Northern Hospital

Metabolic syndrome is common among infertile women and is closely related to insulin resistance (IR). Triglyceride glucose-body mass index (TyG BMI) is a newly explored indicator of IR. Currently, the association between TyG BMI and live birth outcomes has been studied in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF), However, there is a lack of research on the general population of frozen-thawed embryo transfer (FET). This is a cohort study based on data from a reproductive center in China from January 2016 to December 2023. The association between TyG BMI and live birth outcomes in women with clinical pregnancy after FET was evaluated using generalized additive model(GAM) and threshold saturation effect analysis. A total of 3,709 cycles resulted in clinical pregnancy after FET, with a mean age of 32.76 ± 3.99 years. Among these, 2860 cycles (77.11%) resulted in live births, with a mean age of 32.46 ± 3.81 years. After adjusting for confounding factors, TyG BMI was negatively correlated with live birth outcomes (OR = 0.994, 95% CI: 0.992, 0.996; p < 0.001). GAM analysis showed that the smooth term of TyG BMI was significant (p < 0.001), indicating a nonlinear relationship. Threshold effect analysis identified a breakpoint (K) of 176.849 (95% CI: 168.097, 186.702). When TyG BMI was below 176.849, The increase in the live birth rate was not significant, but when TyG BMI exceeded 176.849, for each additional unit, the chance of a live birth decreases by approximately 0.8% (OR = 0.992, p < 0.001). Our findings suggest that a higher TyG BMI is negatively associated with live birth outcomes in women with clinical pregnancy after FET. Further research is needed to validate these findings.

The Argatroban Plus Recombinant Tissue-Type Plasminogen Activator for Acute Ischemic Stroke (ARAIS) trial did not show the benefit of argatroban as an adjunct in patients with acute ischemic stroke who received intravenous alteplase. This post hoc exploratory analysis aimed to determine whether the circadian rhythm can affect the efficacy of argatroban as an adjunct in this population. From the per-protocol population of the ARAIS trial, patients were divided into 2 groups based on the beginning time of intravenous thrombolysis: daytime (06:00-17:59) and nighttime (18:00-05:59) groups. Each group was divided into argatroban plus alteplase and alteplase alone groups. The primary outcome was excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0 to 1 at 90 days. The safety outcome was symptomatic intracerebral hemorrhage (sICH). Among 692 patients from the per-protocol analysis, 489 were in the daytime group, and 203 in the nighttime group. In the daytime group, the proportion of patients with an excellent functional outcome was 60.5% (144/238) in the argatroban plus alteplase group versus 66.9% (168/251) in the alteplase-alone group, respectively, without significant difference between two groups (adjusted odds ratio [aOR] = 1.19; 95% CI 0.80-1.78; p = 0.40). In the nighttime group, argatroban plus alteplase was significantly associated with higher proportion of excellent functional outcome compared with alteplase alone (75.9% vs 60.3%; aOR = 0.47; 95% CI 0.24-0.93; p = 0.03). An interaction effect was found between intervention (argatroban plus alteplase or alteplase only) by different treatment period on primary outcome (P for interaction = 0.02). For safety outcomes, no significant differences in sICH rates were observed between treatment groups within either time stratum. This is the first report that suggested a potential association between argatroban and a higher rate of excellent functional outcome in patients with acute ischemic stroke who received intravenous alteplase during the nighttime. This finding requires further validation in future studies. ClinicalTrials.gov Identifier: NCT03740958.

ABSTRACTNecrotising fasciitis (NF) is a rapidly progressing, life‐threatening infection with mortality rates that are exceedingly high. Despite the notably high risks of developing NF in patients with diabetes mellitus (DM), factors associated with mortality in this population are poorly understood. Therefore, to determine at‐risk patients and to improve overall clinical outcomes via hastening management, the objective of this systematic review is to determine what factors are associated with mortality for diabetic patients with NF. This systematic review followed the PRISMA guidelines. Patient data pertaining to outcomes and surgical management were extracted, and mortality rates were evaluated. Studies were assessed for quality using the Alberta Heritage Foundation for Medical Research (AHFMR) and Risk of Bias tool. A total of 25 studies were reviewed, covering 7879 patients with NF and DM with a 23.5% mortality rate. The most prevalent comorbidities among those who died included chronic kidney disease (15.95%), hypertension (9.42%) and obesity (9.02%). While limbs were the most common location for the disease, NF in the trunk and groin regions showed the highest mortality rates at 62.07%. Among those who died, common complications were acute renal failure (13.41%), pulmonary issues (20.41%) and septicaemia (12.80%). Mortality rates by surgical management were fasciotomy (42.9%), surgical debridement (40.68%) and amputation (9.09%). Mortality was comparable between patients with NF and DM (23.54%) and those with NF alone (23.61%). Although DM may not independently increase mortality, it can worsen outcomes when combined with other comorbidities, indicating a need for clearer clinical guidance.

