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A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

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World Journal of emergency Medicine 2024年第1期15卷 16-22页

作者： Jing Yang Hanqi Tang Shihuan Shao Feng Xu Yangyang Fu Shengyong Xu Chen Li Yan Li Yang Liu Joseph Harold Walline Huadong Zhu Yuguo Chen Xuezhong Yu Jun Xu emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China emergency Department Peking University People’s HospitalBeijing 100044China Department of emergency and Chest Pain Center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital of Shandong UniversityJinan 250012China emergency Department Beijing Jishuitan HospitalBeijing 100035China emergency Department Tianjin Medical University General HospitalTianjin 300052China Department of emergency Medicine Penn State Health Milton S.Hershey Medical Center and Penn State College of MedicineHershey 17033USA

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest *** study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ***:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to ***’general information,ETCO_(2),and POP parameters were collected and statistically ***:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC *** 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),***:Patients with unsustained ROSC have a poor *** combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

关键词： Return of spontaneous circulation Pulse oximetry photoplethysmogram End-tidal carbon dioxide Cardiac arrest Cardiopulmonary resuscitation

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Protective Effect of Shenfu Injection on Vascular Endothelial Damage in a Porcine Model of Hemorrhagic Shock

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Chinese Journal of Integrative Medicine 2022年第9期28卷 794-801页

作者： ZHANG Ming-qing ZHANG Qiang YUAN Wei WU Jun-yuan LIANG Yong QIN Hong-jie LI Chun-sheng Department of emergency Medicine Beijing Friendship HospitalCapital Medical UniversityBeijing100050China Department of Critical Care Medicine Peking University Third HospitalBeijing100191China Department of emergency Medicine Beijing Chaoyang HospitalCapital Medical UniversityBeijing100020China Department of emergency Medicine Beijing Luhe HospitalCapital Medical UniversityBeijing101199China

Objective:To investigate the effects of Shenfu Injection(SFI)on endothelial damage in a porcine model of hemorrhagic shock(HS).Methods:After being bled to a mean arterial pressure of40±3 mm Hg and held for 60 min,32 pigs were treated with a venous injection of either shed blood(transfusion group),shed blood and saline(saline group),shed blood and SFI(SEI group)or without resuscitation(sham group).Venous blood samples were collected and analyzed at baseline and 0,1,2,4,and 6 h after *** necrosis factor-α(TNF-α),serum interleuking(IL)-6,and IL-10 levels were measured by enzymelinked immunosorbent assay(ELISA);expressions of vascular cell adhesion molecule-1(VCAM-1),intercellular adhesion molecule 1(ICAM-1),von Willebrand factor(vWF),plasminogen activator inhibitor-1(PAI-1)and Bcl-2,Bax,and caspase-3 proteins were determined by Western ***:The serum level of TNF-αin the SFI group was significantly lower than in the other groups at 0,1,and 2 h after HS,while the level of IL-6 was lower at 4 and 6 h compared with the saline group(P<0.01 or P<0.05).The concentration of serum IL-10 was significantly higher in the SFI group than in the other groups at 0,1,4,and 6 h after HS(P<0.01).Western blot and immunohistochemistry of vascular tissue showed that the expression of caspase-3 was downregulated,and that of Bcl-2 and Bax was upregulated in the SFI group compared to other groups(P<0.05).Conclusion:SFI attenuated endothelial injury in the porcine model of HS by inhibiting cell apoptosis,suppressing the formation of proinflammatory cytokines,and reducing endothelial activation.

关键词： hemorrhagic shock Shenfu Injection vascular endothelial damage Chinese medicine

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The Role of Endoplasmic Reticulum Stress-related Apoptosis in Vascular Endothelium Pathogenesis

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Biomedical and Environmental Sciences 2018年第7期31卷 555-559页

作者： TAO Yong Kang SHI Jing YU Pu Lin ZHANG Guo Qiang Departments of emergency China-Japan Friendship Hospital Department of Deriatric Medicine Beijing Hospital National Center of Gerontology

Vascular endothelium refers to a single layer of endothelial cells that line the inner surface of blood vessels,serving as barriers and transducers between the circulating blood in the lumen and the rest of the vessel *** cells play essential roles in many aspects of vascular biology,such as barrier functions,thrombosis/fibrinolysis,inflammation,angiogenesis,vasoconstriction and vasodilation.

