As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatri...As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.展开更多
BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation...BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
Chronic migraine(CM)is a prevalent and highly debilitating neurological disorder.Functional magnetic resonance imaging(fMRI)studies have demonstrated associations between abnormal brain region activation and CM,yet th...Chronic migraine(CM)is a prevalent and highly debilitating neurological disorder.Functional magnetic resonance imaging(fMRI)studies have demonstrated associations between abnormal brain region activation and CM,yet the underlying complex neural circuitry mechanisms remain unclear.The spinal trigeminal nucleus caudalis(Sp5C)serves as the primary central hub for orofacial nociceptive input,receiving trigeminal pain signals and projecting to higher-order centers such as the thalamus.Therefore,we sought to investigate whether the Sp5C region and its associated circuits were involved in CM pathogenesis.In this study,we established a CM mouse model through repeated intraperitoneal injections of nitroglycerin(NTG).Using a combination of in vivo fiber photometry and in vitro c-Fos immunohistochemistry,we found a marked periorbital and plantar mechanical allodynia in CM mice,accompanied by increased glutamatergic neuronal activity in Sp5C.Chemogenetic manipulation of Sp5C glutamatergic neurons(Sp5CV^(glut2))bidirectionally modulated migraine-like behaviors and induced pain-related affective states,as evidenced by conditioned place preference/aversion(CPP/CPA)paradigms.Anterograde viral tracing revealed dense projections from Sp5C^(Vglut2)to the subthalamic nucleus(STN),which was activated in CM mice.Optogenetic activation of the Sp5C-STN pathway similarly produced migraine-like behaviors and pain-related aversive memory in mice.Altogether,we revealed a critical role of the Sp5CVglut2-STN circuit in the development and modulation of CM.Our findings provide novel mechanistic insights into the central mechanisms underlying CM,establishing potential theoretical foundations for clinical diagnosis and therapeutic development.展开更多
We present a numerical framework for simulating viscous compressible flows in the presence of solid particles with large size ratios.The volume-filtered Navier-Stokes equations are discretized using a class of high-or...We present a numerical framework for simulating viscous compressible flows in the presence of solid particles with large size ratios.The volume-filtered Navier-Stokes equations are discretized using a class of high-order low-dissipative finite difference operators with energy-preserving properties.No-slip,adiabatic boundary conditions are enforced at the surface of large particles(with diameters significantly larger than the local grid spacing)using a ghost-point immersed boundary method.Two-way coupling between the gas phase and small particles(with diameters proportional to the grid spacing)is accounted for through volumetric source terms for interphase momentum and energy exchange.A simple and efficient approach for collision detection between small and large particles is proposed.The framework is applied to simulations of planar shocks interacting with bidisperse distributions of particles with size ratios of approximately thirty.Particle dispersion and size segregation are reported and a simple analytical model for size segregation is proposed.展开更多
Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter rel...Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter release,and signal transmission,and dysregulation of lipid metabolism is closely associated with various neurodegenerative diseases.The complex roles of lipids in synaptic function and neurological diseases have recently garnered increasing attention,but their specific mechanisms remain to be fully understood.This review aims to explore how lipids regulate synaptic activity in the central nervous system,focusing on their roles in synapse formation,neurotransmitter release,and signal transmission.Additionally,it discusses the mechanisms by which glial cells modulate synaptic function through lipid regulation.This review shows that within the central nervous system,lipids are essential components of the cell membrane bilayer,playing critical roles in synaptic structure and function.They regulate presynaptic vesicular trafficking,postsynaptic signaling pathways,and glial-neuronal interactions.Cholesterol maintains membrane fluidity and promotes the formation of lipid rafts.Glycerophospholipids contribute to the structural integrity of synaptic membranes and are involved in the release of synaptic vesicles.Sphingolipids interact with synaptic receptors through various mechanisms to regulate their activity and are also involved in