scholarly journals Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: A Simple Score

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Wael N. Yacoub ◽  
Mikael Petrosyan ◽  
Indu Sehgal ◽  
Yanling Ma ◽  
Parakrama Chandrasoma ◽  
...  
Keyword(s):  
Heart Rate ◽  
Logistic Regression ◽  
Acute Cholecystitis ◽  
High Probability ◽  
Acute Inflammation ◽  
Gallbladder Wall ◽  
Cutoff Score ◽  
Gangrenous Cholecystitis ◽  
Pathological Review ◽  
Low Probability

The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score) was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point), heart rate > 90 beats/min (1 point), male (2 points), Leucocytosis > 13,000/mm3(1.5 points), and ultrasound gallbladder wall thickness>4.5 mm (1 point). The prevalence of gangrenous cholecystitis was 13% in the low-probability (0–2 points), 33% in the intermediate-probability (2–4.5 points), and 87% in the high probability category (>4.5 points). A cutoff score of 2 identified 31 (69%) patients with no acute inflammation (PPV 90%). This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.

scholarly journals The Association of Extreme Tachycardia and Sustained Return of Spontaneous Circulation after Nontraumatic Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Dong Keon Lee ◽  
Eugi Jung ◽  
You Hwan Jo ◽  
Joonghee Kim ◽  
Jae Hyuk Lee ◽  
...  
Keyword(s):  
Heart Rate ◽  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Model ◽  
Vital Sign ◽  
High Probability ◽  
Logistic Regression Model ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Objective. Heart rate (HR), an essential vital sign that reflects hemodynamic stability, is influenced by myocardial oxygen demand, coronary blood flow, and myocardial performance. HR at the time of the return of spontaneous circulation (ROSC) could be influenced by the β1-adrenergic effect of the epinephrine administered during cardiopulmonary resuscitation (CPR), and its effect could be decreased in patients who have the failing heart. We aimed to investigate the association between HR at the time of ROSC and the outcomes of adult out-of-hospital cardiac arrest (OHCA) patients. Methods. This study was a secondary analysis of a cardiac arrest registry from a single institution from January 2008 to July 2014. The OHCA patients who achieved ROSC at the emergency department (ED) were included, and HR was retrieved from an electrocardiogram or vital sign at the time of ROSC. The patients were categorized into four groups according to the HR (bradycardia (HR < 60), normal HR (60 ≤ HR ≤ 100), tachycardia (100 < HR < 150), and extreme tachycardia (HR ≥ 150)). The primary outcome was the rate of sustained ROSC and the secondary outcomes were the rate of one-month survival and six-month good neurologic outcome. Results. A total of 330 patients were included. In the univariate logistic regression model, the rate of sustained ROSC increased by 17% as HR increased by every 10 beats per minute (bpm) (odds ratio (OR), 1.171; 95% confidence interval (CI), 1.077–1.274, p<0.001). In the multivariate logistic regression model, extreme tachycardia was independently associated with a high probability of sustained ROSC compared to normal heart rate (OR, 15.96; 95% CI, 2.04–124.93, p=0.008). Conclusion. Extreme tachycardia (HR ≥ 150) at the time of ROSC is independently associated with a high probability of sustained ROSC in nontraumatic adult OHCA patients.

scholarly journals Correlation between Non-Alcoholic Fatty Liver Disease (NAFLD) fibrosis score (NFS) with Left Ventricular Mass Index (LVMI) in patients with NAFLD

2021 ◽  
Vol 7 (2) ◽  
pp. 79-85
Author(s):  
Tri Ferry Rachmatullah ◽  
Cecilia Oktaria Permatadewi ◽  
Hesti Triwahyu Hutami ◽  
Charles Limantoro ◽  
Hery Djagat Purnomo, MD, PhD
Keyword(s):  
Logistic Regression ◽  
Left Ventricular Mass ◽  
High Probability ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
Fibrosis Score ◽  
Ventricular Mass Index ◽  
Ventricular Mass ◽  
Nafld Fibrosis Score ◽  
Low Probability

