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Identification of clinical subphenotypes of sepsis after laparoscopic surgery

Laparoscopic, Endoscopic and Robotic Surgery 2024年第1期7卷 16-26页

作者： Jie Yang Bo Zhang Chaomin Hu Xiaocong Jiang Pengfei Shui Jiajie Huang Yucai Hong Hongying Ni Zhongheng Zhang department of emergency medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016China department of emergency medicine Huzhou Central HospitalHuzhou 313000China department of Critical Care medicine Affiliated Jinhua HospitalZhejiang University School of MedicineJinhua 321000China

Objective:Some patients exhibit septic symptoms following laparoscopic surgery,leading to a poor *** clinical subphenotyping is critical for guiding tailored therapeutic strategies in these *** identifying predisposing factors for postoperative sepsis,clinicians can implement targeted interventions,potentially improving *** study outlines a workflow for the subphenotype methodology in the context of laparoscopic surgery,along with its practical ***:This study utilized data routinely available in clinical case systems,enhancing the applicability of our *** data included vital signs,such as respiratory rate,and laboratory measures,such as blood sodium *** process of categorizing clinical routine data involved technical complexities.A correlation heatmap was used to visually depict the relationships between *** points were used to identify the clustering structure and combined with Consensus K clustering methods to determine the optimal ***:Our study highlighted the intricacies of identifying clinical subphenotypes following laparoscopic surgery,and could thus serve as a valuable resource for clinicians and researchers seeking to explore disease heterogeneity in clinical *** simplifying complex methodologies,we aimed to bridge the gap between technical expertise and clinical application,fostering an environment where professional medical knowledge is effectively utilized in subphenotyping ***:This tutorial could primarily serve as a guide for beginners.A variety of clustering approaches were explored,and each step in the process contributed to a comprehensive understanding of clinical subphenotypes.

关键词： Laparoscopic surgery Phenotype Precision medicine Sepsis

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Xuebijing improves intestinal microcirculation dysfunction in septic rats by regulating the VEGF-A/PI3K/Akt signaling pathway

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World Journal of emergency medicine 2024年第3期15卷 206-213页

作者： A-ling Tang Yan Li Li-chao Sun Xiao-yu Liu Nan Gao Sheng-tao Yan Guo-qiang Zhang department of emergency China-Japan Friendship HospitalBeijing 100029China Graduate School Beijing University of Chinese MedicineBeijing 100105China

BACKGROUND:This study aims to explore whether Xuebijing(XBJ) can improve intestinal microcirculation dysfunction in sepsis and its ***:A rat model of sepsis was established by cecal ligation and puncture(CLP).A total of 30 male SD rats were divided into four groups:sham group,CLP group,XBJ + axitinib group,and XBJ *** was intraperitoneally injected 2 h before *** data(blood pressure and heart rate) were *** intestinal microcirculation data of the rats were analyzed via microcirculation ***-linked immunosorbent assay(ELISA) kits were used to detect the serum levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α) in the *** analysis and transmission electron microscopy were used to analyze the injury of small intestinal microvascular endothelial cells and small intestinal mucosa in *** expression of vascular endothelial growth factor A(VEGF-A),phosphoinositide 3-kinase(PI3K),phosphorylated PI3K(p-PI3K),protein kinase B(Akt),and phosphorylated Akt(p-Akt) in the small intestine was analyzed via Western ***:XBJ improved intestinal microcirculation dysfunction in septic rats,alleviated the injury of small intestinal microvascular endothelial cells and small intestinal mucosa,and reduced the systemic inflammatory ***,XBJ upregulated the expression of VEGF-A,p-PI3K/total PI3K,and p-Akt/total Akt in the rat small ***:XBJ may improve intestinal microcirculation dysfunction in septic rats possibly through the VEGF-A/PI3K/Akt signaling pathway.

关键词： Sepsis Xuebijing Vascular endothelial growth factor A Microcirculation Rat Phosphoinositide 3-kinase Protein kinase B

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Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2662-2670页

作者： Lv-Chi Xia Ke Zhang Chuan-Wen Wang department of emergency medicine Jiujiang First People's HospitalJiujiang 332000Jiangxi ProvinceChina

BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of ***,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of *** To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal *** Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,*** operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the *** The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitone

关键词： Radical resection of rectal cancer Goal-directed fluid therapy Preoperative glucose load Cognitive condition Complication

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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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Mediastinal emphysema in the context of perforated gastric ulcer

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World Journal of Clinical Cases 2024年第15期12卷 2479-2481页

作者： Debkumar Chowdhury department of emergency medicine Wythenshawe HospitalManchester M239LTUnited Kingdom

In the context of mediastinal emphysema/pneumomediastinum,the main aetiologies are associated with oesophageal perforation,lung pathology or post head and neck surgery *** main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase *** causes of pneumomediastinum should be differentiated between traumatic and *** perforation(Boerhaave syndrome)is associated with Mackler’s triad in upto 50%of patients(severe retrosternal chest pain,pneumomediastinum,mediastinitis).Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.