cellular processes such as inflammation and apoptosis.Fatty acids are vital for energy metabolism and the synthesis of signaling molecules.Abnormalities in lipid metabolism may lead to impairments in synaptic function,affecting information transmission between neurons and the overall health of the nervous system.Therapeutic strategies targeting lipid metabolism,particularly through cholesterol modulation,show promise for treating these conditions.In neurodegenerative diseases such as Alzheimer’s disease,Parkinson disease,and amyotrophic lateral sclerosis,dysregulation of lipid metabolism is closely linked to synaptic dysfunction.Therefore,lipids are not only key molecules in neural regeneration and synaptic repair but may also contribute to neurodegenerative pathology when metabolic dysregulation occurs.Further research is needed to elucidate the specific mechanisms linking lipid metabolism to synaptic dysfunction and to develop targeted lipid therapies for neurological diseases.展开更多
This study investigates the properties of high-purity starches extracted from Polygonum multiflorum(PMS)and Smilax glabra(SGS).The starches were characterized by scanning electron microscopy,Fouriertransform infrared ...This study investigates the properties of high-purity starches extracted from Polygonum multiflorum(PMS)and Smilax glabra(SGS).The starches were characterized by scanning electron microscopy,Fouriertransform infrared spectroscopy,X-ray diffraction,high-performance anion-exchange chromatography,and differential scanning calorimetry.Significant differences were observed in their morphological,physicochemical,and functional properties.PMS had a smaller particle size(13.68 μm),irregular polygonal shape,A-type,lower water absorption(62.67 %),and higher oil absorption(51.17 %).In contrast,SGS exhibited larger particles(31.75 μm),a nearly spherical shape,B-type,higher crystallinity(50.66 %),and greater amylose content(21.54 %),with superior thermal stability,shear resistance,and gelatinization enthalpy.SGS also contained higher resistant starch(83.28 %) and longer average chain length(20.58 %),but showed lower solubility,swelling power,light transmittance,and freeze-thaw stability.The physicochemical properties differences in crystal pattern and particle morphology between PMS and SGS lead to distinct behaviors during in vitro digestion and fermentation.These findings highlight the potential of medicinal plant starches in functional ingredients and industrial processes.展开更多
VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a ra...VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.展开更多
Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with m...Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.展开更多
After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the tim...After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the timing of interventions,combined with the limitations of current methods.To address these challenges,various techniques have been developed to aid in the repair and reconstruction of neural circuits at different stages of injury.Notably,neuromodulation has garnered considerable attention for its potential to enhance nerve regeneration,provide neuroprotection,restore neurons,and regulate the neural reorganization of circuits within the cerebral cortex and corticospinal tract.To improve the effectiveness of these interventions,the implementation of multitarget early interventional neuromodulation strategies,such as electrical and magnetic stimulation,is recommended to enhance functional recovery across different phases of nerve injury.This review concisely outlines the challenges encountered following spinal cord injury,synthesizes existing neurostimulation techniques while emphasizing neuroprotection,repair,and regeneration of impaired connections,and advocates for multi-targeted,task-oriented,and timely interventions.展开更多
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As...We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.展开更多
Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and manag...Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.展开更多
