Objectives:To investigate the relationship between total ischemic time(TIT)and the risk of major adverse cardiovascular events(MACE,including all-cause death,non-fatal myocardial infarction,non-fatal ischemic stroke)within 1 year after primary percutaneous coronary intervention(PPCI)in patients with ST segment elevation myocardial infarction(STEMI)with TIT≤720 minutes. Methods:A total of 1 812 STEMI patients who underwent PPCI and had a TIT≤720 minutes in the Chest Pain Center of the General Hospital of the Southern Theatre Command of PLA from January 1,2011 to December 31,2021 were selected as the research subjects.Logistic regression and Cox regression models were used to analyze the association between TIT and the risk of MACE in the hospital and within 1 year after discharge.The restricted cubic spline(RCS)analysis was used to analyze the dose-response relationship between TIT and the risk of MACE. Results:Among 1 812 patients,the incidence of MACE during hospitalization was 3.26%,and the incidence of MACE within 1 year after discharge was 6.84%in 1 651 patients who survived.RCS analysis showed that TIT had an approximate logarithmic linear relationship with the risk of MACE during hospitalization and within 1 year after discharge,and the risk of MACE increased with longer TIT.Multivariate logistic regression analysis showed that compared with the group with a TIT of≤480 minutes,the risk of MACE during hospitalization increased by 77.7%(OR=1.777,95%CI:1.020-2.929,P=0.038)in the group with a TIT of more than 480 minutes.Multivariate Cox proportional hazards regression analysis showed that compared with the group with a TIT of≤280 minutes,the risk of MACE within 1 year after discharge increased by 106.7%(HR=2.067,95%CI:1.384-3.089,P<0.001)in the group with a TIT of more than 280 minutes. Conclusions:In STEMI patients after PPCI,the risk of MACE during hospitalization significantly increases when TIT exceeds 480 minutes,and the risk of MACE within 1 year after discharge significantly increases when TIT exceeds 280 minutes.

Objective To investigate the effect of early activity combined with electrical stimulation of neuromuscular system in improving intensive care unit(ICU)-acquired weakness(ICU-AW)patients with severe pneumonia.Methods A total of 150 patients with ICU-AW caused by severe pneumonia admitted to emergency intensive care unit(EICU)in a tertiary hospital in Shanghai were enrolled as the study subjects,and randomly divided into control group(75 cases)and combined group(75 cases).The control group took early exercise,and the combination group was given early exercise plus electrical stimulation of neuromuscular system.The recovery from mechanical ventilation(ICU length of stay,duration of mechanical ventilation,weaning extubation rate,ICU rollout rate),lung function[forced vital capacity(FVC),forced expiratory volume in the 1 s(FEV1)/FVC,massive inspiratory pressure(MIP)],muscle strength[Medical Research Council(MRC)score],disease severity[acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)],and complications were compared between the two groups.Results The ICU length of stay and mechanical ventilation time in the combined group were significantly lower than those in the control group(P<0.05).After intervention,FVC,FEV1/FVC,MIP and MRC scores in the two groups were significantly increased(P<0.05),and compared with the control group,the combined group was significantly increased(P<0.05).After intervention,APACHEⅡ score was significantly reduced in the two groups(P<0.05),and compared with the control group,APACHEⅡ score in combined group were significantly reduced(P<0.05).The complication rate in the combined group(9.33％)was significantly lower than that of control group(24.00％)(P<0.05).Conclusions Early exercise combined with neuromuscular electrical stimulation in patients with severe pneumonia ICU-AW can effec-tively promote recovery of patients because of improved lung function.This therapy is proved to be be safe and effective.

