Hyperkalemia is a common and potentially lethal electrolyte disorder in the emergency department (ED). We aim to explore the real-world effectiveness of hyperkalemia treatment, and the patterns of hyperkalemia management in the ED in China. POETRY-E (ChiCTR2100053100) was a multicenter, prospective, observational study. Adult patients with serum potassium (sK+) ≥ 5.5 mmol/L admitted to the ED were enrolled from 15 centers across China and followed until discharge from the ED. The primary endpoint was the change in sK+ from baseline to 6 h after treatment initiation. Secondary and exploratory endpoints included the clinical burden of hyperkalemia (e.g., severity, complications, survival, etc.), and the real-world management strategies of hyperkalemia in the ED. Between October 2021 and March 2023, 577 patients were enrolled. The median (Q1, Q3) baseline sK+ was 6.25 (5.82, 6.83) mmol/L. At 6 h, after treatment initiation, the median (Q1, Q3) change in sK+ from baseline was − 1.30 (− 1.96, − 0.72) mmol/L (P < 0.001), with 46.4

Tetanus remains an important global public health concern. Currently, the only recommended passive immunization therapy for tetanus prophylaxis is plasma-derived human tetanus immunoglobulin (HTIG), which faces a global supply shortage and can transmit infectious pathogens. Despite not being endorsed by WHO due to safety concerns, equine tetanus antitoxin remains widely used in some countries. We conducted a randomized, double-blind, phase 3 trial to evaluate siltartoxatug—a first-in-class recombinant monoclonal antibody—for tetanus postexposure prophylaxis. Participants ( n = 675) were randomized (2:1) to receive a single intramuscular injection of siltartoxatug 10 mg or HTIG 250 IU. The study met its primary outcome, with siltartoxatug demonstrating superiority to HTIG in the proportion of participants with an increase of anti-tetanus neutralizing antibody titers from baseline (ΔTiter) ≥ 0.01 IU ml − 1 (95.4% versus 53.2%; intergroup difference 42.3% (95% confidence interval, 35.5–49.1; P < 0.0001)). The safety profiles were comparable, with similar incidence of adverse events between the siltartoxatug (38.2%, 168 of 440) and HTIG (33.9%, 75 of 221) groups. These findings highlight siltartoxatug as an effective and safe option for passive immunization against tetanus. ClinicalTrials.gov registration: NCT05664750 .

This study aimed to determine the optimal high-sensitivity cardiac troponin I (hs-cTnI)-based algorithm for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) in Chinese patients. We prospectively enrolled 1,606 patients with suspected NSTEMI from three emergency departments across China, collecting blood samples at 0, 1, and 3 h post-admission. Patients were classified using the 0/1-h and 0/3-h algorithms. The 2015 and 2020 ESC 0/1-h algorithms rapidly triaged 70% of patients with high negative predictive value (NPV) (99.7%) and sensitivity (99.5%). The 0/3-h algorithm showed higher specificity (93.8%) but lower NPV (96.8%) and sensitivity (91.2%). An optimized 0/1-h algorithm improved specificity to 92.1% while maintaining high NPV (99.7%) and sensitivity (99.2%). Low 30-day and 180-day all-cause mortality and major adverse cardiac event (MACE) rates were observed in rule-out groups for all algorithms. The ESC 0/1-h algorithm is a safe and efficient triage method for patients with suspected NSTEMI, with optimization further enhancing specificity and efficiency for the Chinese population.

The association between leukocyte telomere length (LTL) alteration and major adverse cardiovascular events (MACE) or mortality in patients with hypertension is still unclear. 20,034 patients with essential hypertension were enrolled from UK biobank. Multivariable COX regression models were performed to assess the association. LTL was shorter in hypertensive patients with MACE compared to those without MACE. Hypertensive patients in the lowest LTL quartile were at higher risk to develop MACE (adjusted HR 1.15 [95

目的 探讨以团队为基础的教学(team-based learning,TBL)结合客观结构化教学评估(objective structured teaching evaluation,OSTE)反馈策略对住院医师规范化培训(简称住培)指导医师师资培训的应用效果.方法 选取 2021 年 4 月至 2023 年 3 月在广东省 2 家医院分 6 批次参与广东省住培普通师资培训班的 245 名指导医师作为研究对象.课程通过让指导医师体验TBL应用实例的教学过程、研讨TBL逆向教学设计的核心问题、进行TBL住培教案设计与模拟现场TBL授课等环节进行TBL师资培训工作坊模式教学.采用OSTE反馈策略强化指导医师TBL教学能力,采用问卷自评的方式评估培训效果,并采用问卷调查了解培训前后指导医师对TBL教学法的培训需求与反馈意见.结果 61.8%的指导医师此前未接受过TBL培训,指导医师在培训后对TBL教学法的掌握明显提高(98.2%比 44.2%,P<0.001),100%的指导医师愿意在今后的住培教学中尝试使用TBL教学法.97.8%的指导医师对本次培训模式表示满意.结论 TBL教学法有助于指导医师培养住院医师自主学习能力和团队合作能力,采用OSTE反馈策略对指导医师进行TBL师资培训的效果满意,可进一步在住培师资培训中进行推广应用.

