Objective To investigate the therapeutic effects of varying treatment durations of recombinant human brain natriuretic peptide(rhBNP)on heart failure following percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 196 STEMI patients with heart failure(HF)following emergency percutaneous coronary intervention(PCI)were enrolled and randomly assigned to one of four groups:control group(n=53),short-course rhBNP group(n=47),medium-course rhBNP group(n=50),and long-course rhBNP group(n=46).The rates of cardiovascular mortality and HF-related rehospitalization were evaluated at 30 days and 6 months post-treatment.Serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),matrix metalloproteinase-9(MMP-9),tissue inhibitor of matrix metalloproteinase-1(TIMP-1),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)were measured at 24 hours,3 days,1 week,30 days,and 6 months after HF treatment initiation.Results Compared with the control group,both the short-and medium-term rhBNP groups showed a significant reduction in cardiovascular mortality and HF-related rehospitalization rates in the long-term rhBNP group at 30 days and 6 months(P<0.05).Additionally,the medium-term rhBNP group exhibited lower HF-related rehospitalization rates than both the control and short-term rhBNP groups(P<0.05).Serum levels of NT-proBNP,MMP-9,and LVEDD significantly decreased in the short-term rhBNP group within 24 hours compared to the control group(P<0.05),while TIMP and LVEF levels increased(P<0.05).In comparison with the short-term rhBNP group,the medium-term rhBNP group demonstrated sustained reductions in NT-proBNP,MMP-9,and LVEDD levels at 72 hours,1 week,30 days,and 6 months(P<0.05),accompanied by increases in TIMP and LVEF(P<0.05).Furthermore,the long-term rhBNP group showed greater improvements than the medium-term group,with significantly lower NT-proBNP,MMP-9,and LVEDD levels and higher TIMP and LVEF values at 1 week,30 days,and 6 months(P<0.05).In terms of the adverse reactions,the incidence of hypotension in the control group,short course rhBNP group,medium course rhBNP group and long course rhBNP group increased successively(P<0.05).Conclusion The clinical efficacy of rhBNP in STEMI patients with HF following PCI gradually improved as the treatment duration increased,but the incidence of hypotension also rose accordingly.

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective To investigate the therapeutic effects of varying treatment durations of recombinant human brain natriuretic peptide(rhBNP)on heart failure following percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 196 STEMI patients with heart failure(HF)following emergency percutaneous coronary intervention(PCI)were enrolled and randomly assigned to one of four groups:control group(n=53),short-course rhBNP group(n=47),medium-course rhBNP group(n=50),and long-course rhBNP group(n=46).The rates of cardiovascular mortality and HF-related rehospitalization were evaluated at 30 days and 6 months post-treatment.Serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),matrix metalloproteinase-9(MMP-9),tissue inhibitor of matrix metalloproteinase-1(TIMP-1),left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)were measured at 24 hours,3 days,1 week,30 days,and 6 months after HF treatment initiation.Results Compared with the control group,both the short-and medium-term rhBNP groups showed a significant reduction in cardiovascular mortality and HF-related rehospitalization rates in the long-term rhBNP group at 30 days and 6 months(P<0.05).Additionally,the medium-term rhBNP group exhibited lower HF-related rehospitalization rates than both the control and short-term rhBNP groups(P<0.05).Serum levels of NT-proBNP,MMP-9,and LVEDD significantly decreased in the short-term rhBNP group within 24 hours compared to the control group(P<0.05),while TIMP and LVEF levels increased(P<0.05).In comparison with the short-term rhBNP group,the medium-term rhBNP group demonstrated sustained reductions in NT-proBNP,MMP-9,and LVEDD levels at 72 hours,1 week,30 days,and 6 months(P<0.05),accompanied by increases in TIMP and LVEF(P<0.05).Furthermore,the long-term rhBNP group showed greater improvements than the medium-term group,with significantly lower NT-proBNP,MMP-9,and LVEDD levels and higher TIMP and LVEF values at 1 week,30 days,and 6 months(P<0.05).In terms of the adverse reactions,the incidence of hypotension in the control group,short course rhBNP group,medium course rhBNP group and long course rhBNP group increased successively(P<0.05).Conclusion The clinical efficacy of rhBNP in STEMI patients with HF following PCI gradually improved as the treatment duration increased,but the incidence of hypotension also rose accordingly.

