BACKGROUND This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome (AAS) in the emergency department (ED) and to derive a simplified version suitable for rapid clinical application. METHODS: In this multi-center retrospective cohort study, AAS patient data from three hospitals were analyzed. The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region, with Peking University Third Hospital data serving as the external test set. Four machine learning algorithms—logistic regression (LR), multilayer perceptron (MLP), Gaussian naive Bayes (GNB), and random forest (RF)—were used to develop predictive models based on 34 early-accessible clinical variables. A simplified model was then derived based on five key variables (Stanford type, pericardial effusion, asymmetric peripheral arterial pulsation, decreased bowel sounds, and dyspnea) via Least Absolute Shrinkage and Selection Operator (LASSO) regression to improve ED applicability. RESULTS: A total of 929 patients were included in the modeling cohort, and 210 were included in the external test set. Four machine learning models based on 34 clinical variables were developed, achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85, respectively. The simplified model incorporating five key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78, respectively. Both models showed robust calibration and predictive stability across datasets. CONCLUSION: Both kinds of models were built based on machine learning tools, and proved to have certain prediction performance and extrapolation.

Objective:Currently, there is a lack of targeted training programs for resident physicians in cardiopulmonary resuscitation (CPR) in China. This study aims to establish a stratified training indicator system for resident physicians in CPR that is in line with the medical realities in China.Methods:Expert consultation questionnaires were designed through literature review, group discussions, and surveys. Two rounds of expert consultation were conducted using the modified Delphi method to develop the stratified training indicator system for resident physicians in CPR. Statistical analysis was performed using SPSS 26.0 software and Kendall's coefficient of concordance was used to assess the consistency of expert opinions.Results:A total of 15 experts participated in two rounds of questionnaire consultation, with a positive coefficient of 100.00% and an authority coefficient of 0.91, indicating high expert engagement and authority, thus ensuring the credibility of the results. The coefficient of variation for expert ratings in the first round of questionnaire consultation ranged from 0 to 0.40, with a concordance coefficient of 0.22 ( P<0.001). In the second round of questionnaire consultation, the coefficient of variation for expert ratings ranged from 0 to 0.24, with a concordance coefficient of 0.25 ( P<0.001). The Kendall's coefficient of concordance for expert opinions showed statistically significant differences in both rounds of questionnaire consultation, indicating consensus among experts and reliable results. This system consisted of 6 primary indicators and 32 secondary indicators. Conclusions:Based on the modified Delphi method, this study established a stratified training indicator system for resident physicians in CPR. In the future, based on the research findings, CPR training programs adapted to the medical realities in China will be developed and promoted to validate their scientific and practical value.

Objective:This study aimed to investigate the correlation between the ingested dose of amlodipine and the severity of shock in affected patients by analyzing clinical data from documented cases.Methods:This study respectively included adult patients treated for amlodipine poisoning-induced shock at the emergency department of Peking University Third Hospital between January 2018 and December 2022. Additionally, cases reported in the literature from January 1997 to December 2022 were also included. Patients were categorized into two groups: non-refractory shock and refractory shock. Statistical analysis was conducted on the data between the two groups.Results:This study included a total of 80 patients, with 37 experiencing non-refractory shock patients and 43 presenting with refractory shock patients. Significant differences were observed between the two groups in terms of sex distribution ( P=0.037) and the ingested amlodipine dose ( P=0.001). Through binary logistic regression analysis, the amlodipine dose was identified as an independent predictor of shock severity ( OR=1.43, 95% CI: 1.12-1.84, P=0.005). A subgroup analysis was performed on patients who were poisoned by ingesting amlodipine alone, further confirming the significant dose difference ( P=0.003) between the non-refractory shock and refractory shock categories. The area under the receiver operating characteristic curve (AUC) for predicting refractory shock in patients with amlodipine poisoning was 0.723 (95% CI: 0.613-0.833). The optimal cutoff dose for predicting refractory shock was 347.5 mg, with a sensitivity of 0.651 and a specificity of 0.784. Sensitivity analyses, excluding cases of mixed poisoning, yielded a higher AUC of 0.795 (95% CI: 0.634-0.956), with a slightly adjusted cutoff dose of 350 mg, a sensitivity of 0.867, and a specificity of 0.737. The dose-response relationship table between medication dosage and incidence of refractory shock shows that as the dosage increases, the proportion of refractory shock also increases. Conclusions:In adult patients with amlodipine poisoning, the severity of shock was correlated with the ingested dose of the drug. When the ingested amlodipine dose exceeds 347.5 mg, it is crucial to be cautious of the development of refractory shock.

