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 investigate the correlation analysis of serum autotaxin(ATX),tenascin-C(TN-C)and ventricular remodeling indexes in elderly patients with dilated cardiomyopathy(DCM)with heart fail-ure(HF)and their effects on prognosis.Methods 153 elderly patients with DCM with HF who were admit-ted to the 904th Hospital of the Joint Logistic Support Force from January 2020 to January 2022 were selected as DCM with HF group,and 100 elderly patients with simple DCM in the same hospital during the same peri-od were selected as DCM group and 100 healthy elderly individuals who underwent physical examination were selectedas control group.Serum ATX and TN-C levels were detected by enzyme-linked immunosorbent assay,and ventricular remodeling indexes[left ventricular end-diastolic diameter(LVEDD),left ventricular end-sys-tolic diameter(LVESD),and left ventricular ejection fraction(LVEF)]were detected by echocardiography.The correlation between serum ATX,TN-C levels and ventricular remodeling indexes in elderly patients with DCM with HF were analyzed by Pearson correlation analysis.Elderly patients with DCM with HF were fol-lowed up for 1 year,patients were divided into poor prognosis group and good prognosis group according to the prognosis.The influencing factors of poor prognosis in elderly patients with DCM with HF were analyzed by univariate and multivariate logistic regression analysis,the predictive value of serum ATX and TN-C levels for poor prognosis in elderly patients with DCM with HF was analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of ATX and TN-C in DCM combined HF group were higher than those in DCM group and control group,and the difference was statistically significant(P＜0.05).Serum ATX and TN-C levels in DCM group were higher than those in control group,and the difference was statistically significant(P＜0.05).LVEDD and LVESD in DCM with HF group were higher than those in DCM group and control group,and LVEF was lower than those in DCM group and control group,the difference was statis-tically significant(P＜0.05).Pearson correlation analysis showed that serum ATX and TNC levels in elderly patients with DCM with HF were positively correlated with LVEDD and LVESD,and negatively correlated with LVEF(P＜0.05).Univariate analysis showed that HF disease course,NYHA cardiac function grade,NT-proBNP,ATX and TN-C were the influential factors for poor prognosis in elderly patients with DCM with HF(P＜0.05).Multivariate Logistic regression analysis showed that the independent risk factors for poor prognosis in elderly patients with DCM with HF were NYHA cardiac function grade≥Ⅲ and the increase of NT-proBNP,ATX and TN-C(P＜0.05).ROC curve analysis showed that the area under the curve and 95％CI of serum ATX and TNC alone and combined for poor prognosis in elderly patients with DCM with HF were 0.743(0.576-0.911),0.721(0.551-0.911)and 0.808(0.690-0.912),respectively.Conclusion The elevated levels of serum ATX and TN-C in elderly patients with DCM with HF may be relat-ed to ventricular remodeling and poor prognosis,and have certain predictive value for the prognosis of elderly patients with DCM with HF.

This article reported a case of kaposiform lymphangiomatosis (KLA) identified in the fetal stage and diagnosed at the neonatal stage. A routine ultrasound examination at 19 weeks of gestation showed multiple masses in the whole body of the fetus (involving neck, chest wall and armpit) complicated by pleural and peritoneal effusion. Shunting was performed to drain pleural effusion from the right chest in another hospital at 26 +5 weeks of gestation. The patient was born at 34 +3 weeks of gestation by cesarean section due to "intrauterine distress" and required invasive ventilator assisted ventilation support after birth because of respiratory distress. A large amount of hemorrhagic effusion was drained out during the shunting. Coagulation dysfunction and thrombocytopenia occurred on the 3rd day after birth and KLA was suspected. Empirical treatment with sirolimus turned out to be ineffective. Biopsy was taken on postnatal day 7. However, the patient died on the 12th day after birth due to respiratory and circulatory failure. Pathological findings obtained the day after death were consistent with the features of KLA. The diagnosis of KLA was confirmed based on the clinical manifestations and pathological results.

