Objective

To explore the effects of early continuous renal replacement therapy （CRRT）combined with veno-arterial extracorporeal membrane oxygenation （VA-ECMO） on patients with refractory cardiogenic shock and its impact on their prognosis.

Methods

A prospective randomized controlled trial was conducted to analyze 74 patients with refractory cardiogenic shock who received VA-ECMO treatment in the ICU of Xinyang Central Hospital from January 2021 to October 2023. The cohort consisted of 49 males and 25 females， aged between 19 and 78 years， with an average age of 56.3±14.0 years. Patients were randomly assigned to either the early CRRT group （Group A， 35 patients） or the conventional CRRT group（Group B， 39 patients）. The study compared various clinical parameters， including blood tests， liver and kidney function， blood gas analysis， cardiac function indicators， and treatment outcomes at four time points：T0 （pre-VA-ECMO）， T3 （3 days post-VA-ECMO）， T5 （5 days post-VA-ECMO）， and T7 （7 days post-VAECMO）.

Results

A total of 74 patients were enrolled （35 in Group A and 39 in Group B）. No significant differences were observed between the two groups in baseline characteristics. However， significant differences were found in the treatment duration between the groups， including CRRT treatment time ［176.1（152.2-222.9） hours vs. 82.3 （0-103.9） hours， P＜0.001］， mechanical ventilation time ［（309.3±38.5） hours vs（331.7±43.6） hours， P=0.023］， and VA-ECMO support time ［237.0 （220.0-255.5） hours vs. 253.0 （236.5-265.0） hours， P=0.029］. ICU stay and complication incidence rates were not statistically different between the groups ［（16.3±3.0） days vs. （17.8±3.8） days， P=0.052］， ［60% vs 71.79%， P=0.284］， respectively. However，the mortality rate was significantly lower in Group A ［15 （42.86%） vs. 26 （66.67%）， P=0.040］.Hemoglobin（Hb） values at T3 showed a statistical difference ［（106.1±18.7） g/L vs （114.7±19.6） g/L， P=0.018］. C-reactive protein （CRP） values at T3 and T5 were different ［73.0 （39.5-115.5） mg/L vs. 97.0 （62.5-158.5） mg/L， P=0.021］， ［82.0 （59.5-126.5） mg/L vs. 120.0 （47.5-175.0） mg/L， P=0.028］. Interleukin-6 （IL-6） values were also significantly lower in Group A at T3 and T5 ［344.0 （153.0-740.5） pg/mL vs. 667.0 （342.0-1484.0） pg/mL， P=0.038］ and ［270.0 （108.0-556.0） pg/mL vs. 721.0 （401.0-1195.5） pg/mL， P=0.001］. Blood urea nitrogen（BUN） values were significantly lower in Group A at T3， T5， and T7 ［6.7 （6.0-10.3） mmol/L vs. 21.9 （13.5-29.2） mmol/L， P＜0.001； 6.8 （5.4-10.0） mmol/L vs. 27.8 （17.6-37.8） mmol/L， P＜0.001； 6.0 （4.5-10.7） mmol/L vs. 31.0 （24.4-34.7） mmol/L， P＜0.001］. Serum creatinine （Cr） values were also significantly lower in Group A at all three time points ［94.3 （80.0-124.5） μmol/L vs. 257.0 （167.5-362.5） μmol/L， P＜0.001］， ［100.0 （80.5-141.5） μmol/L vs. 318.0 （210.5-490.0） μmol/L， P＜0.001］， and ［108.0 （71.0-146.8） μmol/L vs 350.0 （256.0-440.0） μmol/L， P＜0.001］. Serum pH values at T3 were significantly higher in Group A ［7.3 （7.2-7.4） vs. 7.2（7.1-7.3）， P=0.008］， but with no differences at T5 and T7. Oxygenation index （OI） values were significantly better in Group A at T3 and T5 ［（193.5±48.4） mmHg vs. （153.5±64.4） mmHg， P=0.015］ ， ［ （214.6±49.1）mmHg vs. （176.6±69.6） mmHg， P=0.015］， but with no difference at T7. Left ventricular outflow tract velocitytime integral （LOVTI） at T3 showed a statistical difference ［13.3 （12.2-15.5） cm vs. 12.2 （9.8-13.4） cm， P=0.025］， with no differences at T5 and T7. Left ventricular ejection fraction （LVEF） at T3 and T5 showed statistical differences ［35.1 （32.8-40.0）% vs. 32.3 （26.3-36.9）%， P=0.048］ ， ［40.2 （32.8-51.1）% vs. 35.1 （28.3-41.4）%， P=0.046］， with no difference at T7. Fluid balance showed differences at T3 and T5 time points， with values of ［-16.0 （-23.5 to -8.0） mL/kg vs. -7.0 （-14.5 to 1.0） mL/kg， P=0.007］ ， ［-13.0 （-19.5 to -7.5） mL/kg vs.-5.0 （-10.5 to -1.0） mL/kg， P=0.013］. No significant differences were observed between the two groups in PCT values， liver enzymes （ALT）， albumin， or total bilirubin at any of the time points.

