Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

Development and validation of a 6-gene signature derived from RNA modification-associated genes for the diagnosis of Acute Stanford Type A Aortic Dissection

Background Acute Stanford Type A Aortic Dissection(ATAAD)is a critical medical emergency characterized by significant morbidity and mortality.This study aims to identify specific gene expression patterns and RNA modification associated with ATAAD.Methods The GSE153434 dataset was obtained from the Gene Expression Omnibus(GEO)database.Differential expression analysis was conducted to identify differential expression genes(DEGs)associated with ATAAD.To validate the involvement of RNA modification in ATAAD,RNA modification-related genes(M6A,M1A,M5C,APA,A-to-I)were acquired from GeneCards,following by Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis.A gene prediction signature consisting of key genes was established,and Real-time PCR was used to validate the gene expression in clinical samples.The patients were then divided into high and low-risk groups,and subsequent enrichment analysis,including Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),Gene Set Enrichment Analysis(GSEA),Gene Set Variation Analysis(GSVA),and assessments of immune infiltration.A co-expression network analysis(WGCNA)was performed to explore gene-phenotype relationships and identify key genes.Results A total of 45 RNA modification genes were acquired.Six gene signatures(YTHDC1,WTAP,CFI,ADARB1,ADARB2,TET3)were developed for ATAAD diagnosis and risk stratification.Enrichment analysis suggested the potential involvement of inflammation and extracellular matrix pathways in the progression of ATAAD.The incorporation of pertinent genes from the GSE147026 dataset into the six-gene signature further validated the model's effectiveness.A significant upregulation in WTAP,ADARB2,and TET3 expression,whereas YTHDC1 exhibited a noteworthy downregulation in the ATAAD group.Conclusion Six-gene signature could serve as an efficient model for predicting the diagnosis of ATAAD.

Complementary comments on diagnosis,severity and prognosis prediction of acute pancreatitis

The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma,diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis.Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis,and dual energy computed tomography is also useful in severity assessment and prognosis prediction.Walled off necrosis is an important complication in terms of prognosis,and it is important to know its radiological findings and distinguish it from pseudocyst.

Evaluation of The Effectiveness of Abdominal and Vaginal B-Ultrasound in The Diagnosis of Acute Abdomen in Obstetrics and Gynecology

Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hospital from March 2023 to March 2024 were selected, all of whom were acute abdomen patients admitted to the Department of Obstetrics and Gynecology. In this study, the patients were divided into two groups. One group of 40 patients was given a simple abdominal B-ultrasound diagnosis (control group). The other group of 40 patients was given both abdominal and vaginal B-ultrasound examinations (experimental group). The diagnostic accuracy between the two groups was compared. Results: Patients in the experimental group had higher consistency rates with pathological diagnosis results in ectopic pregnancy rupture, embryonic arrest, acute pelvic inflammation, corpus luteum rupture, and intrauterine adhesions as compared to the control group. At the same time, the inspection accuracy rate of the experimental group (92.50%) was higher than that of the control group (70.00%) (P < 0.05). Conclusion: The combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen was of great significance in improving the accuracy of clinical diagnosis and guiding doctors to provide effective treatment.

Diagnosis of Acute Q Fever in an Elderly Patient Using Metagenomic Next-Generation Sequencing:A Case Report

Query fever(Q fever)is a globally spread zoonotic disease caused by Coxiella burnetii,commonly found in natural foci but rarely seen in Hebei Province.The clinical manifestations of Q fever are diverse and nonspecific,which often leads to missed or incorrect diagnoses in clinical practice.This article reports a case of acute Q fever diagnosed in an elderly patient using metagenomic next-generation sequencing.

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.

Acute pancreatitis:A review of diagnosis,severity prediction and prognosis assessment from imaging technology,scoring system and artificial intelligence

Acute pancreatitis(AP)is a potentially life-threatening inflammatory disease of the pancreas,with clinical management determined by the severity of the disease.Diagnosis,severity prediction,and prognosis assessment of AP typically involve the use of imaging technologies,such as computed tomography,magnetic resonance imaging,and ultrasound,and scoring systems,including Ranson,Acute Physiology and Chronic Health Evaluation II,and Bedside Index for Severity in AP scores.Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity,while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications.Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild,moderate,or severe categories,guiding treatment decisions,such as intensive care unit admission,early enteral feeding,and antibiotic use.Despite the central role of imaging technologies and scoring systems in AP management,these methods have limitations in terms of accuracy,reproducibility,practicality and economics.Recent advancements of artificial intelligence(AI)provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data.AI algorithms can analyze large amounts of clinical and imaging data,identify scoring system patterns,and predict the clinical course of disease.AI-based models have shown promising results in predicting the severity and mortality of AP,but further validation and standardization are required before widespread clinical application.In addition,understanding the correlation between these three technologies will aid in developing new methods that can accurately,sensitively,and specifically be used in the diagnosis,severity prediction,and prognosis assessment of AP through complementary advantages.

