In-flight medical emergencies (IMEs) present significant challenges to healthcare professionals, particularly those with limited training or experience in managing such situations. The objective of this study was to evaluate the level of knowledge, attitudes, and behaviors of licensed doctors in Saudi Arabia concerning IMEs, and to identify the demographic factors influencing their preparedness. A cross-sectional study was conducted with a sample of 383 licensed physicians across five regions of Saudi Arabia. Participants completed a self-administered questionnaire assessing demographics, knowledge of IMEs, attitudes towards providing assistance, and previous experience with in-flight emergencies. Data were analyzed using SPSS 26, with statistical significance set at <0.05. The results revealed a predominantly young (75.8% aged 25-34 years) and male (69.6%) participant pool. While 76.6% of respondents recognized the impact of cabin pressure on oxygen, only 45.4% correctly identified air travel risks for asthmatic patients. Although 66.8% felt confident assisting in IMEs, 20.9% cited medicolegal concerns. Moreover, area of working within Saudi Arabia (=0.020), year of experience (=0.041), prior experience with IMEs (=0.021), and IMEs training (<0.001) had a significant association with levels of knowledge. The study highlights a critical need for enhanced training programs with a focus on the management of IMEs among healthcare practitioners in Saudi Arabia.

The mechanisms underlying hypothermic liver injury necessitate investigation for the development of effective diagnostic and therapeutic approaches. We aim to establish a model of hypothermic liver injury to explore the hepatic alterations, thereby facilitating the prevention and treatment of the liver injury associated with hypothermia. The mice were placed in a -20 °C environment, to establish a hypothermic injury model. The liver function, metabolites, and proteins expression were measured by thromboelastography, histopathology, metabolomics and western blotting, respectively. Furthermore, apoptosis and pathway changes in the liver cells conducted with target metabolites were examined and verified. According to the prolonged righting reflex recovery time and death occurrence, the mice with the anal temperature (AT) dropping to 20 °C or 15 °C were used to establish a model of hypothermia. The model mice showed changes in alanine aminotransferase (ALT), aspartate transaminase (AST), and coagulation indicators. HE staining results indicated that liver tissue in the AT 20°C mice had large hemorrhagic patches, while the AT 15°C mice displayed significant congestion, along with extensive infiltration of inflammatory cells around the central vein. Metabolomic and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of target metabolites revealed a significant increase in 3-hydroxybutyric acid and changes in the cyclic adenosine monophosphate (cAMP) signaling pathway in the liver tissue of hypothermic mice. The hypothermic mice showed decreases in levels of cAMP, protein kinase A C-α (PKA C-α), and phosphorylated BCL-2/BCL-XL-associated death promoter (p-Bad) and an increase in BCL-2/BCL-XL-associated death promoter (Bad) level in the liver. These protein changes and apoptosis were intensified by 3-hydroxybutyric acid in liver cells. Hypothermia may induce apoptosis in the liver cell which may be related to the changes of the cAMP-PKA pathway proteins expression. These findings provide a basis for the treatment of hypothermic injury.

Patients suffering from hemorrhagic shock (HS) complicated by severe trauma are at high risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The underlying pathophysiology is complex, and the lack of targeted therapeutic strategies remains a major clinical challenge. In this narrative review, a literature search was conducted in the PubMed to identify articles published from 2006 to August 2025 concerning trauma, HS, traumatic HS (THS), biomarkers related to ALI, ARDS and HS, as well as their treatment. Through its multifactorial pathogenesis, we discuss the diagnostic and prognostic values of biomarkers, their potential role in treatment, and therapeutic advancements and perspectives. ALI and ARDS are serious complications in severe trauma patients with HS. Hypoperfusion, hypoxia, endothelial cell activation, inflammation, ischemia/reperfusion injury and the intestinal response, as well as chest trauma and transfusion-related events are potential causes of lung injury. The pulmonary epithelial biomarkers soluble receptor for advanced glycation end products (sRAGE) and surfactant protein-D provide indicators for evaluating the severity of lung contusion and injury, whereas Clara cell protein 16 may have clinical value for trauma patients with ALI complicated by pneumonia. Elevated endothelial biomarkers angiopoietin-2 and syndecan-1 are correlated with injury severity, transfusion, coagulopathy, the onset of ARDS, and patient outcomes. The role of biomarkers in therapeutic benefit is reviewed. Preventive and therapeutic strategies for THS-induced ALI/ARDS rely on the implementation of multi-target, multi-mechanism interventions that address the complex pathophysiology. Targeted phenotypic therapy guided by biomarkers would be of interest for future research aimed at improving clinical outcomes.

