Partial Amputation of the Penis with Total Rupture of the Urethra: About a Case in the Urology Department of the Bonamoussadi District Medical Center

Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.

Profile of Discordant Couples for Human Immunodeficiency Virus Infection Followed in Kinshasa: Case of Monkole Medical Center

Background: Programs targeting serodiscordant couples in Africa are not a priority in efforts to prevent Human Immunodeficiency Virus (HIV) infection, although a large proportion of these occur in stable relationships, of which serodiscordance accounts for about two-thirds with a high risk of seroconversion of the seronegative partner. Objective: The objective of this study was to describe the profile of HIV serodiscordant couples followed in Kinshasa, DRC. Methods: Descriptive cross-sectional study to describe the profile of different heterosexual HIV serodiscordant couples followed at the Monkole Medical Center in Kinshasa, DRC, from November 2021 to June 2022. The data were collected from the information sheets elaborated by the research team as well as from the information provided by the computerized files of the patients managed at the Infectious Diseases Unit of the Monkole Medical Center after the signature of the informed consent. An average of 8 cc of blood was taken from a peripheral vein in the patient’s forearm, and was stored in EDTA tubes at −20˚C, of which at least 6 mL were used for biochemical analyses, 2 spots of 200 μL for each partner were stored on filter paper at −20˚C and were used for DNA extraction. Nested PCR confirmed the serological diagnosis. Results: Out of a total of 482 heterosexual couples followed for HIV at the Monkole Medical Center, 28 (5.8%) were HIV serodiscordant, of which 14 (2.9%) couples agreed to participate in the present study. The mean age was 43.39 ± 10 years with extremes ranging from 24 to 62 years. The patients were mainly from the informal sector (53.6%) and weighed between 61 and 71 kg (46.4%). Sexual intercourse continued in all couples, without condom use (85.7%) for desire of procreation (82.1%);although the great majority of HIV-negative partners (85.7%) were not under ARV prophylaxis. Leukopenia was found in 42.9% of HIV-negative partners compared to 21% of HIV-positive partners;all partners had a predominantly lymphocytic white blood cell count. 21.4% of HIV-negative partners had high HDL, 14.3% of HIV-positive partners had low HDL, and 14.3% of HIV-negative partners had high LDL. Chi-square and Pearson correlation tests showed no relationship between the biochemical parameters performed and the couples’ serodiscordance for HIV. Conclusion: The frequency of HIV discordant couples in Kinshasa is significant. Serodiscordance is encountered in young intellectual and entrepreneurial couples with a desire to procreate. It is desirable to carry out further analyses for better management of these couples.

The mortality of patients in a pediatric emergency department at a tertiary medical center in China: An observational study

BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiary children's hospital in Guangzhou, China and to investigate the risk factors associated with the mortality.METHODS: The mortality of pediatric patients at the hospital from 2011 to 2013 was retrospectively analyzed using descriptive statistics.RESULTS: Altogether 466 919 patients visited the PED during the period and 43 925 of them were admitted for further observation. In 230 deaths, the ratio of boys to girls was 1.4:1, and their age ranged from 2 hours to 16 years(median, 5 months). The time from admission to death ranged from 0 to 216 hours(median, 1.5 hours). There were 92(40%) patients who died within 24 hours after admission and 104(45.2%) patients who died on arrival. The prominent causes of the deaths were respiratory diseases, neuromuscular disorders, cardiovascular diseases, and sepsis, most of which were ascribed to severe infection. Sixty-five deaths were associated with more than one concomitant problem. The top concomitant problems were congenital malformation, low gestational age, and severe birth asphyxia.CONCLUSIONS: In our center, 40% of the patients in the PED died of fatal acute diseases, and pneumonia was the first leading cause of the deaths. Almost half of the deaths occurred on arrival and the rest were due to end-stage malignant diseases. This study emphasized the importance of prevention of birth deficits by reducing deaths in infants and children.

