Medicine
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Observational Study
Ultrasound-guided popliteal sciatic nerve block for surgical anesthesia in wound care patients with ongoing anticoagulant/antiaggregant therapy: A single-center, prospective study.
Ultrasound-guided peripheral nerve blocks may be a good alternative in patients under antithrombotic drugs. We evaluated the efficacy of ultrasound-guided popliteal sciatic nerve block in patients undergoing lower extremity wound debridement of whom antithrombotic drugs could not be stopped. We focused on hemorrhagic complications related to sciatic nerve block. ⋯ Mean block onset time was 16.27 ± 5.69 minutes. Mean postoperative analgesia time was 19.5 ± 11.22 hours. Sciatic nerve block under ultrasound guidance using in-plane technique was safe and provided sufficient surgical anesthesia and postoperative analgesia for lower extremity wound debridement surgery in patients on antithrombotic drugs.
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The aim of this study was to develop a machine-learning prediction model for AKI after craniotomy and evacuation of hematoma in craniocerebral trauma. We included patients who underwent craniotomy and evacuation of hematoma due to traumatic brain injury in our hospital from January 2015 to December 2020. Ten machine learning methods were selected to model prediction, including XGBoost, Logistic Regression, Light GBM, Random Forest, AdaBoost, GaussianNB, ComplementNB, Support Vector Machines, and KNeighbors. ⋯ The AdaBoost model showed an AUC of 0.909 (95% CI, 0.849-0.970) in the validation cohort. Although there was an underestimated acute kidney injury risk for the model in the calibration curve, there was a net benefit for the AdaBoost model in the decision curve. Our machine learning model was evaluated to have a good performance in the validation cohorts and could be a useful tool in the clinical practice.
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Preeclampsia is one of the main causes of maternal morbidity and mortality worldwide. Even though preeclampsia is the most prevalent medical complication of pregnancy, it predominantly affects Black women when compared with other ethnicities. APOL1 G1 and G2 risk alleles are genetic risk factors for hypertension and more recently have been associated to the risk of developing preeclampsia. ⋯ This is the first Latin American report of an underage patient with a hypertensive crisis of pregnancy associated with a G1/G2 high risk genotype and a verified matrilineal genetic ancestry represented by a haplogroup L3b. This case reflects the importance of considering genetic predisposition in the context of preeclampsia. A stratified approach to preeclampsia management that acknowledges genetic factors harbors the potential to significantly diminish the maternal morbidity and mortality entwined with this condition.
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Observational Study
A nomogram for predicting coronary artery lesions in patients with Kawasaki disease.
As an acute systemic vasculitis, Kawasaki disease (KD) could develop coronary artery lesions (CAL) sometimes. However, its etiology was still unidentified. This study was to construct a predictive model based on clinical features and laboratory parameters, and then perform a rapid risk assessment of CAL. ⋯ In the verification set, the area under the curve was 0.798. Younger age, fever days ≥ 10, lower hemoglobin and albumin levels, higher C-reactive protein levels were independent risk factors for CAL in KD patients. The predictive nomogram constructed utilizing 5 relevant risk factors could be conveniently used to facilitate the individualized prediction of CAL in KD patients.
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This study aims to investigate the factors affecting the stone-free rate (SFR) of flexible ureteroscopy and laser lithotripsy (fURSL) for renal stones and establish predictive models by identifying their prognostic factors. We retrospectively examined 252 patients with renal stones who were treated with fURSL between July 2020 and April 2022. We analyzed the relationship between the patient's clinical data (sex, age, and body mass index), stone status (side, size, location, stone/transverse process pixel ratio [STPR], and the CT value of stone [SCTV]), and SFR to determine the relevant factors and analyze their influence. ⋯ After 1000 resamples and internal self-validation, the C-indices of models 1 and 2 were 0.924 and 0.895, respectively, showing that the stone clearance predicted by the nomogram matched the actual situation. Stone location, size, and density (SCTV and STPR) were significant predictors of SFR after fURSL. The scoring system based on these factors may be used to guide optimal treatment strategy selection.