Background: Cardiovascular-related mortality is a major concern in NAFLD. Advanced fibrosis was known to be associated with cardiovascular diseases. NAFLD Fibrosis Score (NFS) is used to identify the development of liver fibrosis in NAFLD patients. Left ventricular mass index (LVMI) is a sign of subclinical cardiovascular complications in NAFLD. The correlation between NAFLD fibrosis score with LVMI in NAFLD patients is not fully established.Objective: To analyze the correlation between NAFLD fibrosis score with LVMI  in NAFLD patients.Methods: A cross-sectional study of NAFLD patients in Kariadi Hospital Indonesia. NFS was done using a formula based on clinical and biochemical parameters. LVMI was measured with echocardiography. Pearson’s, Mann-Whitney, and logistic regression were used for analysis.Results: A total of 64 patients with primary NAFLD were enrolled, 54.7% males and 45.3% females. Mean age was 52,8 ± 10,5 years (30-77 years). Based on NFS criteria, high probability group was the highest (50%), followed by intermediate probability group (34,4%) and low probability group (15,6%). Highest increase in LVMI was obtained in the high probability group (93,8%), followed by intermediate probability (59,1%), and low probability group (10%) respectively. There was significant correlation between NFS and LVMI (P 0,002). Logistic regression showed that NFS has a more significant correlation with LVMI compared to gender (P=0,002).Conclusion: NFS is a non‐invasive liver fibrosis scores which independently corelated with Left ventricular mass index (LVMI), a marker of cardiovascular abnormality.

SARS-CoV-2 Spike Glycoprotein and ACE2 interaction reveals modulation of viral entry in wild and domestic animals

2020 ◽  
Author(s):  
Manas Ranjan Praharaj ◽  
Priyanka Garg ◽  
Veerbhan Kesarwani ◽  
Neelam A Topno ◽  
Raja Ishaq Nabi Khan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Viral Entry ◽  
High Probability ◽  
Logistic Regression Model ◽  
Binding Domain ◽  
Human Interaction ◽  
Binding Parameters ◽  
Viral Pathogen ◽  
Low Probability

Background: SARS-CoV-2 is a viral pathogen causing life-threatening disease in human. Interaction between spike protein of SARS-CoV-2 and ACE2 receptor on the cells is a potential factor in the infectivity of a host. The interaction of SARS-CoV-2 spike receptor-binding domain with its receptor - ACE2, in different hosts was evaluated to understand and predict viral entry. The protein and nucleotide sequences of ACE2 were initially compared across different species to identify key differences among them. The ACE2 receptor of various species was homology modeled (6LZG, 6M0J, and 6VW1 as a reference), and its binding ability to the spike ACE2 binding domain of SARS-CoV-2 was assessed. Initially, the spike binding parameters of ACE2 of known infected and uninfected species were compared with each Order (of animals) as a group. Finally, a logistic regression model vis-a-vis the spike binding parameters of ACE2 (considering data against 6LZG and 6M0J) was constructed to predict the probability of viral entry in different hosts. Results: Phylogeny and alignment comparison did not lead to any meaningful conclusion on viral entry in different hosts. Out of several spike binding parameters of ACE2, a significant difference between the known infected and uninfected species was observed for six parameters. However, these parameters did not specifically categorize the Orders (of animals) into infected or uninfected. The logistic regression model constructed revealed that in the mammalian class, most of the species of Carnivores, Artiodactyls, Perissodactyls, Pholidota, and Primates had high probability of viral entry. However, among the primates, African Elephant had low probability of viral entry. Among rodents, hamsters were highly probable for viral entry with rats and mice having a medium to low probability. Rabbits have a high probability of viral entry. In Birds, ducks have a very low probability, while chickens seemed to have medium probability and turkey showed the highest probability of viral entry. Conclusions: Most of the species considered in this study showed high probability of viral entry. This study would prompt us to closely follow certain species of animals for determining pathogenic insult by SARS-CoV-2 and for determining their ability to act as a carrier and/or disseminator.

