Objective To investigate the causal relationships between various circulating micronutrients and aneurysms at different sites using Mendelian randomization (MR) analysis. Methods Summary-level genetic data for 15 common blood micronutrients, including vitamin D, calcium, iron, copper, selenium, zinc, folate, carotene, vitamin C, vitamin B12, vitamin E, magnesium, vitamin B6, omega-3 fatty acids, and homocysteine, were obtained from the IEU Open GWAS database. Genetic associations with aneurysms, including intracranial aneurysm and thoracic aortic aneurysm, were retrieved from the GWAS Catalog and the FinnGen consortium. Bidirectional MR analyses were performed using seven MR approaches, with the inverse-variance weighted (IVW) method as the primary analysis. Multiple sensitivity analyses and visualization tools were used to assess pleiotropy and heterogeneity. Furthermore, multivariable MR was applied to explore the interactions and independent effects of multiple micronutrients on aneurysm risk, and meta-analysis was employed to integrate results from different data sources and minimize bias. Results Through multiple MR and sensitivity analyses, combined with multivariate MR and meta-analysis, the results confirmed that elevated blood levels of vitamin D could significantly increase the risk of intracranial aneurysm [odds ratio (OR)=1.65, 95% confidence interval (CI) (1.20, 2.29), P=0.002], while omega-3 fatty acids [OR=0.82, 95%CI (0.73, 0.92), P=0.001] could significantly reduce the risk. For thoracic aortic aneurysm, selenium [OR=1.08, 95%CI (1.00, 1.15), P=0.042] and folate [OR=1.45, 95%CI (1.13, 1.87), P=0.004] were identified as potential risk factors. No heterogeneity or horizontal pleiotropy was detected, and no reverse causality was found between micronutrients and aneurysm development. Conclusions Variations in circulating micronutrient levels can influence the risk of aneurysm development. These findings provide new insights into the potential roles of micronutrients in aneurysm prevention and treatment and offer a scientific basis for developing targeted clinical intervention strategies.
With the innovation and breakthrough of key technologies in smart medicine, actively exploring smart emergency measures and methods with artificial intelligence as the core technology is helpful to improve the ability of emergency medical team to diagnose and treat acute and critical diseases. This paper reviews the application status of artificial intelligence in pre-hospital and in-hospital diagnosis and treatment capabilities and system construction, expounds on the challenges it faces and possible coping strategies, and provides a reference for the in-depth integration and development of “artificial intelligence + emergency medicine” education, research and production during the new wave of scientific and technological revolution.
Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.
Objective To investigate the potential association between diethyltoluamide and the risk of vascular dementia (VaD), and to predict its core targets and molecular mechanisms using network toxicology and molecular docking. Methods The toxicological characteristics and potential targets of diethyltoluamide were predicted using toxicological databases. VaD-related targets were retrieved from disease databases. The STRING database was used to construct a protein-protein interaction network to screen core genes. Pathway enrichment analyses were conducted on the intersecting genes. Finally, the key protein was selected and its binding affinity with diethyltoluamide was verified through molecular docking technology. Results Network toxicology analysis identified 71 common targets of diethyltoluamide and VaD. Core targets included TNF, TP53, ACTB, HSP90AA1, and KRAS. These targets were enriched in cellular response to oxidative stress, inflammatory response, and apoptotic signaling pathway, as well as key signaling pathways including PI3K-Akt, mitogen-activated protein kinase. Molecular docking confirmed that diethyltoluamide exhibited strong binding affinity with these core targets. Conclusions Diethyltoluamide may participate in the pathological process of VaD by directly acting on multiple core targets such as TNF, TP53, and KRAS, thereby interfering with various pathways including neuroinflammation, oxidative stress, and cerebrovascular regulation.
Effective neuroprotective strategies are still lacking for cerebral ischemia-reperfusion injury secondary to ischemic stroke and cardiac arrest-cardiopulmonary resuscitation. Growing evidence suggests that adiponectin (APN) and its receptors exert pivotal protective effects in these pathological processes. This article summarizes the underlying mechanisms and translational potential of the APN signaling pathway. Exogenous interventions, including recombinant APN, APN peptides, and gene transfection, exert neuroprotective effects through multiple mechanisms such as anti-inflammatory and antioxidant actions, attenuation of excitotoxicity, and inhibition of apoptosis. Endogenous regulatory strategies, such as exercise preconditioning and pharmacological interventions, can upregulate APN and its receptor expression to mitigate injury. In addition, members of the APN homologous CTRP family exhibit synergistic neuroprotective potential. Integrating evidence from basic and clinical studies, targeting the APN pathway provides a promising therapeutic strategy for cerebral ischemia–reperfusion injury.
