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Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt: a descriptive study in northern China 特异性治疗对无心脏分流的肺动脉高压孕妇的潜在影响:中国北方的一项描述性研究
Pub Date : 2023-09-21 DOI: 10.1097/ec9.0000000000000103
Weida Lu, Min Li, Fuqing Ji, Hua Feng, Guo Li, Qiushang Ji, Hongyu Zhang, Xiaopei Cui
Abstract Background Pregnancy in women with pulmonary arterial hypertension (PAH) is a fatal condition, despite the effectiveness of PAH-specific therapies. The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear. To investigate this issue, we conducted a multicenter retrospective study in northern China. Methods The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020. Maternal endpoint events included (1) maternal death and/or (2) major adverse cardiac events, both occurring during pregnancy or within 6 weeks postpartum. Results Although the overall mortality rate was encouraging (11.8%), the number of patients receiving PAH-specific therapies was extremely low (28.2%). Moreover, only 15.3% of patients received adequate duration of PAH-specific therapy (≥4 weeks) before delivery, and this subgroup showed the lowest major adverse cardiac events rate (7.7%) compared with that in the untreated (19.7%) and short-time treated groups (<4 weeks; 54.5%). Conclusion Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks. Short-term PAH-specific therapy does not guarantee favorable maternal outcomes. Prepregnancy screening, early identification, and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.
背景肺动脉高压(PAH)妇女妊娠是一种致命的疾病,尽管PAH特异性治疗有效。中国孕妇PAH无心脏分流术的覆盖状况和特异性治疗效果尚不清楚。为了调查这一问题,我们在中国北方进行了一项多中心回顾性研究。方法选取2010年10月至2020年8月山东省4个临床中心收治的85例患者为研究对象。产妇终点事件包括(1)产妇死亡和/或(2)主要心脏不良事件,均发生在妊娠期间或产后6周内。结果尽管总死亡率(11.8%)令人鼓舞,但接受pah特异性治疗的患者数量极低(28.2%)。此外,只有15.3%的患者在分娩前接受了足够时间的pah特异性治疗(≥4周),与未治疗组(19.7%)和短时间治疗组(4周;54.5%)。结论妊娠期PAH患者未行心脏分流术的死亡风险明显增加。短期pah特异性治疗不能保证良好的产妇结局。孕前筛查、早期识别和及时干预有望改善PAH孕妇的产妇结局。
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引用次数: 0
Emergency Care and Medicine, 2023 急诊护理与医学,2023
Pub Date : 2023-09-05 DOI: 10.3390/ecm1010001
R. Lunevicius
The most recent global emergency medicine 56-question survey highlighted challenges and gaps in providing emergency care [...]
最近的全球急诊医学56个问题调查突出了提供急诊护理方面的挑战和差距[…]
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引用次数: 0
COVID-19 and cardiovascular complications: updates of emergency medicine. COVID-19与心血管并发症:急诊医学最新进展
Pub Date : 2023-09-01 Epub Date: 2023-06-01 DOI: 10.1097/ec9.0000000000000095
Jianli Zhao, Yaoli Xie, Zhijun Meng, Caihong Liu, Yalin Wu, Fujie Zhao, Xinliang Ma, Theodore A Christopher, Bernard J Lopez, Yajing Wang

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.

摘要2019冠状病毒病(新冠肺炎)由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)和SARS-CoV-2变种引起,已成为一种全球大流行,导致严重的发病率和死亡率。新冠肺炎重症病例以低氧血症、高炎症、肺部细胞因子风暴为特征。临床研究报告了新冠肺炎与心血管疾病(CVD)之间的关联。心血管疾病患者如果感染新冠肺炎,心脏损伤生物标志物进一步升高,往往会出现严重症状和死亡。此外,新冠肺炎本身可诱导和促进心血管疾病的发展,包括心肌炎、心律失常、急性冠状动脉综合征、心源性休克和静脉血栓栓塞。尽管严重急性呼吸系统综合征冠状病毒2型诱导的心脏损伤的直接病因尚不清楚,研究不足,但人们怀疑它与心肌炎、细胞因子介导的损伤、微血管损伤和应激相关心肌病有关。尽管疫苗接种为降低总体死亡率提供了最有效的方法,但适应的治疗模式和定期监测心脏损伤生物标志物对于改善有严重新冠肺炎风险的弱势人群的结果至关重要。在这篇综述中,我们重点介绍了新冠肺炎心血管并发症的临床和研究的最新进展,并提供了在急诊医学中治疗新冠肺炎心脏并发症的前景。
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引用次数: 0
Trauma systems in Canada: striving for quality across an expansive landmass 加拿大的创伤系统:在广阔的土地上努力提高质量
Pub Date : 2023-08-09 DOI: 10.1097/ec9.0000000000000102
Natasha G. Caminsky, Evan G. Wong
Although Canada has a universal health care program that provides free in-hospital services to all citizens, its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging, particularly to resource-limited rural regions. This article summarizes the strengths of the prehospital system, facility-based care, trauma network, trauma registry, rehabilitation, and governance/financing/quality assurance components of Canada’s trauma system. Future directions, including the use of telemedicine, standardization of practices, and resource optimization, are also explored. Canada’s trauma system is well developed, yet geography impedes equitable access. More standardization and resource optimization are needed.
