Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS

Objective We aimed to assess the feasibility and superiority of machine learning(ML)methods to predict the risk of Major Adverse Cardiovascular Events(MACEs)in chest pain patients with NSTE-ACS.Methods Enrolled chest pain patients were from two centers,Beijing Anzhen Emergency Chest Pain Center Beijing Bo’ai Hospital,China Rehabilitation Research Center.Five classifiers were used to develop ML models.Accuracy,Precision,Recall,F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system.Ultimately,ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.Results According to learning metrics,ML models constructed by different classifiers were superior over HEART(History,ECG,Age,Risk factors,&Troponin)scoring system when predicting acute myocardial infarction(AMI)and all-cause death.However,according to ROC curves and AUC,ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI.Among the five ML algorithms,Linear support vector machine(SVC),Naïve Bayes and Logistic regression classifiers stood out with all Accuracy,Precision,Recall and F-Measure from 0.8 to 1.0 for predicting any event,AMI,revascularization and all-cause death(vs.HEART≤0.78),with AUC from 0.88 to 0.98 for predicting any event,AMI and revascularization(vs.HEART≤0.85).ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome(ACS),abnormal electrocardiogram(ECG),elevated hs-cTn I,sex and smoking were risk factors of MACEs.Conclusion Compared with HEART risk scoring system,the superiority of ML method was demonstrated when employing Linear SVC classifier,Naïve Bayes and Logistic.ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.

Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis

BACKGROUND Meningitis remains a significant source of mortality and morbidity,with an incidence of 1 per 100000 persons in the United States.Guidelines recommend obtaining blood cultures and cerebrospinal fluid(CSF)studies in patients presenting with acute meningitis syndrome,and beginning treatment with broad spectrum antibiotics based on the age and certain predisposing conditions.In some patients however,the diagnostic lumbar puncture(LP)is not performed due to a multitude of reasons,ranging from increased intracranial pressure to failed attempt.In such situations,appropriate therapy is initiated empirically and often continued without establishment of a definitive diagnosis.AIM To determine whether a diagnostic LP in acute meningitis syndrome was associated with a better outcome and less duration of antibiotic therapy,along with potential causes for deferral of procedure.METHODS A retrospective study was conducted amongst the patients presenting to a 360 bedded community hospital in central Massachusetts with a diagnosis of acute meningitis syndrome between January 2010-September 2022.The electronic health records were accessed to collect necessary demographic and clinical data,including etiology of meningitis,lumbar puncture results,reason for procedure deferral,duration of antibiotic therapy and clinical outcome.The patients were subsequently divided into two groups based on whether they received a LP or not,and data was analyzed.RESULTS A total of 169 patients admitted with acute meningitis syndrome between September 2010-2022 were included in the study.The mean age of the participants was 54.3 years(SD+/-19.2 years).LP was performed for 130(76.9%)participants,out of which,28(21.5%)showed some growth in CSF culture.The most commonly identified organism was streptococcus pneumoniae.Amongst the 39 patients in whom LP was deferred,the major reasons recorded were:Body habitus(n=6,15.4%),and unsuccessful attempt(n=4,10.3%).While 93(71.5%)patients with LP received antibiotic therapy,only 19(48.7%)patients without LP received the antibiotics,with the principal reason being spontaneous improvement in sensorium without any diagnosed source of infection.The mean duration of antibiotic use was 12.3 days(SD+/-5.6)in the LP group and 11.5 days(SD+/-7.0)in the non-LP group(P=0.56;statistically not significant).We observed higher long term sequalae in the non-LP group(n=6,15.4%)compared to the LP group(n=9,6.9%).Similarly,the death rate was higher in the non-LP group(n=7,18.0%)compared to the LP group(n=9,6.9%).CONCLUSION LP remains the cornerstone for diagnosing meningitis,but often CSF results are unavailable,leading to empiric treatment.Our study identified that body habitus and unsuccessful attempts were the most common reasons for LP not being performed,leading to empiric antibiotic coverage.There was no difference between the duration of antibiotics received by the two groups,but a lower proportion of patients without LP received antibiotics,attributed to a spontaneous improvement in sensorium.However,the residual neurological sequelae and death rates were higher in patients without LP,signifying a potential under-treatment.A LP remains crucial to diagnose meningitis,and a lack of CSF analysis predisposes to under-treatment,leading to higher neurological sequelae and increased chances of death.