关键词： ER UPR GRP The Role of Endoplasmic Reticulum Stress-related Apoptosis in Vascular Endothelium Pathogenesis HUVECs

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The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

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World Journal of emergency Medicine 2017年第3期8卷 170-176页

作者： Emily Shao James Hughes Rob Eley Royal Brisbane and Women's hospital emergency Department Princess Alexandra Hospital emergency Medicine Research Program The University of Queensland Faculty of Medicine

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this ***: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ***: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females(71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger(M=37.05, SD=13.23) than the whole ED population(M=46.17 SD=20.50)(P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous(IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates(42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely ***: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

关键词： Migraine Headache Pain emergency department Analgesia

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Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

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World Journal of emergency Medicine 2019年第1期10卷 5-13页

作者： Wen-hua Zhou Jian-qiang He Shi-gong Guo Joseph Walline Xiao-ying Liu Li-yuan Tian Hua-dong Zhu Xue-zhong Yu Yi Li emergency Department Peking Union Medical College Hospital Oxford Centre for Enablement Nuffi eld Orthopaedic Centre Accident and emergency Medicine Academic Unit Prince of Wales Hospital The Chinese University of Hong Kong

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 ***: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working ***: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

关键词： emergency Venous thromboembolism Staff knowledge emergency doctor emergency nurse

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Comparison of surgically induced astigmatism among different surgeons performing the same incision

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International Journal of Ophthalmology(English edition) 2017年第6期10卷 1004-1007页

作者： Sofia Theodoulidou Ioannis Asproudis Aristidis Athanasiadis Michael Kokkinos Miltiadis Aspiotis University Eye clinic Medical School of Ioannina Ioannina 45110 Greece Ophthalmology clinic General Hospital of Piraeus ＂Tzaneio＂ Attiki 18536 Greece Ophthalmology clinic General Hospital of Rhodes Rhodes 85100 Greece

To compare surgically induced astigmatism （SIA） of different surgeons, who perform the same main incision. Two hundred and seventy eyes underwent cataract surgery with phacoemulsification by four different surgeons （A, B, C, and D）. A 3-step, 3.0 mm, superotemporal for the right eye and superonasa! for the left eye clear corneal incision was performed. A comparison in SlA among A, B, C and D surgeon was made. No significant difference was found in SlA at both first and sixth postoperative month between different surgeons （P〉0.05）. SIA is more dependent on incisional characteristics and preoperative astigmatism and less on the surgeon.

关键词： surgically induced astigmatism cataract incision

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The expression of oxidative stress genes related to myocardial ischemia reperfusion injury in patients with ST-elevation myocardial infarction

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World Journal of emergency Medicine 2022年第2期13卷 106-113页

作者： Qian-lin Gu Peng Jiang Hui-fen Ruan Hao Tang Yang-bing Liang Zhong-fu Ma Hong Zhan emergency Department the First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510000China Huangpu District emergency Department the First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510000China

BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technology and try to determine the underlying ***:The mononuclear cells were separated by ficoll centrifugation,and plasma total antioxidant capacity(T-AOC)was determined by the ferric reducing ability of plasma(FRAP)*** expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction(qRT-PCR).Additionally,gene ontology(GO)enrichment analysis was performed on DAVID website to analyze the potential mechanism ***:The total numbers of white blood cells(WBC)and neutrophils(N)in the peripheral blood of STEMI patients(the AMI group)were significantly higher than those in the control group(WBC:11.67±4.85×10^(9)/L vs.6.41±0.72×10^(9)/L,P<0.05;N:9.27±4.75×10^(9)/L vs.3.89±0.81×10^(9)/L,P<0.05),and WBCs were significantly associated with creatine kinase-myocardial band(CK-MB)on the first day(Y=8.945+0.018X,P<0.05).In addition,the T-AOC was significantly lower in the AMI group comparing to the control group(12.80±1.79 U/mL vs.20.48±2.55 U/mL,P<0.05).According to the gene analysis,eight up-regulated differentially expressed genes(DEGs)included GADD45A,PRDX2,HSPD1,DNAJB1,DNAJB2,RAD50,TNFSF6,and *** down-regulated DEGs contained CCNG1,CAT,CYP1A1,and ***6 and CYP1A1 were detected by polymerase chain reaction(PCR)to verify the expression at different time points,and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total *** and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response(UPR)and ***:WBCs,especially neutrophils,were the critical cells that mediating reperfusion injury

关键词： Acute myocardial infarction Myocardial ischemia/reperfusion injury Oxidative stress TNFSF6 CYP1A1 Unfolded protein response

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Violence toward emergency physicians: A prospective-descriptive study

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World Journal of emergency Medicine 2021年第2期12卷 111-116页

作者： Kasım Turgut Erdal Yavuz Mine KayacıYıldız Mehmet Kaan Poyraz Department of emergency Medicine Research and Training HospitalAdiyaman UniversityAdiyaman 02100Turkey

BACKGROUND: The highest rate of workplace violence occurs in the health sector, although most cases remain unreported. emergency services face the majority of these incidents for many reasons, such as the patient profile, long waiting time, and overcrowding. We aimed to determine the characteristics and causes of violence toward emergency physicians. METHODS: The acts of violence toward emergency physicians over a one-year period were prospectively recorded. After a violent incident took place, a third party separately interviewed the physician exposed to the violent behavior and the perpetrator who displayed this behavior. We examined the perpetrator's reasons for violence, their demographic characteristics, and the medical complaints of patients involved in such events to determine the characteristics and causes of ***: Of the violent acts investigated, 85.1% were verbal, and most were directed toward male doctors by the young male relatives of the patients. More than half of the violent acts occurred within the 15 minutes of presentation to emergency service(60.5%) and at off-hours(69.4%). Concerning the health insurance, 20.4% of the cases were covered by the free green card system, and a small number of the perpetrators of violence lived in rural areas(38.2%). The most common reason for violent behavior was the patients' or their relatives' dissatisfaction with the examination or treatment method(38.2%).CONCLUSIONS: Appropriate communication should be established with the patients, and they should be adequately informed about the treatments and interventions to be performed in order to prevent possible acts of violence.

关键词： Violence emergency physician emergency department

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Video versus direct laryngoscopy on successful firstpass endotracheal intubation in ICU patients

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World Journal of emergency Medicine 2018年第2期9卷 99-104页

作者： Yong-xia Gao Yan-bo Song Ze-juan Gu Jin-song Zhang Xu-feng Chen Hao Sun Zhen Lu Department of emergency Medicine the First Affiliated Hospital of Nanjing Medical University

BACKGROUND: Airway management in intensive care unit(ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy(DL) and that by using the video laryngoscopy(VL).METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. RESULTS: A total of 163 ICU patients underwent intubation during the study period(81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group(67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications(all P>0.05). CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

关键词： Intubation Video laryngoscopy Direct laryngoscopy Intensive care unit

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Initial venous lactate levels as a predictor of mortality in severe sepsis: a single-center retrospective cohort study

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World Journal of emergency Medicine 2022年第5期13卷 396-399页

作者： Thidathit Prachanukool Pitsucha Sanguanwit Karn Suttapanit Chaiyaporn Yuksen Piraya Vichiensanth Department of emergency Medicine Faculty of Medicine Ramathibodi HospitalBangkok 10400Thailand

Sepsis is the most common cause of death among critically ill patients.[1]Accordingly,most patients with sepsis are diagnosed and initially treated in the emergency department(ED).[2]Moreover,some studies have shown t... 详细信息

关键词： sepsis patients death

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