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First Deep Learning AI Model Triages Patients with Chest Pain Using X-Rays

By MedImaging International staff writers
Posted on 19 Jan 2023

Researchers used AI to triage patients with chest pain (Photo courtesy of Pexels)

Acute chest pain syndrome can involve tightness, burning or other discomfort in the chest or a severe pain that spreads to the back, neck, shoulders, arms, or jaw, accompanied by shortness of breath. In the U.S., acute chest pain syndrome comprises more than seven million emergency department visits, making it among the most common complaints. However, less than 8% of such patients are diagnosed with the three major cardiovascular causes of acute chest pain syndrome - acute coronary syndrome, pulmonary embolism or aortic dissection. Nevertheless, the life-threatening nature of these conditions and low specificity of clinical tests, such as electrocardiograms and blood tests, result in significant usage of cardiovascular and pulmonary diagnostic imaging, usually ending up with negative results. With emergency departments struggling to manage rising patients and shortage of hospital beds, there is a vital need for effectively triaging patients at very low risk of these serious conditions. Now, a new study has found that artificial intelligence (AI) can help improve care for patients who turn up at the hospital emergency departments with acute chest pain.

Deep learning is an advanced type of AI that can be trained to search X-ray images for identifying patterns associated with disease. For the study, researchers at Massachusetts General Hospital (MGH, Boston, MA, USA) developed an open-source deep learning model to identify patients with acute chest pain syndrome who were at risk for 30-day acute coronary syndrome, pulmonary embolism, aortic dissection or all-cause mortality, based on a chest X-ray. The study evaluated the electronic health records of 5,750 patients (mean age 59 years, including 3,329 men) presenting with acute chest pain syndrome and who had a chest X-ray and additional cardiovascular or pulmonary imaging and/or stress tests between January 2005 and December 2015.

The researchers trained the deep-learning model on 23,005 patients to predict a 30-day composite endpoint of acute coronary syndrome, pulmonary embolism or aortic dissection and all-cause mortality based on chest X-ray images. The team found that the deep-learning tool significantly improved prediction of these adverse outcomes beyond age, sex and conventional clinical markers, like d-dimer blood tests, and also maintained its diagnostic accuracy across age, sex, ethnicity and race. Using a 99% sensitivity threshold, the model managed to defer additional testing in 14% of patients as against 2% when using a model only incorporating age, sex, and biomarker data. In the future, such an automated model could analyze chest X-rays in the background and allow clinicians to select those who stand to benefit the most from immediate medical attention, as well as help identify patients who can be discharged safely from the emergency department.

"To the best of our knowledge, our deep learning AI model is the first to utilize chest X-rays to identify individuals among acute chest pain patients who need immediate medical attention," said the study's lead author, Márton Kolossváry, M.D., Ph.D., radiology research fellow at MGH. "Analyzing the initial chest X-ray of these patients using our automated deep learning model, we were able to provide more accurate predictions regarding patient outcomes as compared to a model that uses age, sex, troponin or d-dimer information. Our results show that chest X-rays could be used to help triage chest pain patients in the emergency department."

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68 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE id=294795961 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294795961 AND published='1' LIMIT 1

69 (35.04753112793): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (278.94973754883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (250.10108947754): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (106.0962677002): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (31.232833862305): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (63.180923461914): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (34.809112548828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.007995605469): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (236.03439331055): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (64.849853515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1664.8769378662): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

105 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

106 (57.93571472168): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (135.18333435059): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

109 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

110 (91.075897216797): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (509.97734069824): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (832.08084106445): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (649.21379089355): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (178.09867858887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

115 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

116 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

117 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

118 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

119 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

120 (451.08795166016): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 67059.04006958): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (281.09550476074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

123 (150.91896057129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

124 (!!!!! 2798.0804443359): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795961 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795961 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1052955.86586): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (73.19450378418): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (32.186508178711): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (57.93571472168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (474.92980957031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (342.84591674805): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=211

136 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=211

137 (613.92784118652): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (549.0779876709): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

140 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

141 (!!!!! 8268.8331604004): TRUNCATE TABLE jos_trademed_module

142 (85.830688476562): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (55.074691772461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294795961 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (831.84242248535): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

147 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

148 (!!!!! 1090.0497436523): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

150 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

151 (49.114227294922): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795961 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795961 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (36.954879760742): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

154 (36.001205444336): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

156 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795961 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795961 AND published='1' LIMIT 1

157 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

158 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

159 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

160 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

161 (259.8762512207): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1158.9527130127): insert into jos_banners_delta values (14615,'2025-04-30 14:20:08','18.118.28.11','view'),(14202,'2025-04-30 14:20:08','18.118.28.11','view'),(14203,'2025-04-30 14:20:08','18.118.28.11','view')

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