Objective : To analyze the risk factors for endophthalmitis requiring evisceration or enucleation. Methods : The charts of 121 eyes of 121 inpatients with endophthalmitis were retrospectively reviewed , and the group that required evisceration or enucleation (24 patients) with those that received salvaging therapies (97 patients) were compared. Age , sex , medication history , past medical history , clinical manifestation , Leukocyte counts and treatment progression were retrospectively analyzed. Results : Twenty four eyes( 19. 8% )underwent enucleation or evisceration. The proportion of corneal ulcerative endophthalmitis ( 33. 3% ) and endogenous endophthalmitis (25. 0% ) in evisceration or enucleation group was greater than that in the salvaging group ( 1. 0% , 4. 1% ) (P < 0. 001) . The group of eviscerated or enucleated eyes was older (P < 0. 05] , had poorer initial visual acuity [(2. 9 ± 0. 2) LogMAR vs (2. 3 ± 0. 5) LogMAR , P < 0. 001] , had longer duration before intervention ( 15. 8 d vs 4. 6 d , P < 0. 05) , and had more Leukocyte counts [( 12. 8 ± 5. 6) × 109/L vs (9. 1 ± 3. 3) × 109/L , P < 0. 005 ] . With Logistic regression analysis , corneal ulcer, endogenous endophthalmitis , initial vision , leukocyte counts , duration before intervention were the risk factor for evisceration or enucleation ( OR = 343. 283 , OR = 22. 608 , OR = 1 920. 384 , OR = 1. 341 , OR = 1. 167 ) . Conclusion The most common cause of evisceration or enucleation caused by infectious endophthalmitis are infections from corneal ulcer and from endogenous source. The risk factors for endophthalmitis requiring evisceration or enucleation would be considered to be corneal ulcer endophthalmitis , endogenous endophthalmitis , initial vision , leukocyte counts , and duration before intervention.

Objective:To investigate the prognosis after salvage radiotherapy with or without hormone therapy for prostate cancer.Methods:From May 2014 to December 2020, 248 patients undergoing salvage radiotherapy due to prostate-specific antigen (PSA)persistence or biochemical progression after radical prostatectomy at Sun Yat-sen University Cancer Center (n=157) and West China Hospital, Sichuan University (n=91) were analyzed. Median age was 66 (45-78) years old. Median PSA was 23.50 (0.18-845.00) ng/ml. The number of PSA persistence and biochemical progression were 143 (59%) and 105 (42%). The number of pT 2, pT 3a, pT 3b, pT 4, and unknown T stage was 99, 49, 78, 15 and 7 cases.The number of N 0, N 1 and unknown N stage was 153, 44 and 51 cases. 165 cases had positive surgical margin. Gleason score of 6, 7, 8, >8 score and unknown was in 12, 104, 34, 90 and 8 patients. Early and late salvage radiotherapy was performed in 117 and 131 patients, and 70 patients (28%) were CRPC. Hormone therapy was used combined with radiotherapy in 182 patients (73%). PSA decline after radiotherapy was compared with Chi-squre test. Kaplan-Meier method and log-rank test were used to compare progression free-survival (PFS)after radiotherapy. Univariate and multivariate analyses of PFS were performed using Cox proportional hazards model. Early salvage radiotherapy was defined as PSA≤0.5 ng/ml before radiotherapy, and late salvage radiotherapy was defined as PSA>0.5ng/ml. Results:PSA response (PSA decline ≥50%) rate was 94% (233/248), and 82% (203/248) patients had PSA decline ≥ 90%. Twelve (5%) patients had rising PSA after completing radiotherapy, but only 4 (2%) had real progression. The median PFS was 69 months (95% CI 68-70), and 3-year and 5-year PFS rate were 80% and 67%. PFS of PSA persistence and biochemical progression were similar ( HR =0.71, 95% CI 0.37-1.37, P=0.311). Compared with late salvage radiotherapy, early salvage radiotherapy had better PFS [69 (95% CI 68-70) vs. 59 (95% CI 44-74) months, P<0.001]. Compared with hormone sensitive, castration-resistant was associated with worse PFS (5-year PFS rate 74% vs. 51%, P<0.001). In multivariate analysis, Gleason score>8, castration-resistant and late salvage radiotherapy were unfavorable prognostic factors. Conclusions:In patients receiving salvage radiotherapy with or without hormone therapy for PSA persistence and biochemical progression after radical prostatectomy, high PSA level before radiotherapy and castration resistant is associated with poor prognosis.

