Pub Date : 2022-11-21DOI: 10.1097/ec9.0000000000000052
Clifton Ewbank, K. Gianaris, A. Kushner
{"title":"Climate change and surgical implications","authors":"Clifton Ewbank, K. Gianaris, A. Kushner","doi":"10.1097/ec9.0000000000000052","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000052","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42682086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Wild edible mushrooms are rich in nutrition and popular with people; however, few laboratory studies are available about the predictability of outcomes among patients with mushroom poisoning. Therefore, this study aimed to analyze the clinical features and death risk factors of patients with mushroom poisoning. Methods Patients with mushroom poisoning admitted to the hospital from 2015 to 2021 were retrospectively evaluated. Results A total of 197 patients with mushroom poisoning were enrolled in this study, of which 100 (50.76%) were males, and the mortality was 10.66% (21/197). Patients who died were more likely to have demonstrated a long latency, high alanine aminotransferase, aspartate aminotransferase, direct bilirubin, total bilirubin (TB), activated partial thromboplastin time, prothrombin time, international normalized ratio, creatinine, and blood urea nitrogen. Multiple logistic regression analysis indicated that TB level greater than or equal to 34.2 μmol/L had the greatest lethal risk and could increase the risk of death by 14.588 times (odds ratio: 15.588; 95% confidence interval: 2.088–116.351), which indicated that TB was an independent risk factor of death in patients with acute mushroom poisoning. Conclusion Bilirubin concentration was associated with the increased likelihood of mortality. Total bilirubin was the independent risk factor of mushroom poisoning.
{"title":"Analysis of the clinical features and risk factors of death in patients with mushroom poisoning","authors":"Yan Yang, Ruifei Shao, Jinfang Xue, Xiran Lou, Deyuan Ning, Guobing Chen","doi":"10.1097/EC9.0000000000000058","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000058","url":null,"abstract":"Abstract Background Wild edible mushrooms are rich in nutrition and popular with people; however, few laboratory studies are available about the predictability of outcomes among patients with mushroom poisoning. Therefore, this study aimed to analyze the clinical features and death risk factors of patients with mushroom poisoning. Methods Patients with mushroom poisoning admitted to the hospital from 2015 to 2021 were retrospectively evaluated. Results A total of 197 patients with mushroom poisoning were enrolled in this study, of which 100 (50.76%) were males, and the mortality was 10.66% (21/197). Patients who died were more likely to have demonstrated a long latency, high alanine aminotransferase, aspartate aminotransferase, direct bilirubin, total bilirubin (TB), activated partial thromboplastin time, prothrombin time, international normalized ratio, creatinine, and blood urea nitrogen. Multiple logistic regression analysis indicated that TB level greater than or equal to 34.2 μmol/L had the greatest lethal risk and could increase the risk of death by 14.588 times (odds ratio: 15.588; 95% confidence interval: 2.088–116.351), which indicated that TB was an independent risk factor of death in patients with acute mushroom poisoning. Conclusion Bilirubin concentration was associated with the increased likelihood of mortality. Total bilirubin was the independent risk factor of mushroom poisoning.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47093763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-18DOI: 10.1097/EC9.0000000000000062
Yibing Shi, Jin Zheng, N. Yang, Yang Chen, Jingxi Sun, Ying Zhang, Xuanxuan Zhou, Yongguang Gao, Suqing Li, Haijing Zhu, J. Acosta-Cabronero, P. Xia, Z. Teng
Abstract Background Hemodynamic parameters derived from computed tomography angiography–based computational fluid dynamics (CFD) analysis have been widely used for clinical decision-making and researches to assess the vulnerability of atherosclerotic plaques and explain the initialization and development of atherosclerosis. Subbranches in the CFD model might affect the accuracy of hemodynamic parameters, but the effectiveness has been least quantified. Methods A coronary artery baseline model was generated with focal stenosis at the proximal left anterior descending artery. Nineteen comparing models were created by systematically removing various subbranches to examine the changes in hemodynamic parameters, including time-averaged pressure (TAP), time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and particle relative residence time (RRT). Changes in these parameters were assessed quantitatively around the stenosis and near the region where subbranches were removed. Results The removal of subbranches caused a significant change in outflow rate, and there was generally a decrease in all CFD parameters in the regions of interest with a decrease in outflow rate. The subbranch removal had a significant impact on the calculation of TAWSS, OSI, and RRT, whereas TAP was insensitive to the removal with approximately 0.25% variation in all 19 models. The local effect from removing branch segments generally became negligible after 5 diameters away from the cutting-off position, but the decrease could be affected by other factors, such as a large curvature. Conclusion The outflow rate is a dominant factor for the calculation of TAP, TAWSS, OSI, and RRT. Removal of subbranches has a minor effect on the TAP calculation, but its effect is considerable on the TAWSS, OSI, and RRT. The effect of subbranch removal is limited in a region with 5 local diameters.
