To investigate the effects and underlying mechanisms of human embryonic stem cell derived mesenchymal stem cells (hESC-MSCs) on post-resuscitation cardiac dysfunction in a porcine model of cardiac arrest (CA).

Twenty-seven healthy male white pigs were randomly allocated to three groups (9 pigs per group) using a random number table: a Sham group, a cardiopulmonary resuscitation (CPR) group, and an hESC-MSCs group. The Sham group only completed the preparations related to surgical catheter placement. The CA-CPR model was established by inducing ventricular fibrillation for 10 minutes via a right ventricular electrode, followed by 6 minutes of CPR in the CPR group and the hESC-MSCs group. At 5 minutes after successful resuscitation, the hESC-MSCs group received an intravenous infusion of 2.5 × 10⁶ cells/kg hESC-MSCs in 1 hour; the Sham and CPR groups received an equivalent volume of 0.9% NaCl solution. Cardiac function parameters, including stroke volume (SV) and global ejection fraction (GEF), were monitored using pulse indicator continuous cardiac output (PiCCO) at 2, 4, 8, 24, 48, and 72 hours after resuscitation, and serum concentrations of cardiac troponin I (cTnI) and creatine kinase MB (CKMB) were quantified via enzyme-linked immunosorbent assay (ELISA). At 24, 48, and 72 hours after resuscitation, three pigs per group were euthanized, and left ventricular myocardial tissue samples were collected. Myocardial apoptosis was assessed using TdT-mediated dUTP nick labeling (TUNEL). Expression levels of protein kinase R-like endoplasmic reticulum kinase (PERK), C/EBP homologous protein (CHOP), cysteinyl aspartate specific proteinase 12 (caspase 12), and caspase 3 were determined via western-blotting.

Significant differences were observed in SV (F = 97.956, 54.970, 46.893, 8.685, 17.754, 18.070; all P < 0.05), GEF (F = 219.499, 95.886, 43.986, 15.809, 16.337, 8.050; all P < 0.05), serum cTnI (F = 112.367, 259.559, 83.680, 69.664, 55.522, 102.025; all P < 0.05), and serum CKMB (F = 77.607, 77.995, 64.601, 43.265, 47.544, 25.836; all P < 0.05) among the three groups at all post-resuscitation time points (2, 4, 8, 24, 48, and 72 hours). Compared with the CPR group, the hESC-MSCs group demonstrated significantly higher SV and GEF at all post-resuscitation time points (all P < 0.05). Significant differences were also observed in the myocardial apoptosis index (F = 68.585, 156.766, 189.283; all P < 0.001) and protein expression of PERK (F = 108.029, 33.089, 42.870; all P < 0.001), CHOP (F = 32.813, 34.275, 69.464; all P < 0.001), caspase 12 (F = 41.344, 16.836, 82.824; all P < 0.001), and caspase 3 (F = 74.913, 41.634, 43.085; all P < 0.001) among the three groups at 24, 48, and 72 hours after resuscitation. Compared with the CPR group, the hESC-MSCs group showed significantly reduced myocardial apoptosis index and downregulated expression of endoplasmic reticulum (ER) stress-related apoptotic proteins at the same time points (all P < 0.05).

Post-resuscitation treatment with hESC-MSCs ameliorates cardiac dysfunction in a porcine CA model, potentially via inhibition of ER stress-induced apoptotic pathways.

To investigate the effects of hydrogen inhalation on the expression of autophagy-related proteins and neural repair function in rats after spinal cord injury (SCI).

