Abstract:In October 2025,the European Resuscitation Council(ERC)released the 2025 ERC Guidelines for Cardiopulmonary Resuscitation,which introduced updates and revisions in the section on adult advanced life support(ALS).Key areas of update include prevention and treatment of in-hospital cardiac arrest and out-of-hospital cardiac arrest,ALS in low-resource settings,CPR-induced consciousness,defibrillation,airway and ventilation,medication and fluids,ALS in highly-monitored cardiac arrest,physiology-guided CPR,waveform capnography during advanced life support,use of ultrasound imaging during advanced life support,devices,extracorporeal CPR,peri-arrest arrhythmias and uncontrolled organ donation after circulatory death.These revisions are all based on the latest evidence-based research.This article provides an interpretation of this section of the guidelines for reference.

Abstract:Objective To describe the clinical characteristics of the patients with diquat(DQ)poisoning combined with respiratory alkalosis,and to analyze the relationship between respiratory alkalosis and the prognosis of poisoning patients.Methods Clinical and laboratory data of the patients with diquat admitted to Emergency Department of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from 2014 to 2024 were retrospectively collected and analyzed.The differences in general conditions,blood test data,treatment process,clinical outcomes,in-hospital mortality rate between two groups were compared.Results Among the 54 patients with diquat poisoning,15 patients(27.8％)had respiratory alkalosis with average age(41.89±19.21)years and 5 patients(33.3％)being female.Compared with those without respiratory alkalosis,the patients with respiratory alkalosis had higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and the poisoning severity score(PSS)(P=0.035,P=0.002),longer mechanical ventilation time(P=0.037)and more use of vasoactive drugs(P＜0.001).In addition,the in-hospital mortality rate was higher(P=0.022).Pearson analysis showed the group with respiratory alkalosis had a correlation with APACHE Ⅱ and PSS score(P＜0.05).Conclusions Respiratory alkalosis as a common acid-base disorder in diquat poisoning patients was associated with the in-hospital mortality rate and higher incidence of adverse events.

Abstract:Objective To systematically investigate the specific training needs of trainee doctors in the emergency department of a general tertiary hospital in Beijing in order to provide reference data for continuing education in emergency medicine.Methods A cross-sectional survey was conducted among all trainee doctors in the emergency department of Peking Union Medical College Hospital from February 2021 to March 2024.Using an electronic questionnaire designed based on expert consultations and literature review,36 training needs were quantitatively assessed via a 10-point Likert scale.Results A total of 200 questionnaires were distributed,with 180 valid responses collected.The study included 180 physicians with an average age of 40.5 years,predominantly from tertiary Grade A hospitals(70.0％).85.6％of physicians pursued training based on personal willingness.Regarding the preferred duration of training,44.4％favored short-term training(1-3 months),while 37.8％preferred ultra-short-term specialized courses.The item with the highest proportion of high demand was rapid emergency management of common acute conditions(88.9％),while the lowest was standard management of extracorporeal membrane oxygenation(ECMO)(57.8％).Inter-group comparisons revealed that the physicians from non-tertiary-A hospitals had significantly higher demand for prevention and management of medical disputes,medical laws and regulations,departmental culture development,various core medical protocols,and management of polytrauma than those from tertiary-A hospitals(P＜0.05).Physicians with intermediate or junior titles had higher demand for various core medical protocols,standard writing of medical documents,and rational use of antibiotics than senior physicians(P＜0.05).Physicians with administrative positions had higher demand for department management,management of emergency wards,and management of emergency observation rooms than those without administrative positions(P＜0.05).There was no significant difference in training needs based on years of work experience(P＜0.05).Conclusions The training needs of emergency visiting physicians demonstrate a clear practical orientation.The design of training programs should prioritize high-demand areas and implement stratified and classified precise training to efficiently enhance the effectiveness of continuing education for emergency physicians.