Introduction: Uterine fibroids are benign tumors that develop from the connective and muscular tissues of the uterus. Common among African-American women, patients suffering from them often arrive late to the hospital...Introduction: Uterine fibroids are benign tumors that develop from the connective and muscular tissues of the uterus. Common among African-American women, patients suffering from them often arrive late to the hospital in our African regions. This study aimed to investigate the knowledge and perception of uterine fibroids among women who came to the gynecology-obstetrics department of the Regional Hospital Center (CHR) Tsévié. Methodology: It was a cross-sectional descriptive study, with data collection conducted from May 7th to 20th, 2024, using systematic sampling. The study included all women present in the Gynecology-Obstetrics Department of CHR Tsévié during the study period who willingly and informedly consented to participate in the survey. Results: 362 women participated in the study. Among them, 36.8% had a secondary level, and 72.9% were Christians. About 97.5% had heard of uterine fibroids. In 63.5% of cases, their entourage was the principal source of information. The diagnostic methods mentioned by the women were ultrasound in 94.6% of cases, while prayers and occultism were also cited in 28% and 33.3% of cases, respectively. While 91.9% of the women considered the hospital, the place for treatment, some indicated that treatment would require plant-based approaches (46.8%) and prayers (26%). The cost of treatment was an obstacle for 85.4% of women, and 61.3% expressed fear of dying during surgery. There was a statistically significant relationship between treatment choice and religion. Conclusion: The majority of women had heard of uterine fibroids but had incorrect information about the treatment.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospit...BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.展开更多
Ischemia–reperfusion injury is a common pathophysiological mechanism in retinal degeneration.PANoptosis is a newly defined integral form of regulated cell death that combines the key features of pyroptosis,apoptosis,...Ischemia–reperfusion injury is a common pathophysiological mechanism in retinal degeneration.PANoptosis is a newly defined integral form of regulated cell death that combines the key features of pyroptosis,apoptosis,and necroptosis.Oligomerization of mitochondrial voltage-dependent anion channel 1 is an important pathological event in regulating cell death in retinal ischemia–reperfusion injury.However,its role in PANoptosis remains largely unknown.In this study,we demonstrated that voltage-dependent anion channel 1 oligomerization-mediated mitochondrial dysfunction was associated with PANoptosis in retinal ischemia–reperfusion injury.Inhibition of voltage-dependent anion channel 1 oligomerization suppressed mitochondrial dysfunction and PANoptosis in retinal cells subjected to ischemia–reperfusion injury.Mechanistically,mitochondria-derived reactive oxygen species played a central role in the voltagedependent anion channel 1-mediated regulation of PANoptosis by promoting PANoptosome assembly.Moreover,inhibiting voltage-dependent anion channel 1 oligomerization protected against PANoptosis in the retinas of rats subjected to ischemia–reperfusion injury.Overall,our findings reveal the critical role of voltage-dependent anion channel 1 oligomerization in regulating PANoptosis in retinal ischemia–reperfusion injury,highlighting voltage-dependent anion channel 1 as a promising therapeutic target.展开更多
Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientati...Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientation,psychosis,cardiotoxicity,and hallucinogenic effects.Consequently,the PCP began to be illicitly distributed.The use methods include snorting,inhalation,IV,and subcutaneous(SC) injection.[1-5] The characteristic toxidrome of PCP includes altered mental status,tachycardia,and nystagmus.At higher doses,patients may become comatose and develop sympathomimetic effects such as tachycardia,hypertension,hypersalivation,urinary retention,and bronchospasm.In cases of intoxication,the pupillary light reflex remains intact,although the pupil size may vary.[1,3-6] PCP has a direct cardiotoxic effect and may induce arrhythmias.[2] Hyperreflexia,muscle rigidity,choreiform movements and muscle fasciculations may occur.[2,4,6] PCP-induced acute respiratory distress syndrome(ARDS) and alveolar hemorrhage(AH) are rare but potentially life-threatening complications.The main causes of non-traumatic death in patients with PCP intoxication include cardiopulmonary arrest,intracranial hemorrhage and rhabdomyolysis.[2,3,5] This case report aims to emphasize the management and potential benefits of inhaled N-acetylcysteine(NAC) and tranexamic acid(TXA)for PCP-induced ARDS and AH.展开更多
