Independent predictors of mortality for critically ill patients with polytrauma: A single center, retrospective study.

Independent predictors of mortality and transfusion therapy in polytrauma patients from the Chinese population remain unknown. Here, we aimed to identify these predictors by retrospectively collecting and analyzing vital signs and laboratory results for 408 critically ill patients suffering from polytrauma who were treated in Affiliated Kunshan Hospital of Jiangsu University, Jiangsu Province, China from January 2020 to December 2021. We identified risk factors for mortality and transfusion therapy using logistic regression analysis. As a results, we enrolled a total of 408 polytrauma patients, with a male-to-female ratio of 2:1, a mean age of 49.02 ± 16.84 years, a mortality rate of 15.9 %, and a blood transfusion rate of 45.8 %. The multivariate logistic regression showed that decreased Glasgow Coma Scale (GCS) score (Odds ratio (OR) = 0.72, 95 % confidence interval (95%CI): 0.63-0.83, P < 0.001), decreased base excess (BE) (OR = 0.77, 95%CI: 0.67-0.87, P < 0.001), and increased Injury Severity Score (ISS) (OR = 1.12, 95%CI: 1.06-1.17, P < 0.001) were independent risk factors for the mortality. In addition, increased GCS score (OR = 1.17, 95%CI: 1.03-1.35, P = 0.020), increased heart rate (OR = 1.05, 95%CI: 1.04-1.07, P < 0.001), decreased systolic blood pressure (SBP) (OR = 0.97, 95%CI: 0.96-0.99, P < 0.001), increased peripheral oxygen saturation (SpO2) (OR = 1.10, 95%CI: 1.04-1.16, P = 0.002), decreased serum lactate (OR = 0.58, 95%CI: 0.42-0.79, P = 0.001), decreased BE (OR = 0.49, 95%CI: 0.39-0.62, P < 0.001), and increased ISS (OR = 1.25, 95%CI: 1.18-1.33, P < 0.001) were independent risk factors for blood transfusion. The area under receiver operating characteristic curves (AUROCs) of the model to predict mortality and blood transfusion were 0.976 (95%CI: 0.960-0.992, P < 0.001) and 0.973 (95%CI: 0.958-0.987, P < 0.001). In conclusion, decreased BE level was significantly associated with all-cause mortality in polytrauma patients. BE, ISS, and GCS might be independent important predictors for mortality and blood transfusion of polytrauma patients.

Ginsenoside Rd: A promising target for ischemia-reperfusion injury therapy (A mini review).

Ischemia-reperfusion injury (IRI) represents a prevalent pathological phenomenon. Traditional treatment approaches primarily aim at restoring blood supply to ischemic organs, disregarding the consequent damage caused by IRI. Belonging to the class of protopanaxadiol ginsenosides that are found in Panax ginseng, ginsenoside Rd (GSRd) demonstrates notable safety alongside a diverse range of biological functions. Its active components exhibit diverse pharmacological effects, encompassing anti-inflammatory, anti-tumor, neuroprotective, cardiovascular-protective, and immune-regulatory properties, making it a promising candidate for addressing multiple medical conditions. GSRd shields against I/R injury by employing crucial cellular mechanisms, including the attenuation of oxidative stress, reduction of inflammation, promotion of cell survival signaling pathways, and inhibition of apoptotic pathways. Additionally, GSRd regulates mitochondrial function, maintains calcium homeostasis, and modulates the expression of genes involved in I/R injury. This review seeks to consolidate the pharmacological mechanism of action of GSRd within the context of IRI. Our objective is to contribute to the advancement of GSRd-related pharmaceuticals and provide novel insights for clinicians involved in developing IRI treatment strategies.

Trends and profiles of acute poisoning cases: a retrospective analysis.

Acute poisoning is a significant public health concern. This retrospective study investigates trends in acute poisoning cases and explores the clinical and sociodemographic profiles associated with this condition. Medical data from 859 hospitalized patients diagnosed with acute poisoning between January 2017 and December 2022 were comprehensively analyzed. The descriptive statistical analysis revealed that 360 patients had underlying diseases, with depression being the most prevalent among them. Furthermore, urban areas accounted for 87.2% of the acute poisoning cases, indicating a higher incidence compared to rural areas. The substances implicated in acute poisoning incidents varied, with drugs of abuse being the most common (53.2%), followed by pesticides (22.2%), carbon monoxide (11.8%), and alcohol (5.4%). Suicide attempt/suicide emerged as the leading cause of acute poisoning incidents, accounting for 75.9% of cases, while poisoning accidents predominantly occurred within the home setting. Through chi-square tests, it was determined that risk factors for suicide attempt/suicide included female gender and underlying medical conditions. Temporal analysis showed that the total number of acute poisoning cases increased from 2017 to 2019 and decreased from 2019 to 2022. Notably, suicide-related cases exhibited an upward trend, with suicide attempt/suicide accounting for over 80% of all acute poisoning cases after 2020. This study contributes valuable insights into the trends, profiles, and risk factors associated with acute poisoning cases.

Negative pressure pulmonary edema (Review).

Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. If left untreated, NPPE can lead to hypoxemia, heart failure and even shock. Furthermore, the drug treatment of NPPE remains a subject of controversy. The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. NPPE exhibits numerous risk factors and causes, with laryngospasm following anesthesia and extubation being the most prevalent. The diagnosis of NPPE often presents challenges due to confusion with conditions such as gastroesophageal reflux or cardiogenic pulmonary edema, given the similarity in initial factors triggering both diseases. Upper airway patency, positive pressure non-invasive ventilation, supplemental oxygen and re-intubation mechanical ventilation are the foundation of the treatment of NPPE. The present review aims to discuss the etiology, clinical presentation, pathophysiology and management of NPPE.

