Objective To explore the diagnostic and treatment value of serum B-type natriuretic peptide (BNP) levels for the chronic heart failure and its correlation with cardiac function classification.Methods 155 patients with heart failure were selected as treatment group.According to cardiac function,grade Ⅱ in 48 cases,grade Ⅲ in 56 cases,grade Ⅳ in 51 cases.122 healthy people during the same period were selected as the control group.Retrospectively detected serum BNP levels of the subjects,and the BNP levels of the treatment group were detected before and after treatment,and its correlation with heart function was analyzed.Results The serum BNP level of the treatmentgroup was (738.67 ± 61.32) pg/mL,which was higher than (22.36 ± 21.89) pg/mL of the control group,the difference was statistically significant (t =19.38,P ＜ 0.05).The serum BNP level of the treatment group after treatment was (329.58 ± 90.74) pg/mL,which was lower than (738.67 ± 161.32) pg/mL of the control group,the difference was statistically significant(t =19.38,P ＜ 0.05).The serum BNP levels of grade Ⅱ,grade Ⅲ and grade Ⅳ patients after treatment compared with pre-treatment,the differences were statistically significant (t =13.65,15.18,17.39,all P ＜ 0.05),from pre-treatment to pro-treatment,the serum BNP levels were gradually increased with increased grade,the differences were statistically significant (t =10.61,21.33,11.06,16.40,all P ＜ 0.05).Conclusion The serun BNP level of chronic heart failure patients significantly increases,and it increases with the increase of cardiac function classification,and shows correlation.As the objective indicators of chronic heart failure,it has better clinical diagnosis value and treatment and prognostic significance.

BACKGROUND: Through exercise and/or hypoxia to increase the body's stress level and timing of hypoxia, so as to improve the body's adaptation level to exercise and/or hypoxia. However, little was known concerning the effects of acute exercise and/or hypoxia on vascular endothelial cell growth factor (VEGF) expression in skeletal muscles.OBJECTIVE: To study the effects of acute exercise and/or hypoxia on VEGF expression in rats' gastrocnemius muscles. DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the Clinical Laboratory, People's Hospital of Jiangsu Province, between September 2005 and September 2006.MATERIALS: Totally 108 health male SD rats were randomly divided into 6 groups, namely, normoxia quiet, normoxia high intensity, normoxia moderate intensity, hypoxia quiet, living high-training low high intensity and living high-training low high intensity moderated intensity groups, with 12 animals in each group.METHODS: In acute normoxia exercise models, rats were performed adaptive activity at 48 hours prior to experiment. The high intensity exercise was comprised of 50 m/minx1.5 min training with 2 minutes rest. The moderate intensity exercise was 30 m/min×30 min. Hypoxia environment was produced by using low oxygen instrument to simulate hypoxia training, with hypoxia for 3 days, 22 h/d, 12.8% altitude, with 22 ℃ temperature and 55% humidity. In acute training low-living high models, rats were placed in above hypoxia environment after high intensity Or moderate intensity exercise. Four rats were sacrificed at hours 0, 2 and 4 after training, and the gastrocnemius muscles were obtained.MAIN OUTCOME MEASURES: The expression of VEGF in rats' gastrocnemius muscles was detected by using western-blot.RESULTS: Hypoxia and acute normoxia exercise enhanced the expression of VEGF, hypoxia after exercise weakened exercise-induced VEGF expression, and the exercise with long time and common intensity induced the higher level VEGF expression. The expression of VEGF was the most at the time points of instantaneousness and 2 hour after exercise, the sorting of the recovery speed of VEGF changes from fast to slow was: hypoxia or training low-living high and normoxic exercise. CONCLUSION: The expressions of VEGF in rats' skeletal muscles induced by acute exercise and/or hypoxia belong to the effect of immediate-early, with existing intensity-threshold, which recovery speed is inversely proportional to the expression amplitude;"training low-living high" may be able to enhance the adaptation of skeletal muscles to sports.

Objective To study the effect of age on the recurrence-free survival rate after hepatic resection for hepatocellular carcinoma(HCC)and the relationship between microvessel density (MVD)and recurrence of HCC in the elderly. Methods　Severty one cases of elderly patients with HCC were analyzed retrospectively with 352 cases of non-elderly HCC patients as control,and the effect of age on the recurrence-free survival rate was studied.The expressions of CD34 and endocan in HCC tissues were detected by immunohistochemistry in 30 elderly and 30 non-elderly patients.Results　The 1-,3- and 5-year recurrence free survival rates were 75.7%,43.0% and 43.0% in the elderly group respectively,which were higher than those in the non-elderly group(53.6%,38.5% and 33.4%,respectively,Log Rank value=10.25,P＜0.05).The positive rate of alpha fetoprotein (AFP)in the elderly group was 47.9%,which was lower than that in the non-elderly group(62.2%)(X2=23.68,P＜0.05).The median survival times in the high CD34-MVD group and high endocan MVD group were shorter than those in the low CD34-MVD group and low endocan-MVD group(260 d vs.850 d,360 d vs.800 d,Log Rank value was 22.18 and 20.56 respectively,both P＜0.05).Conclusions　The long-term prognosis of hepatic resection for HCC is better in elderly patients than in non-elderly patients.The recurrence of HCC in the elderly is closely related with angiogenesis.