{"title":"The effect of subbranch for the quantification of local hemodynamic environment in the coronary artery: a computed tomography angiography–based computational fluid dynamic analysis","authors":"Yibing Shi, Jin Zheng, N. Yang, Yang Chen, Jingxi Sun, Ying Zhang, Xuanxuan Zhou, Yongguang Gao, Suqing Li, Haijing Zhu, J. Acosta-Cabronero, P. Xia, Z. Teng","doi":"10.1097/EC9.0000000000000062","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000062","url":null,"abstract":"Abstract Background Hemodynamic parameters derived from computed tomography angiography–based computational fluid dynamics (CFD) analysis have been widely used for clinical decision-making and researches to assess the vulnerability of atherosclerotic plaques and explain the initialization and development of atherosclerosis. Subbranches in the CFD model might affect the accuracy of hemodynamic parameters, but the effectiveness has been least quantified. Methods A coronary artery baseline model was generated with focal stenosis at the proximal left anterior descending artery. Nineteen comparing models were created by systematically removing various subbranches to examine the changes in hemodynamic parameters, including time-averaged pressure (TAP), time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and particle relative residence time (RRT). Changes in these parameters were assessed quantitatively around the stenosis and near the region where subbranches were removed. Results The removal of subbranches caused a significant change in outflow rate, and there was generally a decrease in all CFD parameters in the regions of interest with a decrease in outflow rate. The subbranch removal had a significant impact on the calculation of TAWSS, OSI, and RRT, whereas TAP was insensitive to the removal with approximately 0.25% variation in all 19 models. The local effect from removing branch segments generally became negligible after 5 diameters away from the cutting-off position, but the decrease could be affected by other factors, such as a large curvature. Conclusion The outflow rate is a dominant factor for the calculation of TAP, TAWSS, OSI, and RRT. Removal of subbranches has a minor effect on the TAP calculation, but its effect is considerable on the TAWSS, OSI, and RRT. The effect of subbranch removal is limited in a region with 5 local diameters.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41630463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-18DOI: 10.1097/EC9.0000000000000049
Biye Zhou, Q. Ao, Hua Zhao, P. Ye
Abstract Background Cardiorenal syndrome is increasingly common and has been reported to be associated with inflammation and oxidative stress, and statins have anti-inflammatory and antioxidant effects. Therefore, we designed this experiment to study the preventive effect of statins on cardiorenal syndrome. The aim of the study is to investigate the effect of early rosuvastatin use on cardiorenal syndrome. Method Forty-five Wistar rats were randomly divided into 3 groups. A unilateral nephrectomy group (Group 1), a unilateral nephrectomy + coronary ligation group (Group 2), and a unilateral nephrectomy + coronary ligation + rosuvastatin group (Group 3). Right kidney removal was performed on all rats during the first week, while Group 3 was given statin intragastric administration at 10 mg/kg/d. One month later, coronary ligation was performed on rats in Groups 2 and 3. Group 3 continued statin treatment. After feeding for 3 months and 2 days, the rats were killed; urine and blood were collected and sent to the laboratory for the determination of the urinary protein/creatinine ratio and blood lipid, creatinine, and urea nitrogen levels, respectively. Serum interleukin 1β, interleukin 6, malondialdehyde, glutathione peroxidase, angiotensin II, neutrophil gelatinase-associated lipocalin, cystatin C, and B natriuretic peptide levels were also determined. On the day before euthanasia, all rats were anesthetized and examined by cardiac ultrasound. Hematoxylin-eosin and periodic acid–Schiff staining were performed on heart and kidney sections. Results The ejection fraction in Group 2 was lower than that in Group 1 (P < 0.01). The ejection fraction value in Group 3 was lower than that in Group 1 (P < 0.01). Interleukin-1β levels in Group 2 were higher than those in Group 1 (P < 0.01). Interleukin-1β levels in Group 3 were lower than those in Group 2 (P < 0.01). The malondialdehyde value in Group 3 was lower than that in Group 2 (P < 0.05). Histopathology showed that Group 1 had slight renal damage, renal injury was aggravated in Group 2, and renal injury was still present in Group 3, but with alleviated morphology. Conclusion The interaction of the heart and kidneys in rats is related to inflammation and oxidation. Rosuvastatin can slow down the development of the heart-kidney interaction through anti-inflammatory and antioxidant effects.