Comparison of diagnostic validity of two autism rating scales for suspected autism in a large Chinese sample

BACKGROUND Autism is the most common clinical developmental disorder in children.The childhood autism rating scale(CARS)and autistic autism behavior checklist(ABC)are the most commonly used assessment scales for diagnosing autism.However,the diagnostic validations and the corresponding cutoffs for CARS and ABC in individuals with suspected autism spectrum disorder(ASD)remain unclear.Furthermore,for suspected ASD in China,it remains unclear whether CARS is a better diagnostic tool than ABC.Also unclear is whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD.AIM To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample.METHODS A total of 591 outpatient children from the ASD Unit at Beijing Children’s Hospital between June and November 2019 were identified.First,the Clancy autism behavior scale(CABS)was used to screen out suspected autism from these children.Then,each suspected ASD was evaluated by CARS and ABC.Receiver operating characteristic(ROC)curve analysis was used to compare diagnostic validations.We also calculated the area under the curve(AUC)for both CARS and ABC.RESULTS We found that the Cronbach alpha coefficients of CARS and ABC were 0.772 and 0.426,respectively.Therefore,the reliability of the CARS was higher than that of the ABC.In addition,we found that the correlation between CARS and CABS was 0.732.Next,we performed ROC curve analysis for CARS and ABC,which yielded AUC values of 0.846 and 0.768,respectively.The cutoff value,which is associated with the maximum Youden index,is usually applied as a decision threshold.We found that the cutoff values of CARS and ABC were 34 and 67,respectively.CONCLUSION This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.

Primary stratification and identification of suspected corona virus disease 2019(COVID-19) from clinical perspective by a simple scoring proposal

In this Commentary,we would like to comment on the article titled"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)"as a featured article in Military Medical Research.In the guideline,except for"confirmed cases","suspected cases","close contact"and"suspicious exposure"were defined by clinical perspective based on epidemiological risk,clinical symptoms and auxiliary examination.Combined with our experience,we introduced a simple scoring proposal additionally based on not only CT imaging as strongly recommended by the guideline but also blood routine test,especially for primary screening of such patients in the out-patient department.

Suspected SARS-CoV-2 infection with fever and coronary heart disease:A case report

BACKGROUND The coronavirus disease 2019(COVID-19)is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Suspected cases accounted for a large proportion in the early stage of the COVID-19 outbreak.The deviation of the nucleic acid test by throat swab(the current gold standard of COVID-19)caused by variation in sampling techniques and reagent kits and coupled with nonspecific clinical manifestations make confirmation of the suspected cases difficult.Proper management of the suspected cases of COVID-19 is crucial for disease control.CASE SUMMARY A 65-year-old male presented with fever,lymphopenia,and chest computed tomography(CT)images similar to COVID-19 after percutaneous coronary intervention.The patient was diagnosed as having bacterial pneumonia with cardiogenic pulmonary edema instead of COVID-19.This was based on four negative results for throat swab detection of SARS-CoV-2 nucleic acid using reverse transcriptase-polymerase chain reaction assay and one negative result for serological antibody of SARS-CoV-2 with the serological assay.Additionally,the distribution of ground-glass opacities and thickened blood vessels from the CT images differed from COVID-19 features,which further supported the exclusion of COVID-19.CONCLUSION Distinguishing COVID-19 patients from those with bacterial pneumonia with cardiogenic pulmonary edema can be difficult.Therefore,it requires serious identification.

