Objective:To investigate the temporal expression of Growth Differentiation Factor-15 (GDF15) in the serum of patients with Acute Coronary Syndrome (ACS) and explore the clinical significance of GDF15 in protecting cardiomyocytes in ACS.Methods:A retrospective study was conducted on 289 ACS patients admitted to the emergency departments from February to October 2023. Data on gender, age, troponin T (TnT), creatine kinase isoenzyme (CK-MB), GDF15, and B-type natriuretic peptide (BNP) within 30 minutes of admission were recorded. Differences in these indicators among different groups were compared. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the diagnostic value of GDF15, TnT, and BNP for ACS. Among the patients, 15 exhibited a temporal expression pattern of GDF15, and their blood samples were re-measured using a GDF15 fluorescent quantitative immunochromatographic assay kit. Fifteen patients without temporal expression were randomly selected as controls, and their samples were also re-measured to exclude detection errors. Fifteen patients with temporal expression were included in the temporal expression group, and 15 without temporal expression were included in the non-temporal expression group. Laboratory indicators such as fasting blood glucose, glycated hemoglobin, triglycerides, creatinine, and uric acid were compared between the groups. Additionally, patient age, gender, body mass index (BMI), coronary angiography results, echocardiography, Gensini score, left ventricular ejection fraction (LVEF), and GRACE risk score were recorded to assess their correlation with GDF15 temporal expression. Statistical analysis was performed using SPSS 27 software, with continuous data expressed as mean ± standard deviation (Mean ± SD) and compared using t-tests and χ2 tests. Results:The overall trend in ACS patients showed a higher proportion of males than females (73.36% vs. 26.64%). The oldest group was the Unstable Angina (UA) group, with a mean age of (63.98 ± 15.19) years, while the youngest group was the non-ACS chest pain group, with a mean age of (54.29 ± 16.39) years. A higher proportion of patients in the UA, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI) groups had a history of smoking. The combination of GDF15 and TnT showed high diagnostic value for ACS, with an area under the ROC curve (AUC) of 0.843, consistent with previous studies. Among all ACS patients, 15 exhibited a temporal expression pattern of GDF15, where GDF15 levels peaked at 4 hours, gradually decreased, and peaked again at 24 hours. Patients in the temporal expression group had higher LVEF and left ventricular end-systolic diameter compared to the non-temporal expression group. The Gensini score was lower in the temporal expression group, and the GRACE risk score was significantly lower in the temporal expression group (00.7±14.72) compared to the non-temporal expression group (116.1±23.46), with a statistically significant difference ( P = 0.0115). There were no significant differences in general characteristics (age, gender, BMI) or clinical biochemical indicators (fasting blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, creatinine, uric acid) between the temporal and non-temporal expression groups ( P > 0.05). Conclusions:GDF15 demonstrates significant diagnostic and prognostic predictive value in ACS. Patients with temporally dynamic expression of serum GDF15 exhibit milder myocardial injury and a lower probability of mortality. These findings provide novel therapeutic targets and research directions for further exploring the role of GDF15 in ACS management.

Objective:To evaluate the utility of pulse oximetry-derived parameters—specifically, the pulse oximetry plethysmographic waveform area under the curve (POP AUC) and the peripheral perfusion index (PPI)—in assessing disease severity and predicting prognosis in patients with sepsis. Methods:In this prospective descriptive study, 68 patients with sepsis were categorized based on illness severity into septic shock and non-shock groups, and by 28-day outcome into survival and non-survival groups. POP AUC, PPI, and lactate (Lac) levels were recorded at 0, 24, 48, 72, and 96 hours after admission. APACHEⅡ and SOFA scores were calculated within the first 24 hours. The prognostic value of these parameters was evaluated. Results:Significant differences were observed between the septic shock and non-shock groups in POP AUC, PPI, Lac (all P < 0.05 except at 96 h), APACHEⅡ, and SOFA scores (all P < 0.05). These differences were most pronounced at admission: POP AUC0 (2475.1 ± 899.0) vs. (4260.3 ± 1028.5), PPI 0 (0.78 ± 0.74) vs. (3.13 ± 2.18), Lac 0 (4.95 ± 4.32) vs. (2.07 ± 1.55), APACHE Ⅱ (16.78 ± 5.59) vs. 11.82 ± 4.89), and SOFA (8.89 ± 3.25) vs. (5.06 ± 2.60). Optimal prognostic cut-off values were 2741.43 for POP AUC, 0.97 for PPI, 2.05 for Lac, 12.5 for APACHEⅡ, and 5.5 for SOFA. ROC curve analysis showed that at 24 hours, POP AUC and PPI had significantly larger AUC values than Lac ( P < 0.05), while no significant differences were found among other parameters. Significant differences between non-survivors and survivors were also found in POP AUC, PPI (at 0, 24, and 48 h), APACHE II, and SOFA (all P < 0.05). No significant differences were observed in PPI (72 h and 96 h) or Lac between the two outcome groups. Conclusions:POP AUC and PPI, as derived from pulse oximetry, are non-inferior to Lac, SOFA, and APACHEⅡ scores in evaluating disease severity and predicting 28-day mortality in sepsis patients. These parameters show promise as practical and non-invasive tools for clinical assessment in sepsis.