BACKGROUND:Acute kidney injury(AKI)is a severe and fatal complication of acute heart failure(AHF).Existing studies on AKI following AHF in the Chinese population have scarce insights available from the emergency depar...BACKGROUND:Acute kidney injury(AKI)is a severe and fatal complication of acute heart failure(AHF).Existing studies on AKI following AHF in the Chinese population have scarce insights available from the emergency department(ED).This study aimed to investigate the predictive factors of patients with AHF complicated with AKI in a Chinese ED cohort,and to establish a risk prediction model.METHODS:Hospitalized patients diagnosed with AHF in the ED from December 2016 to September 2023 were included.The overall dataset were divided into the training set and the testing set at a 7:3 ratio.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for AKI in patients with AHF in the training set,leading to the development of a risk prediction model.The performance of the model was further assessed.RESULTS:A total of 789 patients with AHF were enrolled,with an AKI incidence of 29.7%.The mortality rates of the AKI and non-AKI groups were 23.1%and 7.6%,respectively.Logistic regression analysis showed that the levels of white blood cell(OR=2.368;95%CI:1.502-3.733,P<0.001),albumin(OR=2.669;95%CI:1.601-4.451,P<0.001),serum creatinine(OR=3.221;95%CI:1.935-5.363,P<0.001),and hemoglobin(OR=2.009;95%CI:1.259-3.205,P=0.003),maximum 24-h furosemide dosage(OR=2.196;95%CI:1.346-3.582,P=0.002),the use of non-invasive ventilation(OR=2.419;95%CI:1.454-4.024,P=0.001),and diabetes mellitus(OR=3.192;95%CI:2.014-5.059,P<0.001)were independent risk factors for AKI after AHF.These factors were subsequently incorporated into a risk prediction model.The area under the receiver operating characteristic(AUROC)curve for the predictive model was 0.815(95%CI:0.776-0.854)and 0.802(95%CI:0.776-0.854)in the training set and the testing set,respectively.CONCLUSION:This risk prediction model might assist physician to predict AKI following AHF effectively in the emergency setting.展开更多
Introduction: The therapeutic approach to benign prostatic hyperplasia (BPH) has evolved profoundly. Surgical treatment is reserved for complicated cases and the reference surgical technique is transurethral resection...Introduction: The therapeutic approach to benign prostatic hyperplasia (BPH) has evolved profoundly. Surgical treatment is reserved for complicated cases and the reference surgical technique is transurethral resection of the prostate (TURP). This work aims to study the epidemiological, clinical and therapeutic aspects of monopolar transurethral resection of the prostate in our department. Materials and Methods: We conducted a descriptive study with retrospective data collection over a 12-month period from November 1, 2023 to December 31, 2024. The urology unit, an integral part of the surgery department, of the Sino-Guinean Friendship Hospital in Conakry served as the setting for this study. It included 27 patients with benign prostatic hypertrophy treated surgically by monopolar transurethral resection and having a usable medical record. The parameters studied were epidemiological, clinics and therapeutic. Results: The mean age of the patients was 68.57 ± 5.7 years with extremes from 50 to 79 years. The peak frequency was observed between 70 and 79 years (48.15%). All our patients had lower urinary tract disorders, i.e. 100% of cases. On digital rectal examination, an increase in the volume of the prostate of benign appearance was observed in all cases. The mean prostate volume was 43.7 cc on ultrasound with extremes from 34 cc to 58 cc. The total PSA level was less than 4 ng/ml in the majority of cases. The postoperative course was generally uncomplicated (n = 26) with removal of the urinary catheter on the second postoperative day (D2). However, one peroperative complication was observed in one patient;it was a bladder breach, leading to the passage of glycine into the peritoneum. Conclusion: Transurethral resection of the prostate has reduced the length of hospital stay of our patients, as well as the comorbidities associated with the treatment. The complications associated with it are rare but potentially serious. Its performance requires in-depth mastery of the endoscopic anatomy of the lower urinary tract as well as technical operative expertise.展开更多
文摘As a critical department ensuring the sterility of hospital instruments,the Sterile Supply Center(SSC)directly impacts the sterility status of clinical instruments through its sterilization qualification rate.Geriatric patients,due to physiological decline and compromised immune function,constitute a high-risk group for hospital-acquired infections,with more stringent requirements for instrument sterility.This paper analyzes the current status and influencing factors of sterilization qualification rates in SSCs,explores the mechanistic association between sterilization qualification rates and infections in geriatric departments,and proposes targeted strategies to improve sterilization qualification rates.It highlights the pivotal role of SSC instrument sterilization in infection prevention and control for geriatric patients,providing theoretical basis and practical guidance for optimizing SSC management,reducing infection rates in geriatric departments,and ensuring the safety of elderly patients’medical care.These findings aim to enhance overall infection management standards in hospitals.