Objective To investigate the effect of illness severity on preterm infant's hypothalamusputituary-adrenal (HPA) axis, we measured the serum concentration of cortisol,aldosterone and adrenocorticotropic hormone (ACTH). Methods Ninety preterm infants who were transferred to our hospital within 72 hours after birth were involved. These preterm infants were divided into two groups:gestational age (GA) ≥34 weeks' preterm infants and GA <34 weeks' preterm infants. We evaluated these preterm infants at the time of admission,day 7 and day 14 after birth with neonatal critical illness score (NCIS). Then they were divided into mild group and severe group by the lowest score. We measured their serum cortisol,aldosterone and ACTH at the time of admission,day 7 and day l4 after birth. Results (1) The serum cortisol concentration of preterm infants with severe illness was higher than that of preterm infants with mild illness. Among the GA ≥34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significandy higher than that of preterm infants with mild illness within 72 hours after birth (t = -2.263,P =0. 029). Among the GA <34 weeks' preterm infants,the serum cortisol concentration of preterm infants with severe illness was significantly higher than that of preterm infants with mild illness on day 14 after birth (t =-2. 913 ,P =0. 006). (2) Among the preterm infants with severe illness,the serum cortisol concentration of the GA≥34 weeks' was significantly higher than that of the GA < 34 weeks' within 72 hours after birth (t =-2. 641 ,P =0. 010) ;the serum cortisol concentration of the GA <34 weeks' was significantly higher than that of the GA≥34 weeks' on the day 14 after birth(t = -2. 189,P =0. 036) . (3) The serum cortisol concentration was significantly decreased in the GA≥34 weeks'preterm infants (F = 4. 679, P =0. 012). (4) The serum cortisol concentration of aldosterone and ACTH was not significantly different between preterm infants with severe illness and those with mild illness. Conclusion The preterm infant already has the ability to respond to stimuli by regulating cortisol secretion. The serum cortisol concentration increases as disease severity worsens.Serum aldosterone and ACTH concentration are not correlated with the severity of the disease.

ObjectiveTo picture the trajectory of changes in glucose and lipid metabolism among schizophrenic patients in long-term hospitalization. MethodsA total of 109 inpatients of Shenzhen Kangning Hospital from 2014 to 2022， who were diagnosed with schizophrenia based on the International Classification of Diseases， tenth edition （ICD-10） criteria， were recruited as subjects. Real-world follow-up data on longitudinal glucose metabolism （fasting blood glucose， glycosylated hemoglobin， C-peptide） and lipid metabolism （triglycerides， low density lipoprotein， high density lipoprotein， total cholesterol） were observed. The frequency of visit was once a year， with a total of 9 visits over 8 years. ResultsIn terms of glucose metabolism parameters， fasting blood glucose level decreased to 4.87 mmol/L at the 7^th visit， lower than the baseline level （P<0.01）. Glycated hemoglobin level was 6.08% at the 9^th visit， higher than the baseline level （P<0.05）. C-peptide level was 3.14 ng/mL at the 7^th visit， higher than the baseline level （P<0.01）. As for the trajectory of lipid metabolism parameters， high-density lipoprotein level were significantly lower than baseline level at the second visit （P<0.01） and stayed basically stable thereafter. Total cholesterol levels at the last three visits were 4.06， 4.07 and 3.95 mmol/L， respectively， all lower than the baseline level （P<0.01）. ConclusionThe changes of glycolipid metabolism parameters in long-term inpatients with schizophrenia were generally smooth during the 8-year follow-up period.

BackgroundThe incidence of delirium in critically ill psychiatric patients is high， and there are many factors affecting delirium occurrence. At present， epidemiological studies on delirium among critically ill patients in psychiatric hospitals are limited. ObjectiveTo explore the risk factors for delirium in critically ill patients in a psychiatric hospital， so as to guide the clinical management of delirium in psychiatric hospitals. MethodsThis retrospective study included 427 critically ill patients who were admitted to Shenzhen Kangning Hospital from January 1， 2019 to May 31， 2021. The delirium situation， gender， age， pre-admission course of illness （duration from the onset of acute mental state changes to in-patient registration at a psychiatric hospital）， history of mental illness， history of cognitive dysfunction， history of using psychoactive substances， history of using sedative and hypnotic drugs， number of combined chronic diseases， number of combined drugs and type of disease were examined as potential risk factors for delirium. Single Logistic regression was used to analyze the potential risk factors for delirium， and the potential risk factors were incorporated into the multi-factor Logistic regression analysis model so as to gradually screen out the risk factors for delirium in critically ill psychiatric patients. ResultsDelirium was present in 33.49% （143/427） of critically ill patients. Multi-factor Logistic regression analysis demonstrated that the presence of delirium was associated with mental and behavioral disorders caused by psychoactive substances （OR=8.949， P<0.01）， absent history of mental illness （OR=4.202， P<0.01）， number of combined chronic diseases （OR=1.249， P<0.01）， age （OR=1.031， P<0.01） and pre-admission course of illness （OR=0.942， P<0.01） . ConclusionDelirium was present in nearly 1/3 critically ill patients in the psychiatric hospital. The risk factors for delirium included short course of illness before admission， age， more combined chronic diseases， absent history of mental illness， mental and behavioral disorders caused by psychoactive substances. ［Funded by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties （number， SZGSP013）］

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.