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The Chinese guideline for management of snakebites

World Journal of emergency medicine 2024年第5期15卷 333-355页

作者： Rongde Lai Shijiao Yan Shijun Wang Shuqing Yang Zhangren Yan Pin Lan Yonggao Wang Qi Li Jinlong Wang Wei Wang Yuefeng Ma Zijing Liang Jianfeng Zhang Ning Zhou Xiaotong Han Xinchao Zhang Mao Zhang Xiaodong Zhao Guoqiang Zhang Huadong Zhu Xuezhong Yu Chuanzhu Lyu emergency department the First Affi liated Hospital of Guangzhou Medical UniversityGuangzhou 510120China School of Public Health Hainan Medical UniversityHaikou 571199China Surgery department of Traditional Chinese medicine the Affi liated People’s Hospital of Fujian University of Traditional Chinese MedicineFuzhou 350004China emergency department Chongqing University Central Hospital/Chongqing Emergency Medical CenterChongqing 400014China department of Surgery of Traditional Chinese medicine Affi liated Hospital of Jiangxi University of Chinese MedicineNanchang 330006China department of emergency medicine the Fifth Affi liated Hospital of Wenzhou Medical University/Lishui Central HospitalLishui Hospital of Zhejiang UniversityLishui 323000China General Surgery department the First Affi liated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006China emergency department Shengli Clinical Medical College of Fujian Medical UniversityFuzhou 350001China emergency department Chongqing University Fuling HospitalChongqing UniversityChongqing 408000China emergency department the First Affi liated Hospital of Guangxi Medical UniversityNanning 530021China emergency department the Second Affi liated Hospital of Zhejiang University School of MedicineHangzhou 310009China emergency department Wuming Hospital of Guangxi Medical UniversityNanning 530021China emergency department Central People's Hospital of ZhanjiangZhanjiang 524037China emergency department Hunan Provincial People's HospitalChangsha 410005China emergency department National Geriatrics Center of Beijing HospitalBeijing 100020China emergency department the Fourth Medical Center of the PLA General HospitalBeijing 100048China emergency department China-Japan Friendship HospitalBeijing 100029China emergency department Peking Union Medical College HospitalBeiJing 100730China emergency department Sichuan Academy of Medical Sciences/Sichuan Provincial People's HospitalChengdu 610072China Research Unit of Island emergency

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every *** guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite *** recommendations are based on clinical experience and clinical research *** guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

关键词： Snakebite Envenomation Management Prevention

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Heparin-binding protein as a predictor of mortality in patients with diabetes mellitus and community-acquired pneumonia in intensive care unit:a propensity score matched study

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World Journal of emergency medicine 2024年第4期15卷 263-272页

作者： Yuhan Sun Baoqing Sun Zhigang Ren Mingshan Xue Changju Zhu Qi Liu Translational medicine center Department of Emergency Medicinethe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China State Key Laboratory of Respiratory Disease National Clinical Research Center for Respiratory DiseaseGuangzhou Institute of Respiratory Healththe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510230China department of Infectious Disease the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Henan medical Key Laboratory of emergency and Trauma Research Department of Emergency Medicinethe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

BACKGROUND:Patients with diabetes mellitus(DM)are vulnerable to community-acquired pneumonia(CAP),which have a high mortality *** aimed to investigate the value of heparin-binding protein(HBP)as a prognostic marker of mortality in patients with DM and ***:This retrospective study included CAP patients who were tested for HBP at intensive care unit(ICU)admission from January 2019 to April *** were allocated to the DM or non-DM group and paired with propensity score *** characteristics and clinical outcomes up to 90 days were *** primary outcome was the 10-day *** operating characteristic(ROC)curves,Kaplan-Meier analysis,and Cox regression were used for statistical ***:Among 152 enrolled patients,60 pairs were successfully *** was no significant difference in 10-day mortality,while more patients in the DM group died within 28 d(P=0.024)and 90 d(P=0.008).In the DM group,HBP levels at ICU admission were higher in 10-day non-survivors than in 10-day survivors(median 182.21[IQR:55.43-300]ng/ml *** 66.40[IQR:34.13-107.85]ng/mL,P=0.019),and HBP levels could predict the 10-day mortality with an area under the ROC curve of *** cut-off value,sensitivity,and specificity were 160.6 ng/mL,66.7%,and 90.2%,*** Cox regression analysis indicated that HBP was an independent prognostic factor for 10-day(HR 7.196,95%CI:1.596-32.455,P=0.01),28-day(HR 4.381,95%CI:1.449-13.245,P=0.009),and 90-day mortality(HR 4.581,95%CI:1.637-12.819,P=0.004)in patients with ***:Plasma HBP at ICU admission was associated with the 10-day,28-day,and 90-day mortality,and might be a prognostic factor in patients with DM and CAP.