文摘BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
基金supported by the National Natural Science Foundation of China(No.32571336 and 32271048)Research Funds of Centre for Leading Medicine and Advanced Technologies of IHM(No.2025IHM01100)。
文摘Chronic migraine(CM)is a prevalent and highly debilitating neurological disorder.Functional magnetic resonance imaging(fMRI)studies have demonstrated associations between abnormal brain region activation and CM,yet the underlying complex neural circuitry mechanisms remain unclear.The spinal trigeminal nucleus caudalis(Sp5C)serves as the primary central hub for orofacial nociceptive input,receiving trigeminal pain signals and projecting to higher-order centers such as the thalamus.Therefore,we sought to investigate whether the Sp5C region and its associated circuits were involved in CM pathogenesis.In this study,we established a CM mouse model through repeated intraperitoneal injections of nitroglycerin(NTG).Using a combination of in vivo fiber photometry and in vitro c-Fos immunohistochemistry,we found a marked periorbital and plantar mechanical allodynia in CM mice,accompanied by increased glutamatergic neuronal activity in Sp5C.Chemogenetic manipulation of Sp5C glutamatergic neurons(Sp5CV^(glut2))bidirectionally modulated migraine-like behaviors and induced pain-related affective states,as evidenced by conditioned place preference/aversion(CPP/CPA)paradigms.Anterograde viral tracing revealed dense projections from Sp5C^(Vglut2)to the subthalamic nucleus(STN),which was activated in CM mice.Optogenetic activation of the Sp5C-STN pathway similarly produced migraine-like behaviors and pain-related aversive memory in mice.Altogether,we revealed a critical role of the Sp5CVglut2-STN circuit in the development and modulation of CM.Our findings provide novel mechanistic insights into the central mechanisms underlying CM,establishing potential theoretical foundations for clinical diagnosis and therapeutic development.
基金This work used Expanse systems at UCSD through an allocation[PHY240089]from the Advanced Cyberinfrastructure Coordination Ecosystem:Services&Support(ACCESS)programsupported by U.S.National Science Foundation(Grant Nos.2138259,2138286,2138307,2137603 and 2138296).
文摘We present a numerical framework for simulating viscous compressible flows in the presence of solid particles with large size ratios.The volume-filtered Navier-Stokes equations are discretized using a class of high-order low-dissipative finite difference operators with energy-preserving properties.No-slip,adiabatic boundary conditions are enforced at the surface of large particles(with diameters significantly larger than the local grid spacing)using a ghost-point immersed boundary method.Two-way coupling between the gas phase and small particles(with diameters proportional to the grid spacing)is accounted for through volumetric source terms for interphase momentum and energy exchange.A simple and efficient approach for collision detection between small and large particles is proposed.The framework is applied to simulations of planar shocks interacting with bidisperse distributions of particles with size ratios of approximately thirty.Particle dispersion and size segregation are reported and a simple analytical model for size segregation is proposed.
基金supported by the National Natural Science Foundation of China,No.82201568(to QQ)Capital’s Funds for Health Improvement and Research,No.2024-2-1031(to QQ)Beijing Nova Program,No.20240484566(to QQ).
文摘Synapses are key structures involved in transmitting information in the nervous system,and their functions rely on the regulation of various lipids.Lipids play important roles in synapse formation,neurotransmitter release,and signal transmission,and dysregulation of lipid metabolism is closely associated with various neurodegenerative diseases.The complex roles of lipids in synaptic function and neurological diseases have recently garnered increasing attention,but their specific mechanisms remain to be fully understood.This review aims to explore how lipids regulate synaptic activity in the central nervous system,focusing on their roles in synapse formation,neurotransmitter release,and signal transmission.Additionally,it discusses the mechanisms by which glial cells modulate synaptic function through lipid regulation.This review shows that within the central nervous system,lipids are essential components of the cell membrane bilayer,playing critical roles in synaptic structure and function.They regulate presynaptic vesicular trafficking,postsynaptic signaling pathways,and glial-neuronal interactions.Cholesterol maintains membrane fluidity and promotes the formation of lipid rafts.Glycerophospholipids contribute to the structural integrity of synaptic membranes and are involved in the release of synaptic vesicles.Sphingolipids interact with synaptic receptors through various mechanisms to regulate their activity and are also involved in cellular processes such as inflammation and apoptosis.Fatty acids are vital for energy metabolism and the synthesis of signaling molecules.Abnormalities in lipid metabolism may lead to impairments in synaptic function,affecting information transmission between neurons and the overall health of the nervous system.Therapeutic strategies targeting lipid metabolism,particularly through cholesterol modulation,show promise for treating these conditions.In neurodegenerative diseases such as Alzheimer’s disease,Parkinson disease,and amyotrophic lateral sclerosis,dysregulation of lipid metabolism is closely linked to synaptic dysfunction.Therefore,lipids are not only key molecules in neural regeneration and synaptic repair but may also contribute to neurodegenerative pathology when metabolic dysregulation occurs.Further research is needed to elucidate the specific mechanisms linking lipid metabolism to synaptic dysfunction and to develop targeted lipid therapies for neurological diseases.