Conclusion

Early initiation of CRRT combined with VA-ECMO may improve inflammatory markers， renal function， blood gas parameters， and cardiac function in patients with refractory cardiogenic shock. This approach also appears to reduce in-hospital mortality and improve overall prognosis.

Objective

To identifies the primary factors contributing to the low compliance of cleaning personnel with standard precautions， and devises corresponding intervention measures to enhance compliance by applying failure mode and effects analysis （FMEA） theory.

Methods

An FMEA project team was assembled to systematically analyze the compliance status of cleaning staff with standard precautions. The team established scoring criteria and calculated the risk priority number （RPN） to identify high-risk factors. Based on the principle of prioritizing high-risk interventions， the standard precaution processes were redesigned and optimized， with targeted interventions proposed.

Results

The FMEA intervention significantly improved the compliance of cleaning personnel with standard preventive measures.Compliance scores for handwashing and disinfection timing， proper glove wearing， appropriate use of personal protective equipment， environmental management， and handling of occupational exposure all showed significant increases （P＜0.001）. The implemented improvement measures effectively reduced the RPN， leading to a decline in the infection rate in the hospital ICU from 12.53% to 1.88% （P＜0.001）.

Conclusion

The introduction of the FMEA model to improve compliance with standard precautions among cleaning staff is innovative and provides valuable insights for intervention effectiveness， with important practical significance and potential for broader application.

急性中毒是临床常见的急危重症，某些中毒性疾病起病急、病情重，具有较高的病死率和致残率，可谓是“急诊中的急诊”、“重症中的重症”。随着临床医学的发展，急性中毒救治从学科发展到救治思维等方面均取得较大的进展，但是仍然有不少中毒性疾病特别是新发的急性中毒，尚无成熟的救治方法。从基础到临床、从治疗到预防、从科研到创新，关于急性中毒救治，还有很多工作可以做。

Objective

To investigate the incidence of acute renal dysfunction and related factors in critically ill patients in Xinjiang Uygur Autonomous Region of China， in order to provide evidence for targeted special training and quality control in critical care medicine.

Methods

This was a prospective multicenter cross-sectional survey conducted in Xinjiang Uygur Autonomous Region， China on January 31，2024 and included patients who meet the inclusion criteria.

Results

A total of 591 patients in 77 ICUs were included in the analysis， including 132 patients （22.3%） with acute renal dysfunction. Multivariate logistic regression analysis showed that age， multiple organ dysfunction syndrome （MODS）， diastolic blood pressure， APACHE II score， lymphocyte ratio， alanine aminotransferase， procalcitonin， and base excess were associated with acute renal dysfunction in these patients. Meanwhile， peripheral oxygen saturation （OR=0.966， 95% CI ［0.953， 0.979］， P＜0.001）， mechanical ventilation （OR=3.406， 95% CI ［1.396， 8.309］， P=0.007）， white blood cell count （OR=1.072， 95% CI ［1.009， 1.139］， P=0.025） and lactate （OR=1.241， 95% CI［1.044， 1.475］， P=0.014） were independent risk factors for the 28-day mortality rate in critically ill patients with acute renal dysfunction.

