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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 system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative 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 shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-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,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arres

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

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Neutrophil-to-lymphocyte ratio associated with renal function in type 2 diabetic patients

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World Journal of Clinical Cases 2024年第14期12卷 2308-2315页

作者： Jin-Li Gao Jue Shen Li-Ping Yang Li Liu Kai Zhao Xiao-Rong Pan Lei Li Ji-Ji Xu department of Prevention and health care Community Health Service Center of Miaohang TownShanghai 200443China department of Prevention and health care Community Health Service Center of Songnan TownShanghai 200434China department of General Practice Community Health Service Center of Songnan TownShanghai 200434China department of Administrative Community Health Service Center of Songnan TownShanghai 200434China

BACKGROUND Type 2 diabetes mellitus(T2DM)is a leading risk factor for the development and progression of chronic kidney disease(CKD).However,an accurate and con-venient marker for early detection and appropriate management of CKD in in-dividuals with T2DM is limited.Recent studies have demonstrated a strong correlation between the neutrophil-to-lymphocyte ratio(NLR)and CKD.None-theless,the predictive value of NLR for renal damage in type 2 diabetic patients remains understudied.This study included 1040 adults aged 65 or older with T2DM from Shanghai's Community health Service Center.The total number of neutrophils and lym-phocytes was detected,and NLR levels were calculated.CKD was defined as an estimated glomerular filtration rate≤60 mL/min/1.73 m².Participants were di-vided into four groups based on NLR levels.The clinical data and biochemical characteristics were compared among groups.A multivariate logistic regression model was used to analyze the association between NLR levels and CKD.RESULTS Significant differences were found in terms of sex,serum creatinine,blood urea nitrogen,total cholesterol,and low-density lipoprotein cholesterol among patients with T2DM in different NLR groups(P<0.0007).T2DM patients in the highest NLR quartile had a higher prevalence of CKD(P for trend=0.0011).Multivariate logistic regression analysis indicated that a high NLR was an independent risk factor for CKD in T2DM patients even after adjustment for important clinical and pathological parameters(P=0.0001,odds ratio=1.41,95%confidence intervals:1.18-1.68).CONCLUSION An elevated NLR in patients with T2DM is associated with higher prevalence of CKD,suggesting that it could be a marker for the detection and evaluation of diabetic kidney disease.

关键词： Type 2 diabetes mellitus Neutrophil-to-lymphocyte ratio Chronic kidney disease Logistic regression Diabetes mellitus

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Pregnancy stressors and postpartum symptoms of depression and anxiety:the moderating role of a cognitivebehavioural therapy(CBT)intervention

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General Psychiatry 2024年第1期37卷 112-121页

作者： Yunxiang Sun Soim Park Abid Malik Najia Atif Ahmed Zaidi Atif Rahman Pamela J Surkan department of International health Johns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA department of Public Mental health Health Services AcademyIslamabadPakistan Human Development Research Foundation RawalpindiPakistan department of Primary care and Mental health Institute of Population HealthUniversity of LiverpoolLiverpoolUK

Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention m

关键词： postpartum stress behaviour

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Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

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Neural Regeneration Research 2024年第4期19卷 769-773页

作者： Mario Daidone Sergio Ferrantelli Antonino Tuttolomondo Internal Medicine and Stroke care Ward Department of Health PromotionMother and Child CareInternal Medicine and Medical SpecialtiesUniversity of Palermo Molecular and Clinical Medicine PhD Program University of Palermo

Stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient outcomes.In recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine approaches.This abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke medicine.Recently introduced machine learning algorithms have been extensively employed in all the fields of stroke medicine.Machine learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient prognosis.Despite the tremendous potential of machine learning in stroke medicine,several challenges must be addressed.These include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and bias.In addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke care.Machine learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved prognostication.Continued research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of life.This review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic evaluation.At the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling disease.

