To develop a novel predictive model based on commonly used emergency indicators for assessing the risk of in-hospital mortality among ST-segment elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI) at the emergency department.

A retrospective analysis was conducted based on the clinical data of 842 STEMI patients who received PCI treatment (from Dec. 26, 2020 to Dec. 25, 2021) at the emergency departments of Yonsei University College of Medicine and the Fourth People's Hospital of Shenzhen (From Jan. 1, 2021 to Dec. 31, 2021). 503 cases from Yonsei University were used as the training set, 251 cases as the internal validation set, and 88 cases from the Fourth People's Hospital of Shenzhen as the external validation set. LASSO regression and unconditional logistic stepwise regression were employed to screen predictive variables, to establish a prediction model, and to present it in the form of nomograms. The model's discrimination, calibration, and clinical applicability were evaluated using ROC curves, calibration curves, and clinical decision curves, respectively, followed by internal and external validation.

A total of 842 STEMI patients after PCI were included, with 40 cases of in-hospital deaths. Using LASSO regression and unconditional logistic stepwise regression methods, seven predictive factors were identified: left ventricular ejection fraction, systolic blood pressure, high-density lipoprotein cholesterol, creatine kinase isoenzyme, brain natriuretic peptide, age, and heart rate. A prediction model of in-hospital mortality after PCI in STEMI patients on basis of these factors were constructed as follows: logit (P)=-2.85810-0.10535×left ventricular ejection fraction+0.00551×creatine kinase isoenzyme-0.00002×brain natriuretic peptide+0.07765×age-0.01181×systolic blood pressure-0.03742×high-density lipoprotein cholesterol+ 0.01314×heart rate. The model demonstrated good predictive performance with ROC curve areas (AUC) of 0.88,0.83 for internal and external validation sets, respectively. Calibration curves indicated good agreement between predicted and observed in-hospital mortality values (HL test, P=0.648), and clinical decision curves showed that the model had good calibration and clinical applicability.

Based on easily accessible clinical indicators from the emergency department, the novel in-hospital mortality prediction model for STEMI patients after PCI demonstrates good discrimination, calibration, and clinical applicability.

To investigate the relationship between dynamic changes in neutrophil-to-lymphocyte ratio (NLR) and the occurrence of disseminated intravascular coagulation (DIC) in patients with severe pneumonia.

A total of 340 patients with severe pneumonia hospitalized in Changzhou Second People's Hospital from January 2019 to December 2023 were retrospectively analyzed, and the cohort comprised 264 males and 76 females, aged 28 to 101 years, with a mean age of 73.56±13.65 years. These patients were divided into non-DIC (n=271) and DIC (n=69) groups based on complications. The generalized estimation equation was used to analyze the time-alone effect and the intergroup main effect of NLR in two groups; Logistic regression was used to analyze the effect of NLR on DIC at different time points, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of dynamic NLR in the development of DIC in patients with severe pneumonia.

The results of the generalized estimation equation showed that there was no statistical difference in NLR between DIC patients and non-DIC patients when they entered the emergency room, but the NLR of DIC patients gradually increased with time, while the NLR of non-DIC patients gradually decreased (P<0.001). Multivariate Logistic regression analysis showed that NLR 24 hours, 48 hours and 72 hours after admission were all risk factors for severe pneumonia complicated with DIC (P<0.05). ROC curve analysis showed that NLR (AUC=0.75) at 72 hours after admission was higher than that at 24 hours (AUC=0.60) and 48 hours (AUC=0.63).

Persistent hyperinflammatory response leads to DIC in patients with severe pneumonia. Dynamic changes in NLR can help in early identification of the risk of DIC in severe pneumonia.

To explore the effectiveness of systematic emergency treatment in the rescue process of acute left heart failure patients.

A total of 128 patients with acute left heart failure who received systematic first aid in Xi'an Third Hospital from January 2022 to June 2024 were selected as the subjects of this study, including 68 males and 60 females; their ages ranged from 46 to 82 years, with an average age of (61.38±2.76) years. The 68 patients who followed the routine emergency care process from January 2022 to March 2023 were set as the control group, comprising 36 males and 32 females; their ages ranged from 47 to 82 years, with an average age of (61.39±2.78) years. Their body mass index (BMI) was between 20 and 26 kg/m², with an average of (23.29±2.02) kg/m²; the New York Heart Association (NYHA) cardiac function classification was Grade III in 42 cases and Grade IV in 26 cases. The 60 patients who followed the systematic emergency care process from April 2023 to June 2024 were set as the observation group, including 32 males and 28 females; their ages ranged from 46 to 82 years, with an average age of (61.36±2.74) years. Their BMI 19 was between 26 kg/m², with an average of (23.21±2.07) kg/m²; the NYHA cardiac function classification was Grade III in 39 cases and Grade IV in 21 cases. The time for triage and assessment, establishment of intravenous access and blood sampling, administration of intravenous medication, electrocardiogram timing, total emergency response time, treatment outcomes, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), early diastolic filling velocity to late diastolic filling velocity (E/A) ratio, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and complications and mortality were compared between the two groups.

