Pleural lump after paragonimiasis treated by thoracoscopy: A case report

BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Drainage,praziquantel,and triclabendazole are recommended for the treatment,but when fibrous contents are contained in pleural effusion,surgical interventions are necessary.However,no related reports have been noted.Herein,we present a case of pulmonary paragonimiasis treated by thoracoscopy.CASE SUMMARY A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days.Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani,serological test showed eosinophilia,and moderate left pleural effusion and calcification were detected on computed tomography(CT).She was diagnosed with paragonimiasis,and praziquantel was prescribed.However,radiography showed an egg-sized nodule in the left pleural cavity during follow-up.She was then admitted to our hospital again.The serological results were normal except slight eosinophilia.CT scan displayed a cystic-like node in the lower left pleural cavity.The patient underwent a thoracoscopic mass resection.A mass with a size of 6 cm×4 cm×3 cm adhered to the pleura was resected.The pathological examination showed that the mass was composed of non-structured necrotic tissue,indicating a granuloma.The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.CONCLUSION This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.

Texture and color enhancement imaging for detecting colorectal adenomas: Good, but not good enough

Texture and color enhancement imaging(TXI)has been developed as a novel image-enhancing endoscopy.However,the effectiveness of TXI detecting adenomas is inferior to narrow band imaging.Thus,future studies will need to focus on investigating the feasibility of such combination in clinical settings in order to provide patients with more accurate diagnoses.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

Development and Validation of a Prognostic Risk Score System for COVID-19 Inpatients:A Multi-Center Retrospective Study in China

Coronavirus disease 2019(COVID-19)has become a worldwide pandemic.Hospitalized patients of COVID-19 suffer from a high mortality rate,motivating the development of convenient and practical methods that allow clinicians to promptly identify high-risk patients.Here,we have developed a risk score using clinical data from 1479 inpatients admitted to Tongji Hospital,Wuhan,China(development cohort)and externally validated with data from two other centers:141 inpatients from Jinyintan Hospital,Wuhan,China(validation cohort 1)and 432 inpatients from The Third People’s Hospital of Shenzhen,Shenzhen,China(validation cohort 2).The risk score is based on three biomarkers that are readily available in routine blood samples and can easily be translated into a probability of death.The risk score can predict the mortality of individual patients more than 12 d in advance with more than 90%accuracy across all cohorts.Moreover,the Kaplan-Meier score shows that patients can be clearly differentiated upon admission as low,intermediate,or high risk,with an area under the curve(AUC)score of 0.9551.In summary,a simple risk score has been validated to predict death in patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2);it has also been validated in independent cohorts.

Feature selection and machine learning approach for carotid atherosclerosis in asymptomatic adults

Objective:The presence of carotid atherosclerosis reflects the overall atherosclerotic load and may predict cardiovascular and cerebrovascular accidents.Studies have reported risk factors for carotid atherosclerosis.However,few practical models have been established to predict carotid atherosclerosis risk.Thus,this study was conducted to investigate important features of carotid atherosclerosis and to propose a machine learning-based method for predicting carotid atherosclerosis in asymptomatic adults.Methods:Cross-sectional study was conducted using routine medical check-up data of individuals from January 2019 to January 2020.Pearson’s correlation analysis was performed to correlate the features.Then,features were selected by python’s feature-selection library and analyzed through three algorithms.Multiple machine learning algorithms,including Decision Tree,Random Forest and Logistic Regression(LR)were used to predict the risk of carotid atherosclerotic plaques and compared their precision,accuracy,recall,F1-score and area under the curve.Results:A total of 150 individuals were enrolled in this study,30(20%)of them were found with carotid atherosclerotic plaques.Sex,age,body mass index,total cholesterol,Systolic blood pressure(SBP),and carbohydrate antigen 724(CA724)were independently correlated to carotid atherosclerosis.Pepsinogen Ⅰ and pepsinogen Ⅱ serum levels had no correlations with Carotid intima-media thickness and pulse wave velocity.SBP,diastolic blood pressure age,low-density lipoprotein,Pepsinogen I,pepsinogen II,body mass index,Waist,CA724,and Uric Acid contribute to the cumulative importance of 0.9,and SBP was the most crucial feature for carotid atherosclerosis.LR algorithm has the precision(0.92),values of recall(0.91),F1(0.9),and area under the curve(0.95),and showed the optimal performance to predict the presence or absence of carotid atherosclerosis in asymptomatic adults.The code for analysis in this article was uploaded to GitHub(https://github.com/ganbingliangyi/machine-learning).Conclusions:SBP was the most crucial feature in ranking features,the LR algorithm showed the optimal performance to predict the presence or absence of carotid atherosclerosis in asymptomatic adults.