{"title":"Rosuvastatin alleviates renal injury in cardiorenal syndrome model rats through anti-inflammatory and antioxidant pathways","authors":"Biye Zhou, Q. Ao, Hua Zhao, P. Ye","doi":"10.1097/EC9.0000000000000049","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000049","url":null,"abstract":"Abstract Background Cardiorenal syndrome is increasingly common and has been reported to be associated with inflammation and oxidative stress, and statins have anti-inflammatory and antioxidant effects. Therefore, we designed this experiment to study the preventive effect of statins on cardiorenal syndrome. The aim of the study is to investigate the effect of early rosuvastatin use on cardiorenal syndrome. Method Forty-five Wistar rats were randomly divided into 3 groups. A unilateral nephrectomy group (Group 1), a unilateral nephrectomy + coronary ligation group (Group 2), and a unilateral nephrectomy + coronary ligation + rosuvastatin group (Group 3). Right kidney removal was performed on all rats during the first week, while Group 3 was given statin intragastric administration at 10 mg/kg/d. One month later, coronary ligation was performed on rats in Groups 2 and 3. Group 3 continued statin treatment. After feeding for 3 months and 2 days, the rats were killed; urine and blood were collected and sent to the laboratory for the determination of the urinary protein/creatinine ratio and blood lipid, creatinine, and urea nitrogen levels, respectively. Serum interleukin 1β, interleukin 6, malondialdehyde, glutathione peroxidase, angiotensin II, neutrophil gelatinase-associated lipocalin, cystatin C, and B natriuretic peptide levels were also determined. On the day before euthanasia, all rats were anesthetized and examined by cardiac ultrasound. Hematoxylin-eosin and periodic acid–Schiff staining were performed on heart and kidney sections. Results The ejection fraction in Group 2 was lower than that in Group 1 (P < 0.01). The ejection fraction value in Group 3 was lower than that in Group 1 (P < 0.01). Interleukin-1β levels in Group 2 were higher than those in Group 1 (P < 0.01). Interleukin-1β levels in Group 3 were lower than those in Group 2 (P < 0.01). The malondialdehyde value in Group 3 was lower than that in Group 2 (P < 0.05). Histopathology showed that Group 1 had slight renal damage, renal injury was aggravated in Group 2, and renal injury was still present in Group 3, but with alleviated morphology. Conclusion The interaction of the heart and kidneys in rats is related to inflammation and oxidation. Rosuvastatin can slow down the development of the heart-kidney interaction through anti-inflammatory and antioxidant effects.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49496509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Pulmonary artery systolic pressure (PASP) has often been evaluated as an indicator of heart failure, but the relationship between PASP and the prognosis of elderly patients with acute myocardial infarction (AMI) is not well understood. Methods The medical data of 3460 hospitalized elderly patients diagnosed with AMI between January 2013 and June 2018 were reviewed. PASP was calculated using transthoracic color Doppler ultrasonography. Patients were grouped according to their admission PASP results as follows: Group A, PASP ≤30 mmHg; Group B, 30 mmHg 34 mmHg had a sensitivity of 62.3% and specificity of 65.7% for predicting 6-month all-cause death after AMI. Conclusion PASP at admission is a useful marker for predicting short-term mortality in elderly patients with AMI. This finding could be used to help identify high-risk patients and make appropriate clinical decisions.
