Salt plays a critical role in the development of hypertension,which is a major risk factor for damage to target organs such as the heart,brain,and kidneys.Salt sensitivity serves as the fundamental link between salt intake and hypertension.Considerable progress in research on salt-sensitive hypertension has been made regarding the pathogenesis,detection methods and genetic markers;the prevention and treatment of the disease are also constantly improving.Both salt intake and detection rate of salt-sensitive hypertension are relatively high in China.Therefore,exploring the pathogenesis and enhancing detection of salt-sensitive hypertension are crucial for the effective prevention and control of hypertension.

Objective:To investigate the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage in Chinese population from childhood to middle age.Methods:This study is a population-based, long-term follow-up cohort study. Participants who had their blood pressure measured at least 5 times in the Hanzhong Adolescent hypertension cohort from 1987 to 2023 were included in this study. Group-based trajectory modeling was used to identify different systolic and diastolic blood pressure trajectories, and the subjects were divided into low-increasing group, moderate-increasing group and high-increasing group according to blood pressure trajectories. Blood pressure variability was assessed using standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Target organ damage was evaluated during the final follow-up in 2023 (middle age). Logistic regression models were used to analyze the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage.Results:A total of 2 447 subjects were included, with a median age of 48 years, of whom 1 373 were male (56.1%). Based on systolic blood pressure, 868 were in the low-increasing group, 1 238 in the moderate-increasing group, and 341 in the high-increasing group. For diastolic blood pressure, the distribution was 894, 1 263 and 290, respectively. Compared with the low-increasing group of systolic blood pressure, the moderate-increasing group (arteriosclerosis: OR=4.14, 95% CI 2.96-5.79; proteinuria: OR=2.06, 95% CI 1.38-3.07; left ventricular hypertrophy: OR=1.68, 95% CI 1.00-2.82) and high-increasing group (arterial stiffness: OR=15.44, 95% CI 10.14-23.50; proteinuria: OR=5.80, 95% CI 3.63-9.29; left ventricular hypertrophy: OR=2.93, 95% CI 1.55-5.53) had a higher risk of target organ damage (all P<0.005). The moderate-increasing group of diastolic blood pressure had a higher incidence of arterial stiffness ( OR=3.72, 95% CI 2.69-5.12) and proteinuria ( OR=1.67, 95% CI 1.15-2.42) than the low-increasing group (all P<0.005), while the high-increasing group had a significantly higher risk of all type of target organ damage compared to the low-increasing group (arterial stiffness: OR=10.84, 95% CI 7.08-16.61; proteinuria: OR=3.72, 95% CI 2.31-5.99; left ventricular hypertrophy: OR=2.38, 95% CI 1.23-4.59; all P<0.005). Additionally, higher systolic blood pressure variability was associated with an increased incidence of arterial stiffness (SD: OR=2.25, 95% CI 1.96-2.57; VIM: OR=1.64, 95% CI 1.45-1.86; ARV: OR=1.70, 95% CI 1.50-1.93) and proteinuria (SD: OR=1.65, 95% CI 1.44-1.89; VIM: OR=1.41, 95% CI 1.22-1.63; ARV: OR=1.45, 95% CI 1.26-1.67; all P<0.005). The results for diastolic blood pressure variability indicators were similar to those for systolic blood pressure. Conclusion:Early-life blood pressure trajectories are predictive of target organ damage risk in middle age. Higher blood pressure variability is related to an increased risk of arterial stiffness and proteinuria, but was less associated with left ventricular hypertrophy. Focusing on the risk of high blood pressure early in life can help prevent the occurrence of target organ damage in middle age.