Objective:To investigate the effect of Shenfu injection on serum pepsinogen (PG) Ⅰ, PG Ⅱ and gastrin 17 (G17) in sepsis patients with acute gastrointestinal injury (AGI).Methods:From June 2021 to December 2022, a single-center randomized controlled clinical study was conducted to select patients with sepsis complicated with acute gastrointestinal injury (AGI) admitted to the ICU of the Affiliated Hospital of Xuzhou Medical University. Patients were randomly (random number) divided into Shenfu group and control group. All patients were given routine treatment of sepsis according to the guidelines, including treatment of primary disease, fluid resuscitation and supportive management. The Shenfu group was treated with Shenfu injection at the same time as routine treatment. The gastrointestinal injury indicators (PGⅠ, PGⅡ, G17 and AGI grades) before treatment and on the 3rd and 7th days of treatment, and duration of mechanical ventilation and length of ICU stay of the two groups were recorded and compared.Results:A total of 89 sepsis patients with AGI were enrolled, including 44 patients in the Shenfu group and 45 patients in the control group. Before treatment, there was no statistically significant difference in serum PGⅠ, PGⅡ, and G17 between the two groups of patients (all P>0.05). On the 3rd day of treatment, the serum PGⅠ levels in the Shenfu group were significantly lower than the control group [(156.46±62.90) μg/L vs. (183.03±45.44) μg/L, P<0.05]. There was no statistically significant difference in serum PGⅡ and G17 levels between the two groups (both P>0.05). On the 7th day of treatment, the serum levels of PG I, PG II, and G17 in the Shenfu group were significantly lower than those in the control group [(107.97±23.18) μg/L vs. (154.78±33.11) μg/L, (10.73±5.62) μg/L vs. (13.83±6.30) μg/L, (7.31±3.20) pmol/L vs. (9.29±3.92) pmol/L, all P<0.05]. The AGI grading, duration of mechanical ventilation, and length of ICU stay in Shenfu group were significantly reduced than those in the control group (all P<0.05). Conclusion:Shenfu injection can improve the serum gastric function, lower AGI grading, reduce mechanical ventilation time, and the length of ICU stay in sepsis patients with AGI.

Adult ; Humans ; Heart Arrest/therapy* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Out-of-Hospital Cardiac Arrest/therapy* ; Treatment Outcome