{"title":"Prognostic implications of elevated pulmonary artery systolic pressure on 6-month mortality in elderly patients with acute myocardial infarction","authors":"Sheng-ji Wang, Yonggang Lian, Hongfei Wang, Xiao-Le Fan, Haiying Zhao","doi":"10.1097/EC9.0000000000000035","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000035","url":null,"abstract":"Abstract Background Pulmonary artery systolic pressure (PASP) has often been evaluated as an indicator of heart failure, but the relationship between PASP and the prognosis of elderly patients with acute myocardial infarction (AMI) is not well understood. Methods The medical data of 3460 hospitalized elderly patients diagnosed with AMI between January 2013 and June 2018 were reviewed. PASP was calculated using transthoracic color Doppler ultrasonography. Patients were grouped according to their admission PASP results as follows: Group A, PASP ≤30 mmHg; Group B, 30 mmHg <PASP ≤50 mmHg; and Group C, PASP ≥51 mmHg. The primary endpoint was all-cause death 6 months following AMI. Multiple Cox regression analysis was used to identify independent risk factors for 6-month mortality in elderly patients with AMI. Results PASP was associated with age, Killip classification, AMI site, and decreased ejection fraction in elderly patients. After adjusting for clinical and echocardiographic parameters in the Cox model, PASP was found to be significantly related to all-cause mortality. In receiver operating characteristic analysis, a PASP of >34 mmHg had a sensitivity of 62.3% and specificity of 65.7% for predicting 6-month all-cause death after AMI. Conclusion PASP at admission is a useful marker for predicting short-term mortality in elderly patients with AMI. This finding could be used to help identify high-risk patients and make appropriate clinical decisions.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61678465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-03DOI: 10.1097/EC9.0000000000000050
Jing Yang, Shuting Chang, Jing Liu, Guanzhao Zhang, Yue Wang, Baixue Zhang, Zifan Nie, Yuan Dong, Bo Li
Abstract Background Drug-coated balloons (DCBs) are an up-and-coming tactic in treating in-stent restenosis and coronary artery small vessel disease, but their efficacy in treating acute myocardial infarction needs to be further explored. Methods A meta-analysis of 7 studies was conducted to make a comparison with the results of DCB and drug-eluting stent implantation after a median follow-up of 15 months. Results A total of 922 patients were included in this analysis in total, including 375 patients in the DCB group and 547 patients in the stent group. A total of 962 vascular diseases were manifested in the 2 groups. After 6 to 24 months of follow-up, there was no statistically significant difference with respect to major adverse cardiovascular events (odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.52–1.29; Z = 0.85; P = 0.39), cardiac death (OR: 0.92; 95% CI: 0.39–2.12; Z = 0.21; P = 0.84), target lesion revascularization (OR: 1.09; 95% CI: 0.53–2.25; Z = 0.24; P = 0.81), late lumen loss (MD: −0.05; 95% CI: −0.15 to 0.06; Z = 0.85; P = 0.40), or dual antiplatelet therapy (DAPT) (OR: 1.04; 95% CI: 0.53–2.05; Z = 0.11; P = 0.91) between the 2 groups. In the DCB group, persistent residual stenosis or C-F dissection occurrence necessitated that a total of 30 patients receive extra bailout implantations. The rate of bailout stenting was 11.8% (95% CI: 7.1–16). Moreover, the DCB group had a shorter DAPT duration compared with the stent group. Conclusion Drug-coated balloons with shorter DAPT durations may be as effective and safe as stent therapy in treating acute myocardial infarction.