Objective To investigate the impact of a high-salt diet on blood pressure level and the prevalence of hypertension in individuals with varying salt-sensitive phenotypes.Methods In 2004,339 participants from northern China were subjected to a chronic salt loading diet intervention study,and their salt-sensitive phenotypes were determined based on the study results.The participants were divided into salt-sensitive and salt-insensitive groups.In 2018,we randomly selected 152 participants for follow-up from the original cohort,and assessed their salt intake through 24-hour urine sodium level.The participants were divided into different groups based on various criteria to comprehensively investigate the effects of high-salt diet on blood pressure level and hypertension prevalence in individuals with different salt-sensitive phenotypes.Results Among the 339 subjects,154 were identified as salt-sensitive,accounting for 45.4％,while 185 were classified as salt-insensitive,accounting for 54.4％.The average arterial pressure response to high-salt intake after switching from low-salt intake in salt-sensitive individuals was 8.31(7.60,9.02),while the average arterial pressure response in salt-insensitive individuals was-1.09(-1.49,-0.68).A follow-up visit was conducted in 152 participants,It was found that the systolic blood pressure and diastolic blood pressure[divided according to the average daily salt intake(＞11 g).SBP:140.8 mmHg vs.132.9 mmHg,DBP:85.9 mmHg vs.81.6 mmHg,P＜0.05;divided according to the quartile of daily salt intake,SBP:140.8 mmHg vs.132.9 mmHg,DBP:85.9 mmHg vs.81.6 mmHg,P＜0.05]were significantly higher in the high-salt diet group than in the normal salt diet group in salt-sensitive individuals,but there was no significant difference in salt-insensitive individuals(P＞0.05).Additionally,the high-salt diet could significantly increase the incidence of hypertension among salt-sensitive individuals[divided according to the average daily salt intake(＞11 g):58.8％vs.32.8％,P＜0.05;divided according to the quartile of daily salt intake:58.8％vs.32.8％,P＜0.05],but had no effect on salt-insensitive individuals(P＞0.05).Conclusion A high-salt diet can increase systolic blood pressure and diastolic blood pressure in salt-sensitive individuals,and significantly increase the long-term prevalence of hypertension in salt-sensitive individuals,but not in salt-insensitive individuals.Therefore,the salt-sensitive phenotype plays a crucial role in the relationship between salt intake and salt-sensitive hypertension.

Salt plays a critical role in the development of hypertension,which is a major risk factor for damage to target organs such as the heart,brain,and kidneys.Salt sensitivity serves as the fundamental link between salt intake and hypertension.Considerable progress in research on salt-sensitive hypertension has been made regarding the pathogenesis,detection methods and genetic markers;the prevention and treatment of the disease are also constantly improving.Both salt intake and detection rate of salt-sensitive hypertension are relatively high in China.Therefore,exploring the pathogenesis and enhancing detection of salt-sensitive hypertension are crucial for the effective prevention and control of hypertension.

Objective To investigate the impact of a high-salt diet on blood pressure level and the prevalence of hypertension in individuals with varying salt-sensitive phenotypes.Methods In 2004,339 participants from northern China were subjected to a chronic salt loading diet intervention study,and their salt-sensitive phenotypes were determined based on the study results.The participants were divided into salt-sensitive and salt-insensitive groups.In 2018,we randomly selected 152 participants for follow-up from the original cohort,and assessed their salt intake through 24-hour urine sodium level.The participants were divided into different groups based on various criteria to comprehensively investigate the effects of high-salt diet on blood pressure level and hypertension prevalence in individuals with different salt-sensitive phenotypes.Results Among the 339 subjects,154 were identified as salt-sensitive,accounting for 45.4％,while 185 were classified as salt-insensitive,accounting for 54.4％.The average arterial pressure response to high-salt intake after switching from low-salt intake in salt-sensitive individuals was 8.31(7.60,9.02),while the average arterial pressure response in salt-insensitive individuals was-1.09(-1.49,-0.68).A follow-up visit was conducted in 152 participants,It was found that the systolic blood pressure and diastolic blood pressure[divided according to the average daily salt intake(＞11 g).SBP:140.8 mmHg vs.132.9 mmHg,DBP:85.9 mmHg vs.81.6 mmHg,P＜0.05;divided according to the quartile of daily salt intake,SBP:140.8 mmHg vs.132.9 mmHg,DBP:85.9 mmHg vs.81.6 mmHg,P＜0.05]were significantly higher in the high-salt diet group than in the normal salt diet group in salt-sensitive individuals,but there was no significant difference in salt-insensitive individuals(P＞0.05).Additionally,the high-salt diet could significantly increase the incidence of hypertension among salt-sensitive individuals[divided according to the average daily salt intake(＞11 g):58.8％vs.32.8％,P＜0.05;divided according to the quartile of daily salt intake:58.8％vs.32.8％,P＜0.05],but had no effect on salt-insensitive individuals(P＞0.05).Conclusion A high-salt diet can increase systolic blood pressure and diastolic blood pressure in salt-sensitive individuals,and significantly increase the long-term prevalence of hypertension in salt-sensitive individuals,but not in salt-insensitive individuals.Therefore,the salt-sensitive phenotype plays a crucial role in the relationship between salt intake and salt-sensitive hypertension.