Objective:Currently, there is a lack of targeted training programs for resident physicians in cardiopulmonary resuscitation (CPR) in China. This study aims to establish a stratified training indicator system for resident physicians in CPR that is in line with the medical realities in China.Methods:Expert consultation questionnaires were designed through literature review, group discussions, and surveys. Two rounds of expert consultation were conducted using the modified Delphi method to develop the stratified training indicator system for resident physicians in CPR. Statistical analysis was performed using SPSS 26.0 software and Kendall's coefficient of concordance was used to assess the consistency of expert opinions.Results:A total of 15 experts participated in two rounds of questionnaire consultation, with a positive coefficient of 100.00% and an authority coefficient of 0.91, indicating high expert engagement and authority, thus ensuring the credibility of the results. The coefficient of variation for expert ratings in the first round of questionnaire consultation ranged from 0 to 0.40, with a concordance coefficient of 0.22 ( P<0.001). In the second round of questionnaire consultation, the coefficient of variation for expert ratings ranged from 0 to 0.24, with a concordance coefficient of 0.25 ( P<0.001). The Kendall's coefficient of concordance for expert opinions showed statistically significant differences in both rounds of questionnaire consultation, indicating consensus among experts and reliable results. This system consisted of 6 primary indicators and 32 secondary indicators. Conclusions:Based on the modified Delphi method, this study established a stratified training indicator system for resident physicians in CPR. In the future, based on the research findings, CPR training programs adapted to the medical realities in China will be developed and promoted to validate their scientific and practical value.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

Objective To systematically evaluate the relation between prognostic nutrition index (PNI) and prognosis of bladder cancer (BC) patients treated with radical cystectomy (RC). Methods We searched the literatures about the relation between PNI and the prognosis of patients treated with radical cystectomy published from the inception to January 30, 2021 in PubMed, Embase, Web of Science, CNKI, Wanfang, VIP and Chinese Medical Journal Database, and used RevMan5.3 software for Meta analysis. Results We included six literatures which comprise a total of 1273 patients. The results showed that there was a significant correlation between low PNI and OS of BC patients treated with RC (HR=2.0, 95%CI: 1.56-2.56), and there was a significant difference in RFS, PFS and DSS between low PNI and BC patients treated with RC (HR=1.93, 95%CI: 1.51-2.48). In the subgroup analysis, there were statistical differences in PNI and the prognosis of BC patients treated with RC between the Chinese group (HR=2.13, 95%CI: 1.62-2.81) and the Japanese group (HR=1.78, 95%CI: 1.08-2.94), and the PNI cutoff value had a good predictive effect on the prognosis of patients in the range of 46.08-51.30. Conclusion There is a significant relation between the level of PNI and OS of bladder cancer patients treated with radical cystectomy. Low PNI can be used as an effective marker to predict the prognosis of patients.

Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1538 children and adolescents (aged < 18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95％ CI. Results Of the 1538 patients, CTs were obtained for 339 patients (22.04％). Forty-nine patients (3.19％) had positive CT results, 8 patients (0.52％) underwent neurosurgery, 2 patients (0.13％) died, and 1 patient (0.07％) may be missed. In this study, CHALICE was applied for 1394 children (90.70％; 95％ CI: 89.24％-92.15％), PECARN for 801 children (52.11％; 95％ CI: 49.62％-54.61％), and CATCH for 325 patients (21.15％; 95％CI: 19.10％-23.19％). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6％(74.2％-98.7％), 100％ (56.1％-100％), and 85.7％ (42.0％-99.2％), respectively; the specificities were 78.1％(75.7％-80.2％), 48.0％ (44.5％-51.5％) and 70.8％ (65.4％-75.6％); positive predictive value were 7.7％ (5.1％-11.3％), 0.9％ (0.4％-1.9％) and 6.1％ (2.5％-13.2％); and negative predictive value were 99.8％ (99.2％-100％), 99.1％ (98.1％-99.6％), and 99.6％ (97.2％-100％), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice.