During and after cardiopulmonary resuscitation, patients often have circulatory dysfunction and tissue hypoperfusion. Fluid management strategy has an important impact on hemodynamic stability and prognosis. Restrictive fluid therapy can reduce the risk of fluid overload and brain edema by accurately controlling the volume input. Although liberal fluid therapy strategy can rapidly restore blood volume, it may lead to poor prognosis. This paper summarizes the characteristics of the two strategies in volume management, reperfusion injury prevention and control, and neuroprotection, aiming to provide evidence-based reference for the development of a goal-oriented individualized fluid management program.
Elderly patients account for 80% of cardiac arrest patients. The incidence of poor neurological prognosis after return of spontaneous circulation of these patients is as high as 90%, much higher than that of young. This is related to the fact that the mechanism of hippocampal brain tissue injury after ischemia-reperfusion in elderly cardiac arrest patients is aggravated. Therefore, this study reviews the possible mechanisms of poor neurological prognosis after return of spontaneous circulation in elderly cardiac arrest animals, and the results indicate that the decrease of hippocampal perfusion and the number of neurons after resuscitation are the main causes of the increased hippocampal injury, among which oxidative stress, mitochondrial dysfunction and protein homeostasis disorder are the important factors of cell death. This review hopes to provide new ideas for the treatment of elderly patients with cardiac arrest and the improvement of neurological function prognosis through the comparative analysis of elderly and young animals.
Objective To build a score with the coagulation, inflammation indexes of sepsis patients, named Sepsis-Related Coagulo-Inflammatory Score (SRCIS), and then evaluate the prognostic capability of it in predicting the 28-day mortality of septic patients after the diagnosis. Methods In this prospective nested case-control study, we recruited septic patients according to the Sepsis 3.0 standards, who visited the Emergency Department, West China Hospital of Sichuan University from September 2017 to January 2018. Multiple factor analysis was conducted to confirm which coagulation or inflammation biomarkers were independent risk factors related to the 28-day mortality after their diagnosis. After that, the SRCIS was built based on those independent risk factors. Finally, receiver operating characteristic curve (ROC) analysis was conducted to verify its prognostic capability for the 28-day mortality of septic patients. Results A total of 123 cases were included. Among them, 17 patients died within 28 days, and the mortality rate was 13.8%. There were no significant differences in the demographic characteristics or comorbidities between the survival group and dead group (P>0.05). Multivariate logistic analysis showed that both activated partial thromboplastin time (APTT) [odds ratio (OR)=1.015, 95% confidence interval (CI) (1.017, 1.189), P=0.017] and C-reactive protein (CRP) [OR=1.100, 95%CI (1.006, 1.025), P=0.002] were independent risk factors for predicting the 28-day mortality of septic patients. ROC analysis indicated that the cut-off values of APTT and CRP predicting the 28-day mortality rate of sepsis were 39.25 seconds and 198.05 mg/L, respectively, and the areas under the curve (AUC) of them were 0.618 and 0.671, respectively. The results indicated that the mortality increased from 8.79% to 28.13%, when APTT prolonged to no less than 39.25 seconds (P<0.05). The mortality also increased from 8.89% to 27.27% when CRP elevated to no less than 198.05 mg/L (P<0.05). The AUC of SRCIS in predicting the 28-day mortality of patients with sepsis was 0.707, which was better than that of Sequential Organ Failure Assessment (SOFA) (AUC=0.681) and quick Sequential Organ Failure Assessment (qSOFA) (AUC=0.695). The corresponding 28-day mortality rates for patients with sepsis were 6.94%, 16.22%, and 42.86% (P<0.05), respectively, when the SRCIS score were 0, 1, and 2. Conclusions APTT and CRP are independent risk factors in predicting the 28-day mortality of patients with sepsis. Compared with traditional scoring systems such as SOFA and qSOFA, SRCIS performances better in predicting the 28-day mortality for patients with sepsis.
ObjectiveTo evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.MethodsA clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing’s sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph.ResultsPoor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively.ConclusionReconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
On September 18th, 2023, the American Heart Association published clinical management guidelines for patients with poisoning-induced cardiac arrest and critical cardiovascular illness in Circulation. Considering the important role of the guidelines in clinical practice, our team has divided them into three sections for detailed interpretation based on the different toxic effects of the drugs. This article is the second part of the interpretation, which combines the literature to interpret the recommendations related to cardiotoxic substance poisoning in the guidelines, mainly involving the clinical management of beta blockers, calcium channel blockers, digoxin and other cardiac glycosides, as well as sodium channel blocker poisoning, aiming to assist colleagues in their clinical practice through a detailed explanation of the key recommendations in the guidelines.