尽管加拿大有一个向所有公民提供免费住院服务的全民医疗保健计划,但其广阔的土地和非标准化的院前和院后系统使提供高质量的创伤护理具有挑战性,尤其是在资源有限的农村地区。本文总结了加拿大创伤系统的院前系统、基于设施的护理、创伤网络、创伤登记、康复和治理/融资/质量保证组成部分的优势。还探讨了未来的方向,包括远程医疗的使用、实践的标准化和资源优化。加拿大的创伤系统发展良好,但地理位置阻碍了公平的治疗。需要更多的标准化和资源优化。
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引用次数: 0
Early sodium bicarbonate infusion was associated with improved outcome in critically ill patients with acute moderate metabolic acidosis: a retrospective observational study 急性中度代谢性酸中毒危重患者早期输注碳酸氢钠可改善预后:一项回顾性观察研究
Pub Date : 2023-08-07 DOI: 10.1097/ec9.0000000000000101
Saijia Huang, Bo Yang, Yaojun Peng, Libo Wang, Li-li Wang, J. Wang, Xuan Zhou, Hanyu Zhu, Li Chen, Cong Feng
Sodium bicarbonate (SB) infusion is widely administered for severe metabolic acidosis (MA). However, evidence supporting its effect on mortality in patients with acute moderate MA (MMA) has not yet been established. This study investigated the effect of early SB administration on mortality in critically ill patients with acute MMA and in other subgroups. We retrospectively analyzed a large intensive care unit (ICU) database, Medical Information Mart for Intensive Care (MIMIC)-IV. Patients with acute MMA were identified using MIMIC-IV. Propensity score analysis (PSA) was performed to explain baseline differences in the probability of receiving SB. The marginal structural Cox model (MSCM) was developed to adjust for both baseline and time-varying confounding variables. The primary outcome was ICU mortality, and the secondary outcome was hospital mortality. In total, 1738 patients with acute MMA were identified; 484 were enrolled in the SB group and 1254 in the non-SB group. In the PSA, early SB infusion was not associated with reduced ICU mortality (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.67–1.14; P = 0.33) in the overall cohort. However, it was associated with improved ICU survival in patients with sepsis (HR: 0.69; 95% CI: 0.48–0.99; P < 0.05), sepsis shock (HR: 0.61; 95% CI: 0.40–0.93; P < 0.05), and sepsis and lactic acidosis (lactate >2.2 mmol/L; HR: 0.69; 95% CI: 0.48–0.99; P < 0.05). The results from MSCM were similar to those obtained for PSA. Early SB infusion was associated with improved ICU survival outcomes in critically ill adult patients with sepsis, septic shock, and sepsis and lactic acidosis and acute MMA. Further large randomized controlled trials are required to confirm these results.