Forty-five female Sprague-Dawley rats were selected and divided into three groups using a random number table method, with 15 rats in each group: the control group (treated with only lamina resection), the SCI group (treated with a modified Allen method for modeling after laminectomy), and the hydrogen treatment group (SCI + H₂ group, given hydrogen inhalation after modeling). The Basso-Beattie-Bresnahan (BBB) score was used to evaluate the hind limb motor function of rats in each group at 1, 3, 7, 14, 21, and 28 days after SCI. Hematoxylin-eosin (HE) staining was used to observe the structural and morphological changes of the anterior horn of the spinal cord and the tissue at the injury site; Nissl staining was used to observe the morphological changes of spinal cord neurons. The protein expression levels of phosphatidylinositol 3 kinase (PI3K), protein kinase B (Akt), phosphorylated Akt (p-Akt), mammalian target of rapamycin (mTOR), and phosphorylated mTOR (p-mTOR) in the spinal cord tissue of rats in each group after SCI were detected by western-blotting. The levels of microtubule-associated protein 1 light chain 3 (LC3), Beclin-1, glial fibrillary acidic protein (GFAP), microtubule-associated protein 2 (MAP2), myelin basic protein (MBP), and Tuj-1 of rats in each group after SCI were detected by immunofluorescence staining.

There were significant differences in the BBB scores of the three groups at 1, 3, 7, 14, 21, and 28 days after modeling (F = 4 805.000, 571.200, 323.400, 134.400, 62.740, 28.720, all P < 0.001), and at 21 and 28 days after modeling, the BBB scores in the SCI + H₂ group were significantly higher than those in the SCI group (both P < 0.05). HE staining revealed that the spinal cord structure of the control group was intact, while obvious tissue cavities and neuronal loss occurred in the SCI group. The injury degree of the SCI + H₂ group was significantly improved compared with the SCI group. The Nissl staining showed that the number of Nissl bodies in the SCI + H₂ group was significantly increased compared with the SCI group, but was less than that in the control group. Western-blotting showed that there were significant differences in the ratios of p-mTOR/mTOR (F = 17.030, P = 0.006) and p-AKT/Akt (F = 13.000, P = 0.004) among the three groups. Moreover, the ratios of p-mTOR/mTOR and p-AKT/Akt in the SCI + H₂ group and the control group were much higher than those in the SCI group (all P < 0.05). However, there was no statistically significant difference in the PI3K expression among the three groups (F = 0.267, P = 0.861). The immunofluorescence staining indicated that in the three groups, the average fluorescence intensities of GFAP (F = 181.100, P = 0.001), MAP2 (F = 264.800, P = 0.005), MBP (F = 239.800, P = 0.001), Tuj-1 (F = 105.400, P = 0.001), LC-3 (F = 105.500, P = 0.001), and Beclin-1 (F = 39.530, P = 0.003) all showed statistically significant differences. Moreover, compared with the SCI group, the average fluorescence intensities of GFAP, LC3, and Beclin-1 in the SCI + H₂ group were significantly decreased, while the average fluorescence intensities of MAP2, MBP, and Tuj-1 were significantly increased (all P < 0.05).

Hydrogen inhalation can improve the recovery of motor function in rats after SCI by inhibiting the excessive autophagy response and promoting the expression of proteins related to neural tissue repair.

To explore the predictive value of hemoglobin-to-age ratio (HAR) for 28-day mortality in patients with community-acquired pneumonia (CAP).

Based on the medical information mart for intensive care Ⅳ (MIMIC-Ⅳ) database of American critical care medicine, 6 203 patients who were admitted to the ICU for the first time and met the diagnostic criteria for CAP were included. Demographic information, comorbidities, vital signs, disease severity score, laboratory indicators, and therapeutic measures were extracted. Patients were divided into a Q1 group (0.650 ≤ HAR < 1.200, n = 1 551), a Q2 group (1.200 ≤ HAR < 1.460, n = 1 551), a Q3 group (1.460 ≤ HAR < 1.830, n = 1 552), and a Q4 group (1.830 ≤ HAR ≤ 7.520, n = 1 549) according to HAR values. Kaplan-Meier survival analysis, multivariate Cox regression, and restricted cubic spline (RCS) models were used to explore the association between HAR and 28-day all-cause mortality in CAP patients. The predictive value of HAR for death within 28 days was also clarified by constructing a multivariate Cox model.