The observation group demonstrated shorter times for triage and assessment, venous access establishment and blood collection, intravenous medication administration, ECG monitoring, and emergency response duration compared to the control group (P<0.05). The overall effectiveness rate of the observation group was significantly higher than that of the control group (P<0.05). At admission, there were no statistically significant differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), or heart rate (HR) between the two groups (P>0.05). However, within 24 hours of emergency treatment, the observation group showed lower SBP, DBP, and HR values than the control group (P<0.05). Regarding baseline measurements, no statistically significant differences were observed in echocardiographic parameters such as the E/A ratio, left ventricular ejection fraction (LVEF), or left ventricular end-diastolic diameter (LVEDD) between the groups (P>0.05). After 7 days of hospitalization, the observation group exhibited higher LVEF and E/A ratios but lower LVEDD values compared to the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that of the control group (P<0.05), while there was no statistically significant difference in mortality rates between the two groups (P>0.05).

The systematic first aid process is beneficial to shorten the first aid time and reduce the incidence of complications in the rescue process of acute left heart failure patients

To explore the predictive value of peripheral blood uric acid (UA)/creatinine (Cr) ratio, neutrophil/lymphocyte ratio (NLR), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in acute heart failure (AHF) during the perioperative period of lung cancer patients.

A retrospective cohort study was conducted on 186 patients who underwent surgical treatment for lung cancer from January 2022 to December 2024, including 113 males and 73 females; the age ranged from 41 to 78 years, with an average of (61.19±8.41) years. According to whether patients experienced AHF during the perioperative period, they were divided into AHF group (31 cases) and non AHF group (155 cases). The clinical baseline data of the two groups were compared, and multiple regression analysis was used to analyze the influencing factors of AHF in lung cancer patients during the perioperative period, the receiver operating characteristic (ROC) curve was applied to analyze the predictive value of each factor for AHF in lung cancer patients during the perioperative period.

There were significant differences in pathological stage, NYHA cardiac function grade, UA/Cr, NLR and NT-proBNP between two groups (P<0.05). Multivariate regression analysis showed that blood UA/Cr, NLR and NT-proBNP were all risk factors for perioperative AHF in lung cancer patients (P<0.05). ROC curve analysis showed that the cutoff value of serum UA/Cr in diagnosing perioperative AHF was 16.69, AUC was 0.829 (95%CI0.749-0.909), sensitivity was 74.20%, and specificity was 78.70%. The cut-off value of NLR was 2.205, AUC was 0.856 (95%CI: 0.777-0.935), sensitivity was 90.30%, and specificity was 66.50%. The cut-off value of NT-proBNP was 2 099.495 ng/L, the area under the working characteristic curve (AUC) of the subjects was 0.903 (95%CI: 0.833-0.972), with a sensitivity of 71.00% and a specificity of 98.70%; The combined diagnostic AUC was 0.986 (95%CI: 0.970-1.000), with a sensitivity of 96.80% and a specificity of 94.80%.

The combined diagnosis of peripheral blood UA/Cr ratio, NLR and NT-proBNP has a certain predictive value for perioperative AHF in lung cancer patients, with high sensitivity and specificity.

To explore the preventive effect of four-step rehabilitation program combined with motivational interview on acute attack after discharge in elderly patients with heart failure.

A prospective study was conducted on 126 elderly patients with HF admitted to the First Affiliated Hospital of Shihezi University from March 2023 to July 2024. They were divided into the control group and the study group according to the random number table method, with 63 cases in each group. The control group received routine rehabilitation guidance on the basis of routine management, and the study group received four-step rehabilitation program combined with motivational interview on the basis of routine management. Cardiac function [(Left ventricular ejection fraction (LVEF), cardiac output (CO), stroke volume (SV), 6-min walking distance (6MWD)], Chinese version of Heart Failure Self-care Scale, compliance score, Minnesota Heart Failure Quality of Life Questionnaire (MLHFQ) were compared between the two groups before intervention, at discharge and 3 months after discharge, and the acute attacks within 6 months after discharge were compared between the two groups.