Highly sensitive troponin I assay in the diagnosis of coronary artery disease in patients with suspected stable angina

BACKGROUND Evaluation of suspected stable angina patients with probable coronary artery disease(CAD)in the community is challenging.In the United Kingdom,patients with suspected stable angina are referred by community physicians to be assessed by specialists within the hospital system in rapid access chest pain clinics(RACPC).The role of a highly sensitive troponin I(uscTnI)assay in the diagnosis of suspected CAD in a RACPC in a“real-life”setting in a non-academic hospital has not been explored.AIM To examine the diagnostic value of uscTnI(detection limit 0.12 ng/L,upper reference range 8.15 ng/L,and detected uscTnI in 96.8%of the reference population),in the evaluation of stable CAD in a non-selected patient group,with several co-morbidities,who presented to the RACPC.METHODS One hundred and seventy two RACPC patients were assigned to either functional or anatomical testing according to the hospital protocol.RESULTS The investigations offered to patients were exercise tolerance test 7.6%,24 h ECG 1.2%,Echocardiogram 14.5%,stress echocardiogram 8.1%,coronary computed tomography angiography(CCTA)12.8%,coronary angiogram 13.4%,17.4%were diagnosed with non-cardiac chest pain,3.5%treated as stable angina,8.2%reviewed by cardiologists,electronic medical records were not available in 10.4%.Receiver operating characteristic curves for CAD used uscTnI values measured in patients who underwent functional testing,angiogram or CCTA.Values>0.52 ng/L showed 100%sensitivity and at>11.6 ng/L showed 100%specificity.In the range>0.52-11.6 ng/L,uscTnI may not have the same diagnostic potential.In patients assigned to coronary angiogram higher concentrations of uscTnI was associated with severe CAD.Low levels of uscTnI and low pre-test probability of CAD(QRISK3)may decrease patient numbers assigned to CCTA.CONCLUSION The uscTnI diagnostic cut-off values in a RACPC will depend on patient population and their presenting co-morbidity.In the presence of clinical comorbidities and previous CAD the uscTnI needs to be used in conjunction with clinical assessment.

Application of the Modality of Multiple Disciplinary Team for a Perioperative Patient with Suspected Novel Coronavirus Pneumonia and Cervical Spine Fracture in Nursing

With the explosive spread of novel coronavirus pneumonia, a major public major public health emergency has been declared around the world. Our country has come to a crucial stage of “external defense input, internal defense rebound” and strict quarantine measures are taken in all ports of entry throughout the country. Operations on patients with cervical spine during the quarantine, which not only increases the risk of surgical treatment, but also increases the difficulty of perioperative nursing. The objective is to explore the result of application of the modality of multiple disciplinary team for a perioperative patient with suspected novel coronavirus pneumonia and cervical spine fracture in nursing. The patient’s condition and nursing measures are studied and discussed from various specialist angle through the multidisciplinary team established by the isolation ward, orthopedics department, emergency department, anesthesiology department, operating room, rehabilitation department, psychology department and so on, and the overall and personalized surgical and nursing planning is formed through interdisciplinary advice. The nursing experience is summarized in this paper.

Case report of a patient with suspected COVID-19 with depression and fever in an epidemic stress environment

During the COVID-19 pandemic,the number of suspected cases,confirmed cases and those who passed away from the virus has been reported in major media and the internet,and has caused a high degree of tension.In addition,people's outdoor activities have been limited,making it more difficult to find outlets for releasing stress.Under this situation,some people began to experience emotions of anxiety and depression.This article reports a case of depression with fever caused by the stress tension of the pandemic.The patient was highly suspected to have contracted COVID-19.The reported patient,who had a history of depression and had been to Wuhan to attend an exam,showed obvious pre-exam anxiety under the epidemic situation,which gradually increased the patient's pressure and then caused some adverse symptoms,such as insomnia,anxiety,sweating and a reoccurrent fever.Local community authorities paid close attention to him and later sent him to a general hospital in Jingmen for quarantine and treatment,as he was suspected of having COVID-19.After being hospitalised for half a month,he was ruled out from having‘COVID-19'and was cured of depression and discharged from the hospital.From this case,we can realise that,under the situation of the epidemic,people are easily prone to insomnia,anxiety and even depression.As clinicians in general hospitals,especially when encountering large emergencies,we must carefully inquire about the patient's medical history while strengthening our understanding of psychiatric knowledge to improve the recognition rate for depression.