Prevalence and Antibiotic Resistance Pattern of <i>Escherichia coli</i>and <i>Klebsiella pneumoniae</i>in Urine Tract Infections at the La Paz Medical Center, Malabo, Equatorial Guinea

The study was conducted to isolate and determine the antibiotic resistance in Escherichia coli and Klebsiella pneumonia from urine samples over a 2-year period (August 2013-September 2015) at the La Paz Medical Center, Malabo. A retrospective analysis of 785 urine culture samples over a 2-year period August 2013-September 2015 was carried out according to the routine protocol of urinalysis. Bacterial etiological agents were isolated from 155 (19.7%) samples with highest prevalence of Escherichia coli (55.5%) followed by Klebsiella pneumonia (23.2%), Proteus mirabilis (4.5%), Pseudomonas species (3.2%), Enterobacter species (2.6%), Enterococcus faecalis (2.6%) and others species (8.4%). The E. coli and K. pneumonia represent 78.7% of all isolated bacterial strains. The E. coli and K. pneumoniae isolates possess highly resistant to ampicillin, Trimethoprim/Sulfamethoxazole, Doxycycline, Amoxicicline/Clavulanic acid. Whereas K. pneumonia demonstrated also to be highly resistant to Gentamycin, Cefuroxime and Ceftriaxon, low level of resistance to Piperacilin/Tazobactam, Amikacin and the lowest to Imipenem. The alarming level of MDR strains to the first choice antibiotics treatment was observed.

Establishing an integrated gastroenterology service between a medical center and the community

AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was established.METHODS:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were opened.Continuing education,guidelines and agreed instructions for referral were promoted by the IGS.Six quality indicators were developed by the Delphi method,rigorously designed and regularly monitored.Improvement was assessed by comparing 2010,2011 and 2012 indicators.RESULTS:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination.In this paper we describe a new integrated gastroenterology service established in April 2010.Waiting time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th 2012.Average cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal cancer.CONCLUSION:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.

Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center

A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica,which regressed completely with medical therapy.In Western countries,the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.Not surprisingly,there have been very few cases reported of this clinical entity within the United States.Moreover,we report a patient that had an extremely rare occurrence of two synchronous lesions,one involving the rectum and the other situated in the cecum.We review the current literature on the pathogenesis of invasive E.histolytica infection and ameboma formation,as well as management of this rare disease entity at a western medical center.

Cancers in Eastern Libya: First results from Benghazi Medical Center

AIM:To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya(for the first time in a decade).METHODS:A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya-focusing on those diagnosed in the year 2012.RESULTS:The most common malignancies in men were cancers of the colon(22.3%,n=90),lung(20.3%,n=82),prostate(16.1%,n=65),pancreas(4.2%,n=17)and liver(4.2%,n=17).For women,they were found to be cancers of the breast(41.5%,n=213),colon(16.4%,n=84),uterus(8%,n=41),ovary(5.5%,n=28)and pancreas(3.1%,n=16).Additionally age-standardized rates(ASR)were determined for Libya.The different cities and towns in eastern Libya were compared for any variation.The cityof Beida in particular was found to have a remarkably high incidence of gastric cancer.The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries.The incidence rates given for the eastern region showed differences from previously reported values(i.e.,the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently).Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth.The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya.CONCLUSION:Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society.

Anesthesia Related Closed Claims and Litigations at the Detroit Medical Center: Analysis, Lessons Learned, and Conclusions

The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral to develop new guidelines aimed to reduce adverse anesthesia-related events. In this study, we give a descriptive analysis of anesthesia-related claims at the Detroit Medical Center, Detroit, MI, USA. The study analyzed different components in anesthesia-related closed claims and litigations such as medical, demographic and socio-economic factors. From 67,000 procedures in anesthesiology care provider, related cases claims were made in 0.057% (38/67,000) of all cases. The majority of claims involved procedures involving Caucasian females aged 51-55 years. The highest risk periods involved early shift times during Monday and Tuesday, particularly of procedures performed during August. About 33% of all cases in which death occurred involved patients who received an Obstetrics/Gynecology or an Orthopedic procedure under general anesthesia. The majority of closed claims and litigations cases were distributed between procedures treating nerves injuries and anoxic encephalopathy. The OR and PACU at urban hospitals had the highest claim rates. MD anesthesiologists constituted the lowest proportion of all anesthesia providers involved in closed claims incidents. The average compensation paid was predominately in the range of $200,000-$250,000. In addition to reporting anesthesia related factors involved in closed claims and litigations this study also includes a series of recommendations which may work as a framework for improving anesthesia practices.