Abstract:Survivors of cardiac arrest(CA)often sustain severe neurological impairments due to global cerebral ischemia-reperfusion injury,which is a major determinant of long-term quality of life.Extracorporeal cardiopulmonary resuscitation(ECPR)can provide superior circulatory support compared to conventional cardiopulmonary resuscitation(CCPR)for the patients with refractory CA.Targeted temperature management(TTM)is a core neuroprotective strategy for improving neurological outcomes after CA.However,the efficacy and optimal protocol for applying TTM in the patients supported by ECPR remain subjects of significant debate.This review systematically elaborates the neuroprotective mechanisms and clinical evidence regarding the combined application of ECPR and TTM.It provides an in-depth analysis of key factors influencing its efficacy,such as treatment time windows and target temperature,and highlights the limitations of current research,including the lack of prospective randomized controlled trials and high heterogeneity.Future research directions,including personalized TTM protocols and the integration of multimodal neuromonitoring and artificial intelligence technologies,are also discussed in order to provide assistance in improving neurological outcomes for CA patients.

Abstract:Objective To investigate the impact of dynamic changes in N-terminal B-type natriuretic peptide precursor(NT-proBNP)and high-sensitivity cardiac troponin T(hs-cTnT)on the treatment outcomes of elderly patients with acute left heart failure(ALHF).Methods A retrospective analysis was conducted on the clinical data of 298 elderly ALHF patients admitted to the First Affiliated Hospital of Wenzhou Medical University from March 2022 to February 2025.According to the patient's treatment outcome,they were divided into an improvement group(n=255)and a non-improvement group(n=43).The levels of serum NT-proBNP and hs-cTnT at admission,24 h and 48 h after admission were reviewed and statistically analyzed,and the changing trajectories of NT-proBNP and hs-cTnT were recorded.The effects of two indexes on the treatment outcome of elderly patients with ALHF were analyzed.Multivariate Logistic regression analysis was used to identify the influencing factors of treatment outcomes in elderly patients,and a column chart model was constructed based on this.The predictive value and calibration degree of the prediction model were evaluated by using receiver operating characteristic(ROC)curves and calibration curves.Results At 24 h and 48 h after admission,the serum levels of NT-proBNP and hs-cTnT in the non-improvement group were higher than those at admission(P＜0.05).At 48 h after admission,the levels of NT-proBNP and hs-cTnT in the improvement group were lower than those at admission,24 h after admission(P＜0.05).The serum levels of NT-proBNP and hs-cTnT in the non-improvement group were higher than those in the improvement group at admission,24 h and 48 h after admission(P＜0.05).The proportion of NT-proBNP and hs-cTnT double elevation within 48 h of admission in the non-improvement group was higher than that in the improvement group(P＜0.05).ROC curve analysis found the predictive value of serum NT-proBNP and hs-cTnT for treatment outcome in elderly patients with ALHF at 48 h after admission was the highest,with the areas under ROC curves(AUC)being 0.943 and 0.882,respectively.The results of Logistic regression analysis showed that double increase of NT-proBNP and hs-cTnT within 48 h of admission,age＞85 years old,combined cardiogenic shock,acute kidney injury(AKI),readmission due to acute heart failure(AHF),and elevated blood lactate were risk factors for the treatment outcome of elderly patients with ALHF(P＜0.05).Based on the above factors,the construction of a predictive model for predicting the treatment outcome of elderly patients with ALHF showed that this model had a high predictive value,with the AUC of 0.900,the sensitivity of 0.907 and the specificity of 0.769.The accurate curve indicated good consistency between the predicted probability of the prediction model and the actual probability.Conclusion The dynamic changing trajectories of serum NT-proBNP and hs-cTnT within 48 h after admission in elderly patients with ALHF are related to the treatment outcome.The simultaneous increase of NT-proBNP and hs-cTnT may increase the risk of ineffective treatment.A nomogram constructed based on the dynamic changing trajectories of NT-proBNP and hs-cTnT has predictive significance for the treatment outcome of elderly patients with ALHF.