Human Immunodeficiency Virus and Immunological Profiles among Suspected Tuberculosis Cases in Mombasa County, Kenya

Background: Human immunodeficiency virus (HIV) is a major public health concern and cause of death globally including Kenya. HIV infection is characterised by CD4+ lymphocyte depletion manifested through the loss of the immune response capacity. Aim: This study aimed to determine the prevalence of HIV infection and CD4+T cell counts among suspected tuberculosis (TB) cases seeking healthcare at TB clinics in Mombasa County, Kenya. Study Design: Hospital and laboratory based cross-sectional study was carried between May 2011 and November 2013 in Coast General Referral Hospital, Tudor, Port-Reitz, Mlaleo, Likoni and Mikandani districts and sub-districts hospitals. Methodology: A total of 500 suspected TB cases (271 males and 229 females) were screened for HIV infection using Trinity Biotech Uni-GoldTM test and positives confirmed with the enzyme- linked immunosorbent assay. CD4+ and CD8+T cells were analyzed using a BD FACS Count flow cytometer. A questionnaire was used to collect demographic data of the participants. Results: In total, 127 (25.4%) of the suspects were HIV infected 55.1% females and 44.9% males. Females were significantly affected than males (OR = 0.78;95% CI: 0.44 - 1.37;p = 0.042). The majority (36.2%) of the HIV cases were in the 25 - 34 years age group followed by the 35 - 44 (33.9%), 45 - 54 (16.5%) and 18 - 24 (7.1%) age groups, respectively. Widowed (AOR = 6.14;95% CI: 1.53 - 20.54;p < 0.033), alcohol (AOR = 2.83;95% CI: 1.71 - 4.87;p < 0.001) and condom use (AOR = 2.31;95% CI: 1.62 = 4.71;p < 0.002) were risk factors associated with HIV infection. The mean CD4 cell count was 333.27 ± 150.59 cells/mm3 and it was higher in males (343.05 ± 149.33 cells/mm3) than females (325.93 ± 152.92 cells). The mean values of white blood cells (5.9 ± 2.42) × 109/l), packed cell value (34.1% ± 4.3%), platelets (195.16 ± 88.7) × 109/l and erythrocyte sedimentation rate (102.0 ± 17.4 mm/hr) were significantly lower than the control group (p < 0.05). Conclusion: The prevalence of HIV infection among suspected TB cases was 25.4% which was higher than the current national average HIV prevalence of 6.9%. Lower CD4+ lymphocyte count was found to be the only predicting factor for HIV. There was a significant relationship between CD4/ESR and HIV infection.

Analysis of Clinical and Imaging Characteristics of Suspected and Confirmed COVID-19 Patients

Objective:To analyze the clinical characteristics and chest CT imaging characteristics of patients with confirmed COVID-19(COVID-19)and patients with suspected COVID-19.Methods:The study time span was from February 2020 to May 2020.The case samples were selected from 72 patients with confirmed covid-19 and suspected covid-19 diagnosed and treated by The First People’s Hospital of Yinchuan and Yinchuan Temporary Emergency Hospital,including 38 patients with confirmed covid-19 and 34 patients with suspected covid-19.All patients underwent laboratory examination and chest CT examination,and the specific examination results were compared and analyzed.Results:There were significant differences in number of white blood cell,percentage of lymphocytes,creatine kinase and erythrocyte sedimentation rate between confirmed and suspected COVID-19 patients(P<0.05).The CT imaging characteristics of COVID-19 patients were compared with those of suspected COVID-19 patients.The lesions of COVID-19 patients were mostly characterized by mixed ground glass density and pure ground glass density.There were vascular thickening and interstitial thickness increase,and accompanied by bronchiectasis or air bronchogram.The distribution of lesions was mostly subpleural without pleural effusion.The lesion area of suspected COVID-19 patients mostly showed solid density and mixed ground glass density.The lesion was distributed along bronchovascular and pleural effusion was observed.Conclusion:There are some differences in biochemical indexes and chest CT images between confirmed and suspected covid-19 patients,which can be used for differential diagnosis.

Oral captopril versus placebo among 14962 patients with suspected acute myocardial infarction: a multicenter,randomized,double-blind,placebo controlled clinical trial

Ｏｒａｌｃａｐｔｏｐｒｉｌｖｅｒｓｕｓｐｌａｃｅｂｏａｍｏｎｇ１４９６２ｐａｔｉｅｎｔｓｗｉｔｈｓｕｓｐｅｃｔｅｄａｃｕｔｅｍｙｏｃａｒｄｉａｌｉｎｆａｒｃｔｉｏｎ：ａｍｕｌｔｉｃｅｎｔｅｒ，ｒａｎｄｏｍｉｚｅｄ，ｄｏｕｂｌｅ┐ｂｌｉｎｄ，ｐｌａｃｅ...