Pancreatic cancer is often diagnosed at an advanced stage with poor survival. Risk assessment tools have been developed to aid early diagnosis of pancreatic cancer in primary care settings (QCancer®, electronic Risk Assessment Tool [eRAT], and the Queensland Institute of Medical Research [QIMR] Berghofer Pancreatic Cancer Decision Support Tool [QPaC Tool]) but have not been validated in the Australian setting. To estimate and compare the performance of these tools for identifying patients with undiagnosed pancreatic cancer using Australian primary care data. A cohort study was conducted using linked primary care and cancer registry data from Victoria, Australia. Patients presenting to primary care with signs and/or symptoms included in the tools (recorded in the primary care 'reason for encounter') were included. Diagnostic accuracy statistics for each tool (and their individual signs and symptoms) were compared. Patients with pancreatic cancer were more likely (P<0.001) to present with new-onset diabetes, jaundice, and unexpected weight loss pre-diagnosis than patients without pancreatic cancer. The most common pre-diagnostic presentations in patients with pancreatic cancer were jaundice (29.0%), abdominal pain (25.6%), change in bowel habits (17.6%), and new-onset diabetes (14.8%). Jaundice, steatorrhoea, and pancreatitis had the highest positive predictive values (PPV) for pancreatic cancer (1.96%, 1.77%, and 0.89%, respectively). Among the tools, eRAT had the highest PPV of 1.37% (95% confidence interval [CI] = 1.12 to 1.66); the PPV for QPaC was 1.01% (95% CI = 0.82 to 1.22) and QCancer® was 0.8% (95% CI = 0.54 to 1.15). When applied to Australian primary care data, none of the tools were strongly predictive of pancreatic cancer. New diagnostic models incorporating additional data could potentially improve their predictive performance.

Background:The prognostic significance of resting heart rate (HR) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) after endovascular treatment (EVT) remains to be elucidated.Objectives:To determine whether HR is differentially associated with functional outcomes in patients dichotomized by anterior (ACS) or posterior circulation stroke (PCS) after successful reperfusion.Design:A multicenter retrospective cohort study.Methods:We retrospectively analyzed consecutive successfully recanalized LVO-AIS patients with complete HR recordings at admission, 30 min, 12 h, 24 h, and 48 h post-EVT. A good outcome was defined as modified Rankin Scale (mRS) 0–2 for ACS or mRS 0–3 for PCS at 3 months. Binary logistic regression and receiver operating characteristic analyses were used to assess associations and predictive performance.Results:Among 505 patients (362 ACS, 143 PCS), lower HR at 12, 24, and 48 h post-EVT was independently associated with good outcomes in both groups. HR showed higher predictive accuracy for PCS (AUC: 0.872–0.885) than for ACS (AUC: 0.732–0.762).Conclusion:HR following EVT independently predicts functional outcome in LVO patients, demonstrating stronger predictive value for PCS than ACS. These results highlight the potential of HR monitoring in post-EVT management.

