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Table of Content

    01 September 2024, Volume 15 Issue 5
    Guideline
    The Chinese guideline for management of snakebites
    Rongde Lai, Shijiao Yan, Shijun Wang, Shuqing Yang, Zhangren Yan, Pin Lan, Yonggao Wang, Qi Li, Jinlong Wang, Wei Wang, Yuefeng Ma, Zijing Liang, Jianfeng Zhang, Ning Zhou, Xiaotong Han, Xinchao Zhang, Mao Zhang, Xiaodong Zhao, Guoqiang Zhang, Huadong Zhu, Xuezhong Yu, Chuanzhu Lyu
    2024, 15(5):  333-355.  doi:10.5847/wjem.j.1920-8642.2024.076
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    In 2009, the World Health Organization included snakebite on the list of neglected tropical diseases, acknowledging it as a common occupational hazard for farmers, plantation workers, and others, causing tens of thousands of deaths and chronic physical disabilities every year. This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims. These recommendations are based on clinical experience and clinical research evidence. This guideline focuses on the following topics: snake venom, clinical manifestations, auxiliary examination, diagnosis, treatments, and prevention.

    Review Article
    Understanding the effect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens
    Ariella Gartenberg, Alexander Petrie, Winston Yen, Woojn Cho
    2024, 15(5):  356-364.  doi:10.5847/wjem.j.1920-8642.2024.062
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    BACKGROUND The widespread use of recreational drugs has raised concerns regarding their effects on various organ systems. The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised. This article aims to review the pathophysiology and toxic effects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.

    METHODS Medical literature published from 1970 until 2022 was identified utilizing MEDLINE/PubMed and the Cochrane Library. In addition to the databases, references were obtained through the use of reference lists of published articles identified by the aforementioned databases. The initial search terms included opioids, inhalants, hallucinogens, cannabis, stimulants, and bone health. There were no methodological limitations in relation to the initial acquisition and analysis of data.

    RESULTS A total of 55 research articles were included in this review. Cannabis, stimulants, opioids, and inhalants impact bone maintenance, specifically osteoblast and osteoclast activity, as well as impede hormone production. These substances inhibit bone remodeling and development, manifesting as lower bone mineral density and increased fracture risk in chronic users.

    CONCLUSION Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease, further research is warranted to evaluate the clinical effects of long-term substance use. The evaluation of such effects will aid in establishing appropriate pain regimens, as well as appropriate screening and treatment plans for recreational drug users.

    Original Articles
    An early scoring system to predict mechanical ventilation for botulism: a single-center-based study
    Yaqing An, Tuokang Zheng, Yanling Dong, Yang Wu, Yu Gong, Yu Ma, Hao Xiao, Hengbo Gao, Yingping Tian, Dongqi Yao
    2024, 15(5):  365-371.  doi:10.5847/wjem.j.1920-8642.2024.067
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    BACKGROUND Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism. The present study aimed to establish a new scoring system to predict mechanical ventilation (MV) for botulism patients.

    METHODS: A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022. Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system. The area under the receiver operating characteristic (ROC) curve was calculated.

    RESULTS: A total of 153 patients with botulism (66 males and 87 females, with an average age of 43 years) were included. Of these, 49 patients (32.0%) required MV, including 21 (13.7%) with invasive ventilation and 28 (18.3%) with non-invasive ventilation. Multivariate analysis revealed that botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement were independent risk factors for MV. These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system. Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization ([botulinum toxin type A: 1], [pneumonia: 2], [incubation period ≤1 day: 2], [hypoxia <90%: 2], [severity of muscle involvement: grade II, 3; grade III, 7; grade IV, 11]). The scoring system achieved an area under the ROC curve of 0.82 (95% CI 0.75-0.89, P<0.001). At the optimal threshold of 9, the scoring system achieved a sensitivity of 83.7% and a specificity of 70.2%.

    CONCLUSION: Our study identified botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement as independent risk factors for MV in botulism patients. A score ≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients. This scoring system needs to be validated externally before it can be applied in clinical settings.

    Early peripheral perfusion index predicts 28-day outcome in patients with septic shock
    Cheng Chi, Hao Gong, Kai Yang, Peng Peng, Xiaoxia Zhang
    2024, 15(5):  372-378.  doi:10.5847/wjem.j.1920-8642.2024.081
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    BACKGROUND To investigate the prognostic value of the peripheral perfusion index (PPI) in patients with septic shock.