Repatriation Urged for Suspected Terrorists

Beijing has vigorously con- demned the United States’ recent transfer of suspected Uygur terrorists to Palau and called for their repatriation to China, according to the Chi- nese Foreign Ministry.

Expert Consensus by Qilu Hospital of Shandong University on the diagnosis,management,and treatment of suspected COVID-19 cases(English version)

We devised a protocol to establish a standardized method of screening,diagnosing,and managing suspected cases of coronavirus disease(COVID-19)and to enhance the management of COVID-19 suspected cases.The protocol that included diagnostic criteria,preventive measures,and control measures against COVID-19 was developed based on new evidence regarding the epidemiological and clinical characteristics of COVID-19.A consensus document was subsequently formulated.The consensus focused on the clinical management of patients with suspected fever and reviewed the procedure for undergoing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)nucleic acid testing.This consensus will contribute to the ongoing efforts worldwide for the prevention and control of COVID-19.

Mutations of hMLH1 and hMSH2 genes in suspected hereditary nonpolyposis colorectal cancer

Objective: To analyze the molecular characteristics of 29 ICG-HNPCC families and 34 suspected HNPCC families. Methods: Genomic DNAs were prepared from peripheral blood samples of probands for DNA test. PCR-SSCP and DNA se-

Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively

Suspected Close Contacts as the Pilot Indicator of the Growth Trend of Confirmed Population During the COVID-19 Pandemic: A Simulation Approach

Regarding to the actual situation of the new coronavirus disease 2019 epidemic,social factors should be taken into account and the increasing growth trend of confirmed populations needs to be explained.A proper model needs to be established,not only to simulate the epidemic,but also to evaluate the future epidemic situation and find a pilot indicator for the outbreak.The original susceptible-infectious-recover model is modified into the susceptible-infectious-quarantine-confirm-recover combined with social factors(SIDCRL)model,which combines the natural transmission with social factors such as external interventions and isolation.The numerical simulation method is used to imitate the change curve of the cumulative number of the confirmed cases and the number of cured patients.Furthermore,we investigate the relationship between the suspected close contacts(SCC)and the final outcome of the growth trend of confirmed cases with a simulation approach.This article selects four representative countries,that is,China,South Korea,Italy,and the United States,and gives separate numerical simulations.The simulation results of the model fit the actual situation of the epidemic development and reasonable predictions are made.In addition,it is analyzed that the increasing number of SCC contributes to the epidemic outbreak and the prediction of the United States based on the population of the SCC highlights the importance of external intervention and active prevention measures.The simulation of the model verifies its reliability and stresses that observable variable SCC can be taken as a pilot indicator of the coronavirus disease 2019 pandemic.

Value of optical coherence tomography measurement of macular thickness and optic disc parameters for glaucoma screening in patients with high myopia

BACKGROUND The basic method of glaucoma diagnosis is visual field examination,however,in patients with high myopia,the diagnosis of glaucoma is difficult.AIM To explore the value of optical coherence tomography(OCT)for measuring optic disc parameters and macular thickness as a screening tool for glaucoma in patients with high myopia.METHODS Visual values(contrast sensitivity,color vision,and best-corrected visual acuity)in three groups,patients with high myopia in Group A,patients with high myopia and glaucoma in Group B,and patients with high myopia suspicious for glaucoma in Group C,were compared.Optic disc parameters,retinal nerve fiber layer(RNFL)thickness,and ganglion cell layer(GCC)thickness were measured using OCT technology and used to compare the peri-optic disc vascular density of the patients and generate receiver operator characteristic(ROC)test performance curves of the RNFL and GCC for high myopia and glaucoma.RESULTS Of a total of 98 patients admitted to our hospital from May 2018 to March 2022,totaling 196 eyes in the study,30 patients with 60 eyes were included in Group A,33 patients with 66 eyes were included in Group B,and 35 patients with 70 eyes were included in Group C.Data were processed for Groups A and B to analyze the efficacy of RNFL and GCC measures in distinguishing high myopia from high myopia with glaucoma.The area under the ROC curve was greater than 0.7,indicating an acceptable diagnostic value.CONCLUSION The value of OCT measurement of RNFL and GCC thickness in diagnosing glaucoma in patients with high myopia and suspected glaucoma is worthy of development for clinical use.

