Community-acquired pneumonia (CAP) in adults (≥18 years old) is the most common infectious disease encountered in emergency departments. Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management. The physician-pharmacist collaborative management (PPCM) model, which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists, has demonstrated strong clinical value in practice. However, the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption. This guideline is developed based on evidence-based medicine and clinical practice experience, with a focus on the application of the PPCM model in the management of CAP in emergency settings. It outlines the significance of the PPCM model, its applicable scenarios, the respective roles of emergency physicians and clinical pharmacists, and its practical implementation in the antimicrobial treatment of CAP patients. In addition, the guideline proposes standardized implementation processes and clinical pathways. By promoting the PPCM model, the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP, reduce the risk of antimicrobial resistance, and improve patient outcomes.
Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has become a vital intervention for improving the survival rates after out-of-hospital cardiac arrest. Despite its importance, the DA-CPR research landscape has not been comprehensively analyzed. This study aims to conduct a bibliometric analysis of DA-CPR research published from 2000 to 2024 and to identify trends, key contributors, and international collaborations, mapping the global scientific landscape and highlighting areas for further investigation.
Methods: A retrospective bibliometric analysis was conducted using data from the Scopus database. Articles and reviews published from 2000 to 2024 were included. Data were analyzed using Microsoft Excel and VOSviewer to assess publication trends, geographic distribution, influential authors, journals, and keyword co-occurrence.
Results: A total of 375 publications were identified, with a significant increase in research output since 2014. The United States, South Korea, Germany, Japan, and China were the leading countries in DA-CPR research, whereas contributions from developing regions were nearly nonexistent. Resuscitation emerged as the leading journal publishing the majority of DA-CPR-related articles. Keyword analysis identified 486 unique terms, with “cardiopulmonary resuscitation,” “out-of-hospital cardiac arrest,” and “emergency medical services” being the most frequently used terms, underscoring the central themes in DA-CPR research. Additionally, terms such as “dispatcher-assisted CPR,” “bystander,” and “telephone CPR” highlighted the focus on the critical roles involved in the DA-CPR process.
Conclusion: This bibliometric analysis highlighted the consistent growth in DA-CPR research, with increasing international collaboration and scientific output from North America, Asia, and Europe. Nonetheless, the lack of studies in developing countries underscores the urgent need to expand DA-CPR initiatives and global research efforts to improve cardiac arrest survival outcomes.
Background: We aimed to investigate the clinical value of the Modified Early-Warning Score (MEWS) combined with early-warning symptoms and electrocardiogram (ECG) findings in predicting in-hospital cardiac arrest (IHCA) in critically ill patients, to assess and reduce the occurrence of IHCA.
Methods: This retrospective cohort study examined critically ill patients who were enrolled in a hospital from January 2019 to March 2023 and divided into an IHCA group and NO-IHCA group. The critically ill patients were randomly divided into 2 sets at the ratio of 7:3, for the training set and test set. The training set used to develop the model and the test set used to test the model. Univariate and multivariate logistic regressions were used to determine the independent predictors. The generated prediction models were evaluated using 10-fold cross verification, and the areas under the curve (AUCs), accuracy, sensitivity, and specificity were reported. Hosmer-Lemeshow goodness of fit test was used to compare the calibration degree of the model and Delong test was used to compare the AUC.
Results: Multivariate logistic analysis showed that MEWS, early-warning symptoms, and ECG findings were independent risk factors for IHCA in critically ill patients (P < 0.05). The AUC values for MEWS, early-warning symptoms, and ECG findings were 0.671, 0.527, and 0.723, respectively. The AUC value for the combination of MEWS, early-warning symptoms, and ECG findings was 0.902 (P < 0.001), which was higher than MEWS.
Conclusion: MEWS combined with early-warning symptoms and ECG findings can predict IHCA in critically ill patients, which may help reduce IHCA in this population.
Background: Ketone body metabolism can improve cardiomyocytes metabolism and reduce myocardial oxygen consumption; however, its role in the short-term prognosis of patients with acute myocardial infarction combined with heart failure has not been clearly elucidated. The aim of this study was to investigate the effect of β-hydroxybutyric acid, the main component of ketone bodies, on the short-term prognosis of patients with acute myocardial infarction combined with heart failure.
Methods: This was a retrospective observational study that enrolled patients admitted to the Qilu Hospital of Shandong University for acute myocardial infarction combined with heart failure between January 1, 2019, and December 31, 2022. According to whether β-hydroxybutyric acid was elevated or not, subjects were divided into a β-hydroxybutyric acid elevated and nonelevated groups, to observe the difference in cardiac function improvement between the two groups.
Results: This study included a total of 260 patients, of which 170 exhibited elevated levels of β-hydroxybutyric acid. Compared to the patients in the nonelevated group, patients in the elevated β-hydroxybutyric acid group had higher plasma levels of creatine kinase myocardial band and greater Gensini scores. Multivariate logistic regression analysis indicated that an increase in β-hydroxybutyric acid levels (odds ratio: 3.076; 95% confidence intervals: 1.479-6.395; P = 0.003) is an independent protective factor affecting the prognosis of cardiac function in patients with acute myocardial infarction combined with heart failure.
