Objective:To study clinical characteristics and risk factors of young patients with coronary heart disease (CHD) complicated metabolic syndrome (MS).Methods: A total of 200 CHD young patients were selected from our hospital, including 100 patients with MS (CHD+MS group) and 100 patients without MS (CHD control group).Lesion severity was evaluated according to coronary lesion score.General data were compared between two groups,and risk factors were assessed CHD+MS group.Results: Compared with CHD control group, there were significant rise in body mass index (BMI), levels of total cholesterol (TC), 2h postprandial blood glucose (2hPG), fasting blood glucose (FBG), triglyceride (TG), blood pressure, serum uric acid (UA) and creatinine (Cr) and homeostasis model-insulin resistance index (HOMA-IR), and significant reduction in level of high density lipoprotein cholesterol (HDL-C) in CHD+MS group, P<0.01 all.Compared with CHD control group, there were significant rise in incidence rate of multi-vessel coronary disease (6% vs.32%) and Gensini score of coronary angiography [(5.1±2.0) scores vs.(8.4±5.3) scores] in CHD+MS group, P<0.01 both.Logistic regression analysis indicated that low HDL-C, HOMA-IR, hypertension and diabetes mellitus history were risk factors for CHD complicated MS in young patients(OR=1.097~2.246,P<0.01 all).Conclusion:There are much risk factors and abnormal metabolism,and coronary disease are more serious in young patients with CHD complicated MS.

Objective To explore the diagnostic value of combined bedside detection of aminoterminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in the diagnosis of cardiac dyspnea. Methods A total of 120 patients with dyspnea admitted in our department from June 2014 to February 2016 were included in this study. At the time of admission, NT-proBNP and cTnI levels were measured by bedside test. Values of NT-proBNP>300 ng/L or cTnI>0.16 mg/L were defined as positive for cardiac dyspnea. According to the final diagnosis, patients were divided into two groups:cardiac dyspnea group (n=68) and pulmonary dyspnea group (n=52). At the same time, 30 healthy people were selected as control group. Values of NT-proBNP and cTnI were used for statistical analysis between the three groups. The sensitivity and specificity of NT-proBNP, cTnI and cTnI+NT-proBNP were compared between three groups. Results The levels of NT-proBNP and cTnI were significantly higher in pulmonary dyspnea group and cardiac dyspnea group than those in the control group, and the levels were significantly higher in cardiac dyspnea group than those of pulmonary dyspnea group (P<0.01). The detection sensitivity of NT-proBNP and cTnI alone was 67.65% and 52.94%, combined detection of both was up to 94.12%. The specificity of NT-proBNP and cTnI detection alone was 70.00% and 53.33%, respectively, and combined detection of both was up to 86.67%. The sensitivity of NT-proBNP+cTnI was significantly higher than that of NT-proBNP and cTnI alone (P<0.05), but there was no significant difference in the specificity between combined detection andindividual detection of NT-proBNP. The positive predictive value of the combined detection in the diagnosis of cardiac dyspnea was 94.12%(64/68), and the negative predictive value was 86.67%(26/30). Conclusion Bedside detection with combination of cTnI and NT-proBNP has important clinical application value in the rapid diagnosis of cardiac dyspnea, which is a rapid clinical testing method.