Radiotherapy to the Left Breast with 3DCRT, IMRT or VMAT: International Medical Center Experience

Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer. The aim of radiotherapy is to achieve the best coverage of the Planning Target Volume (PTV), while reducing the dose to the Organs at Risk (OAR). Such goals are not always achievable with the conformal three dimensions plans (3DCRT). Recently, radiation oncologist uses Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast. In this study, we compared 3DCRT, IMRT and VMAT for left breast cancer patients in terms of PTV coverage, OAR. We also revised the different dose distribution in 1) different breast volume categories, 2) nodal irradiation versus breast only, and 3) boost versus no boost. Results: The routinely reported dose constrains for the ipsilateral lung and for the heart were not significantly different on comparing the three techniques. While for the contralateral lung, the difference in mean dose was in favor of 3DCRT. In large breast volume, 3DCRT provided a lower Max dose to the contralateral lung and the lowest mean dose to the contralateral breast when compared to IMRT p < 0. 046. In case of no nodal irradiation, the contralateral breast mean dose was lower in 3DCRT in comparison to IMRT and VMAT p < 0.037. When boost dose was given, 3DCRT plans had produced a lower Max dose to the contralateral lung p < 0.017. Conclusion: The three techniques (3DCRT, IMRT, and VMAT) can meet the clinical dosimetry demands of radiotherapy for left breast cancer after conservative surgery, as long as the routinely OARs only (heart and ipsilateral lung) are reported. Our study showed that 3CDRT can provide a lower dose to the contralateral organs (breast and lung), specially, in case of large breast volumes, no nodal irradiation and when a boost is given.

Perioperative Dental Injuries: A Retrospective Analysis of Documented Injuries at Penn State Hershey Medical Center

Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attributed to anesthetic care at the Penn State Hershey Medical Center. Methods: Data was collected from retrospective chart review of available dental injury records, incident reports, and filed dental claims from January 2008 to June 2014. Results: Forty seven dental injuries were documented amongst 247,323 general anesthetics representing an overall incidence of 0.019%. Seventy percent of injuries occurred in patients with documented pre-existing prosthodontics or poor dentition and largely involved maxillary teeth (68%). Dental fracture (40%) and avulsion (40%) were the most common types of injury. Direct laryngoscopy was used in 60% of cases reporting dental injury;more than one attempt at securing the airway was required in 36% of cases. Total costs related to the injuries were $24347.65. Conclusions: Dental injury is often attributed to the actions of the anesthesiologist. The injury may be unnoticed until after surgery, what makes it difficult to identify the time and mechanism of injury. Our results suggest that the number of attempts at securing an airway is a risk factor for dental injury. Proper preoperative documentation of poor dentition, discussion with the patient about the increased risk of dental injury and detailed documentation of dental injury when it occurs is advised.

Breast Imaging Experiences at Academic Medical Centers during COVID-19: Restructuring, Reopening, and Preparing for Possible Resurgence

Severe acute respiratory syndrome coronavirus 2 has thoroughly reshaped the medical landscape. Much has been written and discussed of the adaptations required by this pandemic, particularly in the realm of elective medical care. While some areas of the country have, in recent weeks, seen a plateau or even a decrease in coronavirus 2019 case-burden, others remain face-to-face with significant ongoing morbidity and mortality. Furthermore, given eased restrictions across numerous states and municipalities, a widespread resurgence of the disease is not precluded. To that end, we have attempted to summarize experiences and best practices in the handling of breast imaging against the backdrop of the novel coronavirus, and we consider future directions.