Abstract:Objective To investigate the effect of Yip1 domain family member 3/4(YIPF3-YIPF4)-mediated Golgiphagy on lipopolysaccharide(LPS)-induced apoptosis in T lymphocytes.Methods The human T lymphocyte leukemia cell line(Jurkat)in the logarithmic growth phase was used.Cells were divided into the following groups:CON group,LPS(1 μg/mL)24 h group,LPS 48 h group,and further treated with LPS(1 μg/mL)combined with Brefeldin A(BFA,0.1 μg/mL)as the BL group or Monensin(MON,1 μg/mL)as the ML group to simulate Golgi stress conditions during sepsis(n=3).The expression of Golgi stress-related proteins(GOLPH3,GM 130)and Golgiphagy-related proteins(YIPF3,YIPF4,LC3B)was detected by Western blot.Golgi autophagy in the cells was observed by immunofluorescence.Jurkat cells with overexpression or low expression of YIPF3-YIPF4 genes were constructed by using lentiviral transfection technology.After stimulating the transfected cells with LPS for 24 h,the expression levels of apoptosis-related proteins were detected by Western blot,and the percentage of apoptotic cells was measured by flow cytometry(n=4).Results Compared with the CON group,GOLPH3 and GM130 showed the most significant changes in the LPS 24 h group(P＜0.05).Electron microscopy revealed morphological alterations in the Golgi apparatus of the LPS-stimulated group,characterized by loosely stacked Golgi membrane cisternae.In the further simulated Golgi stress experiments,compared with the CON group,the expression of YIPF3 and YIPF4 was upregulated,and the conversion of LC3 B-Ⅰ to LC3 B-Ⅱ was significantly increased in the LPS group(P＜0.05).YIPF3 expression was significantly increased in the BL group,while YIPF4 expression was significantly increased and LC3 conversion was enhanced in the ML group(P＜0.05).Immunofluorescence results showed that compared with the CON group,the expression of YIPF3 and its co-localization with the lysosomal probe were significantly enhanced in the LPS group,and this co-localization was more pronounced in the BL and ML groups.After regulating YIPF3 and YIPF4 gene expression,the protein levels of cleaved caspase-3 and Bax in the YIPF3-YIPF4 siRNA+LPS group were higher than those in the NS+LPS group(P＜0.05),while they were lower in the YIPF3-YIPF4 LV-RNA+LPS group than in the NC+LPS group(P＜0.05).Flow cytometry analysis showed that the apoptosis rate in the YIPF3-YIPF4 siRNA+LPS group was higher than that in the NS+LPS group(P＜0.05),whereas it was lower in the YIPF3-YIPF4 LV-RNA+LPS group than in the NC+LPS group(P＜0.05).Conclusion LPS stimulation induces significant Golgi stress in T lymphocytes,accompanied by the activation of YIPF3-YIPF4-mediated Golgiphagy.Promoting the expression of YIPF3-YIPF4 significantly alleviates LPS-induced apoptosis in T lymphocytes.

Abstract:Objective To investigate retrospectively the current status of frailty among emergency observation patients and to analyze the predictive value of clinical indicators for frailty in these patients.Methods A total of 194 emergency observation patients from a tertiary Grade-A general hospital in Beijing from April to September 2022 were selected as the research subjects.General information of the patients,FRAIL scale scores,Barthel index scores,emergency triage levels,and laboratory test results were collected.The patients were divided into the frailty group and the non-frailty group based on whether they developed frailty.Binary Logistic regression was used to analyze the risk factors for frailty in emergency observation patients.A predictive model was constructed by a nomogram.Use Hosmer-Lemeshow test and Boostrap 500 resampling to verify the fitting excellence and accuracy of the evaluation model.The predictive value and calibration performance of clinical indicators for the occurrence of frailty were evaluated by using the receiver operating characteristic(ROC)curve and calibration curve.Results A total of 139 cases(71.65％)of emergency observation patients experienced frailty.There were statistically significant differences in terms of triage level,Barthel index,memory loss,and albumin between the two groups(P＜0.05).With frailty as the dependent variable,Logistic regression analysis revealed that triage level,Barthel index score,and albumin were independent risk factors for frailty in emergency observation patients.The prediction equation for frailty in emergency observation patients was 6.087+0.585 × memory+1.295 × triage level-0.038 × Barthel index-0.092 × albumin,with the optimal cut-off values of Barthel index and albumin being 67.5 points and 35.5 g/L,respectively.The area under ROC curve of Logistic regression model was 0.820(95％CI 0.803-0.828),the accuracy was 0.805(95％CI 0.768-0.830),the sensitivity was 0.908(95％CI0.849-0.957),the specificity was 0.546(95％CI 0.455-0.636),optimal cut-off value was 0.818.Conclusion The incidence of frailty among emergency observation patients is relatively high.Clinical parameters such as self-care ability and nutritional status can predict the degree of frailty in emergency observation patients.

