Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation

AIM To assess the accuracy of serum procalcitionin(PCT)as a diagnostic marker in verifying upper and lower gastrointestinal perforation(GIP).METHODS This retrospective study included 46 patients from the surgical intensive care unit(ICU)of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016.Demographic and clinical patient data were recorded on admission to ICU.Patients were divided into upper(n=19)and lower(n=27)GIP groups according to the perforation site(above or below Treitz ligament).PCT and WBC count was obtained before laparotomy and then compared between groups.Meanwhile,the diagnostic accuracy of PCT was analyzed.RESULTS Patients with lower GIP exhibited significantly higher APACHE II score,SOFA score and serum PCT level than patients with upper GIP(P=0.017,0.004,and0.001,respectively).There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score(r=0.715 and r=0.611,respectively),while there was a significant negative correlation between serum PCT level and prognosis(r=-0.414).WBC count was not significantly different between the two groups,and WBC count showed no significant correlation with serum PCT level,APACHE II score,SOFA score or prognosis.The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778.Patients with a serum PCT level above 17.94 ng/d L had a high likelihood of lower GIP,with a sensitivity of 100%and a specificity of 42.1%.CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.

Clinical characteristics of patients with COVID-19 presenting with gastrointestinal symptoms as initial symptoms: Retrospective case series

BACKGROUND A large number of pneumonia cases due to coronavirus disease 2019(COVID-19)have been first reported in China.Meanwhile,the virus is sweeping all around the world and has infected millions of people.Fever and pulmonary symptoms have been noticed as major and early signs of infection,whereas gastrointestinal symptoms were also observed in a significant portion of patients.The clinical investigation of disease onset was underestimated,especially due to the neglection of cases presenting with gastrointestinal symptoms.AIM To characterize the clinical features of coronavirus-infected patients with gastrointestinal symptoms as initial symptoms.METHODS This is a retrospective,single-center case series of the general consecutive hospitalized patients with confirmed COVID-19 at Wuhan Union Hospital from February 2,2020 to February 13,2020.According to their initial symptoms,these patients were classified into two groups.Patients in group one presented with pulmonary symptoms(PS)as initial symptoms,and group two presented with gastrointestinal symptoms(GS).Epidemiological,demographic,clinical,laboratory,and treatment data were collected for analysis.RESULTS Among the 50 patients recruited,no patient has been admitted to intensive care units,and no patient died during the study.The duration of hospitalization was longer in the GS group than in the PS group(12.13±2.44 vs 10.00±2.13,P<0.01).All of the 50 patients exhibited decreased lymphocytes.However,lymphocytes in the GS group were significantly lower compared to those in the PS group(0.94±0.06 vs 1.04±0.15,P<0.01).Procalcitonin and hs-CRP were both significantly higher in the GS group than in the PS group.Accordingly,the duration of viral shedding was significantly longer in the GS group compared to the PS group(10.22±1.93 vs 8.15±1.87,P<0.01).CONCLUSION COVID-19 patients presenting with gastrointestinal symptoms as initial symptoms need more days of viral shedding and hospitalization than the patients presenting with pulmonary symptoms.

Novel fast FFR derived from coronary CT angiography based on static first-pass algorithm:a comparison study