关键词： cerebrovascular disease deep learning machine learning reinforcement learning stroke stroke therapy supervised learning unsupervised learning

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Unexplained fetal tachycardia:A case report

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World Journal of Clinical Cases 2024年第9期12卷 1698-1703页

作者： Hui Wang Run-Zi Duan Xin-Jiu Bai Bing-Ting Zhang Jie Wang Wen-Xia Song department of Nutrition Changzhi Maternal and Child Health Care Hospital Affiliated to Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina department of Obstetrics Changzhi Maternal and Child Health Care Hospital Affiliated to Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina department of Gynaecology Changzhi Maternal and Child Health Care Hospital Affiliated to Changzhi Medical CollegeChangzhi 046000Shanxi ProvinceChina department of Medical Genetic Changzhi Maternal and Child Health Care Hospital Affiliated to Changzhi Medical CollegeChangzhi 046011Shanxi ProvinceChina

BACKGROUND This study aimed to explore the possible etiology and treatment of severe fetal tachycardia in the absence of organic disease and provide a reference for clinical management of severe fetal tachycardia.CASE SUMMARY A 29-year-old pregnant woman,with a gravidity 1 parity 0,presented with a fetal heart rate(FHR)of 243 beats per minute during a routine antenatal examination at 31+2 wk of gestation.Before termination of pregnancy at 38 wk of gestation,the FHR repeatedly showed serious abnormalities,lasting more than 30 min.However,the pregnant woman and the fetus had no clinical symptoms,and repeated examination revealed no organic lesions.The mother and the baby were regularly followed up.CONCLUSION This was a case of severe fetal tachycardia with no organic lesions and management based on clinical experience.

关键词： Fetal heart rate disorder Fetal tachycardia Severe tachycardia Case report

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Postpartum depression and partner support during the period of lactation:Correlation research and its influencing factors

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World Journal of Psychiatry 2024年第1期14卷 119-127页

作者： Ji-Ming Ruan Ling-Juan Wu department of Obstetrics and Gynecology Huzhou Maternity and Child Health Care HospitalHuzhou 313000Zhejiang ProvinceChina

BACKGROUND Postpartum depression(PPD)not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development.Partners who are in close contact with parturient women play a key role in communication and emotional support.This study explores the PPD support relationship with partners and its influencing factors,which is believed to establish psychological well-being and improve maternal partner support.AIM To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.METHODS Convenience sampling was used to select lactating women(200 women)who underwent postpartum examinations at the Huzhou Maternity and Child health care Hospital from July 2022 to December 2022.A cross-sectional survey was conducted on the basic information(general information questionnaire),depression level[edinburgh postnatal depression scale(EPDS)],and partner support score[dyadic coping inventory(DCI)]of the selected subjects.Pearson’s correlation analysis was used to analyze the correlation between PPD and DCI in lactating women.Factors affecting PPD levels during lactation were analyzed using multiple linear regression.RESULTS The total average score of EPDS in 200 lactating women was(9.52±1.53),and the total average score of DCI was(115.78±14.90).Dividing the EPDS,the dimension scores were:emotional loss(1.91±0.52),anxiety(3.84±1.05),and depression(3.76±0.96).Each dimension of the DCI was subdivided into:Pressure communication(26.79±6.71),mutual support(39.76±9.63),negative support(24.97±6.68),agent support(6.87±1.92),and joint support(17.39±4.19).Pearson’s correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support,stress communication,mutual support,and cosupport(P<0.05).The total mean score of the EPDS and its dimensions were positively correlated with negative support(P<0.05).Multiple linear regression analy

关键词： Lactation period Puerpera Postpartum depression Partner support Correlation

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Atherosis-associated lnc_000048 activates PKR to enhance STAT1-mediated polarization of THP-1 macrophages to M1 phenotype

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Neural Regeneration Research 2024年第11期19卷 2488-2498页

作者： Yuanyuan Ding Yu Sun Hongyan Wang Hongqin Zhao Ruihua Yin Meng Zhang Xudong Pan Xiaoyan Zhu department of Neurology The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina Qingdao Cadre health care Service Center The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina department of Critical care Medicine The Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina

Our previous study has demonstrated that lnc_000048 is upregulated in large-artery atherosclerotic stroke and promotes atherosclerosis in ApoE^(-/-)mice.However,little is known about the role of lnc_000048 in classically activated macrophage(M1)polarization.In this study,we established THP-1-derived testing state macrophages(M0),M1 macrophages,and alternately activated macrophages(M2).Real-time fluorescence quantitative PCR was used to verify the expression of marker genes and the expression of lnc_000048 in macrophages.Flow cytometry was used to detect phenotypic proteins(CD11b,CD38,CD80).We generated cell lines with lentivirus-mediated upregulation or downregulation of lnc_000048.Flow cytometry,western blot,and real-time fluorescence quantitative PCR results showed that down-regulation of lnc_000048 reduced M1 macrophage polarization and the inflammation response,while over-expression of lnc_000048 led to the opposite effect.Western blot results indicated that lnc_000048 enhanced the activation of the STAT1 pathway and mediated the M1 macrophage polarization.Moreover,catRAPID prediction,RNA-pull down,and mass spectrometry were used to identify and screen the protein kinase RNA-activated(PKR),then catRAPID and RPIseq were used to predict the binding ability of lnc_000048 to PKR.Immunofluorescence(IF)-RNA fluorescence in situ hybridization(FISH)double labeling was performed to verify the subcellular colocalization of lnc_000048 and PKR in the cytoplasm of M1 macrophage.We speculate that lnc_000048 may form stem-loop structure-specific binding and activate PKR by inducing its phosphorylation,leading to activation of STAT1 phosphorylation and thereby enhancing STAT1 pathway-mediated polarization of THP-1 macrophages to M1 and inflammatory factor expression.Taken together,these results reveal that the lnc_000048/PKR/STAT1 axis plays a crucial role in the polarization of M1 macrophages and may be a novel therapeutic target for atherosclerosis alleviation in stroke.

关键词： atherosclerosis inflammation lnc_000048 lncRNA macrophage polarization protein kinase RNA-activated(PKR) STAT1

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Ginsenoside Rg3 Promotes the Survival and Migration of Trophoblast Cells in a Rat Model of Gestational Hypertension by Regulating miR-100a/Insulin Growth Factor-2 Axis

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World Journal of Traditional Chinese Medicine 2024年第1期10卷 65-74页

作者： Xiu-Mei Fan Li Yang Gang Zhao Sen-Ye Huo Yan Gao department of Obstetrics Xingtai Third HospitalXingtaiChina department of Obstetrics Xingtai Maternal and Child Health Care HospitalXingtaiChina

Objective:Preeclampsia(PE)is a common complication during pregnancy.miR-100a is expressed in the placenta and regulates the survival and development of placental cells.Insulin growth factor-2(IGF-2)may serve as its downstream target.This study investigated the protective mechanisms of ginsenoside Rg3 against PE in rat model.Materials and Methods:LPS-induced rat PE models were suitable for intravenous administration of the highly expressed miR-100a ginsenoside Rg3 lentiviral vector.Human trophoblasts were cultured in vitro for JEG-3,and PE cell models were constructed.In vivo effects on tumor growth and apoptosis were observed.Ginsenoside Rg3 was treated with different concentrations of shRNA,miR-100a analogs,inhibitors,or IGF-2.Autophagy and the expression of autophagy-related proteins were examined.Trophoblast activity and migration were determined using Cell Counting Kit-8 and Transwell assays.Both drugs strongly inhibited trophoblasts under normal conditions with some synergy between them.Double-luciferase return assay confirmed the binding affinity of miR-100a for IGF-2.Results:In response to Rg3,autophagy and the expression of autophagy-related proteins LC3-I/II,Beclin1,and SQSTM1 were reduced in PE rat placental trophoblasts.Rg3 inhibited autophagy in JEG-3 cells and promoted JEG-3 survival and migration in a concentration-dependent manner.miR-100a upregulated PE expression.These results suggested that autophagy was a vital signaling system.Rg3 intervention inhibited miR-100a expression and miR-100a downregulated IGF-2 expression in placental tissues and promoted autophagy,thereby inhibiting JEG-3cell survival and migration.In rats,Rg3 inhibited PE development by regulating the activity of the miR-100a-IGF-2 signaling axis.Conclusion:Ginsenoside Rg3 positively regulates the miR-100a-IGF-2 axis and protects PE rats by inhibiting trophoblastic autophagy and promoting trophoblastic cell survival and migration.

