Taipei Municipal Wanfang Hospital

Chest pain is a common symptom that presents to the emergency department (ED), and its causes range from minor illnesses to serious diseases such as acute coronary syndrome. Accurate and timely diagnosis is essential for the efficient management and treatment of these patients.

This study aims to expand on a model previously developed by the Chi Mei Medical Group (CMMG) Emergency Department in 2020 to predict adverse cardiac events in patients with chest pain. The main goal is to evaluate the accuracy and generalizability of the model through external validation using data from other hospitals.

The initial model for this study was developed using data from three CMMG-affiliated hospitals in southern Taiwan. We utilized four supervised machine learning algorithms, namely random forest, logistic regression, support-vector clustering, and K-nearest neighbor, to predict the risk of acute myocardial infarction within a one month for emergency chest pain patients. The study used the model with the best area under the curve (AUC), recall and precision for external validation. The external validated data source was data collected from three hospitals associated with Taipei Medical University (TMU) in northern Taiwan.

The original best model constructed by CMMG exhibited an AUC of 0.822, an accuracy of 0.740, a recall of 0.741, a precision of 0.566, a specificity of 0.740, and an NPV of 0.861. Subsequently, during the external validation phase, CMMG's top-performing model demonstrated acceptable validation result with TMU's data, achieving an AUC of 0.63, an accuracy of 0.661, a recall of 0.593, a precision of 0.243, a specificity of 0.691, and an NPV of 0.900. While the results indicate that the model's performance varied across different datasets and are not outstanding, the model is still acceptable for clinical application as a preliminary decision-support tool.

This study highlights the importance of external validation to confirm the applicability of the previously developed predictive model in other hospital settings. Although the model shows potential in assessing chest pain patients in the ED, its broad clinical application requires further validation to ensure it can improve patient outcomes and optimize healthcare resource allocation.

Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication.

We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry.

Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes.

Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients.

The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful.

This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high.

Purpose: To investigate the efficacy of an intravesical instillation of hyaluronic acid (HA) combined with epidermal growth factor (EGF) for the treatment of interstitial cystitis (IC) using a lipopolysaccharide (LPS)-induced IC animal model.Methods: A total of 24 female Sprague-Dawley rats were randomized to 4 groups: sham control, IC, HA, and treatment (HA/ EGF) groups. A polyethylene-50 tube was placed inside the bladder of each animal. IC was induced by twice-weekly instillations of LPS for 3 weeks, which resulted in chronic injury of the urothelium. Animals in the sham control group only received saline instillation. Treatment solutions of HA and HA/EGF were given on days 0, 7, and 14 after IC induction (400 μL of HA in a concentration of 0.4 mg/0.5 mL and 400 μL of NewEpi, a commercialized HA/EGF mixture containing 2 μg of EGF and 0.4 mg of sodium hyaluronate). Animals were sacrificed on day 21 for further examinations.Results: The HA/EGF group showed visible improvement in hematuria with a significant reduction of red blood cells in the urine compared to the HA group. Histological examination revealed that HA/EGF treatment reversed the abnormalities developed in IC, including infiltration of inflammatory cells, irregular re-epithelialization, and fibrotic tissue. Moreover, HA/ EGF significantly reduced the levels of proinflammation cytokines (tumor necrosis factor-α, interleukin [IL]-6, and IL-1β) and substantially lowered the elevated oxidative stress biomarker malondialdehyde, yet restored the levels of antioxidant enzymes glutathione peroxidase and superoxide dismutase, with superior results than HA treatment. Cystometry studies indicated that HA/EGF significantly prolonged intercontraction interval and increased micturition volume.Conclusions: HA/EGF has been demonstrated as a more effective treatment for enhancing the urothelium lining and reducing inflammatory changes to alleviate clinical symptoms associated with IC in rats, compared to HA alone.