World journal of emergency medicine最新文献

{"title":"Clinical characteristics of acute adrenal insufficiency in emergency patients: an analysis of data in Lhasa, Xizang Autonomous Region of China.","authors":"Guiying Dong, Jianbo Yu, Lobsang Chodron, Tenzin Chodron, Peiliang Gao, Xueying Fu, Jihong Zhu, Zhenzhong Yang, Lobsang Cering","doi":"10.5847/wjem.j.1920-8642.2025.085","DOIUrl":"10.5847/wjem.j.1920-8642.2025.085","url":null,"abstract":"<p><strong>Background: </strong>The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa's emergency population to improve diagnostic accuracy and optimize clinical management.</p><p><strong>Methods: </strong>A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People's Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.</p><p><strong>Results: </strong>Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (<i>P</i>=0.001) and diastolic blood pressure (DBP) (<i>P</i><0.001); higher neutrophil count (<i>P</i>=0.048), eosinophil count (<i>P</i>=0.044), CRP (<i>P</i>=0.004), blood urea nitrogen (BUN) (<i>P</i>=0.007); lower sodium (<i>P</i><0.001) and glucose levels (<i>P</i>=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; <i>P</i><0.001).</p><p><strong>Conclusion: </strong>AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"481-485"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic liability to atrial fibrillation, aortic valve disease, and mitral valve disease: a two-sample Mendelian randomization study.","authors":"Yun Zhang, Chengui Zhuo, Ting Chen, Xiaosheng Hu","doi":"10.5847/wjem.j.1920-8642.2025.086","DOIUrl":"10.5847/wjem.j.1920-8642.2025.086","url":null,"abstract":"<p><strong>Background: </strong>Research has revealed a relationship between atrial fibrillation (AF) and valvular heart disease; however, the causality remains largely unknown. This study explored whether a causal association between AF and non-rheumatic aortic valve disease (AVD) and mitral valve disease (MVD) could be found.</p><p><strong>Methods: </strong>A two-sample Mendelian randomization (TSMR) method was applied to determine the causal effect of AF on AVD, mitral regurgitation, and MVD. The inverse variance weighted (IVW) method was used as the primary analytical approach, and several complementary analyses were conducted. Outliers were detected using the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and radial Mendelian randomization (MR) methods.</p><p><strong>Results: </strong>Genetically predicted AF was found to be causally associated with the risk of MVD (odds ratio [<i>OR</i>]=1.001; 95% confidence interval [<i>CI</i>]: 1.000-1.001; <i>P</i>=1.33×10^-6) and mitral regurgitation (<i>OR</i>=1.001; 95% <i>CI</i>: 1.000-1.002; <i>P</i>=0.009). However, no significant causal associations between AF and AVD were detected (<i>OR</i>=1.000; 95% <i>CI</i>: 0.999-1.000; <i>P</i>=0.804). Causal effects were still detected, even after adjusting for potential risk factors or removing the identified outliers. Reverse MR analyses revealed no significant causal effect of valvular heart disease on AF.</p><p><strong>Conclusion: </strong>Our findings demonstrate a positive causal association between AF, MVD, and mitral regurgitation, but not AVD. Further research and an aggressive AF management strategy should be explored as potential measures for preventing MVD.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"475-480"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a nomogram for predicting prolonged ICU stays after pediatric cardiac surgery.","authors":"Jungang Zheng, Wenyuan Zhang, Yuqian Guo, Huiyi Hu, Yue Jin, Xiangming Fang","doi":"10.5847/wjem.j.1920-8642.2025.039","DOIUrl":"10.5847/wjem.j.1920-8642.2025.039","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit (ICU) stays.</p><p><strong>Methods: </strong>Pediatric patients who underwent cardiac surgery were included, with data collected from the pediatric intensive care database. The datasets were randomly divided into a training set (75%) and a testing set (25%). A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.</p><p><strong>Results: </strong>A total of 795 patients and 266 patients were assigned to the training and testing sets, respectively, with consistent variables. The nomogram developed from the training set included eight characteristics: age, systolic blood pressure, respiratory rate, bicarbonate, direct bilirubin, high-sensitivity C-reactive protein, international normalized ratio, and operation time. The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736, respectively. The nomogram demonstrated excellent discrimination and calibration. Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.</p><p><strong>Conclusion: </strong>This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"456-461"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonia with parapneumonic effusion due to <i>Fusobacterium necrophorum</i>: a case report.","authors":"Xiaojun Dong, Qian Li, Anquan Zhu, Xiaocui Wu, Xuejie Wu","doi":"10.5847/wjem.j.1920-8642.2025.077","DOIUrl":"10.5847/wjem.j.1920-8642.2025.077","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"516-518"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical impedance tomography: from technical innovations to bedside clinical solutions.","authors":"Nanxia Xuan, Baoping Tian, Lan Ying, Xiajing Cao, Danqiong Wang, Gensheng Zhang","doi":"10.5847/wjem.j.1920-8642.2025.097","DOIUrl":"10.5847/wjem.j.1920-8642.2025.097","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"497-502"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics of botulinum toxin poisoning following cosmetic injections.","authors":"Jiujiu Gui, Zhi Li, Shuhao Ye, Yuheng Shi, Yahui Tang, Zhongqiu Lu, Aifang Sun","doi":"10.5847/wjem.j.1920-8642.2025.091","DOIUrl":"10.5847/wjem.j.1920-8642.2025.091","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"491-493"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of diaphragmatic excursion in ICU patients: ultrasonography assessment via the conventional M-mode versus the anatomical M-mode.","authors":"Issac Cheong, Francisco Marcelo Tamagnone","doi":"10.5847/wjem.j.1920-8642.2025.090","DOIUrl":"10.5847/wjem.j.1920-8642.2025.090","url":null,"abstract":"","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"488-490"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of fluid balance index with in-hospital mortality in critically ill patients with acute pancreatitis: a multicenter retrospective cohort study.","authors":"Xiaodong Huang, Zhihong Xu, Siyao Liu, Xiong Liu, Long Lin, Mandong Pan, Xianwei Huang, Jiyan Lin","doi":"10.5847/wjem.j.1920-8642.2025.102","DOIUrl":"10.5847/wjem.j.1920-8642.2025.102","url":null,"abstract":"<p><strong>Background: </strong>Fluid resuscitation in acute pancreatitis (AP) patients requires precise titration because both excess and insufficient volumes may worsen outcomes. This study aimed to develop a weight-normalized fluid balance index (FBI) and assess its association with in-hospital mortality in critically ill AP patients.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the MIMIC-IV 3.0 database and the emergency intensive care unit (EICU) of our hospital (validation cohort) and was based on inclusion and exclusion criteria. Using the R package cutoff, an FBI of 145 mL/kg was identified as the optimal risk stratification threshold. The primary outcome was in-hospital all-cause mortality. Machine learning was used to screen covariates for inclusion in multivariable Cox models. Cox regression and restricted cubic spline (RCS) models were used to evaluate the relationship between FBI and mortality. Propensity score matching (PSM) was applied to minimize baseline confounding. After PSM, Kaplan-Meier survival curves were generated, and the results were validated via data from our center.</p><p><strong>Results: </strong>In this study, 547 AP patients from the MIMIC-IV database and 156 from the EICU of our hospital were included. In the MIMIC-IV cohort, the overall in-hospital mortality rate was 8.96%. Patients with FBI ≥145 mL/kg had significantly higher in-hospital mortality than did those with FBI <145 mL/kg (<i>P</i><0.05). High-risk classification remained an independent predictor of death after full adjustment (hazard ratio [<i>HR</i>] 1.99, 95% confidence interval [95% <i>CI</i>]: 1.08-3.69). Post-PSM Kaplan-Meier analysis confirmed significantly higher in-hospital mortality in the high-risk group (<i>P</i><0.05). This result was corroborated by our validation cohort. RCS analysis further demonstrated a non-linear increase in in-hospital mortality with increasing FBI values.</p><p><strong>Conclusion: </strong>An FBI ≥145 mL/kg may be associated with increased in-hospital mortality in critically ill AP patients.