Abstract:Objective To explore the influencing factors of long-term retention of emergency patients based on random forest model,and to put forward targeted measures to optimize the emergency process.Methods A total of 480 patients in the emergency department of Huai'an First Hospital Affiliated to Nanjing Medical University from December 2024 to January 2025 were selected.According to the ratio of 7∶3,they were randomly divided into training set(336 cases)and internal validation set(144 cases).According to the emergency retention time,they were divided into＞7 h group and≤7 h group.The clinical data of patients in the training set were collected.In addition,86 emergency patients in our hospital from February to May 2025 were selected for external verification.Logistic regression analysis and random forest algorithm were used to construct the prediction model of long-term retention of emergency patients.The receiver operating characteristic(ROC)curve,calibration curve and decision curve were drawn to evaluate the prediction performance of two prediction models.In addition,86 emergency patients from our hospital from February to May 2025 were selected for external validation,and the predictive performance of the two prediction models was evaluated by using the ROC curve,calibration curve and decision curve.Results Among the 480 emergency patients,the patients with retention time≤7 h were 80.42％,the patients with retention time＞7 h accounted for 19.58％.Age,involving≥2 departments,visiting at 00:00-07:59,and Charlson comorbidity index(CCI)score were risk factors for long-term retention of emergency patients,while green channel visiting and emergency admission were protective factors(P＜0.05).Logistic regression model:logit(P)=2.176+0.156 × age+1.607 × involvement in≥2 departments+1.452 × treatment during 0:00～07:59+1.636 × CCI score-0.974 × green channel treatment-1.008 × emergency admission.The importance of each variable in the random forest model was ranked as green channel visiting,visiting time,CCI score,emergency admission,involving≥2 departments,age.In the internal and external validation,the area under curve(AUC)of the random forest model was higher than that of the Logistic regression model,and the calibration curve was very close to the ideal diagonal.However,the two lines of the random forest model fitted more closely.Both models had obvious positive net benefits,and the random forest model has higher clinical utility.Conclusion Age,involving≥2 departments,visiting time,CCI score,green channel visiting and emergency admission are the influencing factors of long-term retention of emergency patients.The random forest algorithm can effectively identify the key factors of long-term retention of emergency patients,and provide an important basis for optimizing emergency operation and refined management.

Abstract:Acute respiratory distress syndrome(ARDS),as a high mortality disease,continues to evolve in its treatment strategies.Among these,prone position ventilation(PPV),which optimizes the ventilation-perfusion ratio in the lungs and promotes alveolar recruitment through gravitational effects,has been demonstrated to significantly reduce patient mortality.Based on this,the prolonged prone position ventilation(PPPV)strategy enables more sustained improvement in oxygenation and reduces ventilator-induced lung injury by prolonging the duration of each session.Additionally,it helps mitigate the risks such as catheter displacement and pressure injuries by decreasing the frequency of positional changes.This study systematically reviews the pathological mechanisms and key therapeutic measures of ARDS,the developmental history of PPV,and provides an in-depth exploration of the clinical application and optimization strategies of PPPV.It also analyzes potential complications associated with PPPV and proposes evidence-based comprehensive prevention and management plans to advance PPPV toward safer and more effective implementation,ultimately improving patient clinical outcomes.