BACKGROUND We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury (MIRI) in patients with acute ST-elevation myocardial infarction (STEMI) using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism. METHODS The mononuclear cells were separated by ficoll centrifugation, and plasma total antioxidant capacity (T-AOC) was determined by the ferric reducing ability of plasma (FRAP) assay. The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, gene ontology (GO) enrichment analysis was performed on DAVID website to analyze the potential mechanism further. RESULTS The total numbers of white blood cells (WBC) and neutrophils (N) in the peripheral blood of STEMI patients (the AMI group) were significantly higher than those in the control group (WBC: 11.67±4.85 ×109/L vs. 6.41±0.72 ×109/L, P<0.05; N: 9.27±4.75 ×109/L vs. 3.89±0.81 ×109/L, P<0.05), and WBCs were significantly associated with creatine kinase-myocardial band (CK-MB) on the first day (Y=8.945+0.018X, P<0.05). In addition, the T-AOC was significantly lower in the AMI group comparing to the control group (12.80±1.79 U/mL vs. 20.48±2.55 U/mL, P<0.05). According to the gene analysis, eight up-regulated differentially expressed genes (DEGs) included GADD45A, PRDX2, HSPD1, DNAJB1, DNAJB2, RAD50, TNFSF6, and TRADD. Four down-regulated DEGs contained CCNG1, CAT, CYP1A1, and ATM. TNFSF6 and CYP1A1 were detected by polymerase chain reaction (PCR) to verify the expression at different time points, and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression. GO and kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response (UPR) and apoptosis. CONCLUSIONS WBCs, especially neutrophils, were the critical cells that mediating reperfusion injury. MIRI was regulated by various genes, including oxidative metabolic stress, heat shock, DNA damage and repair, and apoptosis-related genes. The underlying pathway may be associated with UPR and apoptosis, which may be the novel therapeutic target.

BACKGROUND:Amniotic fluid embolism (AFE) is a rare but potentially dangerous severe obstetrics complication, which is accompanied by an incidence between 1.9 and 6.1 per 100,000 births.CASE PRESENTATION:Here, we report an AFE case after cesarean delivery diagnosed on a cardiac arrest complicated by acute respiratory distress syndrome and coagulopathy. Diagnosis, risk factors and pathophysiology for AFE have been fully discussed, besides, extracorporeal membrane oxygenation in the early management of cardiac arrest was used, describing the indication, efficacy and successful performed of open-chest cardiopulmonary resuscitation for the patient.CONCLUSION:In AFE with cute cardiovascular collapse, extracorporeal membrane oxygenation support can be considered as the alternative therapies.

Introduction The flipped classroom (FC) approach and high-fidelity patient simulation (HFPS) training have shown promising effects in short-term acquisition or long-term retention of knowledge in medical education. In this study, we aimed to explore the incorporation of HFPS into the FC and the impact on the long-term (3 months after classes) knowledge retention of medical undergraduate students learning about acute organophosphorus pesticide poisoning (AOPP). Methods Eighty-two fifth-year medical students were randomly divided into an HFPS group (HG, n = 40) and an FC group (FG, n = 42). A postclass quiz and preinternship quiz were performed to assess the short-term knowledge acquisition and long-term (3 months after classes) knowledge retention of both groups of students. Feedback questionnaires were administered immediately after the class and before the internship to assess the students' self-perceived competency. Results In the postclass quiz, the scores achieved by the students from the HG and FG were 15.58 ± 2.69 and 14.62 ± 2.19, respectively. No significant difference was found between the 2 groups (P = 0.19). In the preinternship quiz, the scores achieved by the students from the HG (14.50 ± 2.16) were significantly higher than those achieved by the students from the FG (11.40 ± 2.07, P < 0.001). There was no significant difference between the postclass quiz and preinternship quiz scores achieved by the HG students (P = 0.05). However, scores in the preinternship quiz showed a significant decline compared with the postclass quiz for the FG students (P < 0.001). Students in the HG gave significantly higher scores for self-perceived confidence in dealing with AOPP patients in the forthcoming internship on the postclass and preinternship questionnaires. Conclusions The incorporation of HFPS into the FC approach could improve students' long-term knowledge retention of AOPP and enhance their confidence in caring for these patients in their internship.