关键词： Community-acquired pneumonia Diabetes mellitus Heparin-binding protein Propensity score match

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Biomimetic Integrated Nanozyme for Flare and Recurrence of Gouty Arthritis

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Asian Journal of Pharmaceutical Sciences 2024年第3期19卷 131-145页

作者： Rui Wang Tongyao Liu Xinhong Li Enhao Lu Yiting Chen Kuankuan Luo Tao Wang Xueli Huang Zhiwen Zhang Shilin Du Xianyi Sha Key Laboratory of Smart Drug Delivery(Ministry of Education) Institutes of Integrative MedicineDepartment of PharmaceuticsSchool of PharmacyFudan UniversityShanghai 201203China department of emergency medicine Shanghai Geriatric Medical CenterShanghai 201104China department of emergency medicine Zhongshan HospitalFudan UniversityShanghai 200032China

Flare and multiple recurrences pose significant challenges in gouty *** treatments provide temporary relief from inflammation but fail to promptly alleviate patient pain or effectively prevent subsequent *** should also be noted that both anti-inflammation and metabolism of uric acid are necessary for gouty arthritis,calling for therapeutic systems to achieve these two goals *** this study,we propose a biomimetic integrated nanozyme,HMPB-Pt@MM,comprising platinum nanozyme and hollow Prussian *** demonstrates anti-inflammatory properties by eliminating reactive oxygen species and reducing infiltration of inflammatory ***,it rapidly targets inflamed ankles through the camouflage of macrophage ***,HMPB-Pt@MM exhibits urate oxidase-like capabilities,continuously metabolizing locally elevated uric acid concentrations,ultimately inhibiting multiple recurrences of gouty *** summary,HMPB-Pt@MM integrates ROS clearance with uric acid metabolism,offering a promising platform for the treatment of gouty arthritis.

关键词： Gouty arthritis Inflammation Nanozyme Platinum Prussian blue

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Genetic landscape and clinical significance of cuproptosis-related genes in liver hepatocellular carcinoma

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Genes & Diseases 2024年第2期11卷 516-519页

作者： Dingtao Hu Yichuan Wang Xu Shen Tiantian Mao Xijun Liang Tengjiao Wang Weifeng Shen Yugang Zhuang Jin Ding Clinical Cancer Institute Center for Translational MedicineNaval Medical UniversityShanghai 200433China department of emergency Shanghai Tenth People's HospitalTongji UniversitySchool of MedicineShanghai 200072China Bioinformatics Analysis Laboratory Center for Translational MedicineNaval Medical UniversityShanghai 200433China The department of Hepatic Surgery Eastern Hepatobiliary Surgery HospitalNaval Medical UniversityShanghai 200433China

Recently,Peter et al reported a novel form of cell death(cuproptosis)that was different from other known death mechanisms.1 They found that accumulation of copper ions could induce destabilization of Fe-S cluster proteins and aggregation of mitochondrial lipoylated proteins,ultimately resulting in cuproptosis.1 of note,ten genes were identified as cuproptosis-related genes(CRGs)in copper ion-induced cell death,including PDHB,PDHA1,DLAT,DLD,LIPT1,LIAS,FDX1,CDKN2A,GLS,and MTF1.1 Since dysregulation of copper metabolism is involved in many cancers,cuproptosis and CRGs may play vital roles in cancer development and treatment.1.2 Herein,our pancancer analysis revealed the coordinated upregulation of 9 of 10 CRGs in human liver hepatocellular carcinoma(LIHC)across 33 solid tumors(Fig.S1A;Fig.1A),suggesting the distinct role of CRGs in *** then explored the genetic landscape,biological function,and clinical significance of CRGs in LIHC,and validated our bioinformatic findings by in vitro experiments and clinical *** detailed methods were described in the supplementary material.