【Objective】 To explore the effect of massive blood transfusion on inflammatory factors, islet B cell function, incidence and mortality of multiple organ dysfunction syndrome (MODS) in patients with severe traumatic hemorrhage. 【Methods】 214 traumatic hemorrhage patients who received blood transfusion and were hospitalized in the Third People′s Hospital of Xingtai from January 2015 to June 2019 were enrolled and divided into the routine blood transfusion group (n=118) and massive blood transfusion group (n=96) according to the amount and method of blood transfusion. The changes of the inflammatory factors such as TNF α and IL-6, the functional indexes of Islet B cells such as HOMA-B and Δ INS30 / Δ GLU30, and the incidence and mortality of MODS in two groups 3 d after blood transfusion were observed. 【Results】 The level of TNF α(ng/L), IL-6(ng/L), HOMA-B and Δ INS30 / Δ GLU30 were (64.21±8.41) vs (30.75±5.26), (216.52±17.99) vs (152.45±16.26) (58.55±10.23) vs (103.47±17.48) and (2.95±0.69) vs (5.87±1.30) in the massive transfusion group and routine transfusion group, respectively (P<0.01). The incidence of MODS was 63.54%(61/96) vs 40.07%(52/118)(P<0.01) while the mortality of MODS was 46.88%(40/118) vs 33.90% (P>0.05). 【Conclusion】 The massive blood transfusion could increase the incidence of MODS in patients with severe traumatic hemorrhage by promoting inflammatory reaction and dysfunction of islet B cells.

Objective:To explore the predictive factors of renal replacement therapy (RRT) in extracorporeal membrane oxygenation (ECMO) patients.Methods:The clinical data of 68 ECMO patients treated at Emergence Department of Jiangsu Provincial Hospital from January 2015 to December 2018 were retrospectively analyzed. Vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs on day 1, 2 and 3 of ECMO (24 h VIS, 48 h VIS, and 72 h VIS). According to received RRT or not, patients were divided into the RRT group and non-RRT group. Age, gender, weight, VIS, presence of cardiac arrest before ECMO, ECMO mode, and ECMO treatment time were compared. Logistic regression analysis was used to identify predictive factors for RRT in ECMO patients.Results:Of the enrolled patients, 73.5% of ECMO patients received RRT. The mean age, 24 h VIS, ECMO failure and mortality of the RRT group were significantly higher than those of the non-RRT group ( P <0.05). The use of RRT was 87.8% in elderly ECMO patients (> cutoff age of 38.5 years). According to the cutoff value of 24 h VIS (33.75), ECMO patients were divided into the high VIS group and low VIS group. The rates of RRT and mortality were both exceeded 90% in the high VIS group, which was significantly higher than that of the low VIS group ( P <0.05). Logistic regression analysis showed that age ( OR=1.223) and 24 h VIS ( OR=1.033) were predictive factors of RRT in ECMO patients ( P <0.05). Conclusions:Age and 24 h VIS show the predictive value for RRT in ECMO patients.

Objective To explore the value of prenatal echocardiography in diagnosis of fetal ventricular septal defect (VSD).Methods Prenatal echocardiography was performed on 3 826 fetuses,and the results were compared with those of postnatal echocardiography or autopsy findings.The diagnostic accuracy,misdiagnosis rate and missed diagnosis rate of prenatal echocardiography for VSD were calculated.Results Among 3 826 fetuses,VSD was found in 61 fetuses (61/3 826,1.59％) with prenatal echocardiography,including simple VSD in 36 fetuses (36/3 826,0.94％) and VSD complicated with other heart malformations in 25 fetuses (25/3 826,0.65 ％).According to the results of autopsy and postnatal echocardiography,the final diagnosis of VSD was found in 76 cases (76/3 826,1.99％),of which simple VSD was found in 51 cases (51/3 826,1.33 ％),VSD complicated with other heart malformations were found in 25 fetuses (25/3 826,0.65％).The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of simple VSD with prenatal echocardiography was 58.82％ (30/51),41.18％ (21/51) and 1.06‰ (4/3 775),respectively.The diagnostic accuracy,missed diagnosis rate and misdiagnosis rate of VSD complicated with other heart malformations with prenatal echocardiography was 96.00％ (24/25),4.00％ (1/25) and 0.26‰ (1/3 801),respectively.Conclusion Echocardiography has important clinical value in prenatal diagnosis of fetal VSD,which can provide important references for treatment plan and prognosis evaluation.