BACKGROUND Fractional flow reserve(FFR)is the invasive gold standard for evaluating coronary arterial stenosis.However,there have been a few non-invasive methods such as computational fluid dynamics FFR(CFD-FFR)with coronary CT angiography(CCTA)images that can perform FFR assessment.This study aims to develop a new method based on the principle of static first-pass of CT perfusion imaging technique(SF-FFR)and evaluate the efficacy in direct comparisons between CFD-FFR and the invasive FFR.METHODS A total of 91 patients(105 coronary artery vessels)who were admitted from January 2015 to March 2019 were enrolled in this study,retrospectively.All patients underwent CCTA and invasive FFR.64 patients(75 coronary artery vessels)were successfully analyzed.The correlation and diagnostic performance of SF-FFR method on per-vessel basis were analyzed,using invasive FFR as the gold standard.As a comparison,we also evaluated the correlation and diagnostic performance of CFD-FFR.RESULTS The SF-FFR showed a good Pearson correlation(r=0.70,P<0.001)and intra-class correlation(r=0.67,P<0.001)with the gold standard.The Bland-Altman analysis showed that the average difference between the SF-FFR and invasive FFR was 0.03(0.11–0.16);between CFD-FFR and invasive FFR was 0.04(-0.10–0.19).Diagnostic accuracy and area under the ROC curve on a per-vessel level were 0.89,0.94 for SF-FFR,and 0.87,0.89 for CFD-FFR,respectively.The SF-FFR calculation time was about 2.5 s per case while CFD calculation was about 2 min on an Nvidia Tesla V100 graphic card.CONCLUSIONS The SF-FFR method is feasible and shows high correlation compared to the gold standard.This method could simplify the calculation procedure and save time compared to the CFD method.

A multi-center cross-sectional study on blood purification among adult patients in intensive care unit in China: a study protocol

Background: Blood purification (BP) is one of the most important rescue measures for patients with critical illness in the intensive care unit (ICU), espedally for those with acute kidney injury. The purpose of this nationwide survey was to reveal the real world of current BP practice in different ICUs all over China. This study was designed to be a multi-center cross-sectional study. Methods: All adult patients (over 18 years of age), who were admitted to ICU and required BP in 35 sub-centers across China were included during 30-day survey period in 2018. Demographic characteristics and clinical data were recorded including the timing of treatment initiation, indications, modality, relative contraindication, establishment of vascular access, selection of filter/membrane, settings, anti-coagulation, executive department, complication, intake, and output. Discussion: This nationwide survey may contribute to reveal the real world of current BP practice in different ICUs all over China.

Efficient color routing with a dispersion-controlled waveguide array

Splitting white light into its constituent spectral components has been of interest ever since Newton first discovered the phenomenon of color separation.Many devices have since been conceived to achieve efficient wavelength separation,yet a large number of applications,e.g.,in display technology,still use simple color absorption or rejection filters that absorb or reflect unwanted wavelengths,thus wasting luminous energy.Here,we demonstrate a novel microsized device concept that enables efficient color routing.The device operation is based on differential material dispersion in a waveguide array,which causes different wavelength signals to couple selectively into appropriate waveguides.A theoretical power delivery of greater than 50%for a tricolor wavelength router is obtained,compared to 33%expected from geometry alone.The principle of operation is demonstrated experimentally for a dual-color light field,where we achieve a higher than 70%routing efficiency(compared to 50%from geometry),thus highlighting the feasibility of this novel and promising approach.

Occurrence of Brachyoxylon Hollick et Jeffrey from the Lower Cretaceous of Zhejiang Province, southeastern China

The Lower Cretaceous Guantou Formation is known as an important horizon for the Cretaceous petrified woods in southern China. Though abundant Cretaceous wood remains have been found in this formation, only one species has been recognized. A new coniferous wood, Brachyoxylon zhejiangense sp. nov. is described from the Lower Cretaceous Guantou Formation in Xinchang of Zhejiang Province, southeastern China. Anatomically, the new species is characterized by obscure annual rings, mixed type of radial pitting, araucarioid cross-field pits and uniseriate xylem rays. The finding of Brachyoxylon zhejiangense sp. nov. represents the first well-defined record of Brachyoxylon in southeastern China, and enriches the diversity of the Early Cretaceous petrified wood in southern China. Additionally, the new finding sheds new light on further understanding the floral composition, especially the forest vegetation type of the southern phytoprovince in the late Early Cretaceous. Diverse compressed leaf fossils of Cheirolepidiaceae have been described from the Guantou Formation in the fossil locality of the present petrified wood. The co-occurrence of Brachyoxylon zhejiangense sp. nov. and those cheirolepidiaceous leaf fossils provide additional evidences to support that Brachyoxylon may be systematically related to the Cheirolepidiaceae.