基金supported by the National Natural Science Foundation of China (No.82174074)。
文摘This study investigates the properties of high-purity starches extracted from Polygonum multiflorum(PMS)and Smilax glabra(SGS).The starches were characterized by scanning electron microscopy,Fouriertransform infrared spectroscopy,X-ray diffraction,high-performance anion-exchange chromatography,and differential scanning calorimetry.Significant differences were observed in their morphological,physicochemical,and functional properties.PMS had a smaller particle size(13.68 μm),irregular polygonal shape,A-type,lower water absorption(62.67 %),and higher oil absorption(51.17 %).In contrast,SGS exhibited larger particles(31.75 μm),a nearly spherical shape,B-type,higher crystallinity(50.66 %),and greater amylose content(21.54 %),with superior thermal stability,shear resistance,and gelatinization enthalpy.SGS also contained higher resistant starch(83.28 %) and longer average chain length(20.58 %),but showed lower solubility,swelling power,light transmittance,and freeze-thaw stability.The physicochemical properties differences in crystal pattern and particle morphology between PMS and SGS lead to distinct behaviors during in vitro digestion and fermentation.These findings highlight the potential of medicinal plant starches in functional ingredients and industrial processes.
基金National High Level Hospital Clinical Research Funding(Scientific Research Seed Fund of Peking University First Hospital).
文摘VEXAS(vacuoles,E1 enzyme,X-linked,autoinflammatory,somatic)syndrome is a severe and progressive disease,characterized by clinical features that bridge rheumatologic and hematologic conditions.[1]VEXAS syndrome is a rare condition that was not reported until 2020.[2]Since then,interest among dermatologists,hematologists,and rheumatologists with published works has increased,[3]but none of them reported in the emergency setting,nor have any cases arisen following COVID-19 infection.
文摘Objective:To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.Methods:This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin,Turkey,between January 2019 and January 2022.Clinical findings and laboratory results,including leukocyte count,C-reactive protein(CRP),and procalcitonin levels in blood,were examined.Logistic regression,Chi square test,and receiver operating characteristics(ROC)curve analyses assessed the predictive value of these parameters.Results:A total of 199 participants were included in the study;99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls.Patients with meningitis exhibited significantly higher leukocyte counts(median:11890×10^(3)/μL vs.7905×10^(3)/μL,P<0.001)and CRP levels(median:6.00 mg/dL vs.0.95 mg/dL,P<0.001)compared to controls.Procalcitonin levels were significantly elevated in meningitis patients(median:0.21 ng/mL vs.0.10 ng/mL,P<0.001).Logistic regression identified albumin(OR=0.16,95%CI=0.06-0.40),and CRP(OR=1.18,95%CI=1.08-1.28)as independent predictors of meningitis.ROC analysis for CRP demonstrated a sensitivity of 80.6%and specificity of 70.0%at a cut-off value of 2.23 mg/dL(AUC=0.792).Conclusions:Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service.Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
基金supported by the National Key Research and Development Program of China,No.2023YFC3603705(to DX)the National Natural Science Foundation of China,No.82302866(to YZ).
文摘After spinal cord injury,impairment of the sensorimotor circuit can lead to dysfunction in the motor,sensory,proprioceptive,and autonomic nervous systems.Functional recovery is often hindered by constraints on the timing of interventions,combined with the limitations of current methods.To address these challenges,various techniques have been developed to aid in the repair and reconstruction of neural circuits at different stages of injury.Notably,neuromodulation has garnered considerable attention for its potential to enhance nerve regeneration,provide neuroprotection,restore neurons,and regulate the neural reorganization of circuits within the cerebral cortex and corticospinal tract.To improve the effectiveness of these interventions,the implementation of multitarget early interventional neuromodulation strategies,such as electrical and magnetic stimulation,is recommended to enhance functional recovery across different phases of nerve injury.This review concisely outlines the challenges encountered following spinal cord injury,synthesizes existing neurostimulation techniques while emphasizing neuroprotection,repair,and regeneration of impaired connections,and advocates for multi-targeted,task-oriented,and timely interventions.