{"title":"Drug-coated balloons are not inferior to drug-coated stents in the treatment of acute myocardial infarction and shorten the duration of dual antiplatelet treatment","authors":"Jing Yang, Shuting Chang, Jing Liu, Guanzhao Zhang, Yue Wang, Baixue Zhang, Zifan Nie, Yuan Dong, Bo Li","doi":"10.1097/EC9.0000000000000050","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000050","url":null,"abstract":"Abstract Background Drug-coated balloons (DCBs) are an up-and-coming tactic in treating in-stent restenosis and coronary artery small vessel disease, but their efficacy in treating acute myocardial infarction needs to be further explored. Methods A meta-analysis of 7 studies was conducted to make a comparison with the results of DCB and drug-eluting stent implantation after a median follow-up of 15 months. Results A total of 922 patients were included in this analysis in total, including 375 patients in the DCB group and 547 patients in the stent group. A total of 962 vascular diseases were manifested in the 2 groups. After 6 to 24 months of follow-up, there was no statistically significant difference with respect to major adverse cardiovascular events (odds ratio [OR]: 0.82; 95% confidence interval [CI]: 0.52–1.29; Z = 0.85; P = 0.39), cardiac death (OR: 0.92; 95% CI: 0.39–2.12; Z = 0.21; P = 0.84), target lesion revascularization (OR: 1.09; 95% CI: 0.53–2.25; Z = 0.24; P = 0.81), late lumen loss (MD: −0.05; 95% CI: −0.15 to 0.06; Z = 0.85; P = 0.40), or dual antiplatelet therapy (DAPT) (OR: 1.04; 95% CI: 0.53–2.05; Z = 0.11; P = 0.91) between the 2 groups. In the DCB group, persistent residual stenosis or C-F dissection occurrence necessitated that a total of 30 patients receive extra bailout implantations. The rate of bailout stenting was 11.8% (95% CI: 7.1–16). Moreover, the DCB group had a shorter DAPT duration compared with the stent group. Conclusion Drug-coated balloons with shorter DAPT durations may be as effective and safe as stent therapy in treating acute myocardial infarction.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44783527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Purpura fulminans (PF), characterized by the sudden onset of large, rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation, is an uncommon medical emergency. Early recognition, prompt antibiotic therapy, and intensive supportive care are essential to reduce the mortality rate of this disease. Case Presentation We report the case of a 28-year-old Chinese man with acute infectious PF. He initially presented with a fever, which rapidly progressed to septic shock, followed by skin lesions and disseminated intravascular coagulation. Computed tomography imaging revealed superior and inferior mesenteric vein thromboses. Although the etiology of the patient’s infection was unclear, the patient received early fluid resuscitation, empiric antibiotic therapy, and blood product replacement, which resulted in gradual clinical improvement. Conclusion Sepsis-associated PF may be reversible with timely empirical therapeutic interventions; however, the severity of PF should not be underestimated, and treatment should be tailored to individual patients.
{"title":"Acute infectious purpura fulminans: case report of a medical emergency","authors":"Xueying Li, Yaqian Ma, Qichao Sun, Ruihan Hu, Zhi Liu, Xiao-wei Liu","doi":"10.1097/EC9.0000000000000067","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000067","url":null,"abstract":"Abstract Background Purpura fulminans (PF), characterized by the sudden onset of large, rapidly spreading hemorrhagic skin infarctions and associated disseminated intravascular coagulation, is an uncommon medical emergency. Early recognition, prompt antibiotic therapy, and intensive supportive care are essential to reduce the mortality rate of this disease. Case Presentation We report the case of a 28-year-old Chinese man with acute infectious PF. He initially presented with a fever, which rapidly progressed to septic shock, followed by skin lesions and disseminated intravascular coagulation. Computed tomography imaging revealed superior and inferior mesenteric vein thromboses. Although the etiology of the patient’s infection was unclear, the patient received early fluid resuscitation, empiric antibiotic therapy, and blood product replacement, which resulted in gradual clinical improvement. Conclusion Sepsis-associated PF may be reversible with timely empirical therapeutic interventions; however, the severity of PF should not be underestimated, and treatment should be tailored to individual patients.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44649841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-26DOI: 10.1097/ec9.0000000000000051
Heather Groves, A. Kushner, Shailvi Gupta
{"title":"Protecting heath facilities: design options for armed conflict and climate change disasters","authors":"Heather Groves, A. Kushner, Shailvi Gupta","doi":"10.1097/ec9.0000000000000051","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000051","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45879787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR); however, the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest (OHCA). Methods This was a retrospective study of 126 patients with OHCA who achieved ROSC between January and December 2020. The probability of survival after OHCA related to CPR and ROSC duration was analyzed using the probability density function and empirical cumulative density functions. Results There were no significant differences between ROSC sustained until emergency department arrival and that sustained for at least 20 minutes in terms of the 24-hour survival rate (31.3% [31/99] vs. 35.7% [10/30]; P = 0.84), 30-day survival rate (23.2% [23/99] vs. 25.0% [7/30]; P = 0.99), or survival at 30 days with cerebral performance category (CPC) 1 and 2 (18.2% [18/99] vs. 10.7% [3/30]; P = 0.44). The Kolmogorov-Smirnov test values from the empirical cumulative density functions with ROSC sustained until hospital arrival and that sustained for at least 20 minutes were 0.44, 0.20, and 0.24 for CPC 1 or 2, CPC 3 or 4, and CPC 5, respectively. Conclusion Return of spontaneous circulation is a core outcome element of CPR. It should be defined as sustained for at least 20 minutes or until arrival at the emergency department and as a basic standard for evaluating resuscitation success after OHCA.