Before intervention, there were no differences in cardiac function, Chinese version of Heart Failure Self-care Scale, compliance score and MLHFQ score between the two groups (P>0.05). At discharge and 3 months after discharge, the LVEF, CO, SV, 6MWD, SCHFI score and compliance score of the study group were higher or greater than those of the control group, and the MLHFQ score was lower than that of the control group (P<0.05). At the last follow-up, the acute attack rate of the study group was lower than that of the control group (P<0.05).

Four-step rehabilitation program combined with motivational interview can significantly improve the cardiac function of elderly HF patients and reduce the number of acute attacks after discharge.

To explore the establishment and validation of a risk prediction model for acute radiation dermatitis (ARD) after breast-conserving surgery for breast cancer.

A total of 123 patients who received radiotherapy after breast-conserving surgery for breast cancer in our hospital from January 2020 to October 24 were selected as the study subjects, and were included in the training set (n=86) and the validation set (n=37) according to the ratio of 7:3. According to whether patients in the training set have developed ARD, they were divided into the ARD group and the non ARD group. The occurrence of ARD in patients was recorded, and multivariate logistic regression analysis was conducted to identify risk factors for ARD, to construct a predictive model, and to validate the value of the model in clinical applications using ROC curves.

Of the 86 patients who received radiotherapy after breast-conserving surgery for breast cancer, 67 patients developed ARD (77.91%). By univariate analysis, there was no significant difference between ARD group and non ARD group in body mass index, smoking history, drinking history, hypertension, coronary heart disease, pathological type, TNM stage, triple negative breast cancer, HER2, ER and PR (P>0.05). The age in ARD group was significantly lower than that in non ARD group (42.31±7.67 vs 56.27±9.98, P<0.001); The ARD group combined with diabetes was significantly higher non ARD (34.33% vs 10.53%, P<0.05); The ARD group proportion of malnutrition was significantly higher non ARD group (43.28% vs 10.53%, P<0.01); The ARD group radiation dose was significantly higher non ARD group (57.82±3.24 vs 48.97±4.35, P<0.001). Multivariate logistic regression analysis showed that age, nutritional status, combined diabetes, radiotherapy dose entered the regression model (P<0.05), which were independent risk factors for the occurrence of radiation-induced ARD. A prediction model of radiation-induced ARD was established: P=-2.22-2.35×age+1.75×nutritional status+2.68×combined diabetes+1.99×radiation dose. The ROC curve was used to validate the predictive value of the above model for ARD occurrence. The results showed that the area under the curve was 0.876 (P=0.000, 95%CI0.828-0.924), with a sensitivity of 89.90% and a specificity of 71.00%.

Age, nutritional status, combined diabetes, radiation dose are important factors that affect the occurrence of ARD caused by radiotherapy after breast-conserving surgery for breast cancer. According to the above factors, the corresponding risk prediction model is developed, and the prediction effect of the model is good, which is worth further analysis.

To understand the medical work and life experiences of basic level doctors accompanying ambulance services in basic level areas, to identify sources of their stress, and to provide a basis for developing intervention measures.

From January to December 2023, phenomenological research methods were employed to conduct face-to-face in-depth interviews with basic-level doctors accompanying the "120" emergency service at Yixing Emergency Center. The interviews were recorded on-site, and data was organized and analyzed using NVIVO software based on Colaizzi's content analysis method.

The sources of stress identified among basic-level doctors accompanying the "120" emergency service were categorized into five main themes: pressure from an imbalance between family care time; stress related to pre-hospital emergency work; pressure stemming from unfulfilled self-worth; unmet personal needs leading to stress; and financial pressures.

Basic-level doctors accompanying the "120" emergency service generally experience significant degree of stress originating from various aspects. It is essential for managers at emergency centers to pay attention to this group of physicians by formulating intervention measures that assist them in transitioning roles effectively. By fostering a positive mindset, these professionals can more quickly and successfully integrate into pre-hospital emergency work, thereby enhancing the quality of such services, strengthening management over medical quality safety, and promoting the development of talent within the emergency center workforce.

To understand the first-aid knowledge, attitude and behavior level of employees in township enterprises, as well as the safety management status of enterprises, aimed to provide guidance for improving the health emergency response ability of enterprises.