目的:探讨情景模拟教学结合Mini-CEX、DOPS评分量表在急诊医学见习教学中的应用效果.方法:在见习前后进行基于创伤案例的情景模拟并量化以及见习后问卷调查.结果:见习后评分明显高于见习前.问卷调查显示80％以上学生认可情景模拟教学及Mini-CEX、DOPS量表.结论:情景模拟教学结合Mini-CEX、DOPS评分量表适应医学教学改革趋势,可提高学生的临床综合能力.

目的 探讨在住院医师规范化培训(简称住培)指导医师进行临床操作技能直接观察评估(direct observation of procedural skills,DOPS)均质化培训的需求及培训效果.方法 采用模拟考核小组的模式,对2019年参加广东省住培普通师资培训班的64名指导医师随机分成2组,进行评分标准的均质化培训,采用问卷调查,对培训前后不同组指导医师采用网络版DOPS量表通过对示范视频和现场技能模拟演练进行评分,对评分结果进行一致性分析以评价培训效果.结果 培训前仅39.1％的指导医师对DOPS有所了解,79.7％的指导医师希望了解"DOPS如何实施",76.6％的指导医师希望了解"DOPS各项评分标准的均质化培训".培训后70.3％的指导医师初步学会使用DOPS量表,37.5％的指导医师理解并掌握DOPS的评分标准的均质化制定方法,但仅45.3％的指导医师能"理解并能应用形成性反馈方法".97.5％的指导医师通过培训后表示"在今后临床带教中将尝试应用DOPS",指导医师对工作坊的满意度整体得分较高.通过观看示范视频的评分后进行分析,发现两组指导医师对同一住院医师腹部体查的整体能力评分差异有统计学意义(P<0.05),在评分标准均质化培训后,共有10项评分的3等级正确率显著高于9分制正确率(P<0.05),较传统理论授课培训后的模拟评分有所增加,两组指导医师对同一住院医师腹腔穿刺抽液术整体能力评分的差异无统计学意义(P>0.05).结论 对指导医师采用模拟考核小组模式进行DOPS评分标准的均质化培训效果满意,但仍需通过反复实践以提高指导医师的评估质量和反馈技巧.

Pulmonary embolism (PE) is the most serious type of venous thromboembolism, and pregnancy related PE, while uncommon, is likely to be fatal [1]. PE is one of the main causes of maternal death in high-income countries. At present, there are a limited number of reports about the entire process of PE- it is thought that PE is caused by vein thrombosis and detachment of a thrombus, which can be detected by echocardiography [2, 3].

Background Sepsis-induced cardiomyopathy (SIC) is a sort of severe disease in the intensive care unit. This research focuses on exploring the influence of miR-340-5p on SIC and its specific mechanism. Methods Mice were administered with lipopolysaccharide (LPS) to construct a SIC animal model. Mice were intramyocardially injected with Adenoassociated Virus- (AAV-) 9 containing the miR-340-5p precursor to make the miR-340-5p overexpression in the myocardium. The expression level of myocardial miR-340-5p was evaluated by qRT-PCR. The cardiac function was measured by echocardiography, the myocardial morphology was observed by hematoxylin-eosin (HE) staining, and the oxidative stress level was detected by 4-hydroxynonenal (4-HNE) immunohistochemical staining and malondialdehyde (MDA) assay in mice. The cells were pretreated with miR-340-5p mimic, mimic-NC, miR-340-5p inhibitor, inhibitor-NC, MyD88 siRNA, or si-NC and then administered with LPS or PBS. The cell viability was measured with the CCK-8 assay. The level of intracellular oxidative stress was evaluated using reactive oxygen species (ROS), MDA, and glutathione (GSH) detection. The MyD88 level was assessed via Western blotting analysis. The interaction of miR-340-5p with the MyD88 mRNA was confirmed via dual-luciferase reporter assay and RNA pull-down assay. Results The miR-340-5p overexpression partially alleviated the increase of the MyD88 level, impairment of cardiac function, and oxidative stress injury in the SIC animal model. In the SIC cell model, miR-340-5p mimic pretreatment partially relieved oxidative stress injury, while the miR-340-5p inhibitor had the opposite effect. Besides, the miR-340-5p mimic and inhibitor could reduce and further increase the MyD88 level in the SIC cell model, respectively. Dual-luciferase reporter and RNA pull-down experiments confirmed the interaction between the MyD88 mRNA and miR-340-5p. Finally, it was found that MyD88 siRNA pretreatment also partially alleviates the oxidative stress injury in the SIC cell model. Conclusion In sum, our study demonstrated that miR-340-5p can improve myocardial oxidative stress injury by targeting MyD88 in SIC.

