BACKGROUND: Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents. This study aimed to determine the incidence, characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction (STEMI) thrombolysis in an Asian population.

METHODS: This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital. Total population sampling was used in this study. The primary outcome was bleeding events post-thrombolysis, categorised using the Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria. Inferential statistics were used to determine the associations between relevant variables.

RESULTS: Data from 941 patients were analysed. A total of 156 (16.6%) STEMI patients bled post-thrombolysis. Major, minor, and minimal TIMI occurred in 7 (0.7%), 17 (1.8%), and 132 (14.0%) patients, respectively. Age 65 years (P=0.031) and Malaysian Chinese (P=0.008) were associated with a higher incidence of bleeding post-thrombolysis. Conversely, foreigners (P=0.032) and current smoker (P=0.007) were associated with a lower incidence of bleeding. Both TIMI major (P<0.001) and TIMI minor (P<0.001) were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients. TIMI minor bleeding was significantly higher in the streptokinase recipients. The bleeding sites were comparable between streptokinase and tenecteplase recipients, except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients (P=0.027).

CONCLUSION: In our Asian population, the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported. The development of TIMI major and minor bleeding complications is associated with higher mortality.

BACKGROUND: Poisoned patients often suffer damage to multiple systems, and those experiencing central nervous system disorders present more severe conditions, prolonged hospital stays, and increased mortality rates. We aimed to assess the efficacy of rehabilitation interventions for patients with toxic encephalopathy.

METHODS: This retrospective, observational, comparative cohort study was performed at the teaching hospital affiliated of Nanjing Medical University, from October 2020 to December 2022. Patients who met the diagnostic criteria for toxic encephalopathy and exclusion criteria were included, and patients were divided into three subgroups according to Glasgow Coma Scale (GCS). Demographic and clinical characteristics were collected. The effect of the rehabilitation intervention on patients were assessed in the improvement of consciousness status (Glasgow Coma Scale [GCS] score), muscle strength and movement and swallowing function (Fugl-Meyer Assessment [FMA] scale, Water Swallow Test [WST], and Standardized Swallowing Assessment [SSA]). Subgroup analysis was based on different toxic species.

RESULTS: Out of the 464 patients with toxic encephalopathy, 184 cases received rehabilitation treatments. For the severe toxic encephalopathy patients, patients without rehabilitation intervention have a 2.21 times higher risk of death compared to patients with rehabilitation intervention (Hazard ratio [HR]=2.21). Subgroup analysis revealed that rehabilitation intervention significantly increased the survival rate of patients with pesticide poisoning (P=0.02), while no significant improvement was observed in patients with drug/biological agent poisoning (P=0.44). After rehabilitation intervention, significant improvement in GCS and FMA were observed in severe patients with toxic encephalopathy (P<0.01).

CONCLUSION: Active rehabilitation intervention for patients exposed to poisons that can potentially cause toxic encephalopathy may improve the prognosis and reduce the mortality rate in clinical practice.

BACKGROUND: Ultrasound guidance is commonly used for accessing difficult peripheral veins. For successful access, a tourniquet is required for venodilation. Tourniquets decrease the compressibility and increase the diameter of veins; they also obfuscate artery-vein differentiation on ultrasound. We aimed to establish the upper limit of sphygmomanometer cuff pressure that facilitates artery-vein differentiation during ultrasound-guided peripheral intravenous access.

METHODS: We employed the sphygmomanometer cuff as a tourniquet for venodilation and tested it on seven participants at six different levels as follows: 0 mmHg, DBP/2, DBP, (DBP+SBP)/2, SBP, and SBP+20 mmHg. We used an ultrasound probe attached to a pressure-measuring instrument to record cross-sectional images of the cubital artery and vein. During ultrasonography, compression was applied to the blood vessels through the skin. The following day, we measured the wrist pulse pressure and observed the oximeter pulse wave at six different tourniquet pressure levels. Repeated-measures analysis of variance (ANOVA) on ranks and Tukey’s post-hoc analysis were used for multiple comparisons.

RESULTS: Arterial pulsation was maintained at tourniquet pressures between 0 mmHg and (DBP+SBP)/2. However, arterial pulsation decreased or disappeared when the tourniquet pressure reached or exceeded the SBP. Moreover, at this pressure level, the superior compressibility of veins compared to that of arteries was no longer observed. Compression of the artery to 75% and 50% of its original diameter increased arterial pulsation.

CONCLUSION: Arterial pulsation and the superior compressibility are useful indicators for differentiating veins from arteries until the tourniquet pressure reaches (DBP+SBP)/2. However, these indicators are not reliable once the tourniquet pressure exceeds the SBP.

BACKGROUND: The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury (TSCI) in the intensive care unit (ICU) and assess the incidence and possible risk factors for venous thromboembolism (VTE) following TSCI.

METHODS: We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023. The following parameters were collected: age, sex, body mass index, occupation, underlying diseases, smoking history, education level, etiology of injury, injury segments, American Spinal Injury Association (ASIA) Impairment Scale score, severity of injury, injury severity score (ISS), VTE risk score (Caprini score), treatment, VTE prophylaxis, ICU length of stay, length of hospital stay, concomitant injuries, and complications. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants. Logistic regression analysis was used to determine the risk factors for VTE.