Role of Plain Abdominal X-Ray in the Differential Diagnosis of Common Acute Abdominal Conditions in Children at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria

Background: The plain abdominal x-ray is one of the commonly requested investigations in the children emergency room, paediatric surgical ward and neonatal wards. The short interval required to carry out this investigative procedure and obtain results makes it the first imaging modality used to unravel the different causes of acute abdominal conditions in children. The safety of abdominal x-ray in children makes it attractive for use in paediatric surgical practice as part of routine work-up for undifferentiated acute abdominal conditions and also to diagnose specific causes of acute abdomen in children. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. Objectives: Evaluation of the role of plain abdominal x-ray in diagnosing common acute abdominal conditions in children. Materials and method: Patients admitted to the children emergency room, paediatric surgical wards, children’s ward and neonatal ward who had plain abdominal x-ray as part of their diagnostic work-up were included in the study. They were studied prospectively between March 2011 and April 2021. Results: Three Hundred and Ninety-nine patients who had plain abdominal x-rays as part of their diagnostic work-up were studied. Males were 240 while females were 159, a male to female ratio of 1.5:1. The patients were aged between 1 day to 16 years. Differential diagnoses made with plain abdominal x-ray were intestinal obstruction in 298, perforated viscus 69 patients, intra-abdominal masses 13 patients and location of intra-abdominal foreign body 14. Intestinal obstruction cases in which plain abdominal x-ray played a role in their diagnosis and management included the following: intussusception 66, neonatal sepsis 60, malrotation 48, intestinal atresia 42, anorectal malformation 32, hirschsprung’s disease in 30 cases, pyloric stenosis 24, obstructed hernia 22, post-operative adhesions 16 and intestinal helminthiasis 12. Perforated viscus accounted for 69 indications. Out of these indications, perforated gut in intussusception 19, perforated typhoid ileitis was responsible in 13 cases, gut perforation in blunt abdominal trauma 8, perforation in strangulated hernia 11 cases, perforated gut in malrotation 7, ceacal perforation in hirschsprugs disease 6 and colonic perforation in necrotizing enterocolitis 5 cases. Conclusion: Plain abdominal x-ray remains a role to play in the differential diagnosis and management of common paediatric acute abdominal conditions.

Latent Space Representational Learning of Deep Features for Acute Lymphoblastic Leukemia Diagnosis

Acute Lymphoblastic Leukemia(ALL)is a fatal malignancy that is featured by the abnormal increase of immature lymphocytes in blood or bone marrow.Early prognosis of ALL is indispensable for the effectual remediation of this disease.Initial screening of ALL is conducted through manual examination of stained blood smear microscopic images,a process which is time-consuming and prone to errors.Therefore,many deep learning-based computer-aided diagnosis(CAD)systems have been established to automatically diagnose ALL.This paper proposes a novel hybrid deep learning system for ALL diagnosis in blood smear images.The introduced system integrates the proficiency of autoencoder networks in feature representational learning in latent space with the superior feature extraction capability of standard pretrained convolutional neural networks(CNNs)to identify the existence of ALL in blood smears.An augmented set of deep image features are formed from the features extracted by GoogleNet and Inception-v3 CNNs from a hybrid dataset of microscopic blood smear images.A sparse autoencoder network is designed to create an abstract set of significant latent features from the enlarged image feature set.The latent features are used to perform image classification using Support Vector Machine(SVM)classifier.The obtained results show that the latent features improve the classification performance of the proposed ALL diagnosis system over the original image features.Moreover,the classification performance of the system with various sizes of the latent feature set is evaluated.The retrieved results reveal that the introduced ALL diagnosis system superiorly compete the state of the art.

Approach to Acute Kidney Injury: Diagnosis and Management

Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.