Conclusion: In patients with acute myocardial infarction combined with heart failure, plasma β-hydroxybutyric acid serves as an independent protective factor for short-term improvement in cardiac function.
The management of respiratory failure and hypoxemia in children with cancer presents a critical challenge. Choosing between invasive and noninvasive mechanical ventilation can profoundly impact mortality rates, especially in resource-limited settings. Choosing between invasive and noninvasive mechanical ventilation can impact mortality rates, particularly in resource-limited settings. Extensive clinical studies are imperative to thoroughly evaluate the efficacy of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) during the early stages of treatment. Further research is crucial to determine the most optimal therapeutic approach. Early implementation of IMV or NIV could significantly reduce mortality rates in these patients.[1] Additionally, this article examines the admission of children with terminal cancer, evaluating their use of invasive and noninvasive ventilatory support versus palliative care. The interdisciplinary medical team, in collaboration with the family, must carefully consider the benefits and risks of these interventions, whether in the early or terminal stages of the disease. Furthermore, the article delves into the controversies surrounding the utilization of ventilation in critically ill children with cancer.
As one of the pathological causes of coronary heart disease, atherosclerosis poses a major threat to human health. Macrophages play an important role in regulating atherosclerotic disease progression. Specifically, atherosclerotic inflammation is initiated when low-density lipoproteins infiltrate the subcutaneous area and are phagocytosed by macrophages, leading to foam cell formation. The subsequent inflammation progression or resolution depends on the delicate balance between proinflammatory and anti-inflammatory mediators. In cases where proinflammatory factors dominate, macrophages tend to activate the pyroptosis and necrosis pathways, resulting in the release of intracellular damage-associated molecular patterns and promoting necrotic core formation and plaque progression. Conversely, when anti-inflammatory factors prevail, macrophages engage in autophagy-mediated intracellular lipid metabolism while inhibiting inflammation progression through the efferocytosis of apoptotic cells. The regulatory function of macrophages in atherosclerosis can also be understood from the perspective of their life cycles. Lipid retention within the arterial intima and its subsequent uptake by macrophages are the characteristic pathological hallmarks of atherosclerosis. As pivotal effector cells in this process, macrophages with their distinctive performances decisively determine the progression and resolution of atherosclerotic inflammation. The complete life cycle of macrophages in atherosclerotic plaques encompasses chemotaxis, infiltration, polarization, uptake of lipoproteins for metabolic efflux, foam cell formation, lipid overload, and various forms of programmed necrosis, including autophagy, pyroptosis, apoptosis, necrosis, and efferocytosis, to facilitate the removal of apoptotic macrophages and limit inflammation progression. The behavior of macrophages in atherosclerosis has rarely been comprehensively addressed in previous review articles. This article provides an extensive overview of the entire life cycle of macrophages following their response to atherosclerotic inflammation and the impact of regulatory factors on inflammation progression and resolution. Considering that macrophages play a pivotal role in the inflammatory response associated with atherosclerosis, targeting the regulation of their life cycle holds promise for therapeutic interventions against atherosclerosis-related cardiovascular diseases.
Background: Evidence on the effectiveness of anticoagulation therapy in patients with cardiac arrest is scarce. We aimed to compare the effectiveness of anticoagulation therapy in patients with cardiac arrest by systematic evaluation and meta-analysis.
Methods: The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from database inception until December 31, 2022, comparing adjuvant anticoagulation to standard care during cardiac arrest. Odds ratios with 95% confidence intervals were calculated using a random-effects model. The population included adults with cardiac arrest in any setting. Pairs of investigators reviewed studies for relevance, extracted data, and assessed the risk of bias. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews).
Results: Four studies were included in the final meta-analysis (1 randomized controlled trial, 1 nonrandomized controlled trial, and 2 observational studies). A total of 1374 patients (412 in the intervention group and 962 in the control group) were included. The results show that anticoagulant interventions increased return of spontaneous circulation compliance compared with control, improved neurological prognosis, and are potentially associated with in-hospital survival. The risk of bleeding in the intervention and control groups and 24-hour survival between these groups were not significantly different.
Conclusion: Anticoagulation during cardiac arrest was associated with achieving return of spontaneous circulation, improving survival to hospitalization, and potentially ameliorating neurologic prognosis in patients. Moreover, anticoagulation did not increase the incidence of bleeding events.
Background: Diagnosis of Kounis syndrome, an acute coronary syndrome associated with anaphylactic reactions, is challenging owing to the overlapping symptoms of myocardial ischemia. Takotsubo syndrome (TTS), characterized by stress-induced cardiomyopathy, may share pathophysiological mechanisms with Kounis syndrome and potentially coexist in the same patient.
Case Presentation We present a case of a 63-year-old patient who developed an allergic reaction to contrast medium administration, leading to dyspnea and chest pain. Electrocardiography revealed a new-onset left bundle-branch block, and echocardiography indicated wall motion abnormalities with apical ballooning, suggestive of TTS. Coronary angiography displayed a chronic total occlusion of the right coronary artery. Laboratory tests revealed elevated inflammatory markers, supporting the diagnosis of Kounis syndrome and TTS.
Conclusion: This case highlights the challenges of diagnosing and managing type II Kounis syndrome associated with concurrent TTS. This underscores the need for tailored therapeutic interventions and comprehensive guidelines to address these complex conditions effectively.