RESULTS: The mean age of patients with TSCI was 55.5 ± 13.4 years, with a male-to-female ratio of 6.5:1. The leading cause of TSCI was falls from height (46.5%), followed by traffic accidents (36.5%). The cervical spinal cord was the most affected segment, followed by the thoracolumbar region. Among all the patients, 362 (97.8%) had concomitant injuries. Complications were observed in 255 patients (68.9%) during hospitalization. The incidence rate of VTE was 25.1%. Logistic regression analysis revealed that age (OR=1.721, 95%CI: 1.207-2.454, P=0.003), mechanical ventilation (OR=3.427, 95%CI: 1.873-6.271, P<0.001), and non-use of chemical prophylaxis (OR=2.986, 95%CI: 1.749-5.099, P<0.001) were risk factors for VTE.

CONCLUSION: Falls from height and traffic accidents were the main causes of TSCIs in the ICU, especially for male patients with cervical spinal cord injuries. VTE is a frequent complication in patients with TSCI in the ICU. Age, mechanical ventilation, and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.

BACKGROUND: Previous studies have reported inconsistent results with positive, negative, and J-shaped associations between alcohol consumption and the hazard of aortic aneurysm and dissection (AAD). This study aimed to examine the connections between weekly alcohol consumption and the subsequent risk of AAD.

METHODS: The UK Biobank study is a population-based cohort study. Weekly alcohol consumption was assessed using self-reported questionnaires and the congenital risk of alcohol consumption was also evaluated using genetic risk score (GRS). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the associations between alcohol consumption and AAD. Several sensitivity analyses were performed to assess the robustness of the results.

RESULTS: Among the 388,955 participants (mean age: 57.1 years, 47.4% male), 2,895 incident AAD cases were documented during a median follow-up of 12.5 years. Compared with never-drinkers, moderate drinkers (adjusted HR: 0.797, 95%CI: 0.646-0.984, P<0.05) and moderate-heavy drinkers (adjusted HR: 0.794, 95%CI: 0.635-0.992, P<0.05) were significantly associated with a decreased risk of incident AAD. Interaction-based subgroup analysis revealed that the protective effect of moderate drinking was reflected mainly in participants younger than 65 years and women.

CONCLUSION: Our findings support a protective effect of moderate alcohol consumption on AAD, but are limited to participants younger than 65 years and women.

BACKGROUND: Trauma-induced coagulopathy (TIC) due to serious injuries significantly leads to increased mortality and morbidity among elderly patients. However, the risk factors of TIC are not well elucidated. This study aimed to explore the risk factors of TIC in elderly patients who have major trauma.

METHODS: In this retrospective study, the risk factors for TIC in elderly trauma patients at a single trauma center were investigated between January 2015 and September 2020. The demographic information including gender, age, trauma parts, injury severity, use of blood products, use of vasopressors, need of emergency surgery, duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and clinical outcomes were extracted from electric medical records. Multivariate logistic regression analysis was performed to differentiate risk factors, and the performance of the model was evaluated using receiver operating characteristics (ROC) curves.

RESULTS: Among the 371 elderly trauma patients, 248 (66.8%) were male, with the age of 72.5 ± 6.8 years, median injury severity score (ISS) of 24 (IQR: 17-29), and Glasgow coma score (GCS) of 14 (IQR: 7-15). Of these patients, 129 (34.8%) were diagnosed with TIC, whereas 242 (65.2%) were diagnosed with non-TIC. The severity scores such as ISS (25 [20-34] vs. 21 [16-29], P<0.001) and shock index (SI), (0.90±0.66 vs. 0.58 ± 0.18, P<0.001) was significantly higher in the TIC group than in the non-TIC group. Serum calcium levels (1.97±0.19 mmol/L vs. 2.15±0.16 mmol/L, P<0.001), fibrinogen levels (1.7±0.8 g/L vs. 2.8±0.9 g/L, P<0.001), and base excess (BE, -4.9±4.6 mmol/L vs. -1.2 ± 3.1 mmol/L, P<0.001) were significantly lower in the TIC group than in the non-TIC group. Multivariate logistic regression analysis revealed that ISS>16 (OR: 3.404, 95%CI: 1.471-7.880; P=0.004), SI>1 (OR: 5.641, 95%CI: 1.700-18.719; P=0.005), low BE (OR: 0.868, 95%CI: 0.760-0.991; P=0.037), hypocalcemia (OR: 0.060, 95%CI: 0.009-0.392; P=0.003), and hypofibrinogenemia (OR: 0.266, 95%CI: 0.168-0.419; P<0.001) were independent risk factors for TIC in elderly trauma patients. The AUC of the prediction model included all these risk factors was 0.887 (95%CI: 0.851-0.923) with a sensitivity and specificity of 83.6% and 82.6%, respectively.

CONCLUSION: Higher ISS (more than 16), higher SI (more than 1), acidosis, hypocalcemia, and hypofibrinogenemia emerged as independent risk factors for TIC in elderly trauma patients.