Spatial suppression due to statistical regularities is driven by distractor suppression not by target activation

2018 ◽  
Author(s):  
Michel Failing ◽  
Benchi Wang ◽  
Jan Theeuwes
Keyword(s):  
High Probability ◽  
Target Location ◽  
Target Selection ◽  
Visual Space ◽  
Alternative Interpretation ◽  
Distractor Location ◽  
Target Presentation ◽  
Statistical Regularities ◽  
Low Probability ◽  
Presentation Experiment

Where and what we attend to is not only determined by what we are currently looking for but also by what we have encountered in the past. Recent studies suggest that biasing the probability by which distractors appear at locations in visual space may lead to attentional suppression of high probability distractor locations which effectively reduces capture by a distractor but also impairs target selection at this location. However, in many of these studies introducing a high probability distractor location was tantamount to increasing the probability of the target appearing in any of the other locations (i.e. the low probability distractor locations). Here, we investigate an alternative interpretation of previous findings according to which attentional selection at high probability distractor locations is not suppressed. Instead, selection at low probability distractor locations is facilitated. In two visual search tasks, we found no evidence for this hypothesis: neither when there was only a bias in target presentation but no bias in distractor presentation (Experiment 1), nor when there was only a bias in distractor presentation but no bias in target presentation (Experiment 2). We conclude that recurrent presentation of a distractor in a specific location leads to attentional suppression of that location through a mechanism that is unaffected by any regularities regarding the target location.

Validation of a machine learned model to predict the diagnosis of myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Doudesis ◽  
J Yang ◽  
A Tsanas ◽  
C Stables ◽  
A Shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
High Probability ◽  
Cardiovascular Death ◽  
Gradient Boosting ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Low Probability ◽  
One Year

Abstract Introduction The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown. Methods In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively). Results In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P&lt;0.001). Conclusions In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events. Performance of MI3 at example thresholds Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council

scholarly journals Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Kojiro Omiya ◽  
Kazuhiro Hiramatsu ◽  
Yoshihisa Shibata ◽  
Masahide Fukaya ◽  
Masahiro Fujii ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnetic Resonance ◽  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Gallbladder Wall ◽  
High Signal ◽  
Mri Findings ◽  
Open Conversion ◽  
Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

scholarly journals Successful treatment of emphysematous cholecystitis by laparoscopic surgery

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Hitoshi Funahashi ◽  
Tetsuya Komori ◽  
Naoki Sumita
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Cholecystitis ◽  
Rare Variant ◽  
Successful Treatment ◽  
Gold Standard ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Emphysematous Cholecystitis ◽  
Bacterial Proliferation ◽  
Calot’S Triangle

Abstract Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

Effect of B-ultrasound-guided nerve block on nerve block on analgesia and sedation in patients with acute cholecystitis undergoing puncture and drainage

2021 ◽  
Vol 7 (5) ◽  
pp. 3022-3028
Author(s):  
Fei Guo ◽  
Yongjun Wang ◽  
Shenghui Liu ◽  
Junrong Cao
Keyword(s):  
Oxidative Stress ◽  
Heart Rate ◽  
Acute Cholecystitis ◽  
Nerve Block ◽  
Sedation Score ◽  
The Body ◽  
Control Group ◽  
Observation Group ◽  
Ultrasound Guided ◽  
Total Antioxidant