There were statistically significant differences in age, body weight, gender, tumor, kidney disease, heart rate, pulse oxygen saturation, acute physiology score Ⅲ, Oxford acute severity of illness score, hemoglobin, 24-hour output, invasive mechanical ventilation use, ICU stay days, and 28-day mortality among patients in the Q1-Q4 groups (all P < 0.05). Based on 28-day survival status, 6 203 patients were divided into a survival group (4 435 patients) and a mortality group (1 768 patients). The age, body mass, HAR, complication, vital signs, disease severity score, laboratory examination, 24-hour output, invasive mechanical ventilation use, vasopressor use, length of hospital stay, and ICU admission duration were compared between the two groups, and there were significant differences (all P < 0.05). The Kaplan-Meier survival curve revealed a statistically significant difference in survival rates among the Q1-Q4 groups (χ² = 118.208, P < 0.001), with the Q4 group showing a markedly higher survival rate than the Q1-Q3 group (χ² = 92.768, P < 0.001). Cox regression showed that HAR was an independent influencing factor for the 28-day mortality of CAP patients [hazard ratio (HR) = 0.651, 95% confidence interval (CI) (0.586, 0.722), P < 0.001]. The HR and 95%CI for 28-day mortality decreased with the increase of HAR quartiles, ranging from 1.000 to 0.883 [95%CI (0.780, 0.999)], 0.783 [95%CI (0.687, 0.893)], and 0.534 [95%CI (0.456, 0.625)] respectively. Further analysis using RCS showed that HAR had a non-linear relationship with the 28-day mortality of patients admitted to the ICU. When HAR was below 2.872, the mortality increased sharply with the decrease of HAR (P < 0.001).

HAR is negatively correlated with 28-day mortality in CAP patients. HAR levels can help identify patients at a higher risk of adverse outcomes, guiding clinicians in stratification and early intervention.

To investigate the relationship between the expression of serum long non-coding RNA growth arrest specific 5 (LncRNA-GAS5) and microRNA-221-3p (miR-221-3p) and the pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF).

A total of 137 IPF patients (IPF group) and 70 healthy volunteers (control group) were enrolled at the Xi'an Hospital of Traditional Chinese Medicine from January 2021 to January 2023. According to the presence of PH, the IPF patients were divided into a PH group (n = 42) and a non-PH group (n = 95). Serum LncRNA-GAS5 and miR-221-3p expression levels were measured using quantitative real-time polymerase chain reaction (qPCR). Potential binding sites between LncRNA-GAS5 and miR-221-3p were predicted using the StarBase database, and Pearson correlation analysis assessed their association. Multivariate logistic regression was applied to identify independent factors influencing PH in IPF patients and to construct a predictive model. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of individual factors and the model.

Compared with the controls, IPF patients exhibited lower serum LncRNA-GAS5 and higher miR-221-3p expression (t = 6.489, 8.962; both P < 0.001). The incidence of PH in IPF patients was 30.66% (42/137). PH patients had significantly lower LncRNA-GAS5 and higher miR-221-3p levels compared with non-PH patients (t = 5.553, 5.694; both P < 0.001). LncRNA-GAS5 and miR-221-3p had binding sites and were negatively correlated in the serum of IPF patients (r = -0.788, P < 0.001). Multivariate logistic regression indicated that higher diffusion lung capacity of carbon monoxide as a percentage of predicted value (DLco%pred) [odds ratio (OR) = 0.864, 95% confidence interval (CI) (0.796, 0.938), P = 0.001] and LncRNA-GAS5 expression [OR = 0.463, 95%CI (0.282, 0.759), P = 0.002] were independent protective factors, while elevated B-type natriuretic peptide (BNP) [OR = 1.020, 95%CI (1.009, 1.032), P < 0.001] and miR-221-3p [OR = 2.269, 95%CI (1.423, 3.617), P = 0.001] were independent risk factors for PH in IPF patients. The predictive model equation was: Logit(P) = -1.518 - 0.042 × DLco%pred + 0.019 × BNP - 0.641 × LncRNA-GAS5 + 0.637 × miR-221-3p. The Hosmer-Lemeshow test indicated good model fit (χ² = 7.316, P = 0.412). ROC curve analysis showed that the model had an area under the curve (AUC) of 0.909, superior to DLco%pred (0.708), BNP (0.744), LncRNA-GAS5 (0.779), and miR-221-3p (0.773) alone (Z = 3.899, 3.633, 2.653, 2.760; all P < 0.001).

