Objective:To establish and validate a nomogram model for early prediction of the risk of acute pancreatitis (AP) progressing to severe acute pancreatitis (SAP).Methods:CT signs and clinical laboratory parameters of 361 AP patients admitted to our Hospital from January 2016 to July 2022 were retrospectively collected. There were 221 males (61.2%) and 140 females (38.8%). According to the Atlantic score, all patients were divided into the SAP group (64 cases) and the non-SAP (NSAP) group (297 cases). Univariate analysis was used to screen out variables with statistically significant differences. Multivariate Logistic regression analysis was used to screen out the independent risk factors of SAP, and finally a nomogram prediction model was established. Receiver operating characteristic (ROC) curve, calibration curve and decision curve (DCA) were used to evaluate the predictive efficacy, accuracy and clinical practicability of the model, and Bootstrap method was used to verify the model internally.Results:Univariate analysis and multivariate Logistic regression analysis showed that pleural effusion ( OR=7.353, 95% CI: 3.344-16.170), posterior pararenal space (PPS) involvement ( OR=3.149, 95% CI: 1.314-7.527), serum creatinine concentration (Cr) ( OR=1.027, 95% CI: 1.017-1.038) and serum calcium concentration (Ca 2+) ( OR=0.038, 95% CI: 0.009-0.166) were independent risk factors for SAP ( P<0.05). A Nomogram model was established based on these four factors. The area under the ROC curve (AUC) of this model was 0.905 (95% CI: 0.869-0.933), indicating high predictive efficiency. Internal verification showed that the model had good accuracy in predicting SAP, and C-index was 0.90. DCA analysis showed that the model had high clinical practicability. Conclusions:The Nomogram model combining pleural effusion, PPS involvement, Cr and Ca 2+ had a good effect on early prediction of SAP, which could provide a new reference tool for clinical diagnosis and treatment.

Objective To investigate the relationship between the ratio of signal intensity of fluid-attenuated inversion recovery (FLAIR)sequence lesion side／contralateral side and the onset time of acute ischemic stroke. Methods Forty-three consecutive patients with acute ischemic stroke admitted to the Department of Neurology,Dongguan Hospital of Traditional Chinese Medicine from November 2016 to January 2018 were enrolled retrospectively. They were all first onset and were diagnosed by MRI,and the onset time was 0. 5 to 6. 0 h. According to the time window of effective rescue of the penumbra,43 patients were divided into a ≤4. 5 h group (n＝19)and a ＞4. 5-6. 0 h group (n＝24). The signal intensity values of FLAIR, diffusion-weighted imaging,signal intensity of apparent diffusion coefficient sequence on the lesion side and contralateral brain tissue in the two groups of patients were measured respectively,and the relative signal intensity (RSI)was calculated and compared between the two groups. Taking RSI as the dependent variable and onset time as the independent variable,a general linear regression analysis was performed. Results (1)In FLAIR sequence,the signal intensity value and RSI value of patients in the≤4. 5 h group were lower than those in the ＞4. 5-6. 0 h group. There were significant differences between the 2 groups (disease side signal intensity value:531 ± 109 vs. 681 ± 306,t ＝2. 04;RSI value:1. 19 ± 0. 13 vs. 1. 45 ± 0. 18,t＝5. 29,all P＜0. 05). There was no significant difference in the signal intensity values on the contralateral sides between the two groups (P＞0. 05). (2)In diffusion weighted imaging and apparent diffusion coefficient sequence,there were no significant differences in the signal intensity value and RSI value on the disease side and the contralateral side between the the≤4. 5 hours group and the ＞4. 5-6. 0 h group (all P＞0. 05). (3)In the FLAIR sequence,with the prolongation of the time of the disease,RSI gradually increased,and was positively correlated (r＝0. 756,P＜0. 01). Conclusions The quantitative measurement of the disease side／contralateral side of FLAIR sequence might reflect the onset time of acute ischemic stroke. Its RSI value increased with the prolonged onset time.

As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.