This article reported a set of triplets with type V osteogenesis imperfecta (OI) caused by heterozygous variation in the interferon-induced transmembrane protein 5 ( IFITM5) gene. The triplets developed shortness of breath and multiple fractures at 21, 16, and 17 d after birth, respectively. On theadmission, scattered speckled patterns and hard swelling were observed in all three triplets during physical examination; several blisters were found on the right wrist of the second triplet; the smallest triplet had scattered blisters and ulcers in the mouth, complicated by neonatal sepsis, shock, respiratory failure, necrotizing enterocolitis, and intracranial infection. Whole-exome sequencing identified a pathogenic mutation in the triplets, that was located in the 5'-untranslated region of the IFITM5 coding gene, where a base C was converted to T (c.-14C>T). IFITM5 gene of the triplets. IFITM5 gene mutation can result in type V OI, which is inherited in an autosomal dominant pattern. Based on the clinical phenotype caused by the variation in the IFITM5 gene and literature review, the triplets were diagnosed with congenital type V OI. After respiratory support, anti-infection treatment, and symptomatic support treatment, all three triplets were discharged with improved condition. They were followed up to the age of three years and their nutritional status were good. However, their gross motor development was slightly delayed, and they all experienced different degrees and sites of bone fractures again.

Objective:To investigate the effects of anterolateral wide pedicled double dynamic flap of the calf in repair of soft tissue defects of mid-and forefoot.Methods:From September 2015 to Septemler 2020, 15 cases with severe soft tissue defects of mid-and forefoot were repaired with the anterolateral wide pedicled double dynamic flap of the calf. There were 11 males and 4 females with an average age of 37(range, 22-53)years old. Of the 15 cases, the defects were caused by traffic accident in 6 cases and objects smash in 9 cases. Three cases were simple soft tissue defect, and 12 cases combined with fracture or dislocation and bone defect. The size of soft tissue defects ranged from 4 cm×5 cm to 7 cm×12 cm. All wounds of donor sites were repaired by skin grafting. All patients entered follow-ups at the outpatient clinic or through WeChat. The appearance of flaps and limb recovery were recorded after surgery.Results:All cases followed-up for 6-24 (mean, 16) months. Two days after surgery, 1 case had flap swelling and cyanosis, which was improved after pedicle suture removal and surface bloodletting. The pedicle of the flap was slightly bloated in 4 cases, and the texture and appearance were good in 11 cases. The ankle function of all cases recovered satisfactorily. The ranges of ankle motion were 15°-20° for dorsiflexion and 30°-40° for plantar flexion. The donor site healed well and all the skin grafts survived.Conclusion:The anterolateral wide pedicled double dynamic flap of the calf is one of the ideal flaps for repairing the soft tissue defects of the mid-and forefoot with reliable blood supply, sufficient venous return, simple operation and no require a vascular anastomosis.

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.

Objective To analyze the epidemiological characteristics of an outbreak caused by human brucellosis in a farm in Yantai City,to explore the causes and transmission routes,and to provide evidence for prevention and control of brucellosis in Yantai City.Methods In 2014,an on-site investigation was conducted in a farm where brucellosis occurred in Yantai City,and case searches were conducted on exposed populations in the farm.According to the investigation questionnaire on epidemiology of brucellosis in Shandong Province,general information,clinical manifestation and high-risk behavior exposure information of the cases were collected;blood samples were collected and tested by tiger red plate agglutination test (RBPT) and tube agglutination test (SAT).Brucellosis was diagnosed according to the "Diagnostic Criteria for Brucellosis" (WS 269-2007).Results The first case was male,58 years old,farm worker.A total of 38 suspected cases were found.Eleven patients with positive RBPT and SAT≥1:100 (++) were confirmed cases.The confirmed cases were all male,with a median age of 52 years,ranging from 40 to 60 years old;5 farm workers and 6 construction workers;the onset time was mainly in June and July,a total of 7 cases;clinical manifestations mainly included excessive sweating,muscle and joint pain,fatigue,testicular swelling,etc.Of the 147 sheep in the farm,47 were positive by laboratory tests,accounting for 31.97％,which were the main sources of infection.High-risk exposures for farm workers included hand-delivered births (5 cases) and breeding for livestock (1 case);high-risk exposures for construction workers included entry and exit of sheep houses (6 cases) and handling of supplies in sheep houses (6 cases).Conclusions The epidemic is caused by direct contact with Brucella-infected sheep or caused by respiratory contact with brucellosis contaminated environment.It is necessary to strengthen the health education for prevention and control of the disease in key populations and improve the awareness of the disease.