    METHODS This prospective cohort study, conducted at the emergency intensive care unit of Peking University People's Hospital, recruited 200 patients with septic shock between January 2023 and August 2023. These patients were divided into survival (n=84) and death (n=116) groups based on 28-day outcomes. Clinical evaluations included laboratory tests and clinical scores, with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission. Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses. Receiver operator characteristic (ROC) curve was used to assess predictive performance. Mortality rates were compared, and Kaplan-Meier survival plots were created.

    RESULTS Compared to the survival group, patients in the death group were older and had more severe liver damage and coagulation dysfunction, necessitating higher norepinephrine doses and increased fluid replacement. Higher lactate levels and lower PPI levels at 0 h, 6 h, and 12 h were observed in the death group. Multivariate Cox regression identified prolonged prothrombin time (PT), decreased 6-h PPI and 12-h PPI as independent risk factors for death. The area under the curves for 6-h PPI and 12-h PPI were 0.802 (95% CI 0.742-0.863, P<0.001) and 0.945 (95% CI0.915-0.974, P<0.001), respectively, which were superior to Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (0.864 and 0.928). Cumulative mortality in the low PPI groups at 6 h and 12 h was significantly higher than in the high PPI groups (6-h PPI: 77.52% vs. 22.54%; 12-h PPI: 92.04% vs. 13.79%, P<0.001).

    CONCLUSION PPI may have value in predicting 28-day mortality in patients with septic shock.

    Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning
    Jingyuan Xie, Jiandong Gao, Mutian Yang, Ting Zhang, Yecheng Liu, Yutong Chen, Zetong Liu, Qimin Mei, Zhimao Li, Huadong Zhu, Ji Wu
    2024, 15(5):  379-385.  doi:10.5847/wjem.j.1920-8642.2024.074
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    BACKGROUND Sepsis is one of the main causes of mortality in intensive care units (ICUs). Early prediction is critical for reducing injury. As approximately 36% of sepsis occur within 24 h after emergency department (ED) admission in Medical Information Mart for Intensive Care (MIMIC-IV), a prediction system for the ED triage stage would be helpful. Previous methods such as the quick Sequential Organ Failure Assessment (qSOFA) are more suitable for screening than for prediction in the ED, and we aimed to find a light-weight, convenient prediction method through machine learning.

    METHODS We accessed the MIMIC-IV for sepsis patient data in the EDs. Our dataset comprised demographic information, vital signs, and synthetic features. Extreme Gradient Boosting (XGBoost) was used to predict the risk of developing sepsis within 24 h after ED admission. Additionally, SHapley Additive exPlanations (SHAP) was employed to provide a comprehensive interpretation of the model's results. Ten percent of the patients were randomly selected as the testing set, while the remaining patients were used for training with 10-fold cross-validation.

    RESULTS For 10-fold cross-validation on 14,957 samples, we reached an accuracy of 84.1%±0.3% and an area under the receiver operating characteristic (ROC) curve of 0.92±0.02. The model achieved similar performance on the testing set of 1,662 patients. SHAP values showed that the five most important features were acuity, arrival transportation, age, shock index, and respiratory rate.

    CONCLUSION Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage. This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

    Evolutionary trend analysis and knowledge structure mapping of endothelial dysfunction in sepsis: a bibliometrics study
    Juexian Wei, Hengzong Mo, Yuting Zhang, Wenmin Deng, Siqing Zheng, Haifeng Mao, Yang Ji, Huilin Jiang, Yongcheng Zhu
    2024, 15(5):  386-396.  doi:10.5847/wjem.j.1920-8642.2024.083
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    BACKGROUND A pathophysiological feature of septic organ failure is endothelial dysfunction in sepsis (EDS). The physiological and pathological mechanism of sepsis is considered to be vascular leakage caused by endothelial dysfunction. These pathological changes lead to systemic organ injury. However, an analysis using bibliometric methods has not yet been conducted in the field of EDS. This study was conducted to provide an overview of knowledge structure and research trends in the field of EDS.

    METHODS Based on previous research, a literature search was performed in the Web of Science Core Collection (WoSCC) for publications associated with EDS published between the year 2003 and 2023. Various types of data from the publications, such as citation frequency, authorship, keywords and highly cited articles, were extracted. The "Create Citation Report" feature in the WoSCC was employed to calculate the Hirsch index (h-index) and average citations per item (ACI) of authors, institutions, and countries. To conduct bibliometric and visualization analyses, three bibliometric tools were used, including R-bibliometrix, CiteSpace (co-citation analysis of references), and VOSviewer (co-authorship analysis of institutions, co-authorship analysis of authors, co-occurrence analysis of keywords).

