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Hong-ming Pan,1,* Hong-ling Li,2,* Zhang-shun Shen,2 Hui Guo,2 Qian Zhao,2 Jian-guo Li2 1Graduate School of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China; 2Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian-guo LiDepartment of Emergency Medicine, Hebei General Hospital, No. 348 Heping West Road, Shijiazhuang, 050051, People’s Republic of ChinaTel +86 31185988361Email li_jian_guo3@163.comObjective: The present study aimed to explore the effectiveness of the etiology checklist and process thinking in the differential diagnosis for acute abdominal pain.Methods: A retrospective design was used to include 5,403 patients with acute abdominal pain in the Emergency Department of Hebei Provincial People’s Hospital. The patients with acute abdominal pain between July and December 2017 in whom the etiology checklist and process thinking were not implemented were selected as the traditional group. Those with acute abdominal pain between July and December 2018 in whom the etiology checklist and process thinking were implemented were selected as the process thinking group. The clinical data, such as the emergency length of stay, hospitalization expenses, hospitalization length of stay, diagnostic accuracy, and outcome, were compared between the two groups.Results: For patients at emergency level 2 and above, the average emergency length of stay was shorter in the process thinking group than in the traditional group, while the average emergency length of stay was longer for patients at emergency level 3. For hospitalized patients at emergency level 2 and above and patients at emergency level 3, those in the process thinking group had improved diagnostic accuracy, shorter average hospitalization length of stay, reduced average hospital expenses, and improved outcomes. In the comparison among six physicians, the results in the traditional group were inconsistent and statistically different in terms of the average emergency length of stay and diagnostic accuracy, while the results in the process thinking group tended to be consistent. The differences were not statistically different.Conclusion: The diagnostic model for acute abdominal pain based on the etiology checklist and process thinking could improve the diagnostic accuracy and outcomes for patients with acute abdominal pain.Keywords: acute abdominal pain, emergency diagnosis, lateral thinking, process thinking

Background: Lymph node metastasis (LNM) of lung cancer is an important factor associated with prognosis. Dysregulated microRNAs (miRNAs) are becoming a new powerful tool to characterize tumorigenesis and metastasis. We have developed and validated a miRNA disease signature to predict LNM in lung adenocarcinoma (LUAD). Method: LUAD miRNAs and clinical data from The Cancer Genome Atlas (TCGA) were obtained and divided randomly into training (n = 259) and validation (n = 83) cohorts. A miRNA signature was built using least absolute shrinkage and selection operator (LASSO) (λ = -1.268) and logistic regression model. The performance of the miRNA signature was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). We performed decision curve analysis (DCA) to assess the clinical usefulness of the signature. We also conducted a miRNA-regulatory network analysis to look for potential genes engaged in LNM in LUAD. Result: Thirteen miRNAs were selected to build our miRNA disease signature. The model showed good calibration in the training cohort, with an AUC of 0.782 (95% CI: 0.725-0.839). In the validation cohort, AUC was 0.691 (95% CI: 0.575-0.806). DCA demonstrated that the miRNA signature was clinically useful. Conclusion: The miRNA disease signature can be used as a noninvasive method to predict LNM in patients with lung adenocarcinoma objectively and the signature achieved high accuracy for prediction.

Objective The pathogenesis of sepsis associated encephalopathy (SAE) remains poorly understood. Vagus nerve plays an important role in gut-microbiota-brain axis. This study aimed to investigate whether vague nerve is a key mediator of the impact of intestinal microbiota on SAE. Methods Male rats were randomly divided into four groups (n = 20): SHAM (SH) group, lipopolysaccharide (LPS) group, fecal microbiota transplantation (FMT) +LPS group, and vagotomy (VGX) + LPS + FMT group. The left cervical vagotomy was performed 30 min before LPS administration in LPS + FMT + VGX group. LPS+ FMT and LPS + FMT + VGX groups received nasogastric infusion of feces from healthy donor three times a day. Fecal samples were collected every two days to monitor changes in microbiota composition by 16S rDNA analysis. Brain function was evaluated by behavioral tests and EEG. The levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-10 in brain cortex were detected by ELISA. The expression of Iba-1 in brain cortex was assessed by immunohistochemistry and Western blot analysis. Results Significant modification of microbiota composition, characterized by a profound increase of commensals in the Firmicutes phylum and depletion of opportunistic organisms in the Proteobacteria phylum, was observed in FMT groups compared to LPS group. Furthermore, we identified a reconstituted bacterial community enriched in Firmicutes and depleted of Proteobacteria. In both FMT groups the diversity of the fecal microbiota and the microbiota composition were similar to SH group. LPS mice treated with FMT demonstrated a better spatial memory and less EEG abnormalities, significantly attenuated levels of IL-1β, IL-6, TNF-α, and decreased number of Iba-1 positive microglia in the cortex, but these beneficial effects of FMT were reversed by VGX. Conclusions FMT can change intestinal microbiota in sepsis patients, and vagus nerve is a key mediator between intestinal microbiota and SAE. These findings suggest that FMT and vagus nerve are potential therapy targets for treating SAE.

Radiofrequency ablation (RFA) is a minimally invasive technology for the treatment of liver malignancies and is used as an adjuvant therapy in patients with colorectal liver metastasis (CLM). This study enrolled a total of 49 CLM patients who underwent RFA treatment. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazard model, respectively. Univariate analysis showed that OS was closely correlated with tumor size, frequency of RFA treatment, resection of the liver lesion, and CEA levels before RFA (p p

AIM: To assess the catheterization-associated complications during intraperitoneal chemotherapy (IPCT) for advanced gastric cancer. METHODS: From 1998 to 2002, 80 patients with advanced gastric cancer received a total of 320 courses of IPCT using a large bore central venous catheter and associated complications were analyzed. RESULTS: Catheterization-associated complications occurred in 11 of the 80 patients (13.8%), including abdominal pain caused by catheter in 2 cases (0.63%), insertion failure in 2 cases (0.63%), bowel perforation in 1 case (0.31%) and abdominal pain during chemotherapy in 6 cases (1.88%). No serious complications required surgical intervention. CONCLUSION: IPCT using central venous catheters can be performed safely and simply without severe associated complications.