关键词： Ginsenoside Rg3 inflammatory response miR-100a/insulin growth factor-2 axis preeclampsia pregnancy-induced hypertension

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Characterization of a smog chamber for studying formation of gas-phase products and secondary organic aerosol

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Journal of Environmental Sciences 2024年第2期136卷 570-582页

作者： Qi Yuan Zhuozhi Zhang Meng Wang Kin Fai Ho Tao Wang Shuncheng Lee department of Civil and Environmental Engineering The Hong Kong Polytechnic UniversityKowloonHong KongChina School of Public health and Primary care The Chinese University of Hong KongShatinHong KongChina

Smog chambers provide a potent approach to explore the secondary organic aerosol formation under varied conditions.This study describes the construction and characterization of a new smog chamber facility for studying the formation mechanisms of gas-phase products and secondary organic aerosol from the photooxidation of volatile organic compounds.The chamber is a 5.4 m^(3) Fluorinated Ethylene Propylene(FEP)Teflon reactor with the potential to perform photooxidation experiments at controlled temperature and relative humidity.Detailed characterizations were conducted for evaluation of stability of environmental parameters,mixing time,background contamination,light intensity,and wall losses of gases and particles.The photolysis rate of NO_(2)(J_(NO2))ranged from(1.02-3.32)×10^(-3)sec^(-1),comparable to the average J_(NO2)in ambient environment.The wall loss rates for NO,NO_(2),and O_(3)were 0.47×10^(-4),0.37×10^(-4),and 1.17×10^(-4)min^(-1),while wall loss of toluene was obsoletely found in a 6 hr test.The particle number wall loss rates are(0.01-2.46)×10^(-3)min^(-1)for 40-350 nm with an average lifetime of more than one day.A series of toluene photooxidation experiments were carried out in absence of NO_xunder dry conditions.The results of the simulation experiments demonstrated that the chamber is well designed to simulate photolysis progress in the atmosphere.

关键词： Smog chamber Gas-phase oxidation Chamber characterization Chemical mechanism

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Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression

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World Journal of Psychiatry 2024年第5期14卷 678-685页

作者： Yun Chen Xiao-Yan Sun Cheng Qian Xiao-Xing Zhang Yin-Jian Zhou Hong-Yun Zhang Zhen-Wei Xie department of Gynecology Women’s Hospital School of Medicine Zhejiang UniversityHangzhou 310006Zhejiang ProvinceChina department of Obstetrics and Gynecology Huzhou Maternity and Child Health Care HospitalHuzhou 313000Zhejiang ProvinceChina department of Surgery Huzhou Maternity and Child Health Care HospitalHuzhou 313000Zhejiang ProvinceChina department of Obstetrics Huzhou Maternity and Child Health Care HospitalHuzhou 313000Zhejiang ProvinceChina department of Ultrasound Women’s Hospital School of Medicine Zhejiang UniversityHangzhou 310006Zhejiang ProvinceChina

BACKGROUND Rectus abdominis separation(DRA)affects pelvic stability and body image.No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.AIM To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.METHODS Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child health Hospital from October 2022 to September 2023.The patients were divided into the Group S(35 cases,biomimetic electrical stimulation treatment)and Group L(35 cases,biomimetic electrical stimulation combined with manual massage treatment).Baseline data,the edinburgh postpartum depression scale(EPDS)score,and the visual analog scale(VAS)scores for rectus abdominis distance,waist circumference,and lower back pain before and after treatment were compared.RESULTS No significant differences were found in the baseline data,rectus abdominis distance,waist circumference,and VAS and EPDS scores between the two groups before treatment(P>0.05).After treatment,the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S(P<0.05).Furthermore,lower back pain(VAS score)and the EPDS score in Group L were significantly lower than those in Group S(P<0.05).CONCLUSION Manual massage can significantly reduce early postpartum DRA,waist circumference,and back pain and improve the patient’s mental state and postpartum depression.

关键词： Manual massage Postpartum Rectus abdominis muscle separation Postpartum depression

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