Contribution of Cardiac MRI in the Diagnosis of Acute Myocarditis

Objective: To describe the MRI abnormalities observed in acute myocarditis. Materials and Methods: Retrospective cross-sectional study with a descriptive aim, carried out at the North Franche-Comte Hospital, over a period of 12 months, from January 2021 to December 2021. It covered all patients who received an MRI of heart disease and were diagnosed with myocarditis. The diagnosis of myocarditis was retained in all patients on the basis of two arguments: a T2 PSIR hyper signal and a late enhancement at 15 min in T1 PSIR with gadolinium. Results: Myocarditis was diagnosed in 20 patients out of a total of 214 who performed cardiac MRI, i.e. 10.30% of cases. The average age was 33.7 ± 14.3 with extremes of 17 and 69 years. We observed a male predominance with 11 men (55%) for 9 women (45%) or a sex ratio of 1.2. Clinical suspicion of myocarditis and acute coronary syndrome were the main indications for MRI. The lesion sites were subepicardial (95%) and/or intramural (30%), respecting the subendocardium, interesting for the majority, segments 12 (anterolateral) in 50% and/or 11 (inferolateral) in 43% of cases. Global hypokinesia was observed in 30% of patients associated with a decrease in LVEF. There was no cardiac volume abnormality or valvular abnormality. Conclusion: Cardiac MRI is nowadays the most efficient non-invasive imaging in the diagnosis of acute myocarditis. The diagnosis of myocarditis was made on 2 pathognomonic signs, namely a T2 STIR hyper signal and late enhancement at 15 min in T1 PSIR after injection of gadolinium. The morphology and lesion locations were in agreement with those described in previous studies. Global hypokinesia and pericardial effusion were observed in some patients. On the other hand, there was neither valvular anomaly, nor cardiac volume anomaly.

Chemokine Receptors CCR1, CCR3, CCR7 and Chemokines CX3CL1 and CCL5 are Significantly Up-Regulated and Very Reliable for Acute Rejection Diagnosis of Kidney Transplants

Background: The allo-immune response following organ transplantation constitutes one of the main determinants concerning both short- and long- term outcomes in renal graft recipients. Chemokines and their receptors play a diversified and important role, either homeostatic or inflammatory and direct different immune-competent cell types to the allograft. While deeply studied in the last two decades, controversy persists as a result of chemokines’ pleiotropic actions. We report our analysis of CCR1, CCR3, CCR7, CCL5 and CX3CL1 expression or synthesis by graft-infiltrating cells in human kidney transplants (KTx). At the same time, we tested their robustness in diagnosing acute rejection. Methods: Fine-needle aspiration biopsies (Fnab) were performed either on days 7 or 14 post-transplantation among stable KTx and on the day of acute rejection (AR) diagnosis. Fnab cytopreparations were studied by the enzymatic avidin-biotin complex staining for CCR1, CCR3, CCR7 and CX3CL1. From another subgroup of cases, Fnab samples were cultured for 48 hours and the supernatants were analysed for CCL5 by ELISA. Results: The group of AR cases showed a significantly up-regulated expression of CCR1, CCR3, CCR7 and CX3CL1 and a significantly higher synthesis of CCL5. The positive predictive values were respectively 92%, 97%, 85%, 76% and 78% and negative predictive values were by the same order, 100%, 73%, 100%, 98% and 83%. Conclusions: Our study permits us to advance that CCR1 and CCR3 play a significant and non-redundant role in acute rejection, and it is the first report of CCR3 association with rejection, probably related to CCL5. The presence inside the graft of significant up-regulation for CCR7 surmises that part of antigen presentation may be performed there without being restricted to secondary lymphoid sites. Our results with CX3CL1 confirm other reports.

Lung ultrasound for the early diagnosis of acute lung injury:A case report

BACKGROUND The extensive availability of ultrasound(US)technology has increased its use for point-of-care applications in many health care settings.During anaesthesia and surgery,acute respiratory failure or pulmonary oedema are common lifethreatening events that,if not recognized and treated appropriately,result in a high mortality rate.CASE SUMMARY We report a patient under anaesthesia whose lung US examination showed multiple vertical artefacts(B-lines)in the lung tissue,indicating pulmonary oedema.The respiratory state improved with the resolution of the pulmonary oedema after our treatment.CONCLUSION We believe that US of the lungs may be a useful tool for dynamic respiratory monitoring at the bedside during anaesthesia.

