This review focuses on the close association between glycosylated hemoglobin(HbA1c)and surgical site infection(SSI),deeply analyzing the influencing mechanisms of body metabolism status reflected by HbA1c on occurrence and progression of SSI and comprehensively elaborating the critical role of preoperative assessment,intraoperative and postoperative management strategies based on the monitoring of HbA1c on preven-tion and control of SSI,with the aim to provide the comprehensive and in-depth theoretical bases and operation guidelines for clinical practice.

Objective:To investigate the application value of D-dimer (D-D) as the primary indicator, combined with NT-proBNP and neutrophil percentage in the differential diagnosis of acute aortic dissection (AAD), pulmonary embolism (PE), and acute myocardial infarction (AMI).Methods:A retrospective case-control study was conducted, including 764 patients with acute chest pain who presented to the Emergency Department of Beijing Fuwai Hospital from March 1st, 2024, to February 28th, 2025. Patients were clinically diagnosed with AAD (299 cases) and other acute chest pain conditions (AMI 425 cases, PE 40 cases). The AAD group had the age of 56.00 (45.00, 64.00) years old with 226 males (75.59%); the AMI group had a median the age of 65.00 (55.00, 70.00) years with 339 males (79.76%); and the PE group had the age of 70.00 (59.75, 74.00) years with 15 males (37.50%). Baseline clinical data were collected and compared among the three groups, including general parameters such as heart rate, systolic blood pressure, and diastolic blood pressure. Laboratory parameters included N-terminal pro-brain natriuretic peptide (NT-proBNP), prothrombin time (PT), activated partial thromboplastin time (APTT), D-D, cardiac troponin I (cTnI), myoglobin, creatine kinase-MB (CK-MB), white blood cell count, neutrophil percentage, lymphocyte percentage, platelet count, and mean platelet volume (MPV). Comparisons between groups were performed using the Kruskal-Wallis rank-sum test and χ2 test. Independent discriminatory factors were identified through multivariate logistic regression analysis, and the diagnostic performance of individual indicators and combined models were analyzed using receiver operating characteristic (ROC) curves.Results:The D-D level in the AAD group [3.93 (1.48, 19.59) μg/ml] was significantly higher than that in the AMI group [0.26 (0.14, 0.56) μg/ml] and PE group [2.13 (0.84, 6.13) μg/ml] ( F=200.12, P<0.001). Multivariate analysis showed that D-D, NT-proBNP, neutrophil percentage, and lymphocyte percentage were all independent factors for differentiating AAD from AMI. NT-proBNP, total white blood cell count, neutrophil percentage, and lymphocyte percentage were independent predictors for differentiating AAD from PE. ROC analysis showed that D-D had an area under the curve (AUC) of 0.93 (95% CI 0.91-0.95) for differentiating AAD from AMI, with a sensitivity of 81.6% and specificity of 92.9%. In the differential diagnosis between AAD and PE, the model combining D-dimer, NT-proBNP, and neutrophil percentage had an AUC of 0.86 (95% CI 0.80-0.91), with a sensitivity of 85.0% and a specificity of 72.5%. Conclusion:D-D has significant value in the differential diagnosis of AAD from AMI and PE, with particularly good individual diagnostic performance for differentiating AAD from AMI. Combining NT-proBNP and neutrophil percentage can significantly improve differential diagnostic performance.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

This review focuses on the close association between glycosylated hemoglobin(HbA1c)and surgical site infection(SSI),deeply analyzing the influencing mechanisms of body metabolism status reflected by HbA1c on occurrence and progression of SSI and comprehensively elaborating the critical role of preoperative assessment,intraoperative and postoperative management strategies based on the monitoring of HbA1c on preven-tion and control of SSI,with the aim to provide the comprehensive and in-depth theoretical bases and operation guidelines for clinical practice.