Conclusion

Acute renal dysfunction is a common clinical syndrome in ICU patients. Clinicians need to strengthen the etiological screening of anemia in these patients and optimize the clinical protocol to improve the quality of intensive care for anemia patients in ICU. It is necessary for the intensivist to strengthen the identification of such patients， and optimize the diagnosis and treatment protocol according to the risk factors related to their morbidity and mortality. It is also necessary to carry out training program to improve the medical quality of critical care medicine in the region.

Objective

To explore the risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess by analyzing the clinical characteristics of these patients.

Methods

A retrospective collection of data from 161 patients diagnosed with Klebsiella pneumoniae liver abscess at the First Affiliated Hospital of Nanjing Medical University between January 2017 and September 2023 was conducted. The 161 patients were divided into an invasive group of 64 cases （39.8%） and a non-invasive group of 97 cases （60.2%） based on whether invasive syndrome occurred during hospitalization. Basic data，initial symptoms， vital signs， laboratory examination results， and imaging manifestations were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to assess the correlation of various indicators with the occurrence of invasive syndrome.

Results

The prevalence of diabetes in the invasive group was higher than that in the non-invasive group （P＜0.05）； The heart rate of patients in the invasive group was higher than that in the non - invasive group （P＜0.05）； Imaging manifestations showed that the maximum diameter of intra-hepatic abscesses in the invasive group was lower than that in the non-invasive group， while the probability of multiple intra -hepatic abscesses was higher in the invasive group than in the non-invasive group （P＜0.05）； There was no significant difference in the laboratory test indicators between the invasive group and the non-invasive group（P＞0.05）；Logistic regression analysis showed that independent risk factors included a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses （P＜0.05）.

Conclusion

Independent risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess include a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses. Clinically， it is necessary to strengthen the monitoring and early intervention for these high-risk patients to reduce the harm of invasive syndrome.

Objective

To investigate the current situation of pre-hospital doctors in emergency medical institutions， to analyze the factors impacting their career longevity， to propose countermeasures and recommendations， and to provide insights for stabilizing the emergency team and promoting the sustainable development of pre-hospital emergency services.

Methods

The study selected all doctors from the Zhenjiang Emergency Center between February 2016 and August 2024 as research subjects. Data on current and departed doctors （including age structure， years of service， educational background， professional titles，and training channels） were analyzed using a combination of statistical data and surveys （retrospective questionnaires and interviews）.

Results

The career longevity of emergency doctors was influenced by various factors， such as industry conditions， environment， societal influences， team dynamics， family circumstances， experience， skill updating speed， and physical health. These factors contributed to varying career trajectories and directly impacted the development of the pre-hospital emergency system and the capability to provide public health services.

Conclusion

It is suggested to improve the legal framework，extend the career longevity of emergency doctors， and explore professional development channels. These measures could stabilize the emergency team and enhance the career longevity of those engaged in prehospital emergency services.

Objective

To study the characteristics of periostin， tenascin-C （TNC）， and soluble human matrix metalloproteinase-2 （sST2） levels in asthmatic children infected with Mycoplasma pneumoniae and their impact on acute asthma exacerbations.

Methods

A total of 187 asthmatic children with mycoplasma pneumoniae infection who were hospitalized and treated in our hospital from May 2020 to October 2022 were selected， including 104 males and 83 females， with ages ranging from 10 to 14 years and a mean age of（12.07±1.25） years. The children were categorized into two groups： a remission group （n=134） and an acute exacerbation group （n=53）， based on the presence of acute asthma exacerbation. A comparison was made between the two groups in terms of general clinical characteristics， as well as serum levels of periostin， TNC，and sST2. Univariate and multivariate logistic regression analyses were conducted to ascertain whether serum periostin， TNC， and sST2 levels could independently predict the risk of acute exacerbations in children with asthma infected by Mycoplasma pneumoniae. Through the use of receiver operating characteristic （ROC）curves， cutoff values for serum periostin， TNC， and sST2 were identified. Based on the results of multivariate logistic regression analysis， a risk prediction nomogram model incorporating serum periostin， TNC， and sST2 was constructed. The model degree of fitting was evaluated using Hosmer-Lemeshow test and calibration curves， the predictive performance was assessed through ROC curve analysis， and the clinical application value was evaluated using decision curve analysis （DCA）.