BRASH syndrome (Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia) is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia. Despite increasing recognition, its clinical characteristics, risk factors, and outcomes remain poorly defined. The rationale of this review is to provide clinicians an up-to-date overview of the most commonly encountered risk factors, triggers, clinical pictures, usual lab values, complications and outcomes, via the systemic analysis of currently published cases. A systematic review was conducted using MEDLINE, Web of Science, and Cochrane Library databases through December 2024. Case reports, case series, and conference abstracts involving adult patients with BRASH syndrome were included. Data extraction focused on demographics, clinical presentations, laboratory findings, management strategies, and outcomes. Analysis included 131 patients from 111 published cases. Mean age was (71±13) years, with female predominance (58.1%). Hypertension (77.0%), chronic kidney disease (48.4%), and diabetes mellitus (46.7%) were the most common comorbidities. Beta-blockers were the predominant medication (76.5%). Most common presenting symptoms were syncope (17.9%), generalized weakness (16.2%), and altered mental status (11.9%). Mean potassium level was 6.6 mEq/L, with more than half of cases presenting with non-severe hyperkalemia (<6.5 mEq/L). Management often required multimodal therapy, with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis. This systematic review provides the most comprehensive analysis of BRASH syndrome to date, demonstrating that while potentially serious, outcomes are generally favorable with appropriate recognition and management. The syndrome can develop even with modest hyperkalemia, particularly in elderly patients with multiple comorbidities. Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.

Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology. We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following cardiac surgery. We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020. Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality. The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests. Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy. Among the patients receiving VA-ECMO, the 30-day and 180-day mortality rates were 37.5% and 52.1%, respectively. The level of aspartate aminotransferase (AST) at admission was associated with 30-day mortality (hazard ratios [s]=1.852, 95% 1.010-3.398, =0.046). The AST and alkaline phosphatase (ALP) levels were predictors of 180-day mortality, with adjusted s of 1.799 (95% 1.074-3.014; =0.025) and 1.384 (95% 1.050-1.825; =0.021), respectively. The cut-off value for AST to predict mortality at 30 d was 77 U/L, and that for ALP to predict mortality at 180 d was 269 U/L. Liver function indicators, including AST and ALP, at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.

Previous studies have reported that early computed tomography (CT) findings significantly contribute to the outcomes of cardiac arrest (CA) patients. This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023. All the patients underwent a whole-body CT scan within 1 h of ECPR. Data regarding demographic and clinical characteristics were collected from electronic medical records. The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient. The primary outcome was 28-day survival. Receiver operating characteristic (ROC) curves were used to evaluate the ability of chest CT features (gravity-dependent distribution and CT scores) to predict poor outcomes. The cut-off value of the CT score was determined. Kaplan-Meier curves were used to compare 28-day survival between the low- and high-CT score groups, which were classified using the estimated cut-off value. Among the 100 patients included, 74 were non-survivors. The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors (<0.05). Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution (<0.05). The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually, demonstrating moderate performance (AUC: 0.693, 95% : 0.568-0.801). According to the survival analysis, the risk of death increased as the CT score rose, with an estimated cut-off value of ≥ 11 (=0.016). Chest CT features were associated with poor outcomes in CA patients following ECPR.

Severe acute pancreatitis (SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit (ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population. This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit (ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU (CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores (odds ratio []=3.37, 95% confidence interval []: 1.09-10.43, =0.04), physical restraint (=11.11, 95%: 4.35-28.39, <0.05), invasive mechanical ventilation (IMV) (=2.44, 95%: 1.41-4.25, =0.002), and ICU length of stay ≥ 7 days (=3.14, 95%: 2.27-4.36, <0.05) as independent risk factors of delirium. The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.

Iron metabolism dyshomeostasis is associated with ferroptosis and ischemia-reperfusion injury. We aim to investigate post-cardiac arrest changes in plasma iron metabolism-related parameters and their prognostic value for 28-day neurological outcomes. In this prospective observational cohort study, plasma iron metabolism-related parameters (iron, ferritin, hepcidin, soluble transferrin receptor [sTfR], total iron binding capacity [TIBC], and transferrin saturation), interleukin-6, and neuron-specific enolase (NSE) were assessed in 120 patients after restoration of spontaneous circulation (ROSC) on days 1 and 3 of intensive care unit (ICU) admission and in 40 healthy controls. The primary outcome was poor 28-day neurological prognosis. Compared to controls, post-ROSC patients exhibited significant plasma iron metabolism disturbances, including decreased iron, TIBC, transferrin saturation, with elevated hepcidin, ferritin, sTfR, interleukin-6, and NSE on day 1 after ICU admission (<0.05 for all). On day 28 post-ROSC, patients with poor neurological outcomes (71/120) presented more pronounced alterations than those with good neurological outcomes. Binary logistic analysis revealed that a plasma iron concentration ≤11.2 µmol/L (odds ratio [] 0.607, 95% confidence interval [] 0.455-0.808) and an NSE concentration ≥20.5 ng/mL ( 1.020, 95% 1.005-1.035) on day 1 of ICU admission were associated with 28-day poor neurological outcomes. The plasma iron-NSE combination showed better predictive performance (area under the curve=0.935, sensitivity 89.8%, specificity 84.5%). Early post-ROSC plasma iron metabolism disturbances combined with NSE elevation were associated with the 28-day neurological prognosis, suggesting the therapeutic potential of targeting the iron metabolism pathway.

The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa's emergency population to improve diagnostic accuracy and optimize clinical management.