关键词： Pneumomediastinum Duodenal ulcer Computed tomography Visceral perforation Diagnostic imaging emergency care

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Efficacy and safety of Chinese herbal medicine as adjunctive therapy in sepsis patients with bloodstream infection:a propensity-matched analysis

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Journal of Traditional Chinese medicine 2024年第1期44卷 197-204页

作者： ZHOU Xianshi ZHONG Minlin XI Xiaotu LI Jun TANG Guanghua the Second Clinical College of Guangzhou University of Chinese medicine Guangzhou 510120China emergency department Guangdong Provincial Hospital of Chinese MedicineGuangzhou 510120China Guangdong Provincial Key Laboratory of Research on emergency in TCM Guangzhou 510120China Guangzhou Key Laboratory of Traditional Chinese medicine for Prevention and Treatment of Emerging Infectious Diseases Guangzhou 510120China Administration department the First Hospital of Guangzhou University of Chinese MedicineGuangzhou 510405China

OBJECTIVE:To investigate the efficacy and safety of Chinese herbal medicine in treating sepsis patients with bloodstream ***:A 6-year retrospective study was carried out at a university hospital in *** sepsis patients with bloodstream infection were *** primary outcome was 28-day mortality after *** score method was used to adjust for possible confounding.28-day mortality was estimated by KaplanMeier analysis and compared using the log-rank *** regression analysis was carried out to identify factors impacting in-hospital mortality ***:Following the application of the propensity score method,a total of 176 patients were *** all-cause 28-day mortality in the control group and Chinese herbal medicine group was 21.6%and 14.8%,***-Meier survival analysis showed that Chinese herbal medicine was associated with a lower hazard ratio(HR)in all-cause 28-day death compared with the control group[HR=0.44,95%CI(0.22,0.90),P0.05).Blood-activating and stasis-eliminating herb administration was associated with reduced inhospital mortality among sepsis patients with bloodstream infection[HR=0.54,95%CI(0.34,0.94),Pmedicine,especially the blood-activating and stasis-eliminating herb,might have certain efficacy and safety in treating sepsis patients with bloodstream *** should prescribe blood-activating and stasis-eliminating herb in treating these two coalescent critical diseases as long as no contraindications ***,further studies are needed to validate our results.

关键词： bacteremia medicine Chinese traditional herbal medicine sepsis propensity-matched analysis

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Understanding the eff ect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens

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World Journal of emergency medicine 2024年第5期15卷 356-364页

作者： Ariella Gartenberg Alexander Petrie Winston Yen Woojn Cho emergency medicine department Montefi ore Medical Center and Jacobi Medical CenterNew York 10461USA emergency medicine department Jacobi Medical Center and North Central BronxNew York 10461USA Touro College of Osteopathic medicine Touro UniversityNew York 10027USA

BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ *** use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be *** article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance ***:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane *** addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned *** initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone *** were no methodological limitations in relation to the initial acquisition and analysis of ***:A total of 55 research articles were included in this ***,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone *** substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic ***:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance *** evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.

关键词： Musculoskeletal disorders Bone health Cannabis Opioids Stimulants

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Targeted NGS analysis reveals a complex genetic background of idiopathic erythrocytosis in a large Venetian family

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Genes & Diseases 2024年第2期11卷 561-563页

作者： Bertozzi Irene Benetti Andrea Regazzo Daniela Polese Francesca Biagetti Giacomo Ceolotto Giulio Randi Maria Luigia First Medical Clinic University of Padua Department of Medicine – DIMEDVia Giustiniani 2Padova 35123Italy Transfusion medicine department Ospedale dell'Angelo - Venezia MestreVia Paccagnella 1Venice 30174Italy emergency medicine University of Padua Department of Medicine – DIMEDVia Giustiniani 2Padova 35123Italy

Absolute erythrocytosis,due to an increased production of red blood cells,becomes manifest with hemoglobin(Hb)levels above 165 or 160 g/L or with a hematocrit(HCT)above 51%and 48%in males and females,respectively.1 A minority of patients have polycythemia vera(PV);acquired secondary erythrocytosis frequently occurs due to appropriate or inappropriate erythropoietin(EPO)excess,while congenital secondary erythrocytosis may derive from genetic defects causing tissue *** erythrocytosis occurs in patients with genetic mutations of the oxygen-sensing pathway(VHL,PHD2,_HIF-1-alpha)or the erythropoietin receptor(EPOR)genes.2 Recently,HFE gene variants have been described in sporadic erythrocytoses.3 In a high proportion(about 70%)of patients with erythrocytosis,a specific etiology remains elusive despite extensive testing,and the diagnosis of idiopathic erythrocytosis(IE)is ruled out.

关键词： diagnosis patients congenital

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Total suprarenal aortic occlusion with cardiac disease: a case series of three cases

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World Journal of emergency medicine 2024年第1期15卷 59-61页

作者： Yuanli Lei Jiaozhen Chen Qin Chen Jiana Yin Weijia Huang Wenxing Song Shouquan Chen department of emergency medicine the First Affi liated Hospital of Wenzhou Medical UniversityWenzhou 325000China department of Electrocardiogram Wenzhou People's HospitalWenzhou 325000China

Acute aortic occlusion(AAO)has been very rarely reported in the literature and is a potentially life-threatening emergency.[1-5]AAO mostly occurs in cardiac disease patients,[1-4,6,7]and leads to cardiac complications.[1,2,5,6]Suprarenal aortic occlusion(SAO)is a very rare type of AAO,and infrarenal aortic occlusion(IAO)accounts for 75.8%-97.8%.[1,3,5-7]SAO is different from IAO in some clinical manifestations,treatment strategies,and prognoses.[3,6-8]SAO with cardiac disease will make the condition more complex and could easily cause a delay in diagnosis and portend worse outcomes with amputation and mortality rates.[1,3,6]Early and fast diagnosis and positive revascularization treatment are necessary to prevent cases from becoming fatal.[1-3]Herein,we present a case series of SAO with cardiac disease.

关键词： cardiac occlusion diagnosis

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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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