Abstract:Objective To explore the distribution of pathogenic bacteria and influencing factors of chronic critical illness in sepsis patients.Methods A retrospective analysis was conducted on the clinical data of 292 sepsis patients from December 2023 to September 2025.Based on the clinical trajectory of the patients,they were divided into a chronic critical illness(CCI)group(n=116)and a rapid recovery(RR)group(n=176).The general basic information,blood routine,coagulation routine,C-reactive protein(CRP),procalcitonin(PCT),and related evaluation indicators of the two groups were compared and analyzed.Logistic regression analysis was used to screen for independent factors affecting sepsis prognosis.Results Among the pathogenic bacteria,Klebsiella pneumoniae was the main one(39 strains,accounting for 17.33％),followed by Escherichia coli(34 strains,accounting for 15.11％)and Acinetobacter baumannii(30 strains,accounting for 13.33％).The main site of infection in the patients was pulmonary infection(121 cases,accounting for 42.31％),followed by peritonitis(40 cases,accounting for 13.99％)and urinary tract infection(28 cases,accounting for 9.79％).In univariate analysis,there were significantly statistical differences in age,comorbidities,D-dimer(D-D),CRP,PCT,blood creatinine,blood urine nitrogen,Glasgow coma scale(GCS)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,the days of ventilator use,the days of blood purification,and the days of vasoactive drugs use between RR group and CCI group(P＜0.05).In multivariate Logistic regression analysis,age,combined underlying diseases,D-D,PCT,blood creatinine,GCS score,APACHE Ⅱ score,the duration of ventilator use,and the duration of vasoactive drug use were independent prognostic factors for sepsis patients(OR=3.336,7.524,1.366,1.332,1.037,1.213,1.581,1.861,1.037,P＜0.05).A predictive model was constructed based on risk factors:logit(P)=-3.356+1.205 × ≥70 years+2.018 × comorbidities+0.312 × D-D+0.287 × PCT+0.036 × blood creatinine+0.193 × GCS scores+0.458 × APACHE Ⅱ+0.621 × the duration of ventilator use+0.036 × the duration of vasoactive drug use.The area under curve of the prediction model was 0.922(95％CI 0.901-0.963),with the sensitivity of 89.7％,the specificity of 87.4％,Youden's index of 0.771.Conclusions The pathogens of sepsis patients are mainly Klebsiella pneumoniae,Escherichia coli and Acinetobacter baumannii.And age,combined with underlying diseases,D-D,PCT,blood creatinine,GCS score,APACHE Ⅱ score,the duration of ventilator use,and the duration of vasoactive drugs use are independent factors affecting the prognosis of sepsis patients.Intervention and treatment should be strengthened for elderly patients with underlying diseases,especially for abnormal conditions such as blood routine and coagulation routine,and timely and effective treatment measures should be given.

Abstract:Objective To develop a nomogram-based model for early prediction of acute respiratory distress syndrome(ARDS)in the patients with hypertriglyceridemic acute pancreatitis(HTG-AP),and to evaluate its predictive performance and clinical utility.Methods The clinical data of 219 HTG-AP patients admitted to the First Affiliated Hospital of Xiamen University from January 1,2022 to December 31,2023 were retrospectively analyzed.Univariate and multivariate Logistic regression were performed to identify independent risk factors for ARDS,based on this,a nomogram prediction model was constructed.Internal validation was conducted by using Bootstrap 500 resampling to assess the model's performance.Results A total 38 among 219 HTG-AP patients(17.4％)suffered from ARDS.Multivariate Logistic regression identified SpO2/FiO2(S/F),neutrophil-to-lymphocyte ratio(NLR),modified Marshall score,bedside index for severity in acute pancreatitis(BISAP)score,and presence of pleural effusion as independent risk factors for ARDS in HTG-AP patients(all P＜0.05).A nomogram was constructed based on above five factors.The model achieved the area under ROC curve(AUC)of 0.954(95％CI 0.927-0.981,P＜0.001).The calibration curve demonstrated ARDS risk predicted by the model had a good consistency with the actual incidence rate.Decision curve analysis showed that the nomogram provided a notable clinical net benefit when the threshold probability was between 0.2 and 0.8.Conclusions Nomogram model constructed based on S/F,NLR,modified Marshall score,BISAP score,and the presence of pleural effusion can predict increased risk of ARDS in HTG-AP patients early.The model has high prediction accuracy and good clinical practicality.

Abstract:Sepsis is a systemic inflammatory response caused by infection,often accompanied by severe metabolic disorders and insulin resistance(IR).In recent years,the triglyceride-glucose(TyG)index has been identified as a reliable alternative indicator for assessing IR,and increasing research evidence suggests that it is closely related to the development and prognosis of sepsis,and is a potential indicator for predicting sepsis.This article aims to review the application of TyG index in sepsis research,explore its potential clinical value,and provide new perspectives and ideas for prognosis evaluation of sepsis.

