World journal of emergency medicine最新文献

Background: Hepatic ischemia-reperfusion (I/R) injury is a major challenge in liver surgery and transplantation. Bromodomain protein 4 (BRD4) has emerged as a promising target due to its role in oxidative stress and inflammation. JQ-1, a specific BRD4 inhibitor, has shown protective effects on organs suffering I/R injury. This study aims to investigate the expression of BRD4 in liver tissues after I/R injury and to explore its role in this process using JQ-1 both in vivo and in vitro.

Methods: Our study established a mouse model of hepatic I/R injury and investigated the protective effect of JQ-1. We compared the histological features, BRD4 expression, and liver enzyme levels between JQ-1-treated and untreated groups. Additionally, the antioxidant properties of JQ-1 were analyzed in RAW 264.7 cells by evaluating cytokine expression, NLRP3 inflammasome activity, and reactive oxygen species production.

Results: BRD4 was abundantly expressed in liver tissues after hepatic I/R injury, while JQ-1 treatment had antioxidant and hepatoprotective effects. JQ-1 also suppressed pro-inflammatory cytokine release in vitro. Furthermore, we clarified the mechanism by which JQ-1 enhances liver injury recovery through Kupffer cells by blocking the NOD-like receptor thermal protein domain-associated protein 3 (NLRP3)/caspase-1 pathway.

Conclusion: JQ-1 has potential as a pre-clinical emergency therapy for hepatic I/R injury. Its ability to inhibit BRD4 and modulate the inflammatory response in Kupffer cells offers a promising avenue for future clinical intervention.

Background: Extracorporeal membrane oxygenation (ECMO) is an effective measure for saving the lives of critically ill patients. Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital. This scoping review summarized the representative prognostic scoring systems, aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.

Methods: A comprehensive search of multiple databases, including PubMed, Embase, and the Cochrane Library, was conducted. After removing duplicate studies, a full-text review was performed, and all studies that reported score systems before and/or after ECMO support were included. This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and has been registered with the Open Science Framework (osf.io/zp4ge).

Results: Among the 114 studies included, we identified three scores for patients receiving veno-venous ECMO (VV-ECMO), five scores for patients receiving veno-arterial ECMO (VA-ECMO), and three critical illness scores, which apply to both VV- and VA-ECMO conditions. All characteristics of these scoring systems, their advantages, and their limitations were summarized.

Conclusion: The implementation of an ECMO scoring system helps to assess the condition of critically ill patients, predict outcome, and provide objective indicators to determine the optimal timing for ECMO intervention. Due to the limitations of the currently available scores, further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.

Background: Oxygen supply is a common procedure performed by emergency medical services (EMS); however, whether prehospital oxygen or fraction of inspired oxygen (FiO₂) therapy predict mortality has not been studied to date. This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.

Methods: This was a prospective, observational, cohort, multicenter, EMS-delivery, ambulance-based study. Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces. Epidemiological variables, on-scene vital signs, and prehospital blood analysis data were collected. The primary outcome was short- (2-, 7-, and 30-day), medium- (90- and 180-day), and long-term (365-day) all-cause cumulative mortality. The samples were a priori split according to thresholds of their received FiO₂(FiO₂=0.21, that is without oxygen therapy; FiO₂ between 0.22 and 0.49; and FiO₂≥0.5). The categorical variables FiO₂, epidemiological variables, vital signs, prehospital point-of-care testing (POCT) and patient outcomes were fitted with a logistic regression model. Additionally, a propensity score matching and a survival analysis were used.

Results: The final sample included 7,494 patients, 70.3% of whom did not receive oxygen therapy, 15% with a FiO₂ between 0.22 and 0.49, and 14.7% with a FiO₂≥0.5. The 2-day mortality was 0.4%, 5.3%, and 22.9% respectively (P<0.001). The 365-day mortality was 9.9%, 33.1%, and 50.5% respectively (P<0.001). Finally, the FiO₂ predictive capacities 2-,30-, and 365-day mortality were AUC=0.870 (95%CI: 0.840-0.899), 0.810 (95%CI: 0.784-0.837), 0.704 (95%CI: 0.679-0.728), respectively.

Conclusion: Prehospital oxygen therapy by thresholds of FiO₂ was linked to death and allowed mortality prediction. This finding could provide an aid for EMS providers, allowing to assess more individualized patient risk.

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.