Objective:To explore the complications and nutritional outcomes of Home Enteral Nutritional (HEN) in newborn surgical patients.Method:The medical records of neonates with HEN after surgery between 2017 and 2020 were retrospectively reviewed and complications of HEN and the nutritional status before and after HEN were analyzed.Results:A total of 66 neonates were included. The average gestational age at delivery and birth weight were (35.7 ± 3.0) weeks and (2426 ± 709) g, respectively. Diagnoses were mainly congenital esophageal atresia and intestinal diseases, such as intestinal atresia, intestinal torsion and necrotizing enterocolitis. The median age at HEN initiation was 92 (50, 112) days and HEN duration was 64 (41,95) days. HEN was conducted with tube feeding, with 14 patients (21.2%) through gastrostomy, 52 (78.8%) through nasal feeding tube, 20 (30.3%) through intermittent bolus infusion and 46 (69.7%) through continuous infusion. As for the formulas, 19 patients (28.8%) were given whole protein formula, 33 (50%) extensively hydrolyzed formula and 14 (21.2%) free amino acid-based formula. During the follow-up, 10 patients (71.4%) in gastrostomy group experienced 18 cases of catheter-related complications, including accidental removal (6 patients, 42.8%), catheter displacement (4 patients, 18.6%) and excessive granulation tissue at the gastrostomy site (4 patients, 18.6%). In nasal tube feeding group, 14 patients (26.9%) experienced 21 cases of catheter-related complications, including accidental tube removal (19 cases in 12 patients, 23.1%) and tube breakage (2 patients, 3.8%). Both the weight for age Z score and the height for age Z score were improved after HEN.Conclusions:HEN can help to improve the nutrition status in postoperative neonates. Management of catheter-related complications is challenging and warrants team work to improve the outcome of HEN.

This article reported a case of neonatal CHARGE syndrome complicated by congenital esophageal atresia. A prenatal ultrasound examination at 30 weeks of gestation revealed polyhydramnios and a small magenblase of the fetus, then fetal MRI suggested congenital esophageal atresia. The infant was born with severe asphyxia at 37 +5 gestational weeks by cesarean section due to placental abruption with a birth weight of 2 310 g. Gastric tube could not be placed after resuscitation. Congenital esophageal atresia complicated by tracheoesophageal fistula was diagnosed by esophageal imaging. Bilateral choanal atresia was detected by electronic nasopharyngoscopy and MRI. Moreover, skull defect, suspected meningocele were also observed. CHARGE syndrome was confirmed by whole exome sequencing, revealing a frameshift deletion of c.2155delA (p.Thr719GlnfsTer9) in the CHD7 gene. The infant died after withdrawing treatment.

Objective:To study the incidences of postoperative complications and nutritional status following different timings of stoma reversal in necrotizing enterocolitis (NEC).Method:From January 2017 to December 2019, NEC patients receiving enterostomy surgery and later stoma reversal in our hospital were retrospectively analyzed. They were assigned into three groups according to the timing of stoma reversal: early group (reversal within 8 weeks of stoma formation), middle group (reversal at 8~12 weeks from stoma formation) and late group (reversal after 12 weeks from stoma formation). Weight-for-age-Z-score (WAZ) was used to evaluate nutritional status.Result:A total of 56 infants were enrolled, including 6 cases in the early group, 11 cases in the middle group, and 39 cases in the late group. The gestational age and birth weight were (33.4±3.4) weeks and (1 894±640) g, respectively. The median age of stoma formation and the interval between stoma formation and reversal were 16.5 (8.0, 28.2) days and 94.0 (76.5, 126.5) days. No significant differences existed on gestational age, birth weight, age of stoma formation and complications of stoma reversal among the three groups ( P>0.05). The incidence of growth retardation (WAZ<-2) was 14.3% at stoma formation, and significantly increased to 62.5% at stoma reversal ( P<0.05). The WAZ at stoma reversal in early, middle and late groups were (-3.2±1.9), (-3.0±1.6) and (-2.3±1.5), without significant differences( P>0.05). The WAZ gradually increased to (-0.7±1.2), (-0.1±2.0) and (-0.1±0.8) at 42~48 weeks after reversal, respectively. Conclusion:The timing of stoma reversal may not influence the complications of reversal. Growth retardation are common in NEC infants with stoma formation and stoma reversal may improve the nutritional status of the infants. Early reversal of stoma is suggested to improve the nutritional status of patients with poor weight gain after stoma formation.