碳酸氢钠(SB)输注广泛用于严重代谢性酸中毒(MA)。然而,支持其对急性中度MA (MMA)患者死亡率影响的证据尚未建立。本研究探讨了早期给药SB对急性MMA危重患者及其他亚组患者死亡率的影响。我们回顾性分析了一个大型重症监护病房(ICU)数据库,重症监护医疗信息集市(MIMIC)-IV。使用MIMIC-IV识别急性MMA患者。采用倾向评分分析(PSA)来解释接受SB概率的基线差异。开发了边际结构Cox模型(MSCM)来调整基线和时变混杂变量。主要结局是ICU死亡率,次要结局是医院死亡率。共发现1738例急性MMA患者;484人被纳入SB组,1254人被纳入非SB组。在PSA中,早期SB输注与ICU死亡率降低无关(危险比[HR]: 0.88;95%置信区间[CI]: 0.67-1.14;P = 0.33)。然而,它与脓毒症患者ICU生存率的提高相关(HR: 0.69;95% ci: 0.48-0.99;P < 0.05),脓毒症休克(HR: 0.61;95% ci: 0.40-0.93;P < 0.05),脓毒症和乳酸酸中毒(乳酸>2.2 mmol/L;人力资源:0.69;95% ci: 0.48-0.99;P < 0.05)。MSCM的结果与PSA相似。早期SB输注与脓毒症、感染性休克、脓毒症、乳酸性酸中毒和急性MMA重症成人患者的ICU生存结果改善相关。需要进一步的大型随机对照试验来证实这些结果。
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引用次数: 0
Successful fiberoptic orotracheal intubation by lifting large thyroid mass and tongue protrusion in left lateral position: a case report 左侧位甲状腺大肿块及舌突提起纤维气管插管成功1例
Pub Date : 2023-07-25 DOI: 10.1097/ec9.0000000000000100
Sarfaraz Ahmad, Neeraj Kumar, Ajeet Kumar, Saravanan Palasevam
Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies. After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position, the decision to switch to the left lateral position was made. We present this case to propose the utilization of the lateral position for awake intubation. We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision. The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue. The breathing difficulties subsided in the lateral position. We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.
由于甲状腺恶性肿瘤,清醒纤维支气管镜检查长期以来一直被认为是治疗气道困难的标准。在仰卧位使用纤维支气管镜插管失败后,决定改用左侧位。我们提出了这个案例,建议使用侧位清醒插管。我们报告了一例罕见的甲状腺大乳头状癌患者,计划进行手术切除。患者在我们医院就诊时抱怨仰卧位呼吸困难,坏死组织渗出血液。侧卧时呼吸困难减轻了。我们展示了左侧位和辅助操作如何促进大型甲状腺恶性肿瘤的插管。
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引用次数: 0
Advancing emergency preparedness in a postpandemic world: global collaboration and innovative approaches for hospitals 在大流行后世界推进应急准备:全球合作和医院创新方法
Pub Date : 2023-07-06 DOI: 10.1097/ec9.0000000000000099
Krzysztof Goniewicz, D. Barten
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引用次数: 0
Use of ketamine for severe asthma exacerbation in a pregnant patient with persistent bronchospasm: a case report 氯胺酮治疗持续性支气管痉挛孕妇严重哮喘加重1例
Pub Date : 2023-07-06 DOI: 10.1097/ec9.0000000000000098
Melanie Johnson, M. Abbas, Jaber Abdo, M. Mansour, Jessica Jones
Estimated 4%–8% of pregnancies are complicated by asthma. Adequate management in this population is critical to minimize complications. Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids. However, additional agents may be used in patients with refractory asthma exacerbation. Ketamine has been used in refractory bronchospasm, although its efficacy in published literature is heterogeneous. We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion. After receiving ketamine infusion for several days, the patient had improved air flow and achieved successful extubation, without experiencing rebound bronchospasm. Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations, it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.