{"title":"Association between duration of return of spontaneous circulation and outcomes after out-of-hospital cardiac arrest","authors":"Huixin Lian, Andong Xia, Xinyan Qin, S. Tian, Xuqin Kang, Luxi Zhang, Shengmei Niu, Fei Qin, Jinjun Zhang","doi":"10.1097/EC9.0000000000000054","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000054","url":null,"abstract":"Abstract Background Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR); however, the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest (OHCA). Methods This was a retrospective study of 126 patients with OHCA who achieved ROSC between January and December 2020. The probability of survival after OHCA related to CPR and ROSC duration was analyzed using the probability density function and empirical cumulative density functions. Results There were no significant differences between ROSC sustained until emergency department arrival and that sustained for at least 20 minutes in terms of the 24-hour survival rate (31.3% [31/99] vs. 35.7% [10/30]; P = 0.84), 30-day survival rate (23.2% [23/99] vs. 25.0% [7/30]; P = 0.99), or survival at 30 days with cerebral performance category (CPC) 1 and 2 (18.2% [18/99] vs. 10.7% [3/30]; P = 0.44). The Kolmogorov-Smirnov test values from the empirical cumulative density functions with ROSC sustained until hospital arrival and that sustained for at least 20 minutes were 0.44, 0.20, and 0.24 for CPC 1 or 2, CPC 3 or 4, and CPC 5, respectively. Conclusion Return of spontaneous circulation is a core outcome element of CPR. It should be defined as sustained for at least 20 minutes or until arrival at the emergency department and as a basic standard for evaluating resuscitation success after OHCA.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45953020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-26DOI: 10.1097/EC9.0000000000000056
Cunhui Jia, Rui Tian, M. Zong, Fangyun Luan, Wenjun Wang, Chuanbao Li
Abstract Background Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels. However, the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus (NODM). Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) within 18 months of follow-up. Methods A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017. The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk factors of NODM. Results In total, 220 patients received rosuvastatin and 168 atorvastatin. The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance, compared with that in the atorvastatin group (7.27% vs. 12.50%, respectively; log-rank P = 0.08). Using Cox proportional hazards models, baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM (HR: 4.56; 95% CI: 2.83–7.36; P < 0.01). Conclusion Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.
背景:他汀类药物常被用于降低低密度脂蛋白胆固醇水平，从而降低心血管疾病的发病率和死亡率。然而，他汀类药物的使用导致新发2型糖尿病(NODM)的发病率增加。本研究旨在比较瑞舒伐他汀与阿托伐他汀对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI) 18个月后NODM的影响。方法回顾性队列研究2012年6月至2017年6月期间接受PCI治疗并接受瑞舒伐他汀或阿托伐他汀治疗的ACS患者。采用Kaplan-Meier法估计两组间的生存函数，并以NODM为终点采用log-rank检验进行比较。采用Cox比例风险模型计算NODM危险因素的风险比(hr)和95%置信区间(ci)。结果220例患者接受瑞舒伐他汀治疗，168例接受阿托伐他汀治疗。瑞舒伐他汀组NODM的累积发生率较阿托伐他汀组低，但未达到统计学意义(分别为7.27% vs 12.50%;log-rank P = 0.08)。使用Cox比例风险模型，基线空腹血糖水平与NODM风险的统计学显著增加相关(HR: 4.56;95% ci: 2.83-7.36;P < 0.01)。结论长期使用中度瑞舒伐他汀与阿托伐他汀治疗ACS PCI患者NODM发生率相似。
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