Effect of vaccination status on CORADS and computed tomography severity score in hospitalized COVID-19 patients:A retrospective study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic is continuing.The disease most commonly affects the lungs.Since the beginning of the pandemic thorax computed tomography(CT)has been an indispensable imaging method for diagnosis and follow-up.The disease is tried to be controlled with vaccines.Vaccination reduces the possibility of a severe course of the disease.AIM The aim of this study is to investigate whether the vaccination status of patients hospitalized due to COVID-19 has an effect on the CT severity score(CT-SS)and CORADS score obtained during hospitalization.METHODS The files of patients hospitalized between April 1,2021 and April 1,2022 due to COVID-19 were retrospectively reviewed.A total of 224 patients who were older than 18 years of age,whose vaccination status was accessible,whose severe acute respiratory syndrome coronavirus 2 polymerase chain reaction result was positive,and who had a Thorax CT scan during hospitalization were included in the study.RESULTS Among the patients included in the study,52.2%were female and the mean age was 61.85 years.The patients applied to the hospital on the average 7th day of their complaints.While 63 patients were unvaccinated(Group 1),20 were vaccinated with a single dose of CoronaVac(Group 2),24 with a single dose of BioNTech(Group 3),38 with 2 doses of CoronaVac(Group 4),40 with 2 doses of BioNTech(Group 5),and 39 with 3 doses of vaccine(2 doses of CoronaVac followed by a single dose of BioNTech,Group 6).CT-SS ranged from 5 to 23,with a mean of 12.17.RESULTS CT-SS mean of the groups were determined as 14.17,13.35,11.58,10.87,11.28,10.85,respectively.Accordingly,as a result of the comparisons between the groups,the CT-SS levels of the unvaccinated patients found to be significantly higher than the other groups.As the vaccination rates increased,the rate of typical COVID-19 findings on CT was found to be significantly lower.CONCLUSION Increased vaccination rates in COVID-19 patients reduce the probability of typical COVID-19 symptoms in the lungs.It also reduces the risk of severe disease and decreases CT Severity Scores.This may lead to a loss of importance of Thorax CT in the diagnosis of COVID-19 pneumonia as the end of the pandemic approaches.

Frequency of hepatic steatosis and its association with the pneumonia severity score on chest computed tomography in adult COVID-19 patients

BACKGROUND Recent studies of the coronavirus disease 2019(COVID-19)demonstrated that obesity is significantly associated with increased disease severity,clinical outcome,and mortality.The association between hepatic steatosis,which frequently accompanies obesity,and the pneumonia severity score(PSS)evaluated on computed tomography(CT),and the prevalence of steatosis in patients with COVID-19 remains to be elucidated.AIM To assess the frequency of hepatic steatosis in the chest CT of COVID-19 patients and its association with the PSS.METHODS The chest CT images of 485 patients who were admitted to the emergency department with suspected COVID-19 were retrospectively evaluated.The patients were divided into two groups as COVID-19-positive[CT-and reverse transcriptase-polymerase chain reaction(RT-PCR)-positive]and controls(CT-and RT-PCR-negative).The CT images of both groups were evaluated for PSS as the ratio of the volume of involved lung parenchyma to the total lung volume.Hepatic steatosis was defined as a liver attenuation value of≤40 Hounsfield units(HU).RESULTS Of the 485 patients,56.5%(n=274)were defined as the COVID-19-positive group and 43.5%(n=211)as the control group.The average age of the COVID-19-positive group was significantly higher than that of the control group(50.9±10.9 years vs 40.4±12.3 years,P<0.001).The frequency of hepatic steatosis in the positive group was significantly higher compared with the control group(40.9%vs 19.4%,P<0.001).The average hepatic attenuation values were significantly lower in the positive group compared with the control group(45.7±11.4 HU vs 53.9±15.9 HU,P<0.001).Logistic regression analysis showed that after adjusting for age,hypertension,diabetes mellitus,overweight,and obesity there was almost a 2.2 times greater odds of hepatic steatosis in the COVID-19-positive group than in the controls(odds ratio 2.187;95%confidence interval:1.336-3.580,P<0.001).CONCLUSION The prevalence of hepatic steatosis was significantly higher in COVID-19 patients compared with controls after adjustment for age and comorbidities.This finding can be easily assessed on chest CT images.