Objective:To investigate the application value of D-dimer (D-D) as the primary indicator, combined with NT-proBNP and neutrophil percentage in the differential diagnosis of acute aortic dissection (AAD), pulmonary embolism (PE), and acute myocardial infarction (AMI).Methods:A retrospective case-control study was conducted, including 764 patients with acute chest pain who presented to the Emergency Department of Beijing Fuwai Hospital from March 1st, 2024, to February 28th, 2025. Patients were clinically diagnosed with AAD (299 cases) and other acute chest pain conditions (AMI 425 cases, PE 40 cases). The AAD group had the age of 56.00 (45.00, 64.00) years old with 226 males (75.59%); the AMI group had a median the age of 65.00 (55.00, 70.00) years with 339 males (79.76%); and the PE group had the age of 70.00 (59.75, 74.00) years with 15 males (37.50%). Baseline clinical data were collected and compared among the three groups, including general parameters such as heart rate, systolic blood pressure, and diastolic blood pressure. Laboratory parameters included N-terminal pro-brain natriuretic peptide (NT-proBNP), prothrombin time (PT), activated partial thromboplastin time (APTT), D-D, cardiac troponin I (cTnI), myoglobin, creatine kinase-MB (CK-MB), white blood cell count, neutrophil percentage, lymphocyte percentage, platelet count, and mean platelet volume (MPV). Comparisons between groups were performed using the Kruskal-Wallis rank-sum test and χ2 test. Independent discriminatory factors were identified through multivariate logistic regression analysis, and the diagnostic performance of individual indicators and combined models were analyzed using receiver operating characteristic (ROC) curves.Results:The D-D level in the AAD group [3.93 (1.48, 19.59) μg/ml] was significantly higher than that in the AMI group [0.26 (0.14, 0.56) μg/ml] and PE group [2.13 (0.84, 6.13) μg/ml] ( F=200.12, P<0.001). Multivariate analysis showed that D-D, NT-proBNP, neutrophil percentage, and lymphocyte percentage were all independent factors for differentiating AAD from AMI. NT-proBNP, total white blood cell count, neutrophil percentage, and lymphocyte percentage were independent predictors for differentiating AAD from PE. ROC analysis showed that D-D had an area under the curve (AUC) of 0.93 (95% CI 0.91-0.95) for differentiating AAD from AMI, with a sensitivity of 81.6% and specificity of 92.9%. In the differential diagnosis between AAD and PE, the model combining D-dimer, NT-proBNP, and neutrophil percentage had an AUC of 0.86 (95% CI 0.80-0.91), with a sensitivity of 85.0% and a specificity of 72.5%. Conclusion:D-D has significant value in the differential diagnosis of AAD from AMI and PE, with particularly good individual diagnostic performance for differentiating AAD from AMI. Combining NT-proBNP and neutrophil percentage can significantly improve differential diagnostic performance.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:Dysregulated host immune responses contribute to the pathogenesis of sepsis. G protein-coupled receptor 174 (GPR174) was found to be involved in the immune responses and associated with the susceptibility to autoimmune diseases. This study aimed to investigate the association of GPR174 variants with sepsis susceptibility and the contribution of GPR174 in sepsis development.Methods:From May 2005 to December 2017, a total of 575 sepsis patients and 579 non-septic controls admitted to our Emergency ICU were enrolled in this case-control study. The non-synonymous SNP rs3827440 in GPR174 was genotyped using TaqMan Real-time PCR assays on ABI7900 platform. Then the correlation between rs3827440 and serum levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were investigated in septic patients. Gpr174-deficient mice were generated and subjected to cecal ligation and puncture (CLP). The concentrations of inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA).Results:Rs3827440 TT/T genotype in GPR174 was positively associated with sepsis risk after logistic regression analysis adjusted for sex [odds ratio ( OR) = 1.68, 95% confidence interval ( CI): 1.19-2.20, P = 0.0004]. IL-6 and TNF-α serum levels in female TT and male T allele carriers of septic patients were significantly higher than those in female CC and male C allele carriers ( P < 0.05). Preclinical validation of Gpr174 gene was performed in Gpr174 knockout (KO) mice using CLP models. Gpr174 KO mice had higher survival rate. Moreover, Gpr174 KO mice had significantly decreased serum concentrations of IL-1β, IL-6 and TNF-α compared with WT mice, while the levels of IL-10 was increased ( P < 0.01). Conclusions:GPR174 as a novel sepsis susceptibility gene in Chinese Han population is involved in the development and physiopathology of sepsis.