Opioid-based epidural analgesia, while effective, is frequently associated with maternal side effects such as pruritus and potential central sensitisation. Esketamine provides rapid analgesic and antidepressant effects at subanesthetic doses. We compared esketamine with sufentanil both added to 0.083% ropivacaine focusing on efficacy, maternal safety, and postpartum depression outcomes. In this single-centre, randomised, double-blind, controlled trial, 200 nulliparous parturients (ASA I-II, 18-40 years, cervical dilatation 2-3cm) requesting epidural analgesia were equally allocated to receive patient-controlled epidural analgesia (PCEA) containing either sufentanil 0.3µg/ml or esketamine 0.3mg/ ml combined with ropivacaine 0.083%. Primary outcomes included analgesic onset time, maximum sensory block level and Edinburgh Postnatal Depression Scale (EPDS) at 42 days postpartum. Secondary outcomes included adverse events, VAS scores and neonatal Apgar scores. Between December 2024 and May 2025, 197 participants completed the study (98 of sufentanil, 99 of esketamine). Baseline characteristics were comparable. Esketamine significantly reduced onset time (5.9 ± 0.6min vs. 9.8 ± 1.7min, P < 0.001), achieved a predominant T8 sensory block (67.7% vs. 45.9%, P < 0.001) and lowered EPDS scores (5.6 ± 1.3 vs. 9.8 ± 1.5, P < 0.001). Total ropivacaine consumption throughout the first stage of labour was 17% lower in the esketamine group (12.4ml [10.3-14.5] vs. 14.9ml [12.6-17.2]; P < 0.001). EPDS scores at 42 days were lower with esketamine (5.6 ± 1.3 vs. 9.8 ± 1.5, P < 0.001). The incidence of probable postpartum depression (EPDS ≥13) was also reduced in the esketamine group (4.0% vs. 18.4%, P = 0.003). Maternal adverse events such as pruritus (3.0% vs. 45.9%), hypotension (4.0% vs. 38.8%), and urinary retention (3.0% vs. 22.4%) were markedly reduced with esketamine (all P < 0.001). VAS and Apgar scores were similar between groups. Esketamine-ropivacaine epidural analgesia provides faster onset, fewer maternal side effects, and potential antidepressant benefits compared with sufentanil-ropivacaine. These findings support esketamine as a promising opioid-sparing strategy in obstetric anaesthesia. Chinese Clinical Trial Registry, ChiCTR2500109086. Retrospectively registered on September 11, 2025.

Purpose To develop and validate a deep learning (DL) model for automated assessment of coronary stenosis in vessels with heavily calcified plaques at coronary CT angiography (CCTA), using quantitative coronary angiography as the reference standard. Materials and Methods A total of 10 101 CCTA examinations (June 2017-December 2020) from three tertiary hospitals in China were retrospectively collected for DL model development. External testing dataset 1 included 442 CCTA examinations (Agatston score > 300) from two independent hospitals (January 2021-May 2022) for performance evaluation. The separate external testing dataset 2 of 120 CCTA examinations was used for a reader study assessing whether DL assistance improved diagnostic accuracy among junior, attending, and senior radiologists. External testing dataset 3 included 150 prospectively collected CCTA examinations (June-July 2023) that were analyzed to compare model performance against clinical reports, simulating real-world deployment. Model diagnostic performance was assessed using receiver operating characteristic analysis, with quantitative coronary angiography as the reference. Results In external testing dataset 1, specificities for detecting 50% or more stenosis were 78%, 72%, and 48% and the areas under the receiver operating characteristic curve (AUC) were 0.89, 0.90, and 0.87 at the segment, vessel, and patient levels, respectively. In external testing dataset 2, DL assistance improved radiologist specificity by 7%-11% (P < .001) with improving AUC and increased interreader agreement (Δκ = 0.155-0.228; P < .05). In external testing dataset 3, the model demonstrated 53% specificity and a higher AUC versus clinical reports (0.91 vs 0.76; P < .001). Conclusion The proposed DL model accurately detected coronary stenosis of heavily calcified plaques at CCTA and improved diagnostic performance of radiologists. Keywords: CT Angiography, Cardiac, Heart, Arteriosclerosis, Calcifications, Calculi, Quantification, Diagnosis Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. See also commentary by Maiter and Alabed in this issue.

This review explored the role of digital health in managing rheumatoid arthritis (RA), assessing interventions such as telemedicine, mobile apps, artificial intelligence, and electronic health records. A search of PubMed and the Cochrane Library yielded 976 articles, of which 10 met the inclusion criteria (six randomized controlled trials (RCTs) and four systematic reviews). Half of the RCTs showed improved outcomes, while the others found no significant benefit, and the systematic reviews highlighted substantial heterogeneity across interventions. Overall, digital health shows promise in RA care, but the mixed evidence underscores the need for larger, methodologically robust studies to clarify its effectiveness and guide integration into clinical practice.