Objective To compare the prognosis of different surgical procedures and to find the relatively safe and effective treatment for severe jejunoileal atresia(sJA).Method From January 2007 to June 2018,children with sJA receiving different surgical procedures in our hospital were retrospectively reviewed.Their clinical data were analyzed,including the survival rate,complication rate,unplanned re-operation rate and postoperative nutritional status.Result A total of 130 patients were enrolled in this study.According to the different types of surgical procedures,the patients were assigned into primary anastomosis group (58 cases,44.6％),Mikulicz double barrel ileostomy group (17 cases,13.1％) and Bishop-Koop anastomosis group (55 cases,42.3％).The overall mortality rate was 6.2％ (8/130).No significant differences existed in mortality rates among the three groups (P＞0.05).The incidences of gastrointestinal complications in primary anastomosis group (70.6％,12/17) and Mikulicz group (70.6％,12/17) were both higher Bishop-Koop group (34.5％,19/55),the differences were statistically significant (P＜0.05).The unplanned re-operation rates were 34.5％ (20/58) in the primary anastomosis group and 17.6％ (3/17) in the Mikulicz group,both higher than the Bishop-Koop group (3.6％,2/55),the differences were also statistically significant (P＜0.05).Multivariate analysis showed that the risk of complications in the primary anastomosis group (OR=3.434,95％CI 1.392～8.471) and Mikulicz group (OR=5.933,95％CI 1.467～23.991) were higher than the Bishop-Koop group.The risk of unplanned re-operation in the primary anastomosis group was 12.422 times as the Bishop-Koop group (95％CI 2.535～60.877).No significant differences existed between the Mikulicz group and the Bishop-Koop group in the risk of unplanned re-operation (P＞0.05).The weight for age (Z-score) in the Bishop-Koop group (-1.4,95％CI-2.0～-0.8) at the stoma closure time was better than the Mikulicz group (-3.2,95％CI-4.4～-2.0),the difference was statistically significant (P＜0.01).Conclusion Bishop-Koop anastomosis has lower complication rate and lower unplanned re-operation rate in the treatment of sJA.The nutritional status of children who received Bishop-Koop anastomosis is better than Mikulicz double barrel ileostomy at the stoma closure time.Bishop-Koop anastomosis is relatively safe and effective for sJA patients.