Abstract:Objective Study on the effects of sodium butyrate pretreatment on the outcomes of cardiac arrest/cardiopulmonary resuscitation(CA/CPR),intestinal homeostasis,and tissue inflammatory factors in rats.Methods A 6-minute CPR models in the rats were established by using asphyxia combined with potassium chloride injection.The experimental groups were randomLy divided into a sham operation group(only for surgical preparation),a CPR-only group and a sodium butyrate pretreatment group(50 mg/100 g body weight of sodium butyrate sterile solution administered via oral gavage,3 mL daily for 3 days prior to CPR modeling),with 6 rats in each group.Rats that failed resuscitation or died before sample collection were replaced through supplementary experiments to maintain 6 rats in each group,and an additional sham surgery group(n=6,undergoing surgical preparation only)was included.Parameters including successful rate of resuscitation,resuscitation time,and 24-hour post-resuscitation neurological behavioral scores were observed.Hematoxylin-eosin(HE)staining was used to evaluate ileal epithelial and brain injury,enzyme-linked immunosorbent assay(ELISA)was employed to measure serum and ileal tissue levels of IL-1α,IL-6,IL-10,and ileal intestinal fatty acid binding protein(I-FABP),and 16s rDNA sequencing was applied to analyze microbial taxa in ileal fecal samples.Results Compared with the sham surgery group,the CPR-only group exhibited reduced ileal fecal microbial diversity and a significantly increased relative abundance of Escherichia-Shigella.In contrast to the CPR-only group,the sodium butyrate pretreatment group showed higher successful rates of resuscitation,shorter resuscitation time,elevated serum IL-10 levels at 24 hours after the resuscitation,and reduced ileal IL-1α and I-FABP levels,neurobehavioral scores,pathological ileal injury scores(all P＜0.05)and neuronal necrosis in the CA1 region of brain tissue.Additionally,the pretreatment group demonstrated a decreased relative abundance of Escherichia-Shigella and an increased relative abundance of Romboutsia.Conclusion Sodium butyrate pretreatment can improve the efficacy and successful rate of CPR in the rats,alleviate ileal injury,improve intestinal dysbiosis,and restore intestinal homeostasis after the resuscitation potentially by upregulating serum IL-10 and downregulating ileal tissue IL-1α.

Abstract:Objective To develop a risk prediction model for in-hospital mortality in the patients with acute heart failure with preserved ejection fraction(HFpEF).Methods Clinical data from 556 adult patients with acute HFpEF who visited the emergency departments of 28 tertiary hospitals nationwide were retrospectively collected to establish a database.Logistic regression analysis was used to identify model variables,and a visual nomogram model for in-hospital mortality risk was constructed.The bootstrap method and cohort of different periods were used for internal validation.The performance of the model was evaluated by receiver operating characteristic curve analysis and calibration curve.Results A total of 556 patients with acute HFpEF who were first diagnosed in the emergency department were used for model training,with an average age of 71.1 years,and 29 cases died.After multivariate Logistic regression analysis,four variables including mechanical ventilation,blood lactic acid,serum albumin and alanine aminotransferase were finally identified as the risk factors of in-hospital mortality in the patients with acute HFpEF.The nomogram prediction model was further established,and the area under the curve(AUC)was 0.744,indicating that the model had good discrimination;The calibration curve showed that the model fitted well.A cohort of patients with acute HFpEF who visited the emergency department of Peking University Third Hospital from January 1,2025 to May 31,2025 was used to validate the model in the cohort of different periods.The AUC of the validation set was 0.810,indicating that the model had good discrimination;The calibration curve showed that the model had calibration performance and strong generalization ability.Conclusion This model,based on only four commonly used clinical variables,accurately predicts in-hospital mortality in acute HFpEF patients and is used for early identification of high-risk acute HFpEF patients and improve clinical prognosis.It can aid in routine clinical practice to manage acute HFpEF patients,facilitate early identification of high-risk individuals,and improve clinical outcomes.

Abstract:Objective To evaluate the genetic correlation between heart failure and depression in order to identify shared genetic loci and explore potential causal relationships.Methods We used summary statistics from large-scale genome-wide association studies(GWAS)of heart failure(cases:n=47 309,controls:n=930 014)and depression(cases:n=294 322,controls:n=741 438).Genetic correlation was assessed by using linkage disequilibrium score regression(LDSC).The MiXeR method was applied to estimate the genetic overlap between the two diseases.Conditional/combined false discovery rate(condFDR/conjFDR)frameworks identified loci shared by both diseases,followed by functional annotation.Finally,bidirectional Mendelian randomization(MR)was used to investigate causal relationships between heart failure and depression.Results A significant genetic correlation was found between heart failure and depression(rg=0.286 6,SE=0.028 6,P=1.209 5×10-23).The MiXeR model estimated that 2 100±200 genetic variants contributed to both conditions,indicating substantial overlap.ConjFDR analysis identified seven shared loci:LRRC7,SPATS2L,UBA7,NCR3,GTF2I,IGSF9B,and ASXL3.MR analysis showed that depression increased the risk of heart failure(OR 1.21,95%CI 1.12-1.31,P=2.44×10-6),while reverse MR analysis did not support heart failure as a risk factor for depression.Conclusions This study reveals a genetic correlation between heart failure and depression and depression may increase the risk of heart failure.Though these findings provide initial evidence of shared genetic factors,further research is needed to confirm the biological mechanisms and clinical relevance.