Results

Compared to the remission group， the acute exacerbation group had a lower proportion of regular use of inhaled corticosteroids （ICS）， a lower forced expiratory volume in one second/forced vital capacity ratio （FEV1/FVC），and forced expiratory volume in 1 second as a percentage of predicted value （FEV₁/pred）， and higher levels of serum periostin， TNC， and sST2（P＜0.05）. ROC analysis indicated that the AUC values for serum periostin， TNC， and sST2 in predicting acute exacerbations in children with asthma infected by Mycoplasma pneumoniae were 0.673， 0.737， and 0.720， respectively. Multivariate logistic regression analysis indicated that high periostin ［OR （95%CI）=1.031 （1.014～1.049）］， high TNC ［OR （95%CI）=1.099 （1.055～1.144）］， and high sST2 ［OR （95%CI）=1.171（1.080～1.271）］ were all independent risk factors for acute exacerbations in children with asthma infected by Mycoplasma pneumoniae （P＜0.05）. The nomogram model constructed based on the aforementioned three indicators demonstrated favorable degree of fitting （Hosmer-Lemeshow test： χ²=7.356， df=8， P=0.499）. ROC analysis revealed that the AUC value of this nomogram model for predicting acute exacerbations in pediatric patients was 0.838 （95% CI： 0.779～0.898， P＜0.001）. DCA analysis indicated that this nomogram prediction model exhibited satisfactory clinical net benefit across a threshold probability range of 0～0.95.

Conclusion

The levels of serum periostin， TNC， and sST2 in children with asthma complicated by Mycoplasma pneumoniae infection are strongly correlated with the likelihood of experiencing acute asthma exacerbations.Utilizing a model that incorporates these serum biomarkers can greatly assist healthcare providers in assessing the risk of acute asthma exacerbations in this specific group of children， thereby demonstrating significant clinical utility.

Objective

To explore the roles and immune regulatory mechanisms of key genes in mitophagy and ferroptosis in sepsis-induced acute respiratory distress syndrome （ARDS） using an integrative analysis of machine learning and transcriptomics.

Methods

The DEGs from the GSE32707 dataset in the GEO database were obtained and the differential genes screened. The core genes were identified and validated by secondary screening of DEGs with LASSO regression and the SVM-RFE algorithm， and their diagnostic performance with ROC curves was evaluated. DEGs-related biological pathways and immune cell interactions were investigated via GSEA and immune infiltration analysis. The hub genes by intersecting mitophagy-related genes， ferroptosis markers， and core DEGs were determined. A multi-dimensional regulatory network was established by predicting miRNA targets （using miRWalk， etc.） and ubiquitination interactions （using UbiBrowser）， and then potential regulatory mechanisms of hub genes were explored.

Results

Initially， 576 DEGs were screened. Then， 12 core genes were identified via machine learning algorithms. GSEA and immune infiltration analysis showed these core genes were significantly enriched in immune-related pathways. By integrating mitophagy and ferroptosis-related genes with core DEGs， FTH1 was identified as a hub gene， whose expression positively correlated with neutrophil levels and CCR. Mechanistic exploration suggested FTH1 expression might be regulated by miR-224-5p and interact with the E3 ubiquitin ligase SMURF1， implying its potential involvement in disease progression via ubiquitination modification.

Conclusion

This study， combining machine learning and multi-omics integration， first identifies FTH1 as a key regulator of mitophagy and ferroptosis in sepsis-related ARDS. It reveals a regulatory network where FTH1 might be targeted by miR-224-5p and interact with SMURF1， offering new directions and a theoretical basis for developing early immunointervention targets for this disease.

直升机医学：研究直升机飞行器、航空环境对飞行人员健康的影响和促进飞行能力的理论体系，并运用多种医学方法和手段，最大限度地扩展飞行人员的能力。直升机医学的研究内容：人机工效研究、基础应用研究、医学选拔鉴定研究、航空医学训练研究、安全控制体系研究。直升机医学研究特点：围绕“人-机-环-任务”研究直升机飞行人员作业能力提升和健康水平维护。影响直升机飞行人员作业效能的主要影响因素：噪声、振动、低气压、缺氧、温度、加速度、辐射、有害气体等。直升机飞行人员常见伤病：颈腰相关疾病、噪声性耳聋、鼻炎、泌尿系统结石、飞行错觉、冠心病高血压消化道疾病（慢性胃炎、消化道溃疡）、眼部疾病（青光眼、屈光不正）等。直升机医疗后送是提高创伤救治成功率的主要途径，但必须遵循一系列应急医学救援要求、注意事项和法律法规，而且以安全知识与技能、医疗知识与技能和非技术技能为内容的航空医学救援医务人员培训至关重要。未来直升机医学研究要注重直升机飞行人员创伤救治技术、特殊环境直升机飞行人员创伤谱和直升机女飞行员精准航卫保障等方面研究，直升机应急医学救援则要关注直升机智能化、无人化以及机器人技术的应用和与时俱进的应急医学救援训练。