Objective To study the composition of gut microbiome in neonates with severe bilinebinemia (serum total bilirubin ＞ 342 μmol/L),and to explore the relationship between gut microbiome and bilirubin brain injury.Methods A prospective study was conducted.The neonates with serum total bilirubin ＞ 342 μmol/L from September 2016 to March 2017 in Guangzhou Women and Children's Medical Center,Guangzhou Medical University,were enrolled in the study and 16S rDNA sequence analysis technology was used to detect the composition of gut microbiome in all subjects.According to the results of brain magnetic resonance imaging (MRI),brain stem auditory evoked potential (BAEP) and clinical manifestations,the subjects were divided into the brain injury group (26 cases) and no brain injury group (28 cases).The differences of the composition of gut microbiome between the 2 groups were compared,and the levels of unconjugated bilirubin in serum and cerebrospinal fluid were also compared.Results The level of unconjugated bilirubin in serum of the brain injury group was (463.51 ± 110.62) μmol/L,but in no brain injury group was(364.18 ±63.13) μmol/L,and there was significant difference between the 2 groups(t =4.090,P =0.000 1).The level of unconjugated bilirubin in the cerebrospinal fluid of the brain injury group was (9.53 ± 2.68) μmol/L,but in no brain injury group was (6.94 ± 2.31) μmol/L,and there was significant difference between the 2 groups (t =3.812,P =0.000 3).There was no correlation between the level of unconjugated bilirubin in the cerebrospinal fluid and serum between the 2 groups(r =0.137,0.081,all P ＞0.05).The abundance of gut microbiome in the brain injury group was lower than that in no brain injury group in genus level,among which Fusobacterium,Catabacter,Succinivibrio,Clostridium and Bacteroides were significantly different (all P ＜ 0.05).Conclusions The occurrence of bilirubin brain injury depends on the level of unconjugated bilirubin in serum cerebrospinal fluid,but it may be more directly dependent on the level of bilirubin in the cerebrospinal fluid.The diversity of gut microbiome in neonates with bilirubin brain injury was significantly lower than that in no brain injury group.The level of unconjugated bilirubin in cerebrospinal fluid may be related to the different blood-brain barrier permeability caused by different composition of gut microbiome.

Objective To explore the clinical characteristics of neonatal congenital cystic lung lesions. Methods Between January 2008 and June 2014,total 28 cases diagnosed congenital cystic lung lesions in neonatal center of Guangzhou Women and Children's Hospital were collected.The clinical data were analyzed including manifestations,lesion characteristics,imaging,diagnosis,treatment and prognosis,and the related literature were reviewed.Results There were 20 male and 8 female,16 cases of lobar emphysema,7 cases of pulmonary seques-tration,4 cases of congenital cystic adenomatoid malformation and 1 case of bronchogenic cyst.Main symptoms were dyspnea(78.57%),cyanosis (39.29%),wheezing cough (17.86%),feeding difficulties (14.29%),fever (10.71%),asymptomatic(21.43%).Two cases combined with congenital heart disease,4 cases combined with other malformations(such as diaphragmatic hernia,laryngeal stridor,funnel chest,polycystic kidney).There were lesions in chest CT image,4 cases underwent lobectomy,other cases underwent conservative treatment.Seventeen cases got better and discharge,3 cases dead.Conclusion The most common type of congenital cystic lung lesions in neonate is lobar emphysema.Main manifestations are dyspnea,cyanosis.If we suspect congenital cyst-ic lung lesions,we should do chest CT or MRI scan soon ,also do echocardiography and ultrasound to exclude other malformations.The treatment effect is satisfactory,and the outcome need long time to follow up.

Objective To verify whether the periodic or continuous exposure to high glucose may have different effects on human umbilical vein endothelial cell (HUVEC)apoptosis, and to explore the effect of NF-κB pathway on apoptosis of HUVEC induced by high glucose using the RNAi adenovirus vector. Methods RNAi combinant adenovirus vector which targeted 1566 site of NF-κB p65 mRNA was constructed and the effect of p65 gene knockdown in HUVEC was detected by Western blot analysis. Then, the RNAi adenovirus was transducted to explore the role of NF-κB pathway on the regulation of apoptosis in HUVEC induced by high glucose. The apoptosis of HUVEC was tested by flow cytometry and TUNEL assay. Results High glucose could induce apoptosis of HUVEC. p65 protein expression of nuclear extracts was significantly increased in high glucose culture as compared to control group, but only slightly increased in NF-κB-specific knockdown group, which maintained at basal state. Compared with normal glucose group, the number of TUNEL-positive cells in high glucose group was significantly increased (25.81%±1.77% vs 8.20%±0.63%, P<0.05). The number of TUNEL-positive cells was decreased in 30.5 rmnol/L glucose plus Ad-1566 than that in 30.5 mmol/L glucose plus Ad-DEST (11.49%±0.92% vs 26.10%±0.98%, P<0.01). Flow cytometry and TUNEL assay showed that the apoptosis of human umbilical vein endothelial cells induced by high glucose was inhibited by the RNAi adenovirus. Conclusion High glucose induces apoptosis of HUVEC. Knockdown of NF-κB p65 may protect HUVEC from apoptosis by preventing high glucose-induced NF-κB nuclear translocation.