文摘We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis,a rare clinical condition in pediatric patients presenting to the emergency department.As emergency medicine clinicians,we frequently encounter diverse and complex cases,and such rare conditions pose significant challenges in the diagnostic process.This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
文摘Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.
文摘Introduction: Uterine fibroids are benign tumors that develop from the connective and muscular tissues of the uterus. Common among African-American women, patients suffering from them often arrive late to the hospital in our African regions. This study aimed to investigate the knowledge and perception of uterine fibroids among women who came to the gynecology-obstetrics department of the Regional Hospital Center (CHR) Tsévié. Methodology: It was a cross-sectional descriptive study, with data collection conducted from May 7th to 20th, 2024, using systematic sampling. The study included all women present in the Gynecology-Obstetrics Department of CHR Tsévié during the study period who willingly and informedly consented to participate in the survey. Results: 362 women participated in the study. Among them, 36.8% had a secondary level, and 72.9% were Christians. About 97.5% had heard of uterine fibroids. In 63.5% of cases, their entourage was the principal source of information. The diagnostic methods mentioned by the women were ultrasound in 94.6% of cases, while prayers and occultism were also cited in 28% and 33.3% of cases, respectively. While 91.9% of the women considered the hospital, the place for treatment, some indicated that treatment would require plant-based approaches (46.8%) and prayers (26%). The cost of treatment was an obstacle for 85.4% of women, and 61.3% expressed fear of dying during surgery. There was a statistically significant relationship between treatment choice and religion. Conclusion: The majority of women had heard of uterine fibroids but had incorrect information about the treatment.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
文摘BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.
基金supported by the National Natural Science Foundation of China,Nos.82172196(to KX),82372507(to KX)the Natural Science Foundation of Hunan Province,China,No.2023JJ40804(to QZ)the Key Laboratory of Emergency and Trauma(Hainan Medical University)of the Ministry of Education,China,No.KLET-202210(to QZ)。
文摘Ischemia–reperfusion injury is a common pathophysiological mechanism in retinal degeneration.PANoptosis is a newly defined integral form of regulated cell death that combines the key features of pyroptosis,apoptosis,and necroptosis.Oligomerization of mitochondrial voltage-dependent anion channel 1 is an important pathological event in regulating cell death in retinal ischemia–reperfusion injury.However,its role in PANoptosis remains largely unknown.In this study,we demonstrated that voltage-dependent anion channel 1 oligomerization-mediated mitochondrial dysfunction was associated with PANoptosis in retinal ischemia–reperfusion injury.Inhibition of voltage-dependent anion channel 1 oligomerization suppressed mitochondrial dysfunction and PANoptosis in retinal cells subjected to ischemia–reperfusion injury.Mechanistically,mitochondria-derived reactive oxygen species played a central role in the voltagedependent anion channel 1-mediated regulation of PANoptosis by promoting PANoptosome assembly.Moreover,inhibiting voltage-dependent anion channel 1 oligomerization protected against PANoptosis in the retinas of rats subjected to ischemia–reperfusion injury.Overall,our findings reveal the critical role of voltage-dependent anion channel 1 oligomerization in regulating PANoptosis in retinal ischemia–reperfusion injury,highlighting voltage-dependent anion channel 1 as a promising therapeutic target.
文摘Phencyclidine(PCP,known as angel dust) is a nonbarbiturate,non-narcotic intravenous(IV) anesthetic with potent analgesic effects.However,its medical use was discontinued because of postoperative agitation,disorientation,psychosis,cardiotoxicity,and hallucinogenic effects.Consequently,the PCP began to be illicitly distributed.The use methods include snorting,inhalation,IV,and subcutaneous(SC) injection.[1-5] The characteristic toxidrome of PCP includes altered mental status,tachycardia,and nystagmus.At higher doses,patients may become comatose and develop sympathomimetic effects such as tachycardia,hypertension,hypersalivation,urinary retention,and bronchospasm.In cases of intoxication,the pupillary light reflex remains intact,although the pupil size may vary.[1,3-6] PCP has a direct cardiotoxic effect and may induce arrhythmias.[2] Hyperreflexia,muscle rigidity,choreiform movements and muscle fasciculations may occur.[2,4,6] PCP-induced acute respiratory distress syndrome(ARDS) and alveolar hemorrhage(AH) are rare but potentially life-threatening complications.The main causes of non-traumatic death in patients with PCP intoxication include cardiopulmonary arrest,intracranial hemorrhage and rhabdomyolysis.[2,3,5] This case report aims to emphasize the management and potential benefits of inhaled N-acetylcysteine(NAC) and tranexamic acid(TXA)for PCP-induced ARDS and AH.