Tracheal intubation is one of the most important emergency techniques, and it is a key and difficult point in advanced life support training for cardiopulmonary resuscitation. Our treatment is trying to combine standard video with visual laryngoscopes for tracheal intubation teaching. Firstly, the students watch the standard video. Then, the teacher shows how to perform a tracheal intubation by visual laryngo-scope. Finally, the students practice the intubation process on the simulation device. In this way, the teach-ing process is more intuitive, easier to be mastered, more normalized and repeatable. This method is worth to be promoted.

Objective To investigate the risk factors related to persistent unconsciousness in patients with severe traumatic brain injury (sTBI) by way of building a prognosis model.Methods The clinical data of 165 sTBI patients admitted from July 2011 to November 2013 were retrospectively analyzed.The eligible patients were randomly assigned to derivation cohort (n =115) and verification cohort (n =50) by treatment order.Inclusion criteria:(1) age ＞ 15 years; (2) definitive history of head injury; (3) traumatic brain injury confirmed by head computerized tomography or brain MRI; (4) initial Glasgow coma score (GCS) was less than 8; (5) patient's light come or consciousness impairment gradually deteriorating to profound coma on the day of admission.The exclusion criteria were as follows:(1) only a brief loss of consciousness or coma after trauma (coma time ＜ 6 hours) ; (2) post-injury hysteria or dementia causes appearance like coma ; (3) unconsciousness results of status epilepticus which was induced by emotion after injury.Univariate and muhivariable logistic regression were employed to determine the independent predictors of persistent unconsciousness in the derivation cohort,and then prognosis model was established.The Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve were used to assess the capacity of model for discrimination and calibration.Results Logistic regression analysis was used to identify GCS score,neurological complications,diffuse axonal injury (DAI),electrolytes disturbance as the most important predictors of persistent unconsciousness.The model was well calibrated in the derivation cohort (Hosmer-Lemeshow test,x2 =4.380,P =0.496).The model showed good discrimination (area under the receiver operating characteristic curve) in the derivation cohort (0.87; 95％ CI:0.798-0.942) and in the versification cohort (0.90; 95％ CI:0.803-0.997).Conclusions The prognosis model could accurately predict the persistent unconsciousness lasting in sTBI patients despite its certain limitations,and therefore,it has significantly clinical and societal value.

Objective To investigate the value of multi-slice computed tomography angiography (MSCTA)in the detection of intracranial micro-aneurysms(aneurysm≤3 mm in maximal diameter, IMA).Methods The clinical history and images of 826 patients with suspected intracranial aneurysms were retrospectively analyzed.All patients underwent MSCTA on 16-slice row CT before hospitalization(from 2 h to 4 d after symtom onset).All intracranial aneurysms were confirmed by digital subtraction angiography (DSA), three-dimensional rotational angiography (3DRA) or surgery.Two independent radiologists assessed all the images.The MSCTA findings were compared with the DSA/3DRA results.The sensitivity, specificity, and accuracy of MSCTA for diagnosis of IMA was calculated.The diagnostic consistency between DSA/3 DRA and MSCTA was determined by Kappa statistics.The prevalence of multiple aneurysms between the group of patients with IMA and the group of patients without IMA was evaluated by Chi-square test Results A total of 889 aneurysms in 788 of the 826 patients were detected.Among them, 706 patients had single aneurysm and 82 patients had multiple aneurysms.No aneurysms were detected in 38 patients.Among the 212 patients who underwent DSA/3 DRA, 271 aneurysms were found and 232 were IMA.MSCTAdetected 229 IMA.There was 1 false-positive finding and 4 false-negative findings by MSCTA.The sensitivity, specificity and accuracy of MSCTA for IMA was 98.3% (228/232), 97.4% (38/39), 98.2% (266/271).There was excellent agreement between two techniques (Kappa=0.927, P<0.05).The prevalence of multiple aneurysms was 21.2% (45/212) in the patient group with IMA and 6.4% (37/576) in the group without IMA.There was statistically significant difference between the two groups (X~2=36.421, P<0.01).Conclusions The detection value of IMA by MSCTA was high.The cutoff level of diameter of intracranial IMA should be adjusted from 4-5 mm to ≤3 mm.