Implementation of Clinical Video Telemedicine (CVT) within a VA Medical Center Is Cost Effective and Well Received by Veterans

Background: The Veterans Administration (VA) has been using telehealth to enhance Veteran access to high quality VA care for over a decade. Clinical video telehealth (CVT) is one such telehealth tool that allows Veterans the opportunity to be evaluated by specialists at the Indianapolis VA while they actually remain in their community (in their local healthcare setting). Such tools are reported to improve satisfaction by avoiding the need to make the long, stressful, and often costly trips to the Medical Center. Our goal is to describe the results of CVT implementation at the Indianapolis VA. Methods: A retrospective review of the data from 2011-2014 related to the use of CVT at the Indianapolis VA was undertaken. The data collected during this time period included: the number of CVT visits per year by specialty, the number of miles in travel avoided per visit, and patient satisfaction survey data, which are obtained after each CVT visit. Results: A total of 14,708 Veterans have enrolled in our CVT telehealth program since 2011. There were 23,267 visits in 2013. 486,170 miles related to travel were avoided (calculating the number of miles avoided in travel from home to a local satellite site as compared to having to travel from home to the Indianapolis VA). At the current Government reimbursement rate of $0.42/mile, this is expressed in a cost avoidance of $209,053. In total, since 2011, the telehealth CVT program has saved the Government $331,132, a total of 770,075 miles saved in travel for our Veterans. In addition, the CVT program has been very well received by our Veterans with an overall satisfaction score of 96%. Conclusion: Our results indicate that the implementation of CVT is cost effective and is well received by Veterans. Telehealth modalities such as CVT are viable options that enhance Veteran satisfaction by decreasing the time and the costs related to travel while continuing to offer high quality health care.

Clinical characteristics of pediatric cases infected with the SARS-CoV-2 Omicron variant in a tertiary children's medical center in Shanghai,China

Background The number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant has increased.Here,we describe the clinical characteristics of children in a tertiary children's medical center in Shanghai.Methods A total of 676 pediatric coronavirus disease 2019(COVID-19)cases caused by the Omicron variant who were admitted to the Shanghai Children's Medical Center from March 28 to April 30,2022 were enrolled in this single-center,prospective,observational real-world study.Patient demographics and clinical characteristics,especially COVID-19 vaccine status,were assessed.Results Children of all ages appeared susceptible to the SARS-CoV-2 Omicron variant,with no significant difference between sexes.A high SARS-CoV-2 viral load upon admission was associated with leukocytopenia,neutropenia,and thrombocytopenia(P=0.003,P=0.021,and P=0.017,respectively)but not with physical symptoms or radiographic chest abnormalities.Univariable linear regression models indicated that comorbidities(P=0.001)were associated with a longer time until viral clearance,and increasing age(P<0.001)and two doses of COVID-19 vaccine(P=0.001)were associated with a shorter time to viral clearance.Multivariable analysis revealed an independent effect of comorbidities(P<0.001)and age(P=0.003).The interaction effect between age and comorbidity showed that the negative association between age and time to virus clearance remained significant only in patients without underlying diseases(P<0.001).Conclusion This study describes the clinical characteristics of children infected with the Omicron variant of SARS-CoV-2 and calls for additional studies to evaluate the effectiveness and safety of vaccination against COVID-19 in children.

Magnetic resonance-guided focused ultrasound for essential tremor:a prospective,single center,single-arm study

The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.

Quantitative assessment of the impact of a triage physician on the Accreditation Council for Graduate Medical Education resident milestones in the emergency department

The “door-to-doctor” time for patients to be seen by a physician is an increasingly studied metric.Hospitals may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across departments.TPs put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further evaluation.As the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains unclear.We implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

Standard-definition White-light,High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting Colorectal Adenomas:A Multicenter Randomized Controlled Trial

Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.