Objective

To analyze the impact of feedforward control combined with body temperature management on the rescue quality and prognosis of patients with traumatic hemorrhagic shock in the emergency department.

Methods

A total of 80 patients with traumatic hemorrhagic shock admitted to the emergency department of Zhujiang Hospital， Southern Medical University from October 2023 to October 2024 were studied， including 46 males and 34 females， aged 18 to 78 years， with an average age of （48.12±2.63） years. From October 2023 to April 2024， 40 patients were in the control group （without feedforward control combined with temperature management）， and from May 2024 to October 2024， 40 patients were in the experimental group （with feedforward control combined with temperature management）. The changes in body temperature， rescue quality， and prognosis of the two groups were observed.

Results

There was no significant difference in pre-hospital body temperature between the two groups （P＞0.05）. At admission and 1 hour after admission， the body temperature of the experimental group was higher than that of the control group.The effective rewarming rate of the experimental group was 95.00%，which was higher than 80.00%of the control group （P＜0.05）. The rescue time of the experimental group was shorter， and the rescue success rate was 92.50%， which was higher than 75.00% of the control group （P＜0.05）. The complication rate of the experimental group was 10.00%， which was lower than 32.50% of the control group （P＜0.05）.

Conclusion

In patients with traumatic hemorrhagic shock in the emergency department， feedforward control combined with temperature management can effectively increase body temperature， improve rescue efficiency and success rate，and reduce the risk of complications，thereby helping to improve prognosis.

Objective

To observe the effect of different doses of dexmedetomidine nasal drops in the elderly percutaneous vertebroplasty （PVP）.

Methods

A total of 100 elderly patients who underwent elective Percutaneous Vertebroplasty （PVP） at the Traditional Chinese Medicine Hospital of Pi District，Chengdu City from June to December 2023， including 38 males and 62 females. Their ages ranged from 60 to 79 years old， with an average age of （69.08±4.86） years. Patients were divided into 4 groups（n=25） by random number table method： dexmedetomidine 0.8 μg/kg group （D1 group）， 1.0 μg/kg group （D2 group）， 1.2 μg/kg group （D3 group） and normal saline control group （N group）. Ramsay calm score， visual analog scale （VAS）， mean arterial pressure （MAP）， heart rate （HR） and pulse oxygen saturation （SpO₂） were compared immediately after entering the operating room （T1）， 30 min after nasal drops （T2）， immediately after cannula reached vertebra （T3）， bone cement injection （T4）， and 5 min after resuming position （T5）between the groups. Intraoperative adverse reactions were recorded.

Results

The sedation score at each time point of D3 group after nasal drip was higher than that of other groups （P＜0.05）.At T3 and T4，the pain score of D3 group was lower than that of other groups （P＜0.05）. There was no significant difference in MAP and HR of D3 group at T3 and T4 compared with T2 （P＞0.05）.Postoperative blood glucose in all groups was higher than that before surgery （P＜0.05）， and the increase of blood glucose in D3 group was lower than that in other groups （P＜0.05）. The amount of lidocaine and operation time in D3 group were lower than those in other groups （P＜0.05）， and the satisfaction score in D3 group was higher than that in other groups （P＜0.05）.The incidence of agitation and intraoperative hypertension in group N was higher than that in other groups（P＜0.05）.However，there was no statistical difference in the occurrence of adverse reactions among all groups（P＞0.05）.

Conclusion

For elderly patients undergoing PVP treatment， 1.2 μg/kg of dexmedetomidine can be effectively sedated and analgesic before operation，and patients are safer，more comfortable and satisfied.