Objective:To investigate the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage in Chinese population from childhood to middle age.Methods:This study is a population-based, long-term follow-up cohort study. Participants who had their blood pressure measured at least 5 times in the Hanzhong Adolescent hypertension cohort from 1987 to 2023 were included in this study. Group-based trajectory modeling was used to identify different systolic and diastolic blood pressure trajectories, and the subjects were divided into low-increasing group, moderate-increasing group and high-increasing group according to blood pressure trajectories. Blood pressure variability was assessed using standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). Target organ damage was evaluated during the final follow-up in 2023 (middle age). Logistic regression models were used to analyze the relationship between blood pressure trajectories and blood pressure variability with the risk of target organ damage.Results:A total of 2 447 subjects were included, with a median age of 48 years, of whom 1 373 were male (56.1%). Based on systolic blood pressure, 868 were in the low-increasing group, 1 238 in the moderate-increasing group, and 341 in the high-increasing group. For diastolic blood pressure, the distribution was 894, 1 263 and 290, respectively. Compared with the low-increasing group of systolic blood pressure, the moderate-increasing group (arteriosclerosis: OR=4.14, 95% CI 2.96-5.79; proteinuria: OR=2.06, 95% CI 1.38-3.07; left ventricular hypertrophy: OR=1.68, 95% CI 1.00-2.82) and high-increasing group (arterial stiffness: OR=15.44, 95% CI 10.14-23.50; proteinuria: OR=5.80, 95% CI 3.63-9.29; left ventricular hypertrophy: OR=2.93, 95% CI 1.55-5.53) had a higher risk of target organ damage (all P<0.005). The moderate-increasing group of diastolic blood pressure had a higher incidence of arterial stiffness ( OR=3.72, 95% CI 2.69-5.12) and proteinuria ( OR=1.67, 95% CI 1.15-2.42) than the low-increasing group (all P<0.005), while the high-increasing group had a significantly higher risk of all type of target organ damage compared to the low-increasing group (arterial stiffness: OR=10.84, 95% CI 7.08-16.61; proteinuria: OR=3.72, 95% CI 2.31-5.99; left ventricular hypertrophy: OR=2.38, 95% CI 1.23-4.59; all P<0.005). Additionally, higher systolic blood pressure variability was associated with an increased incidence of arterial stiffness (SD: OR=2.25, 95% CI 1.96-2.57; VIM: OR=1.64, 95% CI 1.45-1.86; ARV: OR=1.70, 95% CI 1.50-1.93) and proteinuria (SD: OR=1.65, 95% CI 1.44-1.89; VIM: OR=1.41, 95% CI 1.22-1.63; ARV: OR=1.45, 95% CI 1.26-1.67; all P<0.005). The results for diastolic blood pressure variability indicators were similar to those for systolic blood pressure. Conclusion:Early-life blood pressure trajectories are predictive of target organ damage risk in middle age. Higher blood pressure variability is related to an increased risk of arterial stiffness and proteinuria, but was less associated with left ventricular hypertrophy. Focusing on the risk of high blood pressure early in life can help prevent the occurrence of target organ damage in middle age.

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.