Delta shock index predicts injury severity,interventions,and outcomes in trauma patients:A 10-year retrospective observational study

BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ2 and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.

New injury severity score(NISS)outperforms injury severity score(ISS)in the evaluation of severe blunt trauma patients

Purpose:The injury severity score(ISS)and new injury severity score(NISS)have been widely used in trauma evaluation.However,which scoring system is better in trauma outcome prediction is still disputed.The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes,including mortality,intensive care unit(ICU)admission and ICU length of stay.Methods:The data were collected retrospectively from three hospitals in Zhejiang province,China.The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic(ROC)curves and Hosmer-Lemeshow statistics.Results:A total of 1825 blunt trauma patients were enrolled in our study.Finally,1243 patients were admitted to ICU,and 215 patients died before discharge.The ISS and NISS were equivalent in predicting mortality(area under ORC curve[AUC]:0.886 vs.0.887,p=0.9113).But for the patients with ISS>25,NISS showed better performance in predicting mortality.NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay.Conclusion:NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS.Considering the convenience of NISS in calculation,it is advantageous to promote NISS in China's primary hospitals.

Comparison of the new injury severity score and the injury severity score in multiple trauma patients

Objective： To assess whether these characteristics of less misclassification and greater area under receiver operator characteristic （ROC） curve of the new injury severity score （NISS） are better than the injury severity score （ISS） as applying it to our multiple trauma patients registered into the emergency intensive care unit （EICU）. Methods： This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively registered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and multivariate logistic progression model. Results： Among the 2 286 patients, 176 （7.7%） were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 1 10 patients. Mean EICU length of stay （LOS） was 7.8 days ± 2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the penetrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups （4.01% versus 4.49%）. However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate （21.04% versus 15.55% for IS S, t=-3.310, P〈0.001）, resulting in an overall misclassification rate of 23.57% for NISS versus 18.79% for ISS （t=3.290, P〈0.001）. In the whole sample, NISS presented equivalent discrimination （area under ROC curve： NISS=0.938 versus ISS=0.943）. The H-L statistics showed poorer calibration （48.64 versus 32.11, t=3.305, P〈0.001） in the penetrating injury group. Conclusions： NISS should not replace ISS because Lhey share similar accuracy and calibration in predicting multiple blunt trauma patients. NISS may be more sensitive but less specific than ISS in predicting mortality in certain penetrating injury patients.

Application of injury severity score to multiple injuries headed by spinal cord injury

Objective： To evaluate the application of injury severity score （ISS） to multiple injuries headed by spinal cord injury. Methods： The data of 55 cases （40 males and 15 females, aged 17-69 years, mean = 41 years） of multiple injuries headed by spinal cord injury treated in our hospital from January 2000 to December 2004 were reviewed and analyzed with ISS （Version of AIS-2005 ） to explore their relationship. Results ： The ISS values increased with the number of injured regions, so did the complications. The recovery rate was negatively related to ISS values. During the period of immunity observation, the patients with ISS 〉 25 could undergo planned operations safely. Conclusions： Treatment for multiple injuries headed by spinal cord injury closely depends on the general and local conditions of the patients. ISS may provide useful data for the choice of treatment methods.

Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

AIMTo investigate the prevalence and the risk of temporomandibular disorders (TMDs) in patients with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhoea, and mixed) compared to the general population.METHODSBetween January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls (HC) without IBS. At enrollment, we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 IBS-M) and 57 HC in the study. We found a higher risk of having TMD (OR = 3.41, 95%CI: 1.66-7.01) compared to the HC. The risk of having TMD was independent of IBS-subtype. Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was similar in different IBS subtypes. IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.