目的 探讨改良以团队为基础的教学(team-based learning,TBL)结合模拟教学的方法对低年级医学生早期临床思维能力培养的效果.方法 采用对照试验的方法,选择2020年秋季学期40名选课医学生为试验组,采用改良TBL结合模拟教学的方法,以2017年秋季和2018年秋季两学期选课的各40名医学生分别为对照组1和对照组2,分别已实施传统理论授课教学(lecture-based learning,LBL)和LBL结合案例为基础的教学(case-based learning,CBL),比较三组学生的急诊临床思维模拟演练成绩和问卷调查结果,根据数据类型不同分别使用单因素方差分析和χ2检验分析比较各组的教学效果.结果 试验组在初步诊断正确性方面与对照组2无显著差别,但在急诊处理决策能力、团队合作能力和模拟演练总成绩方面均高于对照组1和对照组2(P<0.05).问卷调查结果显示,在赞同"增强团队合作意识"和"增强沟通能力"两个方面,试验组的正面评价均高于对照组1和对照组2,其差异有统计学意义(P<0.05).试验组和对照组2在赞同"喜欢该教学方式"和"激发学习兴趣"两方面均优于对照组1(P<0.05).结论 改良TBL结合模拟教学的方法可提高已接受过临床理论LBL后的低年级医学生的临床决策能力、团队合作能力和沟通能力,适用于医学生早期临床思维的培养,并值得逐渐应用推广.

Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1–15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31–45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.

目的 通过建立小鼠心肌缺血再灌注损伤模型,探讨阿利吉仑对于改善心肌缺血再灌注损伤的药物效果及可能的作用机制.方法 将C57小鼠分为假手术组、模型组、低剂量组、高剂量组.假手术组和模型组给予等量生理盐水灌胃,低剂量组和高剂量组分别给予25、50μg/g阿利吉仑灌胃.超声心动图检测各组小鼠心脏功能,ELISA检测各组肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平.实时荧光定量PCR和蛋白免疫印迹实验检测凋亡通路相关因子的表达水平.结果 本实验成功建立小鼠心肌缺血再灌注损伤模型.与假手术组比较,其他3组小鼠的每搏输出量、心输出量、收缩期末左心室前壁厚度、收缩期末左心室后壁厚度、舒张期末左心室后壁厚度均显著降低(P<0.05).与模型组比较,低、高剂量组小鼠的左心室射血分数和左心室短轴缩短率明显升高(P<0.05),且随着阿利吉仑剂量的增加而呈浓度依赖性升高(P<0.05),但TNF-α和IL-6水平明显降低(P<0.05).与假手术组比较,模型组的B淋巴细胞2蛋白(Bcl-2)的mRNA和蛋白表达量均显著降低(P<0.05),而Bcl-2相关X蛋白(Bax)的表达量明显增加(P<0.05).阿利吉仑能增加Bcl-2的表达量(P<0.05),而使Bax的表达量明显下降(P<0.05).结论 阿利吉仑可以通过抑制炎症反应、调控凋亡相关通路,改善小鼠心肌缺血再灌注损伤,促进其心功能的恢复.

This study investigates the alteration in function and number of circulating endothelial progenitor cells (EPCs) in patients with aortic dissection (AD), compared with hypertensive patients, and its possible mechanism. Thirty-four patients with acute aortic dissection (AAD) and 20 patients with primary hypertension were involved. Flow cytometry analysis was performed to detect the number of CD34+/KDR+ cells, and acetylated low density lipoprotein (ac-LDL) and lectin fluorescent staining method was applied to test the number of cultured EPCs. In addition, EPC migration and proliferation were measured, and plasma interleukin 6 (IL-6) and interleukin 17 (IL-17) levels were investigated. The number of circulating EPCs in the AAD group was lower than that in the non-AD group, and the proliferation and migration of circulating EPCs in the AAD group were lower than that in the non-AD group. In addition, the number, proliferation, and migration of circulating EPCs were significantly inversely correlated with the aortic dissection detection risk score (ADD-RS). More importantly, increased plasma IL-6 and IL-17 level was found in the AAD group, and the two inflammatory factors were inversely associated with the function and number of circulating EPCs in the AAD group. We first demonstrated that the number and function of circulating EPCs are reduced in the AAD group, which may be partly related to upregulated plasma IL-6 and IL-17. Our study provides novel insight on the underlying mechanism and potential therapeutic target of AAD.