关键词： clinical metabolism hepatocellular

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Upregulation of circ0000381 atienuates microglial/macrophage pyroptosis after spinal cord injury

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Neural Regeneration Research 2024年第6期19卷 1360-1366页

作者： Yan Zhang Wenkai Zhang Tao Liu Ziqian Ma Wenxiu Zhang Yun Guan Xueming Chen Central Laboratory Beijing Luhe HospitalCapital Medical UniversityBeijingChina department of Orthopedics Beijing Luhe HospitalCapital Medical UniversityBeijingChina department of emergency medicine Aerospace Center HospitalBeijingChina department of Anesthesiology and Critical Care medicine Johns Hopkins University School of MedicineBaltimoreMDUSA department of Neurological Surgery Johns Hopkins University School of MedicineBaltimoreMDUSA

Neuroinflammation exacerbates secondary damage after spinal cord injury,while microglia/macrophage pyroptosis is important to *** RNAs(circRNAs)play a role in the central nervous ***,the functional role and mechanism of circRNAs in regulating microglia/macrophage pyroptosis after spinal cord injury are still poorly *** the present study,we detected microglia/macrophage pyroptosis in a female rat model of spinal cord injury,along with upregulated levels of circ0000381 in the spinal *** further experimental results suggest that circ0000381 may function as a sponge to sequester endogenous microRNA423-3p(miR-423-3p),which can increase the expression of NOD-like receptor 3(NLRP3),a pyroptosis ***,upregulation of circ0000381 may be a compensatory change after spinal cord injury to attenuate microglia/macrophage ***,knockdown of circ0000381 expression exacerbated microglia/macrophage ***,our findings provide novel evidence for the upregulation of circ0000381,which may serve as a neuroprotective mechanism to attenuate microglia/macrophage pyroptosis after spinal cord ***,circ0000381 may be a novel therapeutic target for the treatment of spinal cord injury.

关键词： circ0000381 inflammasome macrophage microglia miR-423-3p neuroinflammation neuroprotection NLRP3 pyroptosis RNA-Seq spinal cord injury

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Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

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World Journal of emergency medicine 2024年第1期15卷 3-9页

作者： Rashed Alremeithi Quincy K.Tran Megan T.Quintana Soroush Shahamatdar Ali Pourmand department of emergency medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA department of emergency medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA center for Trauma and Critical Care Department of Surgerythe George Washington University School of Medicine&Health SciencesWashington DC 20037USA

BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare *** there have been advances in treatment modalities,survival rates for TCA patients remain *** narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating ***:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,*** search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English *** the search,943 articles were retrieved,and two independent reviewers conducted a screening ***:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable *** were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital *** thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt *** endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic *** implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality ***-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,*** the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ***:TCA remains a signifi cant challenge for emergency medical services due to its high m

关键词： Traumatic cardiac arrest emergency thoracotomy Resuscitative endovascular balloon occlusion of the aorta

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Effect of tubastatin A on NLRP3 inflammasome activation in macrophages under hypoxia/ reoxygenation conditions

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World Journal of emergency medicine 2024年第4期15卷 289-296页

作者： Hao Li Chang Liu Ying Cui Panpan Chang Wei Chong department of emergency medicine the First Hospital of China Medical UniversityShenyang 110001China Trauma medicine center Peking University People's HospitalBeijing 100871China Key Laboratory of Trauma and Neural Regeneration Peking UniversityBeijing 100871China National center for Trauma medicine of China Beijing 100871China

