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Effi cacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

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World Journal of emergency Medicine 2024年第1期15卷 10-15页

作者： Yi Shan Yang Zhao Chengcheng Li Jianxin Gao Guogeng Song Tanshi Li Department of emergency Medicine Chinese PLA Medical SchoolBeijing 100853China Department of emergency Medicine the Sixth Medical Center of PLA General HospitalBeijing 100048China Department of emergency Medicine School of MedicineSouth China University of TechnologyGuangzhou 510006China Department of emergency Medicine the First Medical Center of PLA General HospitalBeijing 100853China

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic ***,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains ***,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic ***:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)*** the cREBOA and C-pREBOA groups,the balloon was inflated for 60 *** hemodynamic and laboratory values were compared at various observation time *** samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin ***:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent *** tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

关键词： Non-compressible torso hemorrhage Liver injury Ischemia-reperfusion injury Resuscitative endovascular balloon occlusion of the aorta

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World Journal of emergency Medicine 2024年第4期15卷 256-262页

作者： Jie Er Janice Soo Yuan Helen Zhang Gek Hsiang Lim Fatimah Lateef Department of emergency Medicine Singapore General HospitalSingapore 168753Singapore Health Services Research Unit Singapore General HospitalSingapore168753Singapore

BACKGROUND:This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury ***:This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore general Hospital from January to June *** records were reviewed and *** analyses were used to summarize patient characteristics,and differences in characteristics subgrouped by triage acuity and discharge status were ***:The study included 272 patients with a mean age of 43 years and a male predominance(71.7%).Most presented without referrals(88.2%)and were not conveyed by ambulances(70.6%).Based on acuity category,there were 24(8.8%)Priority 1(P1)patients with 7 trauma activations,174(64.0%)and 74(27.2%)P2 and P3 patients *** most common injuries were fractures(34.2%),followed by superficial abrasion/contusion(29.4%)and laceration/wound(19.1%).Thirteen(4.8%)patients experienced head injury and 85 patients(31.3%)were documented to be wearing a *** majority occurred on the roads as traffic accidents(32.7%).Forty-two patients(15.4%)were admitted with a mean length of stay of 4.1 d and 17(6.3%)undergone surgical *** of 214(78.7%)discharged patients,no re-attendances or mortality were *** the subgroup analysis,higher acuity patients were generally older,with higher proportions of head injuries leading to ***:Our study highlights significant morbidities in bicycle-related *** is also a high proportion of fractures in the young healthy male *** prevention is paramount and we propose emphasizing helmet use and road user safety.

关键词： Cycling Injuries emergency department

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Cryptococcus splenic abscess in primary biliary cholangitis: a case report

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World Journal of emergency Medicine 2024年第4期15卷 319-321页

作者： Yuxin Dong Qing Tang Lijun Wang Songtao Shou Department of emergency Medicine Tianjin Medical University General HospitalTianjin 300052China

Chronic liver diseases,including primary biliary cholangitis(PBC),are recognized as immunosuppressive conditions due to the impaired functionality of hepatic sinusoidal Kupffer cells.[1]PBC is specifically characterized by cholangitis and progressive liver pathology,which may eventually lead to *** compromised liver function and reduced efficacy of Kupffer cells in patients with PBC weaken their cell-mediated immune responses,increasing their susceptibility to opportunistic pathogens such as Cryptococcus.[2]Cryptococcosis is an infectious disease caused by pathogenic encapsulated yeasts of the genus Cryptococcus,which is distributed worldwide and exhibits diverse clinical presentations.[3]Most case reports on cryptococcal infections are associated with HIV infection or other conditions that compromise the immune system.[4]Case reports related to primary biliary cholangitis are ***,this case report underscores a rare cryptococcal infection in a patient with primary biliary cholangitis,emphasizing the need to consider opportunistic infections in those with compromised liver function and immune dysregulation.