From June to December 2024, the convenient sampling method was used to select employees of township enterprises in Kunshan City as the research object. The first-aid knowledge, attitude and behavior questionnaires were used for investigation; the persons in charge of enterprise safety management were Interviewed and a questionnaire was made based on the type of emergency equipment in the operating environment, quantity, usage, and the willingness of employees to receive first aid knowledge training.

A total of 3,388 employees participated in the pre-hospital first aid knowledge questionnaire, with a first-aid knowledge score of (15.23±2.14), a first-aid attitude score of (38.45±5.67), and a first-aid behavior score of (28.20±4.95); Different training experiences had statistical significance for the differences in first-aid knowledge and behavior scores. The P values were 0.001 and 0.002, respectively. There was no statistical significance for the difference in first-aid attitude score, with a (P>0.05); Questionnaires on the safety management status of 39 enterprises were prepared. Enterprises set up 100% of security personnel, and 58.97% of security personnel received first-aid training. The proportion of AED for first-aid equipment in enterprises was 25.64%, and the AED training rate of enterprise employees was 90.00%.

The first-aid knowledge of employees in township enterprises is at a medium and low level, and their first-aid attitude and behavior are at a medium level. The number and type of first-aid equipment configured by enterprises and the training of employees on the use of first aid equipment are insufficient. Safety management positions meet the requirements of fixed personnel, fixed number, fixed post, fixed responsibility and regular training. It is necessary for enterprises to strengthen the transformation of safety personnel training achievements and formulate reasonable first-aid training and drills for all personnel to improve their ability to cope with accidental injuries.

To explore the role of forsythoside A (FA) in regulating neutrophil extracellular traps (NETs) and alleviating sepsis-related ARDS, as well as its possible mechanism.

A total of 80 mice were randomly divided into sham, model (CLP), FA, and FA+PPAR-γ groups. A sepsis-induced lung injury mice model was established using the classic cecal ligation and puncture (CLP) procedure. The sham group underwent only laparotomy. siPPAR-γ (10 nmol/20g) was administered via tail vein injection (twice a week for 2 weeks), while FA was administered via intraperitoneal injection (80 mg/kg, once daily for 3 days). After successful model establishment, Kaplan-Meier survival curves were used to analyze the cumulative 7-day survival rate of 10 mice per group. For the remaining mice, six per group were randomly selected to collect lung tissue. Inflammatory factors (TNF-α, IL-6, IL-1β) and NET markers (NE-DNA, MPO-NDA) were detected using ELISA kits. SOD, MDA, and ROS levels were measured by spectrophotometry. The lung wet/dry weight (W/D) ratio was calculated. Pathological changes were observed under light microscope after H&E staining, and lung injury histopathological scoring was conducted. Immunofluorescence was used to detect H3-cit protein expression in lung tissue. Western blotting was performed to measure the relative expression levels of PPAR-γ, H3-cit, MPO, and NE proteins.

Kaplan-Meier survival curve analysis revealed that the 7-day cumulative survival rate in the FA group was significantly higher than in the CLP and FA+PPAR-γ groups (P<0.05). The CLP group showed partial alveolar destruction, thickened alveolar septa, extensive inflammatory cell infiltration, alveolar and partial alveolar hyaline membrane formation, and alveolar collapse. In the FA group, H&E staining showed significant reduction in inflammatory cell infiltration, thinner alveolar septa, and less alveolar collapse. Compared to the sham group, the CLP group exhibited higher lung injury histopathological scores and W/D ratios (P<0.05), increased levels of inflammation factors (TNF-α, IL-6, IL-1β, P<0.05), elevated NE-DNA and MPO-NDA expressions (P<0.05), increased MDA and ROS levels (P<0.05), and decreased SOD levels (P<0.05). PPAR-γ protein expression was reduced (P<0.05), while H3-cit, MPO, and NE protein expressions were elevated (P<0.05). Compared to the CLP group, the FA group showed lower lung injury histopathological scores and W/D ratios (P<0.05), decreased levels of inflammatory factors (TNF-α, IL-6, IL-1β, P<0.05), reduced NE-DNA and MPO-NDA expression (P<0.05), lower MDA and ROS levels (P<0.05), higher SOD levels (P<0.05), and increased PPAR-γ protein expression (P<0.05). H3-cit, MPO, and NE proteins were reduced (P<0.05).

Forsythoside A alleviates sepsis-related ARDS by activating PPAR-γ to inhibit the formation of neutrophil extracellular traps.