基金supported by the Research and Development Fund of Peking University People’s Hospital,China(No.PTU2021-02).
文摘BACKGROUND:Acute kidney injury(AKI)is a severe and fatal complication of acute heart failure(AHF).Existing studies on AKI following AHF in the Chinese population have scarce insights available from the emergency department(ED).This study aimed to investigate the predictive factors of patients with AHF complicated with AKI in a Chinese ED cohort,and to establish a risk prediction model.METHODS:Hospitalized patients diagnosed with AHF in the ED from December 2016 to September 2023 were included.The overall dataset were divided into the training set and the testing set at a 7:3 ratio.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for AKI in patients with AHF in the training set,leading to the development of a risk prediction model.The performance of the model was further assessed.RESULTS:A total of 789 patients with AHF were enrolled,with an AKI incidence of 29.7%.The mortality rates of the AKI and non-AKI groups were 23.1%and 7.6%,respectively.Logistic regression analysis showed that the levels of white blood cell(OR=2.368;95%CI:1.502-3.733,P<0.001),albumin(OR=2.669;95%CI:1.601-4.451,P<0.001),serum creatinine(OR=3.221;95%CI:1.935-5.363,P<0.001),and hemoglobin(OR=2.009;95%CI:1.259-3.205,P=0.003),maximum 24-h furosemide dosage(OR=2.196;95%CI:1.346-3.582,P=0.002),the use of non-invasive ventilation(OR=2.419;95%CI:1.454-4.024,P=0.001),and diabetes mellitus(OR=3.192;95%CI:2.014-5.059,P<0.001)were independent risk factors for AKI after AHF.These factors were subsequently incorporated into a risk prediction model.The area under the receiver operating characteristic(AUROC)curve for the predictive model was 0.815(95%CI:0.776-0.854)and 0.802(95%CI:0.776-0.854)in the training set and the testing set,respectively.CONCLUSION:This risk prediction model might assist physician to predict AKI following AHF effectively in the emergency setting.
文摘Introduction: The therapeutic approach to benign prostatic hyperplasia (BPH) has evolved profoundly. Surgical treatment is reserved for complicated cases and the reference surgical technique is transurethral resection of the prostate (TURP). This work aims to study the epidemiological, clinical and therapeutic aspects of monopolar transurethral resection of the prostate in our department. Materials and Methods: We conducted a descriptive study with retrospective data collection over a 12-month period from November 1, 2023 to December 31, 2024. The urology unit, an integral part of the surgery department, of the Sino-Guinean Friendship Hospital in Conakry served as the setting for this study. It included 27 patients with benign prostatic hypertrophy treated surgically by monopolar transurethral resection and having a usable medical record. The parameters studied were epidemiological, clinics and therapeutic. Results: The mean age of the patients was 68.57 ± 5.7 years with extremes from 50 to 79 years. The peak frequency was observed between 70 and 79 years (48.15%). All our patients had lower urinary tract disorders, i.e. 100% of cases. On digital rectal examination, an increase in the volume of the prostate of benign appearance was observed in all cases. The mean prostate volume was 43.7 cc on ultrasound with extremes from 34 cc to 58 cc. The total PSA level was less than 4 ng/ml in the majority of cases. The postoperative course was generally uncomplicated (n = 26) with removal of the urinary catheter on the second postoperative day (D2). However, one peroperative complication was observed in one patient;it was a bladder breach, leading to the passage of glycine into the peritoneum. Conclusion: Transurethral resection of the prostate has reduced the length of hospital stay of our patients, as well as the comorbidities associated with the treatment. The complications associated with it are rare but potentially serious. Its performance requires in-depth mastery of the endoscopic anatomy of the lower urinary tract as well as technical operative expertise.