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"462-468"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activation of the α7 nicotinic acetylcholine receptor mitigates cognitive deficits in mice with sepsis-associated encephalopathy by inhibiting microglial pyroptosis.","authors":"Qiaosheng Wang, Qiong Luo, Zhiwei Su, Yan Xu, Liangshan Peng, Yin Wen, Hongke Zeng, Hongguang Ding","doi":"10.5847/wjem.j.1920-8642.2025.099","DOIUrl":"10.5847/wjem.j.1920-8642.2025.099","url":null,"abstract":"<p><strong>Background: </strong>While the α7 nicotinic acetylcholine receptor (α7 nAChR) is implicated in sepsis-associated encephalopathy (SAE), its pathophysiological contributions require further investigation.</p><p><strong>Methods: </strong>SAE was induced in mice via cecal ligation and puncture (CLP), and microglia were treated with lipopolysaccharide (LPS). PHA-543613 (an α7 nAChR agonist) was used to activate α7 nAChR. To study the role of α7 nAChR in mitophagy and pyroptosis, caspase-1-deficient mice and PTEN-induced kinase 1 (PINK1) small interfering RNA (siRNA) were used. Cognitive function, cerebral oxygen extraction ratio (CERO₂), and brain tissue oxygen pressure (PbtO₂) were measured. Blood-brain barrier (BBB) integrity was evaluated via Evan's blue staining. Mitophagy, pyroptosis, and cytokine levels were analyzed via Western blotting and immunofluorescence.</p><p><strong>Results: </strong>CLP or LPS treatment significantly down-regulated α7 nAChR protein expression in microglia. The administration of PHA-543613 to activate α7 nAChR not only restored its expression post-sepsis, but also notably decreased BBB permeability and mitigated cognitive deficits. Both α7 nAChR activation and caspase-1 knockout effectively suppressed microglial pyroptosis. The activation of α7 nAChR also promoted mitophagy in microglia. This led to an amelioration of brain tissue hypoxia, as shown by elevated PbtO₂ and reduced CERO₂ levels. The suppression of microglial pyroptosis by α7 nAChR was counteracted when mitophagy was inhibited through the siRNA-mediated silencing of PINK1.</p><p><strong>Conclusion: </strong>The activation of α7 nAChR reduces pyroptosis by enhancing microglial mitophagy, thereby mitigating SAE.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"438-446"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of a novel medical artificial intelligence large language model on supporting decision-making for emergency patients with suspected sepsis.","authors":"Sen Jiang, Xiandong Liu, Tong Liu, Yi Gu, Bo An, Chunxue Wang, Dongyang Zhao, Haitao Zhang, Lunxian Tang","doi":"10.5847/wjem.j.1920-8642.2025.095","DOIUrl":"10.5847/wjem.j.1920-8642.2025.095","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are being explored for disease prediction and diagnosis; however, their efficacy for early sepsis identification in emergency departments (EDs) remains unexplored. This study aims to evaluate MedGo, a novel medical LLM, as a decision-support tool for clinicians managing patients with suspected sepsis.</p><p><strong>Methods: </strong>This retrospective study included anonymized medical records of 203 patients (mean age 79.9±10.2 years) with confirmed sepsis from a tertiary hospital ED between January 2023 and January 2024. MedGo performance across nine sepsis-related assessment tasks was compared with that of two junior (<3 years of experience) and two senior (>10 years of experience) ED physicians. Assessments were scored on a 5-point Likert scale for accuracy, comprehensiveness, readability, and case-analysis skills.</p><p><strong>Results: </strong>MedGo demonstrated diagnostic performance comparable to that of senior physicians across most metrics, achieving a median Likert score of 4 in accuracy, comprehensiveness, and readability. MedGo significantly outperformed junior physicians (<i>P</i><0.001 for accuracy and case-analysis skills). MedGo assistance significantly enhanced both junior (<i>P</i><0.001) and senior (<i>P</i><0.05) physicians' diagnostic accuracy. Notably, MedGo-assisted junior physicians achieved accuracy levels comparable to those of unassisted senior physicians. MedGo maintained consistent performance across varying sepsis severities.</p><p><strong>Conclusion: </strong>MedGo shows significant diagnostic efficacy for sepsis and effectively supports clinicians in the ED, particularly enhancing junior physicians' performance. Our study highlights the potential of MedGo as a valuable decision-support tool for sepsis management, paving the way for specialized sepsis AI models.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"16 5","pages":"447-455"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}