Extrapancreatic necrosis volume:A new tool in acute pancreatitis severity assessment?

BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigated so far.AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology,St Spiridon Hospital between January 1,2017 and December 31,2019 were analyzed retrospectively.Pancreatitis was classified according to the revised Atlanta classification(rAC)as mild,moderate,or severe.Severity was also evaluated by computed tomography and classified according to the computed tomography severity index(CTSI)and the modified CTSI(mCTSI).The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC(r=0.926,P<0.001 and r=0.950,P<0.001;r=0.784,P<0.001,respectively).The correlation of C-reactive protein with severity was positive but not as strong,and was not significant(r=0.133,P=0.154).The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume[area under the curve(AUC)=0.993;95%confidence interval(CI):0.981-1.005],with a 99.5%sensitivity and 99.0%specificity at a cutoff value of 167 mL,followed by the mCTSI 2007 score(AUC=0.972;95%CI:0.946-0.999),with a 98.0%sensitivity and 96.5%specificity,and the CTSI 1990 score(AUC=0.969;95%CI:0.941-0.998),with a 97.0%sensitivity and 95.0%specificity.CONCLUSION Radiological severity scores correlate strongly and positively with disease activity.Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.

High scored thyroid storm after stomach cancer perforation: A case report

BACKGROUND Thyroid storm is a life-threatening emergency.Reportedly,the prevalence of thyroid storm is 1%-2%among patients admitted to the hospital for thyrotoxicosis.Burch and Wartofsky(1993)introduced a scoring system using precise clinical criteria to identify thyroid storms.Only 17 cases of thyroid storm with a score>70 points have been reported.Although thyroid storms are uncommon,their clinical findings resemble those of sepsis.CASE SUMMARY A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation;medications for hypertension,diabetes mellitus,and hyperthyroidism had been suspended 1 year prior to this visit.We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation,and the patient was referred to the surgical intensive care unit(ICU).On the 2nd d in the ICU,his body temperature(BT)increased to 41.3℃ at 19:00,with the thyroid storm score(90 points)peaking at 18:00(BT;41.2℃,pulse rate;138/min,irritable status).The patient was administered propylthiouracil,intravenous glucocorticoids,acetaminophen,and Lugol’s solution daily.Subsequently,we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT.His vital signs were stable on the 8th day in the ICU.CONCLUSION Thyroid storms are uncommon,with few reports in the literature;however,their clinical findings resemble those of sepsis and require further investigation.Since an untreated thyroid storm results in a high mortality rate,it should be investigated when managing sepsis.

The applied value of modified POSSUM score in evaluating lung cancer surgery’s risk

Objective: The aim of this study was to explore the modified physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system and the relationship between predicted data and actual data of complication and surgical mortality of lung cancer radical surgery made by such score system. Methods: Retrospective analysis on the 86 cases of the clinical materials of patients with primary lung cancer radical surgery for thoracic surgery of line lung cancer in the 81st Hospital of PLA from October 2010 to October 2011 and using the POSSUM scoring system to predict the cases of postoperative complication and death toll, then making a comparison with the actual cases. Results: The POSSUM scoring system predicting 29 cases of postoperative complications, but 32 cases of practical complications, the difference between them has no statistical significance (P﹥0.05), 8 cases of predicted postoperative deaths, 2 cases of practical deaths, by comparison, there was statistical significance (P﹤0.05). Conclusion: The modified POSSUM scoring system can be used to predict the postoperative complication of lung surgery patients, but sometimes overestimates the postoperative death cases.

Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a major and costly public health emergency.AIM To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.METHODS All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled.We collected data on demographics,daily visits,injury type,injury mechanism,injury severity score,and patient management for comparative analysis.RESULTS The total number of patients in the trauma center of our hospital decreased by 50.38%during the COVID-19 Lockdown in 2020 compared to the same period in 2019.The average number of trauma visits per day in 2019 was 47.94,compared to 23.79 in 2020.Comparing the patients’demographic data,loss of employment was the most predominate characteristic in 2020 compared to 2019,while there was no significant difference in gender,age,and marital status between both periods.During the lockdown period,the proportion of traffic accident-related injuries,injuries due to falls greater than 1.5 m,and mechanical injuries decreased significantly,whereas the proportion of injuries caused by falls less than 1.5 m,cuts,assault,bites,and suicidal tendencies and other injuries increased relatively.In addition,the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown.The hospitalization rate increased significantly,and there was no significant difference in emergency surgery and death rates.CONCLUSION The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital,which can be monitored regularly.Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries.Emergency surgery and mortality rates remain high,increased because of factors such as family injury and penetrating injury,and hospitalization rates have increased significantly.Therefore,our trauma center still needs to be fully staffed.Finally,from the perspective of the injury mechanism,indoor trauma is a major risk during a lockdown,and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Evaluation under Semi-Controlled Conditions of the Pathogenicity of Three Isolates of Phaeoisariopsis personata (Berk. & M.A Curt.)

Peanut (Arachis hypogaea L.) late leaf spot is an important disease caused by Phaeoisariopsis personata (Berk. Et M. A Curt.). This fungus is responsible for the most damaging leaf spots in peanut production. The present experiment was undertaken to evaluate the pathogenic variability of Phaeoisariopsis personata in Burkina Faso. To this end, detached leaves and healthy plants of three peanut varieties were inoculated. Isolates I3TF, I2TG and I1TK of the pathogen (105 conidia/ml), collected respectively in the western, central and eastern agroecological zones of country, were used. The inoculated leaves were kept in Petri dishes on moist blotting paper and stored in the laboratory during the experimental period. The inoculated plants were grown under glass in pots containing a mixture of sterilized sand and clay. The development of disease was monitored and severity was scored every 15 days using rating scale. The results obtained in the laboratory and in the greenhouse revealed that there is pathogenic variability in the isolates tested. Indeed, for each variety, the highest severity score was recorded in plants inoculated with isolate I3TF and the lowest severity score with isolate I1TG. In the laboratory the severity scores ranged from 6.76 to 8.80 in TS32-1, 6.18 to 8.29 in SH70P and 5.98 to 7.92 in PC79-79. In the greenhouse, the average severity scores ranged from 5.61 to 8.33 in TS32-1, from 5.19 to 8.00 in SH70P, from 4.90 to 7.50 in PC79-79. Thus, the variety TS32-1 was the most susceptible to all three isolates of the pathogen.

Effectiveness of an amino acid beverage formulation in diarrheapredominant irritable bowel syndrome:A pragmatic real-world study

BACKGROUND Amino-acid based medical foods have shown promise in alleviating symptoms of drug induced gastrointestinal side effects;particularly,diarrhea-predominant symptoms.Irritable bowel syndrome(IBS)is a gastrointestinal disorder that affects up to 9% of people globally,with diarrhea predominant IBS(IBS-D)being the most prevalent subtype.Further trials are needed to explore potential added benefits when integrated into standard care for IBS-D.AIM To assess the effectiveness of an amino acid-based medical food as an adjunct to standard of care for adults with IBS-D.METHODS This is a pragmatic,real world,open label,single arm study comparing a 2-week baseline assessment to a 2-week intervention period.One hundred adults,aged 18 to 65 years,with IBS-D,according to Rome IV criteria,were enrolled after completing a 2-week baseline assessment period and received a 2-week supply of an amino acid based medical food which was consumed at home twice daily on top of their standard of care.The primary outcome was an assessment of tolerability after 2-weeks of consumption,while secondary outcomes included changes in stool consistency(Bristol Stool Form Scale),severity of abdominal pain&discomfort,symptoms of urgency,Global Improvement Survey(GIS),and the IBS severity scoring system(IBS-SSS).RESULTS The test product was well-tolerated as each participant successfully completed the full 14-day trial,and there were no instances of dropouts or discontinuation of the study product reported.Forty percent of participants achieved a 50% or more reduction in the number of days with type 6-7 bowel movements(IBS-D stool consistency responders).Fifty-three percent of participants achieved a clinically meaningful reduction of 30% in mean weekly pain scores,and 55%experienced the same for mean weekly discomfort scores(IBS-D pain and discomfort responders).Participants experienced a mean-109.4(95% confidence interval:-130.1,-88.8)point reduction on the IBS-SSS and 52% experienced a minimally clinically important difference of>95 points.An IBS-SSS category shift from severe to moderate or mild occurred in 69% of participants.For functional symptoms,76% of participants reported symptom relief on the GIS.CONCLUSION The amino acid-based medical food was well-tolerated,when added to the standard of care,and demonstrated improvements in both overall IBS symptom severity and IBS-D symptoms within just 2 wk.