目的:探讨TBL结合情景模拟在全科心肺复苏(CPR)团队急救师资培训中的应用效果及反馈.方法:选取2021年3月在粤北人民医院参加广东省住院医师规范化培训全科普通师资培训班的学员139人为研究对象,采用TBL结合情景模拟教学法进行CPR团队急救培训,培训后进行CPR技能与团队合作的评估.采用问卷星调查培训后学员对不同人数组合CPR团队合作的掌握情况,并评估教学满意度.结果:培训后全科师资对不同人数组合复苏团队急救的掌握程度超过98％.各项课程满意度评价得分均超过94.5分,97.12％的学员认可采用TBL结合情景模拟教学的方法对全科住培学员进行培训,99.28％的学员愿意今后在教学中使用此方法.结论:TBL结合情景模拟教学能有效地提高全科师资对CPR团队急救能力的掌握,调动其采用新型教学方法的积极性,提高全科住院医师CPR团队急救的培训质量.

To investigate the effect of GRACE scores on prediction of 30-day cardiovascular adverse events in acute chest pain patients. A prospective, observational analysis was conducted in the patients with acute chest pain in Emergency Department (ED) from January 1, 2016 through January 1, 2017. Data including characteristics and GRACE scores were collected. All causes leading to MACE were followed up at 30th day after the onset of acute chest pain. Among a total of 600 patients presenting with acute chest pain enrolled in this study, 302 were male (50.3%) and 298 were female (49.7%). The range of age was 20-80 years old. During follow-up period, 102 patients had MACE, 498 patients had no MACE. When compared with non-MACE group, factors including number of Smoker, Hypercholesterolemia, Diabetes, Hypercholesterolemia and patients admitted in CCU as well as GRACE scores, were significantly higher in MACE group (P<0.05). The predictive ROC curve area of GRACE scores in 30-day MACE was 0.739 (0.687 to 0.791). The probability of 30-day cardiovascular adverse events in various GRACE score risk stratification was 2.0% (low-risk), 5.33% (medium-risk), and 9.67% (high-risk), respectively. The GRACE score was a useful predictor to the occurrence of 30-day cardiovascular adverse events in acute chest pain patients. Patients with low GRACE score risk stratification have a low risk of 30-day MACE, which may be able to convey risk quickly and efficiently.

Out-of-hospital cardiac arrest (OHCA) due to drowning carries high morbidity and mortality. There are a few studies on drowning-related out-of-hospital cardiac arrest (OHCA), in which patients are followed from the scene to hospital discharge. This study aims to compare patient characteristics between the survival group and mortality group of OHCA due to drowning. OHCA due to drowning cases were selected from the North America Termination of Resuscitation Association database between 2011 and 2015. The retrospective analysis of epidemiological characteristics and clinical features of all OHCA patients were performed. Of the 17,094 OHCA cases in the registry, 54 cases of OHCA due to drowning were included in this study. Among the 54 OHCAs due to drowning, 7 (13.0%) survived, while 47 (87.0%) died. Compared to the mortality group, the survival group had a higher bystander witness rate (57.1% versus 17.0%, p < 0.05), higher asystole rate (42.9% versus 78.7%, p < 0.05), and higher mild therapeutic hypothermia rate (28.6% versus 2.1%, p < 0.05). In addition, a large proportion of survivors were children (71.4%) and males (71.4%). Survival among OHCA's due to drowning was found to be improved with a higher bystander rate, higher asystole rate, and higher mild hypothermia rate. In addition, children and males comprised the majority of survivors.

Objective To evaluate the clinical characteristics of acute pancreatitis (AP) concomitant with diabetic ketoacidosis (DKA) in a cohort from South China and identify factors associated with early detection of DKA in AP patients. Methods Inpatient medical records of AP concomitant with DKA were retrospectively reviewed. Results Forty-eight patients with AP concomitant with DKA were enrolled in this study. The results indicated that comorbidity history of diabetes mellitus and mental status of not alert on admission were factors associated with DKA in AP patients. Compared with patients without DKA, patients with DKA showed significantly higher rates of hypertriglyceridemia and lower rates of gallstones than those without DKA. AP patients with concurrent DKA had higher levels of serum triglycerides, longer lengths of hospital stays, and higher complication rates of systemic inflammatory response syndrome and acute kidney injury. Conclusion AP patients might have higher risks of concomitant DKA if presenting as not alert upon admission or if they have past medical histories of diabetes mellitus. Serum triglyceride levels were significantly higher in AP patients with DKA. DKA raised the severity of AP, but did not increase in-hospital mortality.