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.
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.
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.
ObjectiveTo investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder, create a simple scoring system, and evaluate its predictive value for the poor neurological outcome.MethodsWe retrospectively collected and analyzed the demographic data, clinical data, 28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st, 2017 and May 31st, 2018. Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis, and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic (ROC) curve analysis, a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.ResultsA total of 149 patients with sepsis complicated with consciousness disorder were included in this study, including 103 males (69.1%) and 46 females (30.9%), with an average age of (58.2±18.6) years old. There were 72 patients (48.3%) with poor outcome of neurological function on Day 28 after admission. Multiple logistic regression analysis revealed that total bile acid [odds ratio (OR)=1.040, 95% confidence interval (CI) (1.004, 1.077), P=0.027], blood ammonia [OR=1.014, 95%CI (1.001, 1.027), P=0.030], pulmonary infection [OR=3.255, 95%CI (1.401, 7.566), P=0.006], and Glasgow Coma Score (GCS) [OR=0.837, 95%CI (0.739, 0.949), P=0.005] were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission. The area under the ROC curve predicting the 28-day poor neurological function was 0.754 [95%CI (0.676, 0.832)], and the sensitivity and specificity were 79.2% and 63.6%, respectively.ConclusionFor emergency patients with sepsis complicated with consciousness disorder, a simple scoring system based on early GCS, pulmonary infection, serum ammonia, and total bile acid has a favorable predictive value for short-term neurological function.
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.
The treatment of organ function damage secondary to return of spontaneous circulation in patients with cardiac arrest is an important part of advanced life support. The incidence of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest is as high as 79%. Understanding the characteristics and related mechanisms of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, and early identification and treatment of lung injury secondary to return of spontaneous circulation are crucial to the clinical treatment of patients with cardiac arrest. Therefore, this article reviews the research progress on the characteristics, risk factors, mechanisms and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, in order to provide a reference for the research and clinical diagnosis and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest.
On September 18th, 2023, the American Heart Association published clinical management guidelines for cardiac arrest and critical cardiac conditions caused by poisoning in the journal Circulation. Based on the differences in drug toxicity effects, our team has systematically interpreted the guidelines in three parts. This article, as the third part, focuses on interpreting the clinical management strategies for cardiac arrest caused by cyanide, organophosphates, carbamate and methemoglobinemia, and reviews the application of veno-arterial extracorporeal membrane oxygenation in poisoning treatment. Through in-depth analysis of the key recommendations in the guidelines, it aims to provide reference for clinical diagnosis and treatment.