To investigate the effect of B-ultrasound-guided nerve block on analgesia and sedation in patients with acute cholecystitis undergoing puncture and drainage. Methods 96 patients with acute cholecystitis who underwent puncture and drainage from May 2018 to November 2020 were randomly divided into control group and observation group by random number table method, with 48 cases in each group. The patients in the control group were anesthetized by local infiltration. The patients in the observation group were anesthetized by B-ultrasound-guided nerve block. Heart rate, blood pressure, analgesia score, sedation score, and oxidative stress level were compared between the two groups. Results At the time of puncture (T2), heart rate (HR) and mean arterial pressure (MAP) in the two groups were significantly lower than those before operation (T1) (P<0.05); at the end of operation (T3), HR and MAP in the control group were significantly higher than those at T1 (P<0.05); at T2, HR and MAP in the observation group were significantly higher than those in the control group (P<0.05); at T3, HR and MAP in the observation group were significantly lower than those in the control group (P<0.05). AtT2 and T3, Ramsay sedation score in both groups was significantly lower than that at T1 (P<0.05), while Ramsay score in the observation group was significantly higher than that in control group (P<0.05); atT2 and T3, visual analog scale (VAS) pain score in both groups was significantly higher than that at T1 (P<0.05), while VAS score in the observation group was significantly lower than that in the control group (P<0.05). After operation, the levels of serum malondialdehyde (MDA) and superoxide dismutase (SOD) in the two groups were significantly higher than those before operation (P<0.05), and the levels of serum total antioxidant capacity (T-AOC) were significantly lower than those before operation (P<0.05); after operation, the levels of serum SOD and T-AOC in the observation group were significantly higher than those in the control group (P<0.05), and the levels of MDA in the observation group were significantly lower than those in the control group (P>0.05). Conclusion B-ultrasound-guided nerve block anesthesia can maintain the stable hemodynamic index of patients with acute cholecystitis undergoing puncture and drainage therapy, improve the analgesic and sedative effect and reduce the oxidative stress response of the body.

Frequency of enforcement is more important than the severity of punishment in reducing violation behaviors

2021 ◽  
Vol 118 (42) ◽  
pp. e2108507118
Author(s):  
Kinneret Teodorescu ◽  
Ori Plonsky ◽  
Shahar Ayal ◽  
Rachel Barkan
Keyword(s):  
High Probability ◽  
Real Life ◽  
Expected Value ◽  
Relative Importance ◽  
Decisions From Experience ◽  
High Severity ◽  
Low Probability ◽  
Violation Rate ◽  
Severity Of Punishment ◽  
Enforcement Policies

External enforcement policies aimed to reduce violations differ on two key components: the probability of inspection and the severity of the punishment. Different lines of research offer different insights regarding the relative importance of each component. In four studies, students and Prolific crowdsourcing participants (Ntotal = 816) repeatedly faced temptations to commit violations under two enforcement policies. Controlling for expected value, we found that a policy combining a high probability of inspection with a low severity of fines (HILS) was more effective than an economically equivalent policy that combined a low probability of inspection with a high severity of fines (LIHS). The advantage of prioritizing inspection frequency over punishment severity (HILS over LIHS) was greater for participants who, in the absence of enforcement, started out with a higher violation rate. Consistent with studies of decisions from experience, frequent enforcement with small fines was more effective than rare severe fines even when we announced the severity of the fine in advance to boost deterrence. In addition, in line with the phenomenon of underweighting of rare events, the effect was stronger when the probability of inspection was rarer (as in most real-life inspection probabilities) and was eliminated under moderate inspection probabilities. We thus recommend that policymakers looking to effectively reduce recurring violations among noncriminal populations should consider increasing inspection rates rather than punishment severity.

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

2018 ◽  
Vol 35 (10) ◽  
pp. 1032-1038 ◽  
Author(s):  
Aaron S. Weinberg ◽  
William Chang ◽  
Grace Ih ◽  
Alan Waxman ◽  
Victor F. Tapson
Keyword(s):  
Pulmonary Embolism ◽  
Chest Radiograph ◽  
High Probability ◽  
Hemodynamic Instability ◽  
X Rays ◽  
X Ray ◽  
Abnormal Chest ◽  
Chest X Ray ◽  
Low Probability ◽  
Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

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