Abstract:There is a complex interaction between obesity and septic shock.Obese patients,due to their unique pathophysiological characteristics,face many challenges in the diagnosis and treatment of septic shock.This article reviews the clinical diagnosis and treatment of obese patients with septic shock,elaborating on the impact of obesity on the pathophysiology of septic shock,diagnostic criteria,assessment methods,treatment strategies,etc.Through a comprehensive analysis of existing research and clinical practice,it aims to provide comprehensive and scientific guidance for the diagnosis and treatment of obese patients with septic shock,in order to improve the prognosis and quality of life of obese patients with septic shock.

Abstract:Objective To evaluate the predictive value of bedside ultrasound and clinical parameters for fluid status in non-resuscitation phase patients undergoing fluid therapy.Methods This study was a prospective observational investigation involving the patients admitted to the Emergency ICU of the First Affiliated Hospital of the University of Science and Technology of China between January 2024 and March 2024.The daily fluid intake and output of patients during the first 6 days of the non-resuscitation phase of fluid therapy were recorded.After adjusting for insensible fluid loss and endogenous metabolic water,the corrected daily fluid intake-output gap(dIOg)and the cumulative fluid intake-output gap(cIOg)over 6 days were calculated.Patients were grouped based on whether the gap was greater than 0.Clinical parameters,laboratory test results,and daily ultrasound parameters were collected to analyze the relationship between cIOg and patient prognosis during the observation period,as well as the predictive value of related parameters for dIOg+.Results A total of 30 patients were included in this study,with 16 in-hospital deaths(53.3%).Among the deceased patients,10(62.5%)had positive cIOg(cIOg+).Logistic regression analysis indicated that cIOg was an independent risk factor for in-hospital mortality.A total of 180 dIOg measurements were performed on 30 patients,among which 99 measurements(55.0%)were dIOg+.In the prediction model for dIOg+,after adjusting for confounding factors in Logistic regression analysis,intrarenal vein flow(IRVF)grading,hepatic vein flow(HVF)grading,and venous excess ultrasound score(VexUS)grading were identified as independent risk factors for dIOg+occurrence.Among the predictors,IRVF had the highest predictive value,with the area under ROC curve(AUC)of 0.78(95%CI 0.72-0.84).In contrast,pulmonary crackles and B-lines were not significantly associated with dIOg+.Conclusions In non-resuscitation phase patients undergoing fluid therapy,the cumulative corrected fluid balance difference is significantly associated with patient mortality.Among the predictors,IRVF has the highest predictive value for the daily corrected fluid balance difference.