Objective:To explore the effect of the new model of "5G cloud plus medicine" network and linkage in improving the therapeutic effect for patients with severe trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 410 patients with severe trauma admitted to Qingzhou People′s Hospital affiliated to Shandong First Medical University from November 2016 to November 2020. There were 258 males and 152 females, aged 16-80 years [(45.7±16.1)years]. The injury severity score (ISS) ranged from 17 to 55 points [(28.1±7.6)points]. A total of 210 patients with severe trauma were rescued by using the new model of "5G cloud plus medicine" network and linkage from November 1, 2018 to November 30, 2020 (observation group), and another 200 patients with severe trauma were rescued by the traditional treatment mode from November 1, 2016 to October 31, 2018 were selected as the control group. Time to start rescue (time from admission to the start of rescue), CT examination time (time from consultation to completion of CT scan), time to receive blood transfusion (time from blood transfusion request to execution), residence time in emergency room, ISS at postoperative 28 days, proportion of patients with blood transfusion, success rate of rescue and mortality rate were compared between the two groups.Results:Time to start rescue [(2.4±1.1)minutes], CT examination time [(29.1±10.3)minutes], time to receive blood transfusion [(28.1±10.2)minutes] and residence time in emergency room [(3.0±1.1)hours] in observation group were significantly shorter than those in control group [(5.5±1.2)minutes, (42.8±10.1)minutes, (48.5±13.1)minutes, (5.0±1.4)hours] (all P<0.05 or 0.01). ISS was (18.7±2.8)points in observation group, significantly lower than (22.1±3.4)points in control group ( P<0.05). Proportion of patients with blood transfusion was 49.5% (104/210) in observation group, similar with 42.5% (85/200) in control group ( P>0.05). Success rate of rescue was 99.0% (208/210) in observation group, significantly higher than 93.0% (186/200) in control group ( P<0.05). The mortality rate was 4.3% (9/200) in observation group, significantly lower than 8.5% (17/200) in control group ( P<0.05). Conclusion:For patients with severe trauma, the new model of "5G cloud plus medicine" network and linkage can effectively shorten the time to start rescue, CT examination time, time to receive blood transfusion and residence time in emergency room, improve the success rate of rescue and reduce the mortality rate, which is worthy of further promotion.

Objective:To investigate the effect of the liquid resuscitation therapy strategy using intra-abdominal pressure (IAP) and oxygenation index (PaO 2/FiO 2) as the end point in patients with severe acute pancreatitis (SAP). Methods:A retrospective study was performed, including 84 patients with SAP in emergency intensive care unit of Qingzhou Hospital Affiliated to Shandong First Medical University from January 2018 to August 2021. According to the status of fluid balance at admission, all patients were divided into the positive fluid balance group (43 cases) and the negative fluid balance group (41 cases). The clinical data including gender, age, etiology, underlying disease, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) of all patients were collected. Fluid balance, PaO 2/FiO 2, IAP, compliance rate, new mechanical ventilation rate and overall hospital stay of 1 week after admission were recorded and compared between the two groups. Results:After 72 hours of treatment, the cumulative fluid balance was (5 219.5±1 038.4) mL in the positive fluid balance group; IAP was higher than that before treatment [mmHg (1 mmHg≈0.133 kPa): 11.9±2.0 vs. 11.7±2.1], but no significant difference was found ( P > 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 299.8±51.4 vs. 220.5±50.4, P < 0.05). After 72 hours of treatment, the cumulative fluid balance in negative fluid balance group was (-3 542.4±1 310.6) mL; IAP was significantly lower than before treatment (mmHg: 11.4±1.8 vs. 15.2±1.9, P < 0.05); PaO 2/FiO 2 was significantly higher than that before treatment (mmHg: 309.9±50.9 vs. 215.4±49.7, P < 0.05). In the fluid resuscitation goals, after 72 hours of treatment, the compliance rate in the negative fluid balance group was significantly higher than that in the positive fluid balance group [82.93% (34/41) vs. 62.79% (27/43), P < 0.05]; 1 week after admission, the new mechanical ventilation rate in the negative fluid balance group was significantly lower than that in the positive fluid balance group [21.95% (9/41) vs. 41.86% (18/43), P < 0.05]; however, there was no significant difference in overall hospital stay between the two groups (days: 41.2±10.9 vs. 39.1±11.5, P > 0.05). After treatment, 70 patients survived and 14 patients died (including 9 cases in the positive fluid balance group and 5 cases in the negative fluid balance group). Conclusions:Using IAP and PaO 2/FiO 2 to guide liquid therapy could result in effective fluid resuscitation in SAP. The treatment strategy effectively improved prognosis of patients with SAP.