估计有4%-8%的妊娠合并哮喘。适当的治疗对减少并发症至关重要。出现哮喘加重的患者通常使用标准支气管扩张剂和全身皮质类固醇治疗。然而,对于难治性哮喘加重患者,可使用其他药物。氯胺酮已被用于治疗难治性支气管痉挛,尽管其疗效在已发表的文献中是不一致的。我们提出了一个病例的孕妇严重哮喘加重难治性标准和抢救治疗谁达到终止支气管痉挛氯胺酮输注。在接受氯胺酮输注数天后,患者空气流动改善,拔管成功,未发生支气管痉挛反弹。虽然这一单独的临床病例不能改变难治性哮喘加重的指南或指令,但它为具有减轻危险因素的异常严重病例的患者和提供者提供了一种可能的治疗选择。
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引用次数: 0
Vaspin alleviates pathological cardiac hypertrophy by regulating autophagy-dependent myocardial senescence Vaspin通过调节自噬依赖性心肌衰老来减轻病理性心肌肥大
Pub Date : 2023-06-22 DOI: 10.1097/ec9.0000000000000097
Huaxiang Yu, Haiying Rui, Dan Zou, Kai Chi, Ping Xu, Xiaoshuai Song, Lulu Liu, Xuting Wu, Jinxin Wang, Li Xue
Abstract Background Visceral adipose tissue–derived serine protease inhibitor (vaspin), a secretory adipokine, protects against insulin resistance. Recent studies have demonstrated that serum vaspin levels are decreased in patients with coronary artery disease and that vaspin protects against myocardial ischemia-reperfusion injury and atherosclerosis. However, it remains unclear whether vaspin exerts specific effects on pathological cardiac hypertrophy. Methods An in vivo study was conducted using a cardiac hypertrophy model established by subcutaneous injection of isoproterenol (ISO) in C57BL/6 and vaspin-ko mice. Rapamycin was administered intraperitoneally to mice, for further study. H9c2 cells and neonatal rat ventricular myocytes (NRVMs) were treated with ISO to induce hypertrophy. Human vaspin fusion protein, the proteasome inhibitor MG132, and chloroquine diphosphate were used for further mechanistic studies. Results Here, we provide the first evidence that vaspin knockdown results in markedly exaggerated cardiac hypertrophy, fibrosis, and cardiomyocyte senescence in mice treated with ISO. Conversely, the administration of exogenous recombinant human vaspin protected NRVMs in vitro against ISO-induced hypertrophy and senescence. Furthermore, vaspin significantly potentiated the ISO-induced decrease in autophagy. Both rapamycin and chloroquine diphosphate regulated autophagy in vivo and in vitro, respectively, and participated in vaspin-mediated cardioprotection. Moreover, the PI3K-AKT-mTOR pathway plays a critical role in vaspin-mediated autophagy in cardiac tissues and NRVMs. Our data showed that vaspin downregulated the p85 and p110 subunits of PI3K by linking p85 and p110 to NEDD4L-mediated ubiquitination degradation. Conclusion Our results show, for the first time, that vaspin functions as a critical regulator that alleviates pathological cardiac hypertrophy by regulating autophagy-dependent myocardial senescence, providing potential preventive and therapeutic targets for pathological cardiac hypertrophy.
背景:内脏脂肪组织源性丝氨酸蛋白酶抑制剂(vaspin)是一种分泌性脂肪因子,可预防胰岛素抵抗。最近的研究表明,冠状动脉疾病患者血清血管素水平降低,血管素对心肌缺血再灌注损伤和动脉粥样硬化具有保护作用。然而,vaspin是否对病理性心肌肥厚具有特异性作用尚不清楚。方法采用皮下注射异丙肾上腺素(ISO)建立C57BL/6和vaspin-ko小鼠心肌肥厚模型进行体内研究。小鼠腹腔注射雷帕霉素,以作进一步研究。用ISO诱导H9c2细胞和新生大鼠心室肌细胞(nrvm)肥大。使用人血管蛋白融合蛋白、蛋白酶体抑制剂MG132和二磷酸氯喹进行进一步的机制研究。在这里,我们提供了第一个证据,表明vaspin敲低导致ISO处理小鼠心肌肥大、纤维化和心肌细胞衰老明显加剧。相反,外源性重组人vaspin在体外保护nrvm免受iso诱导的肥大和衰老。此外,vaspin显著增强了iso诱导的自噬减少。雷帕霉素和二磷酸氯喹分别在体内和体外调节自噬,并参与血管素介导的心脏保护。此外,PI3K-AKT-mTOR通路在血管素介导的心脏组织和nrvm自噬中起关键作用。我们的数据显示,vaspin通过将p85和p110与nedd4l介导的泛素化降解联系起来,下调了PI3K的p85和p110亚基。结论我们的研究结果首次表明,vaspin是通过调节自噬依赖性心肌衰老来减轻病理性心肌肥厚的关键调节剂,为病理性心肌肥厚提供了潜在的预防和治疗靶点。
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引用次数: 0
A novel machine learning-assisted clinical diagnosis support model for early identification of pancreatic injuries in patients with blunt abdominal trauma: a cross-national study 一种新的机器学习辅助临床诊断支持模型用于早期识别钝性腹部创伤患者胰腺损伤:一项跨国家研究
Pub Date : 2023-06-08 DOI: 10.1097/ec9.0000000000000096
Saijia Huang, Xuan Zhang, Bo Yang, Y. Teng, Li Mao, Li-li Wang, J. Wang, Xuan Zhou, Li Chen, Yuan Yao, Cong Feng
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引用次数: 0
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Emergency and critical care medicine
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