Background: Sepsis-induced coagulopathy (SIC) is a life-threatening complication of sepsis characterized by dysregulated coagulation, hyperinflammation, and microvascular thrombosis. Despite advancements in its pathophysiology, therapeutic strategies remain controversial, and clinical trials have yielded inconsistent outcomes.
Methods: This study conducts a bibliometric analysis (1995-2024) to map research trends, identify knowledge gaps, and evaluate the translational challenges in SIC management. A systematic search of the Web of Science Core Collection (6382 articles) and Scopus (8423 articles) retrieved on sepsis-related coagulation dysfunction. VOSviewer and Bibliometrix analyzed publication trends, citation networks, international collaborations, and keyword co-occurrence. Metrics included annual growth rates, total link strength, and relative research interest. We visualized temporal and thematic trends to highlight emerging frontiers and interdisciplinary linkages.
Results: Global research output exhibited exponential growth (annual rate: 18.4%), peaking during the coronavirus disease 2019 pandemic. The United States and China dominated research contributions, with the University of Texas MD Anderson Cancer Center leading in citation impact. Van Der Poll, Tom (Netherlands), and Toshiaki Iba (Japan) emerged as pivotal figures, focusing on molecular mechanisms and diagnostic standardization, respectively. Keyword clustering revealed 4 pillars: (1) etiology and clinical management, (2) molecular mechanisms, (3) biomarkers and prognostics, and (4) pathophysiology and syndromes. Coronavirus disease 2019-associated coagulopathy and artificial intelligence-driven diagnostics emerged as recent hotspots.
Conclusions: This analysis reveals the exponential but heterogeneous expansion of SIC research, driven by mechanistic discoveries and pandemic-related demands. Persistent challenges include the standardization of diagnostic criteria, patient heterogeneity in clinical trials, and geographic disparities in research capacity. Future priorities include integrating precision medicine and adopting artificial intelligence for patient stratification. Bridging mechanistic insights with clinical translation will be critical to improving outcomes in SIC.
Background: Ambient temperature has been shown to have a positive association with the increasing emergency department burden. However, no studies have investigated the effects of ambient temperature on the number of emergency department visits (EDVs) for abdominal pain. Therefore, we conducted this study to evaluate the relationship between the two, with the aim of rationally allocating medical resources.
Methods: We collected daily numbers of EDVs for abdominal pain data from the Zhongnan Hospital of Wuhan University and daily meteorological data from Wuhan from January 1, 2016, to December 31, 2018. We chose a generalized additive model combined with a distributed lag nonlinear model to assess the short-term effects of ambient temperature on EDVs for abdominal pain. We conducted stratification analyses according to sex, age, and the Chinese Emergency Triage Scale.
Results: A total of 16,318 visits for abdominal pain were identified during the study period. The significant effects of extremely low temperature (−1°C) and moderately high temperature (26°C) were observed at Lag 0 day and Lag 0-1 day models. In the Lag 0 day model, the relative risks for extremely low and moderately high temperatures were 0.83 (95% confidence interval [CI]: 0.70-0.99; P = 0.038) and 1.15 (95% CI: 1.06-1.25; P = 0.001), respectively. Younger people were more likely to be affected by temperature. Cold and mildly hot weather were associated with the L2 and L3 levels, respectively. Moreover, low temperatures were negatively correlated with the risk of urolithiasis and cholecystitis.
Conclusion: Low temperatures significantly reduced abdominal pain-related EDVs, whereas high temperatures had the opposite effect.
Background: Sepsis-associated acute kidney injury (S-AKI) is a common complication of sepsis, and early identification can improve patient prognosis. This study incorporated novel inflammatory markers as features to construct a model and employed 6 machine learning methods to predict the occurrence of S-AKI.
Methods: A total of 3613 patients with sepsis were included in this study. Novel inflammatory markers, including neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic inflammatory response index, systemic immune-inflammation index, systemic inflammatory aggregate index, lactate-to-albumin ratio, and prognostic nutritional index, along with demographic characteristics, clinical conditions, and routine laboratory results, were used to construct the model. The machine learning methods employed included logistic regression, support vector machine, random forest (RF), extreme gradient boosting (XGBoost), and ensemble methods(RF+XGBoost). Model performance and stability were evaluated using 5-fold cross-validation. Model performance was assessed using the area under the receiver-operating characteristic curve, sensitivity, specificity, accuracy, precision, recall, and F1 score. Additionally, SHapley Additive exPlanations values were used to interpret the predictive model.
Results: In the final algorithm group, the ensemble model of RF and XGBoost (0.843; 95% confidence interval: 0.820-0.866) was higher than those of other models. Among the single models, the XGBoost model exhibited the highest sensitivity (0.856) and F1 score (0.780), indicating its stronger ability to identify patients who will develop S-AKI, albeit at the expense of lower specificity (0.667). The 4 most influential features for XGBoost were mechanical ventilation, mean arterial pressure, blood urea nitrogen level, and sequential organ failure assessment score. Among the 3 novel inflammatory markers, lactate-to-albumin ratio showed the greatest effect.
Conclusion: We successfully developed machine learning methods to predict S-AKI, highlighting the importance of novel inflammatory markers in model construction. This breakthrough offers novel perspectives for feature selection in the future development of related predictive models.
Cardiac arrest occurs rapidly, requires high timeliness in treatment, and has a poor prognosis. Cardiopulmonary resuscitation (CPR) is a key intervention to save the lives of patients with cardiac arrest. In recent years, CPR has made significant progress with the update of evidence-based research and technological development. The evolution of specific recommendations in international guidelines reflects the changes in the certainty of and understanding about emerging evidence. To unravel the logical progression of cognitive development in the CPR field, this review systematically clarifies the evidence base and evolutionary history of recommendations for core components of adult CPR, including the chain of survival, interruptions in compressions, high-quality CPR, early defibrillation, dispatcher-assisted CPR, extracorporeal CPR, and temperature control. Moreover, it identifies knowledge gaps and proposes potential development directions to provide systemic insights and strategic thinking in CPR for providers, researchers, and healthcare administrators.
Sepsis is a common syndrome with a high mortality rate worldwide, characterized by complex physiological, pathological, and biochemical abnormalities. The complement system, an essential component of innate immunity, consists of approximately 30 proteins that undergo a series of cascading enzymatic reactions to form a membrane attack complex, leading to cell lysis. Sepsis-induced complement activation drives endothelial cells toward a proinflammatory and prothrombotic phenotype. This review highlights the complex interactions among the complement, coagulation, and inflammatory systems, examines the prognostic significance of complement activation in patients with sepsis, and discusses the potential clinical applications of complement inhibitors.
In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VV-ECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.
Background: Spinal cord injuries (SCI), although rare in children, lead to significant morbidity and mortality.
Case presentation: This report describes the case of a 15-year-old male adolescent who developed SCI due to paradoxical embolism of a deep vein thrombus following strenuous exercise. He presented with bilateral upper limb weakness that progressed to severe tetraparesia, sensory deficits, and autonomic instability. Imaging revealed medullary ischemia with hypoperfusion of the anterior spinal artery. A family history of thromboembolism and obesity were noted as risk factors in the patient; however, thrombophilia screening was negative. Optimized fluid therapy was initiated for the medullary shock associated with dexamethasone and enoxaparin. As neurological recovery was incomplete, the patient was enrolled in an intensive rehabilitation program.
Conclusion: To the best of our knowledge, this is the first reported case of medullary ischemia due to a paradoxical embolism of a deep vein thrombus through a patent foramen ovale in an adolescent. This case highlights the need for a multidisciplinary approach to optimize long-term outcomes after medullary ischemia.