Inclusion of the workshop model in the standardized training of emergency medicine residents.

Background: Standardized training of resident physicians (STRP) includes clinical practice, professional required courses, and public required courses, among others. Of them, clinical practice is the most important as it allows residents to implement what they have learned in theoretical education to practice. Clinical practice includes different teaching methods, such as traditional lectures, bedside teaching, and workshops, and each method has its advantages and disadvantages in different situations of interest. Emergency medicine (EM) focuses on the diagnosis and treatment of urgent medical conditions and entails several emergency procedures. In this study, we aimed to compare the effects of workshop-based STRP and traditional STRP on emergency physicians. Methods: Overall, 125 residents who received STRP in EM between January and December 2021 were selected and randomly divided into two groups: the control group (n = 60; received traditional teaching) and the intervention group (n = 65; received workshop-based training). The theoretical performance, operative performance, and satisfaction of both groups were compared and analyzed. Results: Regarding theoretical assessment, the scores of airway management, cardiopulmonary resuscitation, and trauma management in the intervention group were 4.81 (t = 5.82, p < 0.001), 6.90 (t = 7.72, p < 0.001), and 5.25 (t = 6.14, p < 0.001), respectively. Regarding skill assessment, the scores for the same items in the intervention group were 4.43 (t = 5.30, p < 0.001), 4.55 (t = 5.61, p < 0.001), and 5.62 (t = 6.65, P < 0.001), respectively. Regarding satisfaction evaluation, the scores in the intervention group were 1.99 (t = 6.03, p < 0.001), 1.98 (t = 6.41, p < 0.001), and 1.96 (t = 6.14, p < 0.001), respectively. Overall, the scores were higher in the intervention group than in the control group. Conclusion: The workshop training model effectively improves the theoretical knowledge and practical skills of EM residents undergoing standardized training. The residents found the training and its outcomes satisfactory, ultimately improving their emergency response and first-responder skills.

miR-128b Promotes Cerebral Infarction by Regulating the Expressions of BCL-2 and CAPASE3.

OBJECTIVE: To investigate the effect of miR-128b on apoptosis and BCL-2 and CAPASE3 expression in a rat middle cerebral artery occlusion (MCAO) model. METHODS: The MCAO model was established by the thread embolism method. miR-128b agomir and antagomir were injected into the ventricle of MCAO rats by stereotaxic intracerebral injection. Then the rats were divided into a sham group, model group, miR-128b agomir group, and miR-128b antagomir group. Zea Longa was used to score the modeling rats. The area of cerebral infarction was assessed by 2,3,5-triphenyltetrazolium chloride staining. Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The miR-128b relative expression was detected by real-time polymerase chain reaction. The expressions of BCL-2 and CAPASE3 were detected by immunohistochemistry and Western blotting. RESULTS: The MCAO model was constructed successfully. The expressions of miR-128b in the MCAO groups were higher than that of the sham group (P < 0.05). Compared with the model group, the cerebral infarction area in the miR-128b agomir group was significantly bigger and that of the miR-128b antagomir group was smaller (P < 0.05). The number of apoptotic cells in the miR-128b agomir group was more and that of miR-128b antagomir group was less (P < 0.05 vs. model group). The BCL-2 expression reduced and CAPASE3 expression increased in the MCAO groups (P < 0.05 vs. sham group). Compared with the model group, the Bcl-2 expression decreased and Caspase 3 expression increased in the miR-128b agomir group, and those in the miR-128b antagomir group were opposite. CONCLUSIONS: miR-128b promoted cerebral infarction in MCAO rats by regulating Bcl-2 and Caspase 3 expression.

High Expression Levels of Trigger Receptor Expressed on Myeloid Cells-1 on Neutrophils Associated with Increased Severity of Acute Pancreatitis in Mice.

Triggering receptor expressed on myeloid cells (TREM)-1 expression on neutrophils is associated with inflammation and infection. However, the dynamic changes of the TREM-1 expression on neutrophils have not been clarified in inflammatory acute pancreatitis (AP). The aim of this study was to longitudinally investigate the TREM-1 expression on peripheral blood and peritoneal neutrophils and its relationship with the levels of plasma cytokines and disease severity in a mouse model of AP following injection with varying doses of L-arginine to induce mild AP (MAP) or severe AP (SAP). The results indicated that induction of MAP or SAP was associated with moderate and severe pancreatic tissue damage and varying levels of serum and peritoneal fluid amylase as well as survival rates in mice. In comparison with that in the healthy controls, significantly increased percentages of peripheral blood and peritoneal fluid CD14-TREM-1(+) neutrophils and higher levels of TREM-1 mRNA transcripts in peripheral blood nuclear cells were detected in the MAP and SAP mice, particularly in the SAP mice. Higher levels of plasma tumor necrosis factor (TNF)-α and granulocyte-macrophage colony stimulating factor (GM-CSF), but lower levels of plasma interleukin (IL)-10, were detected in the MAP and SAP mice at varying time points post induction. The percentages of peripheral blood CD14-TREM-1(+) neutrophils were correlated positively with the levels of TNF-α, GM-CSF, and amylase as well as the pathogenic scores, but negatively with the levels of IL-10 in the AP mice. Therefore, TREM-1(+) neutrophils may participate in the pathogenesis of AP and serve as a biomarker for evaluating the severity of AP.