Laboratory Diagnosis of Acute Leukemia in Kenya: The Gaps and Opportunities

Acute leukemia (AL) is a malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development. The diagnosis of leukemia and lymphomas, beyond morphology, is limited in low-resource countries including Kenya. Morphological diagnosis includes Cytological and Histological assessment of blood, bone marrow aspirates and tissues on suspected Acute leukemia patients. The World Health Organization (WHO, 2016) international guidelines on Acute leukemia diagnosis recommend that cytogenetic analysis, appropriate molecular genetics, Fluorescent in situ Hybridization (FISH) testing, and flow cytometric immuno-phenotyping should be done in addition to a morphologic assessment of Acute Leukemia. In facilities where resources are relatively available, immunophenotypic and genetic features have resulted not only in providing a more accurate leukemia diagnosis but also in identifying antigens or genes that can then be targeted for therapy. This article will look at the gaps in the diagnosis of Acute leukemia in low-resource settings like Kenya and opportunities available to improve diagnosis.

Acute suppurative terminal cholangitis:Clinical characteristics of a new subtype of acute cholangitis

Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.

Stage at diagnosis of colorectal cancer through diagnostic route:Who should be screened?

BACKGROUND Colorectal cancer(CRC)is a global health concern,with advanced-stage diagnoses contributing to poor prognoses.The efficacy of CRC screening has been well-established;nevertheless,a significant proportion of patients remain unscreened,with>70%of cases diagnosed outside screening.Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources,the association between the diagnostic routes and identification of these subgroups has been less appreciated.In the Japanese cancer registry,the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms.AIM To clarify the stage at CRC diagnosis based on diagnostic routes.METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals.The diagnostic routes were primarily classified into three groups:Cancer screening,follow-up,and symptomatic.The early-stage was defined as Stages 0 or I.Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups,referencing the follow-up group.The adjusted covariates were age,sex,and tumor location.RESULTS Of the 2083 patients,715(34.4%),1064(51.1%),and 304(14.6%)belonged to the follow-up,symptomatic,and cancer screening groups,respectively.Among the 2083 patients,CRCs diagnosed at an early stage were 57.3%(410 of 715),23.9%(254 of 1064),and 59.5%(181 of 304)in the follow-up,symptomatic,and cancer screening groups,respectively.The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group[P<0.001,adjusted odds ratio(aOR),0.23;95%confidence interval(95%CI):0.19-0.29].The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups(P=0.493,aOR for early-stage diagnosis in the cancer screening group vs follow-up group=1.11;95%CI=0.82-1.49).CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier,similar to cancer screening.CRC screening should be recommended,particularly for patients without periodical hospital visits for comorbidities.

Value of procalcitonin and presepsin in the diagnosis and severity stratification of sepsis and septic shock

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.[1,2]Septic shock,the most severe form of sepsis,is characterized by circulatory and cellular/metabolic abnormalities,and can increase mortality to>40%.[1-3]Early recognition and risk stratification of septic shock are crucial but challenging because of the heterogeneity of its presentation and progression.

Visceral adipose tissue predicts severity and prognosis of acute pancreatitis in obese patients

Acute pancreatitis is a common systemic inflammatory disease, manifested by a spectrum of severity, ranging from mild in the majority of patients to severe acute pancreatitis. Patients with severe acute pancreatitis suffer from severe local and systemic complications and organ failure, leading to a poor prognosis. The early recognition of the severe condition is important to improve prognosis. Obesity has risen in tandem with an increase in the severity of acute pancreatitis in recent years. Studies have revealed that adipose tissue, particularly visceral adipose tissue is associated with the prognosis of acute pancreatitis. This review discussed the role of visceral adipose tissue in obese patients with acute pancreatitis and explored the possible mechanism involved.

Dynamic Vision Enabled Contactless Cross-Domain Machine Fault Diagnosis With Neuromorphic Computing

Dear Editor,This letter presents a novel dynamic vision enabled contactless cross-domain fault diagnosis method with neuromorphic computing.The event-based camera is adopted to capture the machine vibration states in the perspective of vision.

Implementation of gastrointestinal function protection in severe acute pancreatitis

Severe acute pancreatitis(SAP)is a serious systemic disease associated with strong local inflammatory reactions and serious systemic pathophysiological disorders caused by trypsin spillover.Patients with SAP are prone to exhibit gastrointestinal dysfunction.Meanwhile,gastrointestinal dysfunction further aggravates the systemic inflammatory response and metabolic abnormalities,resulting in a more critical condition of SAP.Gastrointestinal dysfunction is considered to be the“trigger”of multiple organ dysfunction syndrome[1].Thus,it is important to maintain gastrointestinal homeostasis in the treatment of SAP.