Objective To explore the dynamic changes in brain natriuretic peptide (BNP) concentration and the diagnostic value of BNP for heart failure at different time points in the early phase of acute myocardial infarction (AMI). Methods AMI patients who were admitted in our department between January 1, 2016 and July 31, 2016 and underwent emergency percutaneous coronary intervention (PCI) within 12 h after onset were enrolled in this study. All the patients received bedside examinations of BNP concentration and clinical cardiac function within 1 h after PCI and at 12, 20, 24 and 48 h after the onset of AMI. According to the peak BNP concentration, the patients were divided into high peak BNP group (>400 pg/mL) and normal peak BNP group (≤400 pg/mL). Results Seventy patients were enrolled in the study. Within 48 h after AMI onset, BNP concentration variations followed a pattern of an initial increase till reaching the peak concentration at 20 to 24 h, with subsequent gradual decrease. BNP concentrations differed significantly among the indicated time points (χ2=141.7, P<0.05) except for those between 20 h and 24 h (χ2=0.173, P>0.05). Compared with those in normal peak BNP group, the patients in high peak BNP group had an older age, a lower BMI, a longer time to perfusion, and a higher likeliness of anterior myocardial infarction and pulmonary infection (P<0.05). Logistic regression analysis showed that age, BMI and anterior myocardial infarction were independently associated with the increase of peak BNP concentration. ROC curve analysis showed that BNP concentration within 1 h after emergency PCI was unable to diagnose heart failure at that time (P>0.05), while BNP concentrations at 12, 20, 24 and 48 h after AMI onset had significant diagnostic values for heart failure (P<0.05) with areas under ROC of 0.860, 0.786, 0.768 and 0.863, and optimal cutoff values of 156.5, 313.7, 240.9 and 285.9 pg/mL, respectively. Conclusions BNP concentration increases first and then decreases in the early phase of AMI, and the peak concentration occurs at 20-24 h after the onset. The diagnostic values of BNP concentrations at different time points also vary.

Objective To explore the dynamic changes in brain natriuretic peptide (BNP) concentration and the diagnostic value of BNP for heart failure at different time points in the early phase of acute myocardial infarction (AMI). Methods AMI patients who were admitted in our department between January 1, 2016 and July 31, 2016 and underwent emergency percutaneous coronary intervention (PCI) within 12 h after onset were enrolled in this study. All the patients received bedside examinations of BNP concentration and clinical cardiac function within 1 h after PCI and at 12, 20, 24 and 48 h after the onset of AMI. According to the peak BNP concentration, the patients were divided into high peak BNP group (>400 pg/mL) and normal peak BNP group (≤400 pg/mL). Results Seventy patients were enrolled in the study. Within 48 h after AMI onset, BNP concentration variations followed a pattern of an initial increase till reaching the peak concentration at 20 to 24 h, with subsequent gradual decrease. BNP concentrations differed significantly among the indicated time points (χ2=141.7, P<0.05) except for those between 20 h and 24 h (χ2=0.173, P>0.05). Compared with those in normal peak BNP group, the patients in high peak BNP group had an older age, a lower BMI, a longer time to perfusion, and a higher likeliness of anterior myocardial infarction and pulmonary infection (P<0.05). Logistic regression analysis showed that age, BMI and anterior myocardial infarction were independently associated with the increase of peak BNP concentration. ROC curve analysis showed that BNP concentration within 1 h after emergency PCI was unable to diagnose heart failure at that time (P>0.05), while BNP concentrations at 12, 20, 24 and 48 h after AMI onset had significant diagnostic values for heart failure (P<0.05) with areas under ROC of 0.860, 0.786, 0.768 and 0.863, and optimal cutoff values of 156.5, 313.7, 240.9 and 285.9 pg/mL, respectively. Conclusions BNP concentration increases first and then decreases in the early phase of AMI, and the peak concentration occurs at 20-24 h after the onset. The diagnostic values of BNP concentrations at different time points also vary.

Objective: To access the risk for smoking on morbidity of acute ST-segment elevation myocardial infarction (STEMI) at different gender and age population. Methods: A case-control study was conducted in 2026 STEMI patients and 2026 control subjects with matched gender and age (±2 years) in our hospital from 2010-01-14 to 2016-02-27. The relationship between smoking and STEMI morbidity was analyzed. Results: Smoking was an important risk factor for STEMI morbidity in male gender and it was negatively related to age, as STEMI in young male smokers (≤45 years): adjusted OR=7.000, 95% CI 4.235-11.570; in middle age male smokers (46-59 years):adjusted OR=5.296, 95% CI 3.904-7.185 and in elder male smokers (≥60 years): adjusted OR=4.686, 95% CI 2.860-4.751. Conclusion: Smoking is a major risk factor for STEMI morbidity, while it is different from age and gender; the young male smokers have the highest risk to suffer from STEMI.