Objective To study the nutritional status and risk factors in neonates receiving enterostomy.Method From January 2015 to July 2017,patients who had enterostomy during neonatal period and had the stoma closed in our hospital were retrospectively studied.Z score (weight-for-age) was used to evaluate their nutritional status.The patients were divided into two groups according to the nutritional status when the stoma closed:the malnutrition group and the normal nutrition group.The differences in gender,premature birth,low birth weight,primary disease,ostomy methods,length of proximal small intestine and high output diarrhea through stoma were compared between the two groups.Multivariate Logistic regression analysis was used to determine the risk factors of malnutrition at the closure of the stoma.Result A total of 75 infants with various primary diseases were included.Among them,23 patients were diagnosed with neonatal necrotizing enterocolitis,27 patients jejunoileal atresia,5 patients meconium ileus,15 patients meconium peritonitis and 5 patients Hirschsprung's disease.The median age of enterostomy was 3 (2,8) days,and the median hospital stay after enterostomy was 26 (20,40) days.The median age of stoma closure was 6.0 (5.0,8.5) months.The median Z score at discharge and stoma closure were -1.6 (-2.9,-0.9) and-1.5 (-2.6,-0.5) respectively.No statistically significant differences existed between the two groups (P ＞ 0.05).28 infants (37.3％) were malnutrition when the stoma was closed.The incidence of low birth weight and high output diarrhea through stoma in malnutrition group were significantly higher than the normal nutrition group (35.7％ vs.10.6％,32.1％ vs.10.6％,P ＜0.05).No significant differences in gender,premature birth rate,primary disease,ostomy method and length of proximal intestine between the two groups (P ＞ 0.05).Multivariate Logistic regression analysis indicated that low birth weight,high output diarrhea and jejunoileal atresia were risk factors for malnutrition.Conclusion Malnutrition is common in neonates after enterostomy,and the risk factors for malnutrition are low birth weight,high output diarrhea through stoma and the primary disease jejunoileal atresia.

Objective To observe and study the influence degree of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus. Methods A total of 64 patients with diabetes mellitus from January 2015 to March 2016 were selected and divided into two groups by the method of random number table,32 patients in control group were taken care with routine nursing of diabetes mellitus,32 patients in observation group were taken care with strengthen training for family members,then the treatment compliance,related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention and at 4th, 8th and 12th week after the intervention were compared. Results The treatment compliance, related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention all had no obvious differences (all P>0.05). The treatment compliance at 4th, 8th and 12th week after intervention were (6.26 ± 0.32), (6.95 ± 0.36), (7.28 ± 0.40) scores in observation group, and (5.23 ± 0.29), (6.01 ± 0.30), (6.30 ± 0.33) scores in control group, and the differences were significant (t=8.253, 9.201, 10.257, all P<0.05). The related knowledge cognition of unhealthy lifestyle at 4th, 8th and 12th week after intervention were (80.78±5.90), (89.44±6.02), (93.43±6.20) scores in observation group, and (73.38± 5.73), (77.93±5.84), (82.20±6.01) scores in control group, and the differences were significant (t=11.258,12.563, 13.324, all P<0.05 ). The unhealthy lifestyle situation at 4th, 8th and 12th week after intervention were 75.00%(24/32), 90.63%(29/32), 96.88%(31/32) in observation group, and 59.38%(19/32), 68.75%(22/32),78.13%(25/32) in control group, and the differences were significant (χ2=7.251, 7.468, 9.169, all P<0.05). Conclusions The influence of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus are more active, so the value of strengthen training for family members of patients with diabetes mellitus is higher.

Objective To evaluate combined effect on different population through 2 459 data of SAA,hs-CRP and PCT from 8 three-level hospitals in Guangdong region.Methods Subjects were divided into five groups by ages,and every group had bacterial and virus type.In order to confirm diagnostic effect on infection,methods were performed including in tendency of SAA and hs-CRP,Paired t test between bacterial and virus group,efficiency of 3 indexes in judging infection depending on ROC and parameters,multiple logistic regression,consistency between positive bacterial infection and bacterial culture.Re-sults There were statistically significant differences in SAA and hs-CRP between bacterial and virus in infants and children (P <0.001).SAA had the biggest AUC area 0.824 with sensibility 71.8% and specificity 82.6% in younger group.Corre-sponding,hs-CRP had the biggest area 0.806 with sensibility 84%.There was the accuracy of 78.8% for differential diagno-sis in younger group,while 65.1% in elder group.AUC of SAA was 0.883 for positive bacterial culture with sensibility 71.2% and specificity 90.7%,accuracy of 95.2% for differential diagnosis.Conclusion There was obvious trend of age in SAA and hs-CRP,3 indexes could be used for differential diagnosis alone or combined,especially in younger group.SAA is the best index as a separated index.There is less value at ratio of SAA and hs-CRP.