关键词： cholangitis impaired diseases

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Factors inﬂuencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

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International Journal of Nursing Sciences 2024年第4期11卷 457-464页

作者： Caixia Liu Huiling Zheng Baiyu Li Shijia He Rongrong Hu Feifei Li Yao Zheng Weimin Lou Biyan Jiang Department of Nursing Zhejiang HospitalHangzhouZhejiangChina general ward Hangzhou Seventh People’HospitalHangzhouZhejiangChina Department of emergency Zhejiang HospitalHangzhouZhejiangChina School of Nursing Zhejiang Chinese Medical UniversityHangzhouZhejiangChina Department of Cadre Health Care Zhejiang HospitalHangzhouZhejiangChina

Objective:The institutionalization of care for patients with dementia is becoming a *** the burden on employed caregivers and exploring associated factors are of great importance in ***,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing ***:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December *** burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of inﬂuencing factors.A hierarchical multiple regression analysis was conducted to explore the factors inﬂuencing the burden on employed caregivers in nursing ***:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver *** such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were signiﬁcantly associated with caregiver *** ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,***:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various *** recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce th

关键词： Caregiver burden Caring ability Dementia Employed caregivers Nursing homes

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Metabolic disorders and hepatitis: Insights from a Mendelian randomization study

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1775-1790页

作者： Ling-Bo Liang Xiang-Ping Liu Ting-Rui Mao Qiao-Li Su general Practice ward General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Primary Health Care The Fourth People’s Hospital of Dazhu CountyDazhou 635100Sichuan ProvinceChina

BACKGROUND Hepatitis is a systemic disease that often results in various ***-bolic disorders,the most common comorbidities in clinical practice,were selected for this *** To investigate the causal relationship between comorbidities and hepatitis trea-tment *** A total of 23583378 single nucleotide polymorphisms from 1248743 cases and related summaries of genome-wide association studies were obtained from online public databases.A two-sample Mendelian randomization(MR)was performed to investigate causality between exposure[type 2 diabetes mellitus(T2D),hyperlipidemia,and hypertension]and outcome(chronic hepatitis B or C in-fections).RESULTS The data supported the causal relationship between comorbidities and hepatitis infections,which will affect the severity of hepatitis progression and will also provide a reference for clinical *** three exposures showed a link with progression of both hepatitis B(T2D,P=0.851;hyperlipidemia,P=0.596;and hypertension,P=0.346)and hepatitis C(T2D,P=0.298;hyperlipidemia,P=0.141;and hypertension,P=0.035).CONCLUSION The results of MR support a possible causal relationship between different ex-posures(T2D,hyperlipidemia,and hypertension)and chronic hepatitis progression;however,the potential mechanisms still need to be elucidated.

关键词： Hepatitis Comorbidity Type 2 diabetes mellitus Hyperlipidemia Hypertension

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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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Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest:a prospective single-center observational study

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World Journal of emergency Medicine 2024年第3期15卷 197-205页

作者： Subi Abudurexiti Shihai Xu Zhangping Sun Yi Jiang Ping Gong Department of emergency Medicine Ruijin Hospital Affi liated to Shanghai Jiaotong University School of MedicineShanghai 200025China Department of emergency Medicine Shenzhen People's Hospital(the Second Clinical Medical CollegeJinan Universitythe First Affi liated HospitalSouthern University of Science and Technology)Shenzhen 518020China Department of emergency Medicine the First Affi liated Hospital of Dalian Medical UniversityDalian 116011China Department of emergency Medicine General Hospital of Tianjin Medical UniversityTianjin 300052China