BACKGROUND:There are currently no effective drugs to mitigate the ischemia/reperfusion injury caused by fluid resuscitation after hemorrhagic shock(HS).The aim of this study was to explore the potential of the histone deacetylase 6(HDAC6)-specific inhibitor tubastatin A(TubA)to suppress nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome activation in macrophages under hypoxia/reoxygenation(H/R)***:The viability of RAW264.7 cells subjected to H/R after treatment with different concentrations of TubA was assessed using a cell-counting kit-8(CCK8)***,2.5μmol/L TubA was used with RAW264.7 cells under H/R ***264.7 cells were divided into three groups,namely the control,H/R,and TubA *** levels of reactive oxygen species(ROS)in the cells were detected using fluorescence *** protein expression of HDAC6,heat shock protein 90(Hsp90),inducible nitric oxide synthase(iNOS),NLRP3,gasdermin-D(GSDMD),Caspase-1,GSDMD-N,and Caspase-1 p20 was detected by western *** levels of interleukin-1β(IL-1β)and IL-18 in the supernatants were detected using enzyme-linked immunosorbent assay(ELISA).RESULTS:HDAC6,Hsp90,and iNOS expression levels were significantly higher(P<0.01)in the H/R group than in the control group,but lower in the TubA group than in the H/R group(P<0.05).When comparing the H/R group to the control group,ROS levels were significantly higher(P<0.01),but significantly reduced in the TubA group(P<0.05).The H/R group had higher NLRP3,GSDMD,Caspase-1,GSDMD-N,and Caspase-1 p20 expression levels than the control group(P<0.05),however,the TubA group had significantly lower expression levels than the H/R group(P<0.05).IL-1βand IL-18 levels in the supernatants were significantly higher in the H/R group compared to the control group(P<0.01),but significantly lower in the TubA group compared to the H/R group(P<0.01).CONCLUSION:TubA inhibited the expression of HDAC6,Hsp90,and iNOS in macrophages

关键词： Hemorrhagic shock Hypoxia/reoxygenation Macrophage NLRP3 Tubastatin A

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Advancing emergency preparedness in a postpandemic world:global collaboration and innovative approaches for hospitals

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emergency and Critical Care medicine 2024年第3期4卷 103-104页

作者： Krzysztof Goniewicz Dennis G.Barten department of Security Studies Polish Air Force UniversityDęblinPoland department of emergency medicine VieCuri Medical CenterVenlothe Netherlands

As the world transitions into a postpandemic era,hospitals and healthcare systems must adapt their emergency management plans to address the unique challenges that *** upon the previous Hospital emergency Management Plan^([1])during the coronavirus disease 2019 pandemic,this commentary offers updated and novel suggestions for emergency preparedness,emphasizing the need for international coordination and the implementation of innovative strategies.

关键词： innovative prepare global

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Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation

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World Journal of emergency medicine 2024年第3期15卷 190-196页

作者： Huixin Zhao Yiming Dong Sijia Wang Jiayuan Shen Zhenju Song Mingming Xue Mian Shao department of emergency medicine Zhongshan HospitalFudan UniversityShanghai 200032China

BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis *** this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis ***:Data from 419 sepsis patients were retrospectively collected from July 2018 to December *** performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or *** SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify *** SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant ***:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,*** specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting *** sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.

关键词： Sepsis Disseminated intravascular coagulation Sepsis-induced coagulopathy Sepsis-associated coagulopathy

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Simulation-based assessment for the emergency medicine milestones: a national survey of simulation experts and program directors

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World Journal of emergency medicine 2024年第4期15卷 301-305页

作者： Afrah A Ali Ashley Crimmins Hegang Chen Danya Khoujah department of emergency medicine University of Maryland School of MedicineBaltimore 21201USA department of Epidemiology and Public Health University of Maryland School of MedicineBaltimore 21201USA department of emergency medicine AdventHealth TampaTampa 33606USA

The focus of outcome-based education has shifted from the process of training to the end“product”of *** has necessitated a reframing of the teaching,learning,and ***,in 2013,the Accreditation Council for Graduate medical Education(ACGME)implemented the educational milestones for all accredited residencies and fellowship programs.[1]The milestones have been described as“developmentally based,specialty-specific achievements that residents are expected to demonstrate at established intervals as they progress through training.”[1]Milestones are based on the six core competencies established by the ACGME and American Board of medical Specialties(ABMS),which consist of medical knowledge(MK),patient care(PC),interpersonal and communication skills(ICS),practice-based learning and improvement(PBLI),professionalism(PROF),and systems-based practice(SBP).[2,3]ACGME,in conjunction with the American Board of emergency medicine(ABEM),drafted 23 detailed subcompetencies relevant to emergency medicine(EM).[4]

关键词： Miles milestone education

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