In Hospital Death among under Five Years Children Hospitalized with Meningitis in the Eastern of the Democratic Republic of Congo

Background: Meningitis is a major public health problem needing timely diagnosis, appropriate treatment, prevention and control. Despite the advances in diagnosis and treatment of infectious diseases, meningitis is still considered as an important cause of mortality and morbidity, especially in the paediatric population of lower income countries such as the Democratic Republic of the Congo (DR Congo). In this study, we aimed to analyse the fatality aspect of suspected meningitis among children under five years. Materials and Methods: A prospective, descriptive study was carried out in the Paediatrics departments of four hospitals in the South-Kivu province in the Eastern part of the DR Congo from April 2021 to March 2022. Of the 1386 children enrolled, 251 children were suspected of meningitis. This study captures data generated in the framework of routine medical practice, which includes medical history, clinical diagnosis and results of locally conducted laboratory tests. Results: Throughout the study period, a total of 251 patients (18.1%) aged 1 month to 59 months with suspected meningitis were recruited out of 1386 children hospitalized in the Paediatrics. The fatality among hospitalized children with suspected meningitis during the study period was 27.9%, however the mortality linked to meningitis decreases with age, ranging from 37.5% among children under 2 years to 19.4% among those over 2 years old. Children hospitalized for meningitis with malnutrition as an underlying conditions, had a 3.5 times greater risk of dying. The case fatality rate was higher in transferred and not vaccinated children respectively (2.3 and 2.5 times). We observe that the death occurs early within the first 3 days. Conclusion: Our study noted a higher fatality rate in children with suspected meningitis that could probably be linked to the gape in vaccination and malnutrition as underline condition.

为价值虚无的困境开启道路——希腊化时期从伦理哲学到宗教的转向

希腊化时期是个价值虚无主义的时代,这个时期哲学家的思想虽然缺乏创造性和深邃性,但他们却肩负起了为价值虚无的困境开启道路的使命。伊壁鸠鲁幸福主义的伦理学以原子论为基础,探究人生及其终极目的;斯多葛学派的中心思想是以宿命论的伦理学反对伊壁鸠鲁学派的无神论和快乐论;怀疑论者则对希腊哲学的对象、问题、方法进行全面质疑。普罗提诺本体论而非神学的世界结构把本体归结为一个最高的神,启示了基督教教父把"本体"译作神的"位格"(person),并引出上帝"三位一体"的概念,哲学的伦理观念由此转向宗教。

沉默短片断的实质的发生内视镜地在一个成年日本主要照顾惯例怀疑了食道的组织变形

AIM: To determine the incidence and characteristics of endoscopically suspected esophageal metaplasia (ESEM) in a primary adult care institution. METHODS: Eight hundred and thirty two consecutive individuals (mean age, 67.6 years) undergoing upper gastrointestinal endoscopy between January 2009 and December 2010 were included in this study. The diagnosis of ESEM was based on the criteria proposed by the Japan Esophageal Society, and was classified as long segment ESEM (3 cm or more) or short segment ESEM (【 3cm). Short segment ESEM was further divided into circumferential and partial types. Age, gender, hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD)-suggested symptoms, and antacid medications were recorded as background factors. Esophagitis was graded according to the Los Angeles classification. Hiatus hernia was divided into absent and at least partially present. RESULTS: Long and short segment ESEM were found in 0 and 184 (22.1%) patients, respectively (mean age of short segment ESEM patients, 68.3 years). Male gender and hiatus hernia were shown to be signifi cant factors affecting short segment ESEM by both univariate (P = 0.03 and P = 9.9x10-18) and multivariate [Odds ratio (OR) = 1.45; P = 0.04, and OR = 43.3; P = 1.5x10-7)] analyses. Two thirds of patients with short segment ESEM did not have GERD-suggested symptoms. There was no correlation between short segment ESEM and GERD-suggested symptoms.