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Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

The D-dimer level is a sensitive but nonspecific marker of thrombosis D-dimer testing is useful for excluding venous thromboembolism (VTE), where a low D-dimer level helps exclude deep vein thrombosis (DVT) and pulmonary embolism (PE). However, elevated levels are nonspecific and may occur with infection, cancer, pregnancy, and older age. Results can be combined with clinical pretest probability to avoid unnecessary imaging. For hemodynamically stable patients with suspected PE, Wells' criteria or the Simplified Revised Geneva Score can guide interpretation. D-dimer levels may be used to identify patients at low risk of recurrent VTE who can discontinue anticoagulation. When applying the HERDOO2 criteria, choice of D-dimer assay is critical. The HERDOO2 criteria were validated using only 1 commercially available assay, while using other assays may misclassify 14% to 20% of patients, potentially misestimating recurrence risk. Clinicians should interpret HERDOO2 results cautiously if not using the specific assay used for validation. D-dimer levels rise in pregnancy, which limits specificity for diagnosing PE.

We show that for every$\\eta \\gt 0$every sufficiently large$n$-vertex oriented graph$D$of minimum semidegree exceeding$(1+\\eta )\\frac k2$contains every balanced antidirected tree with$k$edges and bounded maximum degree, if$k\\ge \\eta n$. In particular, this asymptotically confirms a conjecture of the first author for long antidirected paths and dense digraphs. Further, we show that in the same setting,$D$contains every$k$-edge antidirected subdivision of a sufficiently small complete graph, if the paths of the subdivision that have length$1$or$2$span a forest. As a special case, we can find all antidirected cycles of length at most$k$. Finally, we address a conjecture of Addario-Berry, Havet, Linhares Sales, Reed, and Thomassé for antidirected trees in digraphs. We show that this conjecture is asymptotically true in$n$-vertex oriented graphs for all balanced antidirected trees of bounded maximum degree and of size linear in$n$.

We prove the Erdős–Sós conjecture for trees with bounded maximum degree and large dense host graphs. As a corollary, we obtain an upper bound on the multicolour Ramsey number of large trees whose maximum degree is bounded by a constant.

A graph is called t -perfect, if its stable set polytope is defined by non-negativity, edge and odd-cycle inequalities. We characterise the class of all claw-free t -perfect graphs by forbidden t -minors, and show that they are 3-colourable. Moreover, we determine the chromatic number of claw-free h -perfect graphs and give a polynomial-time algorithm to compute an optimal colouring.

Background Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), however, the optimal time frame to measure CRP for risk stratification is not known. We evaluated the relation between the change in CRP over time (CRP velocity-CRPv) and AKI among STEMI patients treated with primary PCI. Methods We included 801 STEMI who presented between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in h) between the two measurements. Patient’s medical records were reviewed for occurrence of AKI. Results Mean age was 62 ± 16 and 80% were males. Patients with AKI had significantly higher CRPv (1.47 versus 0.4 mg/l/h, p < 0.001). In a multivariate regression model CRPv was independently associated with AKI (OR 1.03, 95% CI 1.01–1.0 5, p = 0.001). On receiver operating characteristic (ROC) curve the optimal cutoff value of CRPv to predict AKI was measured as more than 0.8 mg/l/h, with 70% sensitivity and 65% specificity (AUC 0.712, 95% CI 0.64–0.78, p < 0.001). Conclusion CRPv might be an independent and rapidly measurable biomarker for AKI following primary PCI in STEMI patients.