OBJECTIVE:To provide reference for further standardizing and perfecting the management of drug unpacking in outpatient pharmacy.METHODS:A total of 6 primary and secondary health institutions (4 community health service centers and 2 secondary hospitals) were selected from 2 districts in Shanghai to conduct a questionnaire survey on the use of their drugs and drug unpacking in outpatient pharmacy.The survey data was analyzed statistically.RESULTS:Totally 6 institution questionnaires and 6 pharmaceutical staff questionnaires were sent out,all were received with recovery of 100％.In 2015,the average number of essential medicines in community health service centers and secondary hospitals were 496.50,542.00,respectively,and the average number of varieties sold were 530.75,1 052.00.In outpatient pharmacy of surveyed community health service center,the number of unpacked drugs was 10-21 which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 5.56-16.70 ten thousand yuan.In outpatient pharmacy of 2 two secondary hospitals,the number of unpacked drugs were 17 and 23,respectively,most of which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 13.19 to 158.06 ten thousand yuan.The proportion of unpacked drugs was less than 5％ of the total number of varieties sold,and the proportion of consumption sum of unpacked drugs was less than 1％ of total consumption sum.Estazolam tablets and Alprazolam tablets took up the top 5 in the list of consumption sum of unpacking drugs in 2 types of intervi ewed instiutions.All the surveyed institutions were not equipped with drug dispensing machine in the outpatient pharmacy,still depended on manually unpacking.There were four institutions to regularly arrange the unpacking,unpacking frequency was usually 1 to 3 times a week,supplemented by the need to arrange unpacking,and another two to implement a daily unpacking.There were 5 institutions to develop a drug unpacking mechanism in the institutions,but the relevant system was not perfect.CONCLUSIONS:The enthusiasm of pharmaceutical saff in primary and secondary health institutions in Shanghai to carry out or engage in unpacking work need to be improved,the instructions for unpacked drugs are not available on request,and the way to unpack drugs still needs to explore.

Objective To observe changes in mean platelet volume ( MPV) and investigate its possibility as a predictor and influence in patients with pulmonary artery hypertension associated with secundum atrial septal defect (ASD-PAH) . Methods 627 patients who suffered from secundum ASD were included in the study from the First Affiliated Hospital of Xinjiang Medical University Heart Center between January 2010 and March 2014. Patients were divided into two groups based on whether they had PAH or not (PAH group, n = 420 and non-PAH group, n = 207) . We also included 690 healthy people as a control group who received routine body check up at the same time. Examinations including complete blood count, serum biochemistry and ECG were done. Right heart catheterization examination was performed in patients who suffered from secundum ASD. Results The MPV was significantly higher in secundum ASD patients than in the control group [ (9. 4 ± 1. 6) fl vs. (8. 9 ± 1. 5) fl, P ﹤ 0. 001] . No significant difference was observed in MPV between PAH group and non-PAH group (P = 0. 268) . In univariate and multivariate logistic regression analysis, age ( OR 1. 401, 95% CI 1. 087 to 1. 806, P = 0. 009), RV diameter (OR 1. 101, 95% CI 1. 026 - 1. 181, P = 0. 008) and ASD defect diameter (OR 1. 064, 95% CI 1. 013 - 1. 118, P = 0. 013) were associated with ASD-PAH. Conclusions Our study demonstrated that age, RV diameter and ASD defect diameter were associated with ASD-PAH. Platelet activation exists in ASD-PAH, but this may not be the precipitating cause that contribute to the pathogenesis of ASD-PAH. MPV at admission does not predict the risk of PAH in patients with secundum ASD.

Objective: To study the predictive value of combination scores of leukocyte and platelet counts (COL-P) for in-hospital mortality in patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) treatment. Methods: A total of 660 STEMI patients with emergent PCI in our hospital from 2009-11 to 2013-08 were retrospectively studied. The patients were divided into 3 groups according to COL-P scores: COL-P0 group,n=283, COL-P1 group,n=319 and COL-P3 group,n=58. The relationship between the in-hospital mortality and COL-P scores was analyzed among different groups. Results: There were 88/660 in-hospital death. The patients in death group had the higher white blood cell count and lower platelet count than those in survival group, bothP<0.01. Logistic regression analysis indicated that compared with COL-P0 group, the COL-P scores at COL-P1 level (OR 4.346, 95% CI 2.134-8.850,P<0.001) and COL-P2 level (OR 10.126, 95% CI 4.061-25.250,P<0.001) were the independent risk factors for in-hospital death in STEMI patients after emergent PCI. The in-hospital mortality in COL-P0, COL-P1 and COL-P2 groups were at 4.9%, 15.4% and 43.1% respectively, allP<0.001. Conclusion: COL-P score was useful for predicting the in-hospital mortality in STEMI patients after emergent PCI, while the long term mortality estimation should be further studied.