BACKGROUND:We aimed to observe the dynamic changes in glucose metabolic reprogrammingrelated parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation(ROSC).METHODS:Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Aflliated Hospital of Dalian Medical University from August 1,2017,to May 30,2021,were *** to 28-day survival,the patients were divided into a non-survival group(n=82) and a survival group(n=38).Healthy adult volunteers(n=40) of similar ages and sexes were selected as *** serum levels of glucose metabolic reprogrammingrelated parameters(lactate dehydrogenase [LDH],lactate and pyruvate),neuron-specific enolase(NSE) and interleukin 6(IL-6) were measured on days 1,3,and 7 after *** Acute Physiology and Chronic Health Evaluation II(APACHE II) score and Sequential Organ Failure Assessment(SOFA) score were *** Cerebral Performance Category(CPC) score was recorded on day 28 after ***:Following ROSC,the serum LDH(607.0 U/L vs.286.5 U/L),lactate(5.0 mmol/L vs.2.0 mmol/L),pyruvate(178.0 μmol/L vs.70.9 μmol/L),and lactate/pyruvate ratio(34.1 vs.22.1) significantly increased and were higher in the non-survivors than in the survivors on admission(all P<0.05).Moreover,the serum LDH,pyruvate,IL-6,APACHE II score,and SOFA score on days 1,3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality(all P<0.05).The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve(AUC) of 0.904 [95% confidence interval [95% CI]:0.851–0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950(95% CI:0.911–0.989) with 94.7% specificity for predicting 28-day all-cause mortality,which was the highest among the glucose metabo

关键词： Glucose metabolic reprogramming Lactate dehydrogenase Cardiac arrest Prognosis

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Beyond the Usual Suspects (Aortic Dissection in Patients with Chronic Kidney Disease)

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International Journal of Clinical Medicine 2024年第9期15卷 436-442页

作者： Marwa Morgom Shazad Anjum Sujood Musa Awadelseed Hanan Nayef Alajard Yageen Ismail Bakhiet emergency Medicine Hamad General Hospital Doha Qatar

A comprehensive differential diagnosis is essential in the emergency department, even when patient presentations are atypical. Timely recognition of life-threatening conditions, such as aortic dissection, hinges on th... 详细信息

关键词： Chest Discomfort Atypical Presentation of Aortic Dissection Differential Diagnosis Acute Type A Aortic Dissection Aortic Dissection Diagnosis

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Death from caustic ingestion:A case report

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Journal of Acute Disease 2024年第2期13卷 81-84页

作者： Shao Hui Koh Jacqueline C.L.Tan Department of emergency Medicine Sengkang General HospitalSingapore

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed *** of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system ***’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning ***:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and *** patient then underwent urgent ***:The patient suffered gastrointestinal bleeding as a result of local caustic *** addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually ***:The clinician needs to be mindful of the multi-system complications arising from such a caustic *** patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

关键词： Phosphoric acid poisoning Caustic ingestion Acid ingestion Cleaner ingestion Corrosive ingestion

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Precision medicine in inflammatory bowel disease

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Precision Clinical Medicine 2024年第1期7卷 54-80页

作者： Zhen Zeng Mingshan Jiang Xi Li Jing Yuan Hu Zhang Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041China Centrefor Inflammatory Bowel Disease West China HospitalSichuan UniversityChengdu 610041China Lab of Inflammatory Bowel Disease Frontiers Science Center for Disease-Related Molecular NetworkWest China HospitalSichuan UniversityChengdu 610041China general Practice ward/International Medical Center ward General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041China

Inflammatory bowel disease(IBD)is an incurable disease characterized by remission-relapse cycles throughout its *** Crohn's disease(CD)and ulcerative colitis(UC),the two main forms of IBD,exhibit tendency to develop complications and substantial heterogeneity in terms of frequency and severity of relapse,thus posing great challenges to the clinical management for *** treatment strategies are effective in different ways in induction and maintenance therapies for *** advances in studies of genetics,pharmacogenetics,proteomics and microbiome provide a strong driving force for identifying molecular markers of prognosis and treatment response,which should help clinicians manage IBD patients more effectively,and then,improve clinical outcomes and reduce treatment costs of *** this review,we summarize and discuss precision medicine in IBD,focusing on predictive markers of disease course and treatment response,and monitoring indices during therapeutic drug monitoring.

关键词： disease course inflammatory bowel disease precision treatment precision monitoring treatment response

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