Abstract:Objective To collect and summarize the clinical characteristics,treatment measures,curative effect of patients with acute heart failure(AHF)in the emergency department of the Affiliated Hospital of Inner Mongolia Medical University,as well as the follow-up data of 1 month,6 months and 1 year after discharge,to analyze the treatment status and prognosis of AHF in our region in recent years.Methods This prospective,single-center observational study enrolled acute heart failure patients admitted to the Emergency Department of the Affiliated Hospital of Inner Mongolia Medical University between March 2023 and March 2024.Data collected included age,gender,etiology,comorbidities,symptoms,physical signs,imaging findings and laboratory results,treatment regimens,and prognosis.Follow-up concluded on March 31,2025.Results This study included 166 AHF patients with complete clinical data.The median age was 68.00(59.00,75.00)years old.The median hospital stay was8.00(6.00,11.00)days.The main etiologies of AHF were coronary artery disease(65 cases,39.16%),cardiomyopathy(33 cases,19.88%),arrhythmia(28 cases,16.87%),and hypertension(21 cases,12.65%).Among them,132 cases(79.52%)were complicated with respiratory diseases,and 100 cases(60.24%)were complicated with coronary heart disease.Clinical manifestations:Over 85%of patients presented with dyspnea and fatigue,while more than half of the patients with chest tightness or chest pain;most crackles were indentified in 133 patients(80.1%),while a galloping rhythm was noted in 98 patients(59.04%).NYHA class Ⅲ and Ⅳ heart failure accounted for 58 cases(34.94%)and 55 cases(33.13%),respectively.Imaging and lab findings:Meanleftventricularejection fraction(LVEF)was(42.21±11.19)%,and77 patients(46.39%)were classified as having heart failure with reduced ejection fraction(HFrEF).NT-proBNP was5 315.00(2 206.50,12 148.50)pg/mL.Treatment measures:In the drug treatment,162 patients(97.59%)received oral diuretics,146 patients(87.95%)intravenous diuretics,160 patients(96.39%)spironolactone,147 patients(88.55%)recombinant human brain natriuretic peptide within 3 days of admission,49 patients(29.52%)nitrates,40 patients(24.10%)digoxin,101 patients(60.84%)β-blockers,75 patients(45.18%)sacubitril/valsartan,and 44 patients(26.51%)SGLT2 inhibitors.In non-drug treatment,All patients received oxygen therapy(159,95.78%via nasal cannula),with 30 patients(18.07%)undergoing PCI and2 patients(1.20%)pacemaker implantation.All-cause mortality rates were 5.4%at 1 month,14.3%at 6 months,and 18.7%at 1 year.Corresponding readmission rates were 9.0%,14.5%,and 20.5%,while the combined mortality or rehospitalization rates reached 13.5%,24.7%,and 37.6%at the same time points,respectively.Conclusions Early identification and management of underlying causes in AHF patients are crucial in the emergency department.Prompt pharmacological intervention,supportive care,and bedside ultrasound-guided volume optimization can effectively relieve symptoms such as pulmonary edema.This targeted approach helps mitigate AHF manifestations,reduce hospitalization duration,and improve outcomes.

Abstract:Vascular endothelial dysfunction plays a crucial role in the pathogenesis of sepsis.During sepsis,the vascular endothelium undergoes phenotypic and functional changes such as pro-adhesion,pro-inflammation and pro-coagulation,which are interconnected and mutually regulatory.This article provides an overview of the mechanisms and characteristics of sepsis-related vascular endothelial dysfunction,and reviews of both domestic and international research progress on endothelial therapy.The aim is to offer intervention strategies for improving the prognosis of sepsis patients by targeting vascular endothelial dysfunction in sepsis.

Abstract:Objective To describe the occurrence of acid-base disturbance(ABD)in intensive care unit(ICU)patients and its relationship with clinical outcomes.Methods Adult ICU patients with serum albumin,pH,bicarbonate,PCO2,chloride,sodium,and potassium levels measured within 24 hours of admisson were included from the eICU database.The type of ABD was evaluated based on blood biochemical tests and arterial blood gas indicators.The prevalence of each disease in different ABD types and the incidence of each ABD type in different diseases were calculated.The differences in mortality rates among different ABD subtypes were calculated by using the chi-square test.Results A total of 13 363 patients were included.9 912 patients(74.2%)had ABD.Compared with patients without ABD,the ICU mortality rate(9.9%vs.18.9%,P<0.001)and in-hospital mortality(15.9%vs.25.9%,P<0.001)of patients with ABD were significantly increased.Among the overall ABD population,the prevalence of double ABD was the highest(53.0%),with respiratory acidosis+metabolic acidosis being the main type(31.2%).Regardless of the type of ABD,the prevalence of respiratory failure,shock,and sepsis ranked among the top three.Among the patients with respiratory failure,shock,sepsis,pneumonia and renal failure,respiratory acidosis combined with metabolic acidosis accounted for 34.1%,32.9%,31.3%,32.6%and 36.3%of the cases,respectively.Among the patients with respiratory failure,shock,sepsis and renal failure,the ICU mortality rates(38.2%,46.0%,38.7%,and 38.3%)and in-hospital mortality(48.8%,56.8%,50.0%,and 50.3%)of those with respiratory acidosis+metabolic acidosis+high anion gap(AG)acidosis were the highest.Conclusions The main type of ABD in ICU patients is respiratory acidosis+metabolic acidosis.Although the prevalence of respiratory acidosis+metabolic alkalosis+high AG acidosis is relatively low,the ICU mortality rates and hospital mortality rates of this type are the highest.In the acid-base management of ICU patients,it is essential to assess their acid-base status promptly,particularly to identify respiratory acidosis,metabolic alkalosis,and high AG acidosis as early as possible.