World journal of emergency medicine最新文献

Background: Fluid resuscitation in acute pancreatitis (AP) patients requires precise titration because both excess and insufficient volumes may worsen outcomes. This study aimed to develop a weight-normalized fluid balance index (FBI) and assess its association with in-hospital mortality in critically ill AP patients.

Methods: This retrospective cohort study utilized data from the MIMIC-IV 3.0 database and the emergency intensive care unit (EICU) of our hospital (validation cohort) and was based on inclusion and exclusion criteria. Using the R package cutoff, an FBI of 145 mL/kg was identified as the optimal risk stratification threshold. The primary outcome was in-hospital all-cause mortality. Machine learning was used to screen covariates for inclusion in multivariable Cox models. Cox regression and restricted cubic spline (RCS) models were used to evaluate the relationship between FBI and mortality. Propensity score matching (PSM) was applied to minimize baseline confounding. After PSM, Kaplan-Meier survival curves were generated, and the results were validated via data from our center.

Results: In this study, 547 AP patients from the MIMIC-IV database and 156 from the EICU of our hospital were included. In the MIMIC-IV cohort, the overall in-hospital mortality rate was 8.96%. Patients with FBI ≥145 mL/kg had significantly higher in-hospital mortality than did those with FBI <145 mL/kg (P<0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [HR] 1.99, 95% confidence interval [95% CI]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (P<0.05). This result was corroborated by our validation cohort. RCS analysis further demonstrated a non-linear increase in in-hospital mortality with increasing FBI values.

Conclusion: An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.

Background: While the α7 nicotinic acetylcholine receptor (α7 nAChR) is implicated in sepsis-associated encephalopathy (SAE), its pathophysiological contributions require further investigation.

Methods: SAE was induced in mice via cecal ligation and puncture (CLP), and microglia were treated with lipopolysaccharide (LPS). PHA-543613 (an α7 nAChR agonist) was used to activate α7 nAChR. To study the role of α7 nAChR in mitophagy and pyroptosis, caspase-1-deficient mice and PTEN-induced kinase 1 (PINK1) small interfering RNA (siRNA) were used. Cognitive function, cerebral oxygen extraction ratio (CERO₂), and brain tissue oxygen pressure (PbtO₂) were measured. Blood-brain barrier (BBB) integrity was evaluated via Evan's blue staining. Mitophagy, pyroptosis, and cytokine levels were analyzed via Western blotting and immunofluorescence.

Results: CLP or LPS treatment significantly down-regulated α7 nAChR protein expression in microglia. The administration of PHA-543613 to activate α7 nAChR not only restored its expression post-sepsis, but also notably decreased BBB permeability and mitigated cognitive deficits. Both α7 nAChR activation and caspase-1 knockout effectively suppressed microglial pyroptosis. The activation of α7 nAChR also promoted mitophagy in microglia. This led to an amelioration of brain tissue hypoxia, as shown by elevated PbtO₂ and reduced CERO₂ levels. The suppression of microglial pyroptosis by α7 nAChR was counteracted when mitophagy was inhibited through the siRNA-mediated silencing of PINK1.

Conclusion: The activation of α7 nAChR reduces pyroptosis by enhancing microglial mitophagy, thereby mitigating SAE.

Background: Large language models (LLMs) are being explored for disease prediction and diagnosis; however, their efficacy for early sepsis identification in emergency departments (EDs) remains unexplored. This study aims to evaluate MedGo, a novel medical LLM, as a decision-support tool for clinicians managing patients with suspected sepsis.

Methods: This retrospective study included anonymized medical records of 203 patients (mean age 79.9±10.2 years) with confirmed sepsis from a tertiary hospital ED between January 2023 and January 2024. MedGo performance across nine sepsis-related assessment tasks was compared with that of two junior (<3 years of experience) and two senior (>10 years of experience) ED physicians. Assessments were scored on a 5-point Likert scale for accuracy, comprehensiveness, readability, and case-analysis skills.

Results: MedGo demonstrated diagnostic performance comparable to that of senior physicians across most metrics, achieving a median Likert score of 4 in accuracy, comprehensiveness, and readability. MedGo significantly outperformed junior physicians (P<0.001 for accuracy and case-analysis skills). MedGo assistance significantly enhanced both junior (P<0.001) and senior (P<0.05) physicians' diagnostic accuracy. Notably, MedGo-assisted junior physicians achieved accuracy levels comparable to those of unassisted senior physicians. MedGo maintained consistent performance across varying sepsis severities.

Conclusion: MedGo shows significant diagnostic efficacy for sepsis and effectively supports clinicians in the ED, particularly enhancing junior physicians' performance. Our study highlights the potential of MedGo as a valuable decision-support tool for sepsis management, paving the way for specialized sepsis AI models.

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.