Philippine retinoblastoma initiative multi-eye center study 2010-2020

AIM:To provide a comprehensive and more representative national data on the disease,especially on treatment options and outcomes,and to determine access of retinoblastoma patients from Luzon,Visayas and Mindanao to eye care,and determine if access is associated with delay in consultation,staging and outcomes.METHODS:Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon,Vizayas and Mindanao from 2010-2020.RESULTS:Totally 636 patients,involving 821 eyes,were included.Majority(57%)were from Luzon and were seen in institutions in Luzon(72%).Annually,58±10 new cases were seen with 71%having unilateral disease.Median delay of consultation remained long at 9(3,17)mo,longest in patients with unilateral disease(P<0.02)and those from the Visayas(P<0.003).Based on the International Retinoblastoma Staging System,only 35%of patients had Stage 1 while 47%already had extraocular disease.Enucleation was the most common treatment received by 484 patients while intravenous chemotherapy was received by 469.There were 250(39%)patients alive,195(31%)dead,85(13%)abandoned,17(3%)refused and 89(14%)with no data.CONCLUSION:This study presents the largest cohort of retinoblastoma patients in the Philippines in terms of patients’and participating institutions’number and geographical location and type of institution(private and public).It also presents more comprehensive data on the treatments used and outcomes(survival,globe salvage,and vision retention rates).Delay in consultation was still long among patients leading to advanced disease stage and lower survival rate.Despite increasing capacity to diagnose and manage retinoblastoma in the country,the delay of consultation remains long primarily due to accessibility issues to eye care institutions especially in the Visayas and financial concerns.The delay was still significant that overall survival rate remain low.

Accurate diagnosis of severe coronary stenosis based on resting magnetocardiography: a prospective, single-center, cross-sectional analysis

OBJECTIVE To evalu ate the role of resting magnetocardiography in identifying seve re coronary artery stenosis in patients with suspected coronary artery disease.METHODS A total of 513 patients with angina symptoms were included and divided into two groups based on the extent of coronary artery disease determined by angiography:the non-severe coronary stenusis group(<70% stenosis) and the severe coronary stenosis group(≥70% stenosis).The diagnostic model was constructed using magnetic field map(MFM) parameters,either individually or in combination with clinical indicators.The performance of the models was evaluated using receiver operating characteristic curves,accuracy,sensitivity,specificity,positive predictive value(PPV) and ne gative predictive value(NPV).Calibration plots and decision curve analysis were performed to investigate the clinical utility and performance of the models,respectively.RESULTS In the severe coronary stenosis group,QR_MCTDd,S_MDp,and TT_(MA)C_(50) were significantly higher than those in the non-severe coronary stenosis group(10,46±10.66 vs,5.11±6.07,P <0.001;7.2±8.64 vs.4.68±6.95,P=0.003;0.32±57.29 vs.0.26±57.29,P <0.001).While,QR_MV_(amp),R_(MA),and T_(MA) in the severe coronary stenosis group were lower(0.23±0.16 vs.0.28±0.16,P<0.001;55.06±48.68 vs.59.24±53.01,P<0.001;51.67±39.32 vs. 60.45±51.33,P <0.001).Seven MFM parameters were integrated into the model,resulting in an area under the curve of 0.810(95% CI:0.765-0.855).The sensitivity,specificity,PPV,NPV,and accurecy were 71.7%,80.4%,93.3%,42.8 %,and 73.5%;respectevely.The combined model exhibited an area under the curve of 0.845(95% CI:0.798-0.892).The sensitivity,specificity,PPV,NPV,and accuracy were 84.3%,73.8%,92.6%,54.6%,and 82.1%;respectively.Calibration curves demonstrate d excellent agreement between the nomogram prediction and actual observation.The decision curve analysis showed that the c ombine d model provided greater net benefit compared to the magnetocardingraphy model.CONCLUSIONS The novel quantitative MFM parameters,whether used individually or in combination with clinical indicators,have been shown to effectively pre dict the risk of severe coronary stenosis in patients presenting with angina-like symptoms.Magnetocardiography,an emerging non-invasive diagnostic tool,warrants further exploration for its potential in diagnosing coronary heart disease.