Low serum LncRNA-GAS5 and high miR-221-3p expression are closely associated with PH in IPF patients. The predictive model integrating LncRNA-GAS5, miR-221-3p, DLco%pred, and BNP demonstrates good predictive value for PH in this population.

To investigate the association between cathepsin S (CTSS) and the severity and prognosis of pneumonia-related acute respiratory distress syndrome (p-ARDS).

This study was a single-center prospective observational study. Twenty-three patients with p-ARDS admitted to the intensive care unit of the Second Hospital of Tianjin Medical University between July 2022 and December 2022 were included as the p-ARDS group. Ten patients with pneumonia alone who were admitted to the respiratory ward during the same period were selected as the pneumonia group. Matched bronchoalveolar lavage fluid (BALF) and serum samples were collected from both groups. The levels of CTSS, interleukin 6 (IL-6), IL-8, and lung surfactant protein D (SP-D) were determined using a Luminex^® magnetic bead multiplex kit. The levels of CTSS were compared based on clinical diagnosis, severity of lung injury, and clinical outcomes. The clinical utility of CTSS was assessed using the receiver operating characteristic (ROC) curve, Spearman correlation, and logistic regression analyses.

Among the p-ARDS group, 10 patients were classified with mild lung injury, 9 with moderate lung injury, and 4 with severe lung injury. Within 28 days of admission, 10 patients in the p-ARDS group died, resulting in a mortality rate of 43.5% (10/23). The level of CTSS in BALF (CTSS^BALF) was higher in the p-ARDS group than in the pneumonia group [94 (76, 103) × 10³ ng/L vs. 15 (5, 54) × 10³ ng/L, Z = 4.152, P < 0.001], whereas there was no significant difference in serum CTSS levels between the two groups [6 (4, 10) × 10³ ng/L vs. 6 (4, 7) × 10³ ng/L, Z = 0.407, P = 0.684]. ROC curve analysis demonstrated that the CTSS^BALF level could effectively distinguish p-ARDS from common pneumonia [area under the curve (AUC) = 0.961, 95% confidence interval (CI) (0.829, 0.998), P < 0.001]. The CTSS^BALF levels were observed to increase with the worsening severity of lung injury and were negatively correlated with the oxygenation index (r = -0.689, P < 0.001). According to the clinical outcomes at 28 days after hospitalization, the 23 p-ARDS patients were divided into a death group (10 cases) and a survival group (13 cases). Among the p-ARDS patients, the non-survivors showed significantly higher CTSS^BALF levels compared to survivors (Z = 2.729, P = 0.006). Logistic regression analysis revealed a trend of an independent correlation between CTSS^BALF and 28-day mortality, but the result did not reach statistical significance [odds ratio = 1.409, 95%CI (0.974, 2.038), P = 0.069].

CTSS^BALF may serve as a valuable biomarker for diagnostic grading and prognostic assessment of patients with p-ARDS.

To systematically evaluate the incidence rate of unscheduled return visits (URV) in the emergency department.

Observational studies reporting the URV incidence in the emergency department were retrieved from ten databases (CBM, CNKI, Wanfang, VIP, PubMed, Embase, CINAHL, Cochrane Library, Web of Science, and ProQuest) from their inception to February 2025. After literature search, screening, and data extraction by two researchers, a meta-analysis was performed using R software.

Twelve studies were included, with 11 239 523 emergency department patients. The meta-analysis showed that the overall incidence of URV among emergency department patients was 7.22% [95% confidence interval (CI) (4.28%, 10.17%), Z = 4.808, P < 0.001]. Subgroup analysis showed that patients aged 40 to < 60 years old, with a return visit interval of 30 days, from North America, and in the emergency department observation unit had a higher incidence of URV (all P < 0.05).

Patients aged 40 to < 60 years old, with a return visit interval of 30 days, from North America, and in the emergency department observation unit have a higher incidence of URV.