Lymphocyte-to-white blood cell ratio is associated with outcome in patients with hepatitis B virus-related acute-on-chronic liver failure

BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.

Electro-acupuncture at Conception and Governor vessels and transplantation of umbilical cord bloodderived mesenchymal stem cells for treating cerebral ischemia/reperfusion injury

Mesenchymal stem cell transplantation is a novel means of treating cerebral ischemia/reper- fusion, and can promote angiogenesis and neurological functional recovery. Acupuncture at Conception and Governor vessels also has positive effects as a treatment for cerebral ischemia/ reperfusion. Therefore, we hypothesized that electro-acupuncture at Conception and Governor vessels plus mesenchymal stem cell transplantation may have better therapeutic effects on the promotion of angiogenesis and recovery of neurological function than either treatment alone. In the present study, human umbilical cord blood-derived mesenchymal stem cells were isolated, cultured, identified and intracranially transplanted into the striatum and subcortex of rats at 24 hours following cerebral ischemia/reperfusion. Subsequently, rats were electro-acupunctured at Conception and Governor vessels at 24 hours after transplantation. Modified neurological severity scores and immunohistochemistry findings revealed that the combined interventions of electro-acupuncture and mesenchymal stem cell transplantation clearly improved neurological impairment and up-regulated vascular endothelial growth factor expression around the isch- emic focus. The combined intervention provided a better outcome than mesenchymal stem cell transplantation alone. These findings demonstrate that electro-acupuncture at Conception and Governor vessels and mesenchymal stem cell transplantation have synergetic effects on promot- ing neurological function recovery and angiogenesis in rats after cerebral ischemia/reperfusion.

In vivo tracking of human adipose-derived stem cells labeled with ferumoxytol in rats with middle cerebral artery occlusion by magnetic resonance imaging

Ferumoxytol, an iron replacement product, is a new type of superparamagnetic iron oxide ap- proved by the US Food and Drug Administration. Herein, we assessed the feasibility of tracking transplanted human adipose-derived stem cells labeled with ferumoxytol in middle cerebral artery occlusion-injured rats by 3.0 T MRI in vivo. 1 × 104 human adipose-derived stem cells labeled with ferumoxytol-heparin-protamine were transplanted into the brains of rats with middle cerebral artery occlusion. Neurologic impairment was scored at 1, 7, 14, and 28 days after transplantation. T2-weighted imaging and enhanced susceptibility-weighted angiography were used to observe transplanted cells. Results of imaging tests were compared with results of Prussian blue staining. The modified neurologic impairment scores were significantly lower in rats transplanted with cells at all time points except I day post-transplantation compared with rats without transplantation. Regions with hypointense signals on T2-weighted and enhanced susceptibility-weighted angiography images corresponded with areas stained by Prussian blue, suggesting the presence of superparamagnetic iron oxide particles within the engrafted cells. Enhanced susceptibility-weighted angiography image exhibited better sensitivity and contrast in tracing ferumoxytol-heparin-protamine-labeled human adipose-derived stem ceils compared with T2-weighted imaging in routine MRI.

Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

BACKGROUND:To analyze early changes in white blood cells(WBCs),C-reactive protein(CRP)and procalcitonin(PCT)in children with multiple trauma,before secondary inflammation develops.METHODS:This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU).According to the prognostic outcome of 28 d after admission to the PICU,patients were divided into survival group(n=141)and non-survival group(n=36).Characteristics between the two groups were compared.Receiver operation characteristic(ROC)curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.RESULTS:The percentages of children with elevated WBC,CRP,and PCT levels were 81.36%,31.07%,and 95.48%,respectively.Patients in the non-survival group presented a statistically significantly higher injury severity score(ISS)than those in the survival group:37.17±16.11 vs.22.23±11.24(t=6.47,P<0.01).WBCs were also higher in non-survival group than in the survival group([18.70±8.42]×109/L vs.[15.89±6.98]×109/L,t=2.065,P=0.040).There was no significant difference between the survival and non-survival groups in PCT or CRP.The areas under the ROC curves of PCT,WBC and ISS for predicting 28-day mortality were 0.548(P=0.376),0.607(P=0.047)and 0.799(P<0.01),respectively.CONCLUSIONS:Secondary to multiple trauma,PCT levels increased in more patients,even if their WBC and CRP levels remained unchanged.However,early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

Efficacy and safety profile of LCR35 complete freeze-dried culture in irritable bowel syndrome:A randomized,double-blind study

AIM:To assess the effects and safety of Lactobacillus casei rhamnosus LCR35 complete freeze-dried culture(LCR35) in patients suffering from irritable bowel syndrome(IBS).METHODS:A randomized,double-blind pilot study was performed in 50 patients complaining of IBS symptoms complying with RomeⅢcriteria.Patients were allocated to receive either LCR35(n = 25) at a minimum daily dose of 6 × 108 colony forming units or placebo(n = 25) for 4 wk.At inclusion,after treatment and 2 wk later,patients completed the IBS severity scale.Change from baseline in the IBS severity score at the end of treatment was the primary efficacy criterion.Changes were compared between groups in the whole population and in IBS subtypes(IBS with predominance of constipation,IBS with predominance of diarrhoea,mixed IBS,unsubtyped IBS).The presence of lactobacillus casei rhamnosus in stools was investigated at inclusion and at the end of treatment.The gastrointestinal quality of life questionnaire and the hospital anxiety and depression(HAD) scale were also completed.RESULTS:Both groups were balanced for baseline characteristics.In 85% of patients,stool analyses showed that lactobacillus casei rhamnosus able to survive in the digestive tract.In the whole population,improvements in the IBS severity score did not differ significantly between treatments with a 25% decrease after 4-wk treatment,and a 15% decrease from baseline 2 wk later in both groups.In IBS subgroups,statistical analysis could not be performed due to small sample size,but a clinical response in favour of LCR35 was observed in IBS patients with predominance of diarrhoea:no change in the symptom severity score was seen with the placebo after 4 wk treatment,whereas a clinically relevant decrease occurred with LCR35(-37% vs-3%).Furthermore,in spite of an increase in symptom intensity,the IBS severity score was maintained below the baseline value 2 wk later with LCR35(-19% from baseline),whilst a slight 5% increase from baseline was observed with placebo.In the IBS subgroup with predominance of diarrhoea only,a clinically relevant decrease in abdominal pain severity score(-36%)was observed with LCR35,whereas no change occurred with placebo.In mixed IBS patients,the 20% and 30% decreases in the IBS severity score observed after treatment with LCR35 and placebo,respectively,were maintained 2 wk later in both groups.A clinical response slightly in favour of placebo was observed at the end of the treatment period in IBS patients with predominance of constipation(-41% vs-20%) and unsubtyped IBS patients(-47% vs-17%),with the same value maintained 2 wk later.In both groups,no clinically relevant changes were observed either for the gastrointestinal quality of life index or HAD score.Thus,these results suggest that sub-grouping of IBS patients may be important for optimizing treatment responses by the physician.CONCLUSION:This pilot study suggests that LCR35 could have some efficacy in IBS patients complaining of diarrhoea.These preliminary results need to be conf irmed in larger studies.