    RESULTS After excluding invalid records, the study finaly included 4,536 publications with 135,386 citations. Most of these publications originated in the USA, China, Germany, Canada, and Japan. Harvard University emerged as the most prolific institution, while professor Jong-Sup Bae and his research team at Kyungpook National University emerged as authors with the greatest influence. The "protein C", "tissue factor", "thrombin", "glycocalyx", “acute kidney injury”, “syndecan-1” and “biomarker” were identified as prominent areas of research. Future research may focus on molecular mechanisms (such as as vascular endothelial [VE]-cadherin regulation) and therapeutic interventions to enhance endothelial repair and function.

    CONCLUSION Our findings show a growing interest in EDS research. Key areas for future research include signaling pathways, molecular mechanisms, endothelial repair, and interactions between endothelial cells and other cell types in sepsis.

    Research Letters
    Evaluation of disease burden and symptom scores in patients with acute atrial fibrillation in the emergency department
    Nikola Schütz, Dominik Roth, Michael Prinz, Filippo Cacioppo, Sebastian Schnaubelt, Alexander O. Spiel, Hans Domanovits, Harald Herkner
    2024, 15(5):  397-400.  doi:10.5847/wjem.j.1920-8642.2024.075
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    Myocardial injury caused by Amanita pseudoporphyria Hongo
    Junliang Xiao, Chengliang Liao, Xiquan Yan, Xiaotong Han, Maiying Fan
    2024, 15(5):  401-403.  doi:10.5847/wjem.j.1920-8642.2024.070
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    Risk factors for early death in severe non-brain-injured trauma patients
    Hui Feng, Ronghai Shao, Zihao Fan, Limei Ma, Jiake Gao, Lijun Liu, Lichao Fang, Jianjun Zhu
    2024, 15(5):  404-406.  doi:10.5847/wjem.j.1920-8642.2024.061
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    Acute abdominal pain from ovarian endometriosis
    Zhengyun Chen, Tao Shen, Yongqing Zhang, Yuanyuan Zhou, Xiaoyong Li, Jiabin Lin
    2024, 15(5):  407-409.  doi:10.5847/wjem.j.1920-8642.2024.080
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    Shared diagnostic genes and potential mechanisms between COVID-19 and sepsis revealed by bioinformatics analysis
    Weifei Wang, Zhong Chen, Wenyuan Zhang, Yuan Lin, Yaqi Sun, Qi Yao, Jian Lu, Jungang Zheng
    2024, 15(5):  410-412.  doi:10.5847/wjem.j.1920-8642.2024.064
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    Case Letters
    Strongyloides stercoralis-induced sepsis and acute respiratory distress syndrome in a patient with Guillain-Barré syndrome
    Juhao Zeng, Yin Wen, Hongguang Ding, Dongxin Li, Hongke Zeng
    2024, 15(5):  413-415.  doi:10.5847/wjem.j.1920-8642.2024.063
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    Diabetic ketoacidosis complicated with intussusception: a case report
    Qin Huang, Xiang Peng, Shanshan Hu, Xinyu Tan, Xiangmin Li
    2024, 15(5):  419-421.  doi:10.5847/wjem.j.1920-8642.2024.084
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    Subdiaphragmatic abscess caused by the recently identified pathogen Cutibacterium modestum: a case report
    Lian Liang, Ni Tan, Mingbin Feng, Xiaolin Xu, Zuyong Li, Xiaoxing Tan, Tangchun Liu, Nengtai Ouyang, Yin Zhang, Zhengfei Yang
    2024, 15(5):  422-424.  doi:10.5847/wjem.j.1920-8642.2024.072
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    Laparoscopic surgery for trans-anal barotrauma: a case report
    Chengxi Liu, Liang Zong, Huadong Zhu, Jun Xu
    2024, 15(5):  425-427.  doi:10.5847/wjem.j.1920-8642.2024.082
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    A young patient with Trousseau syndrome presenting with multiple arterial emboli
    Linqiang Huang, Yin Wen, Wenhong Zhong, Mengting Liu, Hongke Zeng
    2024, 15(5):  428-430.  doi:10.5847/wjem.j.1920-8642.2024.071
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