American Heart Association updated the guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care in November 2019. This focused update incorporates the systematic review conducted by the International Liaison Committee on Resuscitation, an expert group consisting of hundreds of international resuscitation scientists, to identify the new evidence supporting the basic and advanced life support and first aid in emergency medical care. This focused update involves the life chain of CPR (dispatcher-assisted CPR and cardiac arrest centers), advanced cardiovascular life support (advanced airways, vasopressors, and extracorporeal CPR), and first aid for presyncope. This present review aims to interpret these updates by reviewing the literature and comparing the recommendations in this update with previous guidelines.
[Abstract]High-grade histologic subtypes of lung adenocarcinoma, such as micropapillary and solid patterns, are characterized by high invasiveness, increased risk of recurrence, and poor prognosis. Early preoperative identification of these subtypes is crucial for achieving individualized treatment and improving clinical outcomes. This review summarizes the clinical features, imaging manifestations, molecular mechanisms, and diagnostic advances related to these aggressive patterns. Studies have shown that micropapillary and solid subtypes are more common in male smokers, often present as solid nodules, and demonstrate strong predictive value in FDG-PET metabolic parameters and CT-based radiomics models. At the molecular level, EGFR mutations are more frequently observed in micropapillary types, whereas solid subtypes are often associated with high PD-L1 expression and TP53 mutations, indicating distinct therapeutic strategies for targeted and immunotherapies. In addition, serum markers such as CEA and CYFRA21-1, along with inflammatory indices like NLR and SII, may serve as auxiliary tools for subtype identification. Histologic subtypes of lung adenocarcinoma are evolving from descriptive classifications into critical determinants of treatment decisions and precision management. Clinicians should incorporate comprehensive histologic evaluation into individualized therapeutic planning. Multimodal integration technologies, combined with artificial intelligence algorithms, are advancing the accurate preoperative prediction and management of high-risk subtypes, thereby facilitating early diagnosis and stratified treatment of lung adenocarcinoma.
Objective To externally validate a prediction model based on clinical and CT imaging features for the preoperative identification of high-grade patterns (HGP), such as micropapillary and solid subtypes, in early-stage lung adenocarcinoma, in order to guide clinical treatment decisions. Methods This study conducted an external validation of a previously developed prediction model using a cohort of patients with clinical stage ⅠA lung adenocarcinoma from the Fourth Hospital of Hebei Medical University. The model, which incorporated factors including tumor size, density, and lobulation, was assessed for its discrimination, calibration performance, and clinical impact. Results A total of 650 patients (293 males, 357 females; age range: 30-82 years) were included. The validation showed that the model demonstrated good performance in discriminating HGP (area under the curve>0.7). After recalibration, the model's calibration performance was improved. Decision curve analysis (DCA) indicated that at a threshold probability>0.6, the number of HGP patients predicted by the model closely approximated the actual number of cases. Conclusion This study confirms the effectiveness of a clinical and imaging feature-based prediction model for identifying HGP in stage ⅠA lung adenocarcinoma in a clinical setting. Successful application of this model may be significant for determining surgical strategies and improving patients' prognosis. Despite certain limitations, these findings provide new directions for future research.
With the development of clinical medicine, laboratory personals are required to participate in the analysis and explanation of clinical laboratory tests, and the cultivation of compound senior medical laboratory professionals becomes an urgent clinical need. This article describes the post-graduation education process and content of senior laboratory technicians training in West China Hospital of Sichuan University since 2004, and assesses their comprehensive capabilities of clinical service, teaching and research on the trainees who have graduated for more than 5 years. It is believed that the training mode of senior laboratory technicians could improve the comprehensive quality and personal ability of trainees, make our setting goal come true, and cultivate practical senior laboratory professionals who can fulfill social demands.
In November 2018, the American Heart Association (AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Rather than a comprehensive revision of the 2015 edition guidelines, the 2018 AHA guidelines update was updated again according to the rule " the update of the guideline is whenever new evidence is available”, providing the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated the guideline, reaffirming the 2015 pediatric advanced life support guideline recommendation that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.
ObjectiveTo explore course content and teaching-learning strategies of advanced nursing practice in graduate nursing education, so as to provide reference for nursing schools to develop relevant courses.MethodsA teamof course teachers was set up, and the course was developed. The course was implemented in grade 2015 and 2016 graduate nursing students. The students’ perception and evaluation of course contents, teaching methods, teaching quality, curriculum value and course satisfaction were collected through questionnaires and interviews.ResultsA totalof 23 students were enrolled. The mean scores of teaching quality, curriculum value and course satisfaction were 93.48±1.01, 51.04±4.88, and 17.00±2.28, respectively. Students recognized the necessity and the importance of including the advanced nursing practice in each specialty in the course content, and hoped to add in practice sections.ConclusionsIt is advisable to include the advanced nursing practice in each specialty as well as the practice section, so as to strengthen the students’ concrete understanding of the advanced nursing practice. Seminar and discussion are the teaching methods with first priority.
In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.