Objective To investigate the relationship of miRNA gene polymorphisms with blood pressure(BP)responses to the sodium and potassium diet intervention.Methods In 2004,we recruited 514 participants from 124 families in seven villages of Baoji,Shaanxi Province,China.All subjects were given a three-day normal diet,followed by a seven-day low-salt diet,a seven-day high-salt diet,and finally a seven-day high-salt and potassium supplementation.A total of 19 miRNA single nucleotide polymorphisms(SNPs)were selected for analysis.Results Throughout the sodium-potassium dietary intervention,the BP of the subjects fluctuated across all phases,showing a decrease during the low-salt period and an increase during the high-salt period,followed by a reduction in BP subsequent to potassium supplementation during the high-salt diet.MiR-210-3p SNP rs 12364149 was significantly associated with systolic BP(SBP),diastolic BP(DBP)and mean arterial pressure(MAP)responses to low-salt diet.MiR-4638-3p SNP rs6601178 was significantly associated with SBP while miR-26b-3p SNP rs115254818 was significantly associated with MAP responses to low-salt intervention.In addition,miR-26b-3p SNP rs115254818 was significantly correlated with SBP,DBP and MAP responses to high-salt intervention.MiR-1307-5p SNPs rs1 1191676 and rs2292807 were associated with SBP and MAP responses to high-salt diet.MiR-4638-3p SNP rs6601178,miR-210-3p SNP rs12364149,miR-382-5p SNP rs4906032 and rs4143957 were significantly associated with SBP response to high-salt diet.In addition,miR-26b-3p SNP rs115254818 was significantly associated with SBP,DBP and MAP responses to potassium supplementation.MiR-1307-5p SNPs rs11191676,rs2292807,and miR-19a-3p SNP rs4284505 were significantly associated with SBP responses to high-salt and potassium supplementation.Conclusion miRNA gene polymorphisms are associated with BP response to sodium and potassium,suggesting that miRNA genes may be involved in the pathophysiological process of salt sensitivity and potassium sensitivity.

Comprehensively improving the new efficiency of high-quality development of public hospitals is the key top-level design for deepening the reform of public hospitals during the"14th Five-Year Plan"period.In view of the changes in the macro environment faced by public hospitals in recent years,such as the cancellation of the addi-tion of pharmaceutical consumables and the deep promotion of the reform of payment methods,as well as the out-standing problems existing at the micro level of public hospital operation,such as the separation of diagnosis and treatment business from economic operation activities,extensive decision-making methods,unreasonable alloca-tion of resources and urgent optimization of processes.By referring to relevant theories such as value management theory,a new"trinity"public hospital lean operation management model based on"integration of industry and fi-nance,lean operation and evidence-based decision-making"is explored and constructed.It breaks the relatively parallel operation barriers of clinical diagnosis and treatment business and economic operation management,innovates a new method of linear staff management with the integration of industry and finance,gives full play to the role of experts in governing hospitals,and integrates the professional committee system driven by"technology+manage-men"into the hospital decision-making staff system to provide data evidence-based basis for assisting the hospital leadership to make scientific decisions.

【Objective】 To investigate the association between genetic variations in the glucagon-like peptide-1 receptor (GLP-1R) gene and BP responses to sodium and potassium intake. 【Methods】 A total of 514 subjects from 124 families were recruited in Meixian County, Shaanxi Province, in 2004, resulting in the establishment of a "salt-sensitive hypertension study cohort" . The subjects followed a dietary regimen which involved a normal diet for 3 days, a low-salt diet for 7 days, a high-salt diet for 7 days, and a high-salt potassium-supplemented diet for 7 days. BP measurement was conducted at different intervention periods, and peripheral blood samples were collected. Additionally, eight single nucleotide polymorphisms (SNPs) of the GLP-1R gene were genotyped using the MassARRAY detection platform. 【Results】 The GLP-1R gene SNP rs9462472 exhibited a significant association with systolic BP, diastolic BP, and mean arterial pressure response to high-salt intervention. Similarly, SNP rs2268637 showed a significant association with systolic BP response to high-salt intervention. Furthermore, SNP rs2268637 was significantly associated with systolic BP and mean arterial pressure responses to high-salt plus potassium supplementation intervention. 【Conclusion】 Our findings indicate a significant association of genetic variations in the GLP-1R gene with BP responses to sodium and potassium intake. This suggests that the GLP-1R gene plays a role in the regulation of BP salt sensitivity and potassium sensitivity.