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Objective:To explore the mechanism of complement 5a (C5a) in the pathogenesis of sepsis.Methods:SPF male C57BL/6J mice were selected and divided into sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+anti-C5A monoclonal antibody intervention group (CLP+anti-C5a group) according to random number table with 20 mice in each group. A CLP model was reproduced to induce sepsis, and those in the Sham group only underwent laparotomy without ligation and perforation. In the CLP+anti-C5a group, 0.15 mg of anti-C5a monoclonal antibody was injected intraperitoneally immediately after CLP, and in the Sham group and CLP group were given equal amount of normal saline. The cumulative survival rate was analyzed by Kaplan-Meier method. Serum levels of tumor necrosis factor-α (TNF-α), interleukins (IL-12, IL-4), and interferon-γ (IFN-γ) were measured 24, 48 and 72 hours after operation by enzyme linked immunosorbent assay (ELISA). Immunohistochemical staining was used to observe the expression of C5a receptor (C5aR) in lung and kidney tissues 48 hours after operation. The proportions of dendritic cell (DC), regulatory T cell (Treg) and helper T cell 17 (Th17) in splenic mononuclear cells 48 hours after operation were analyzed by flow cytometry.Results:The 7-day cumulative survival rate of mice in the CLP group was significantly lower than that in the Sham group (30.00% vs. 100.00%; Log-Rank test: χ 2 = 47.470, P < 0.001), and the peripheral blood inflammatory mediators TNF-α, IL-12 and IL-4 were increased 24 hours after operation, followed by a significant decreasing at 48 hours, and then gradually increased at 72 hours. IFN-γ gradually increased 24 hours after operation and lasted for 72 hours. Immunohistochemistry showed that a large number of C5aR was expressed in pulmonary and renal endothelial cells 48 hours after operation in the CLP group. Compared with the Sham group, the proportion of DC [(1.80±0.30)% vs. (6.90±1.20)%, P < 0.05] and Treg [(0.38±0.02)% vs. (4.00±0.50)%, P < 0.05] in splenic mononuclear cells was down-regulated in the CLP group, the proportion of Th17 was up-regulated [(0.83±0.08)% vs. (0.32±0.03)%, P < 0.05], and disorder of immune function was found. After anti-C5A monoclonal antibody intervention, the 7-day cumulative survival rate increased significantly compared with the CLP group (54.54% vs. 30.00%; Log-Rank test: χ 2 = 28.090, P < 0.001); TNF-α, IL-12 and IFN-γ were further increased, while IL-4 was significantly decreased; the expression of C5aR in lung and kidney tissues were significantly decreased, and the expression of mature DC cells [(5.10±1.20)% vs. (1.80±0.30)%, P < 0.05] and Treg [(2.58±0.05)% vs. (0.38±0.02)%, P < 0.05] in spleen were significantly increased compared with the CLP group, and Th17 was significantly decreased [(0.54±0.05)% vs. (0.83±0.08)%, P < 0.05]. Conclusion:It is preliminarily concluded that anti-C5A monoclonal antibody may improve the prognosis of sepsis by improving the polarization of mature DC and T cells in the spleen, and C5a plays an important role in the immune regulation of sepsis cells.

Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.

As the body′s largest organ, skin harbors a large amount of immune cells to regulate both innate and adaptive immune responses. Regulatory T cells (Tregs), as a subset of T lymphocytes with negative regulatory functions, play an important role in maintaining the immune homeostasis of different tissue. However, researches of skin Tregs are largely limited and uncompleted as compared with other tissue. In recent years, a comprehensive understanding is increasingly showing the specialized functions of Tregs in skin, including the orchestration of tissue wound healing, involvement in hair follicle recycling, and modulation of proper immune homeostasis. In this review, we outline the classification and characteristics of Tregs in skin, distribution, migration routes, immune effects, and relationship with wound healing, which aims to deepening our understanding towards the immunological effects of T lymphocytes subsets in skin and its regulatory pathways.

Objective: To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney). Method: A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded. Results: Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method. Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method.

Objective To explore the timeliness value of cardiopulmonary resuscitation quality index (CQI) in patients' prognostic evaluation during cardiopulmonary resuscitation (CPR).Methods A prospective descriptive study was conducted.According to whether they got return of spontaneously circulation (ROSC) or not,45 patients receiving CPR were divided into the ROSC group and non-ROSC group.The changes of CQI and partial pressure of end-tidal carbon dioxide (PETCO2) during CPR were collected,and were analyzed to valuate the prognosis of patients.Results The initial,end,and average PETCO2 were statistically different between the ROSC group and the non-ROSC group [7.0(3.6,14.6) vs 7.0(3.6,14.6) mmHg;29.5(19.8,35.9) vs 4.0(2.3,10.2)mmHg;and 22.2(11.8,36.3) vs 4.0(2.5,9.0) mmHg,respectively;P＜0.05],and the end CQI was statistically different between the two groups (59.6±8.9 vs 34.8±5.2,P＜0.05).The CQI differences between the two groups initiated at 11 min after CPR,and stopped at 29 min after CPR.The optimal cut-offpoint of terminal CQI and PETCO2 for prognostic was 33.2 and 16.1 mmHg respectively,and there was a statistically difference in the area under the curve between them (P＜0.05).Conclusions During CPR,both CQI and PETCO2 can be used to evaluate the prognosis,and CQI is more capable of predicting in the late stage of CPR.