedtime and SBP showed a U-shaped relationship.

Association of Uric Acid With Blood Pressure in Hypertension Between Treatment Group and Non-treatment Group.

Objective: This study aimed to explore the association between uric acid (UA) and blood pressure (BP) in hypertension treatment and non-treatment groups. Methods: A cross-sectional study with 6,985 individuals from the National Health and Nutrition Examination Survey (NHANES) was performed. Multiple linear regression analysis was performed to explore the relationship of UA and BP in hypertension between the treatment group (n = 5,983) and the non-treatment group (n = 1,002). Results: A significantly negative association was discovered in SBP (ß, -0.36 [95% CI, -0.71, -0.01]) and DBP (ß, -0.47 [95% CI, -0.69, -0.26]) in the hypertension treatment group. In the hypertension non-treatment group, the associations between UA and BP including SBP, DBP were both an inverted U-shape. The inflection point of SBP and DBP was 7 and 7.5 mg/dl, respectively. For SBP, the association was positively significant (ß, 3.11 [95% CI, 1.67, 4.56]) before the inflection point of 7 mg/dl. However, after the inflection point of 7 mg/dl, the association was negative (ß, -5.44 [95% CI, -8.6, -2.28]). For DBP, the inflection point was 7.5 mg/dl, and the effect size was positive (ß, 1.19 [95% CI, 0.37, 2.01]) before the inflection point. However, after it, the effect size was negative (ß, -3.24 [95% CI, -5.72, -0.76]). Conclusion: The association between UA and BP was negative in the hypertension treatment group. In the hypertension non-treatment group, the associations between UA and BP including SBP and DBP were both an inverted U-shape.

Mechanical thrombectomy for a 12-year-old boy with acute ischemic stroke: A case report.

RATIONALE: Acute ischemic stroke (AIS) is one of the most severe diseases that endanger human health. It is very common among middle-aged and elderly people, but it is rare in children. The treatment varies among children and adults, since the cause for AIS in children differs from that in adults. In adults with AIS, endovascular therapy has been recommended, but guidelines for endovascular therapy in children with AIS have not been established yet. In China, few relevant evidence is present so far in clinical research of mechanical thrombectomy in the treatment for children with AIS. PATIENT CONCERNS: A 12-year-old boy without any special physical collision and trauma was admitted to emergency department of Changsha central hospital due to hemiplegia of left limbs for 3 hours. DIAGNOSES: He was diagnosed with AIS after magnetic resonance imaging (MRI) examination and magnetic resonance angiography (MRA) examination. Cerebral infarction in the right parietal, temporal, insular, and frontal lobes was revealed by the MRI test. The MRA test detected occlusions in right internal carotid artery, A1 segment of right anterior cerebral artery, right middle cerebral artery, and distal branch. INTERVENTIONS: Mechanic thrombectomy and antiplatelet aggregation therapy with clopidogrel helped the patient to recover, along with active rehabilitation training. OUTCOMES: A significant improvement in muscle strength of his left limbs was proved. He walked by himself and had 2 of Modified Rankin Scale (MRS). At 1-year follow-up visit, he recovered well except feeling a bit pain of left lower limb when walking, with finally MRS of 1. CONCLUSIONS: Mechanical thrombectomy can be performed safely for children with AIS, but needs a further research with large samples.

Lactate dehydrogenase as a predictor of in-hospital mortality in patients with acute aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To evaluate the significance of lactate dehydrogenase (LDH) as a predictor of in-hospital mortality in patients with acute aortic dissection(AAD). Methods     We conducted a retrospective analysis of the clinical data of 445 AAD patients who were admitted to the Second Xiangya Hospital of Central South University and the Changsha Central Hospital from January 2014 to December 2017 within a time interval of ≤14 days from the onset of symptoms to hospital admission, including 353 males and 92 females with the age of 45-61 years. LDH levels were measured on admission and the endpoint was the all-cause mortality during hospitalization. Results    During hospitalization, 86 patients died and 359 patients survived. Increased level of LDH was found in non-survivors compared with that in the survived [269.50 (220.57, 362.58) U/L vs. 238.00 (191.25, 289.15) U/L, P<0.001]. A nonlinear relationship between LDH levels and in-hospital mortality was observed. Using multivariable logistic analysis, we found that LDH was an independent predictor of in-hospital mortality in the patients with AAD [OR=1.002, 95% CI (1.001 to 1.014), P=0.006]. Furthermore, using receiver operating characteristic (ROC) analysis, we observed that the best threshold of LDH level was 280.70 U/L, and the area under the curve was 0.624 (95% CI 0.556 to 0.689). Conclusion    LDH level on admission is an independent predictor of in-hospital mortality in patients with AAD.