目的:探讨急性非ST段抬高型心肌梗死(ANSTEMI)患者血清S100钙结合蛋白A4(S100A4)、S100钙结合蛋白A12(S100A12)与经皮冠状动脉介入治疗(PCI)术后预后的关系.方法:选取2020年1月～2021年7月上海交通大学医学院附属瑞金医院急诊科收治的224例ANSTEMI患者为ANSTEMI组,PCI术后随访1年,根据预后情况分为预后不良组和预后良好组,另选取同期67名健康体检者为对照组.采用酶联免疫吸附法检测血清S100A4、S100A12水平.采用多因素Logistic回归分析ANSTEMI患者PCI术后预后不良的影响因素,采用受试者工作特征(ROC)曲线分析血清S100A4、S100A12水平对ANSTEMI患者PCI术后预后不良的预测价值.结果:ANSTEMI组血清S100A4、S100A12水平高于对照组(P＜0.05).随访1年,224例STEMI患者PCI术后预后不良发生率为16.07％(36/224).多因素Logistic回归分析显示,年龄偏大、KILLIP分级≥ Ⅱ级、S100A4、S100A12水平升高为ANSTEMI患者PCI术后预后不良的独立危险因素,左心室射血分数(LVEF)升高为其独立保护因素(P＜0.05).ROC曲线分析显示,血清S100A4、S100A12水平联合预测ANSTEMI患者PCI术后预后不良的曲线下面积(AUC)大于S100A4、S100A12单独预测.结论:血清S100A4、S100A12水平升高与ANSTEMI患者PCI术后预后不良密切相关,血清S100A4、S100A12水平联合预测ANSTEMI患者PCI术后预后不良的价值较高.

Survivors of intensive care unit (ICU) transfer to the common ward are often accompanied by psychological distress, negative emotions, fatigue, and sleep disturbances that affect recovery. Mindfulness-based stress reduction (MBSR) has achieved reliable results in improving physical and mental health. However, no clinical study has been conducted to evaluate the effects of MBSR on negative emotions, fatigue and sleep quality of patients who survived ICU and were transferred to general wards.This is a prospective randomized controlled trial (RCT) examining the effects of MBSR on negative emotions, fatigue, and sleep quality in inpatients transferred from ICU to general ward. Participants were randomly divided into the treatment group and the control group in a ratio of 1:1. On the basis of the same nursing plan and health education, the treatment group received MBSR therapy, while the control group received no other interventions, and all the patients were followed up for 3 months after 2 weeks of continuous treatment. The indicators included negative mood indicators [Self-rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)], fatigue index [Fatigue Severity Scale (FSS) and Brief Fatigue Inventory (BFI)], and sleep quality index [Pittsburgh Sleep Quality Index (PSQI)]. Finally, SPSS 20.0 software was used for statistical analysis of the data.This study will evaluate the effects of MBSR on negative emotions, fatigue, and sleep quality in hospitalized patients transferred from ICU to general ward. The results of this study will provide a reference for MBSR to improve psychological distress in ICU survivors transferred to general ward.This study protocol was registered in the Open Science Framework (OSF) (registration number: DOI 10.17605/OSF.IO/PD7SU).

Purpose:The spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a great threat to human health, especially in the intensive care unit. The aim of this study was to identify the origin and transmission route of a CRKP outbreak in an emergency intensive care unit (EICU), so as to provide prevention and control strategies for CRKP outbreak.Methods:Between Mar and Jun 2018, 10 CRKP isolates from 5 patients in the EICU ward of Shanghai Ruijin hospital north were collected. Modified carbapenem inactivation method (mCIM) and whole-genome sequencing (WGS) were performed on all 10 CRKP isolates. By integrating the genomic and epidemiological data of our isolates and 9 CRKP isolates from an outbreak in another hospital, a putative transmission map was constructed.Results:All 10 outbreak strains were carbapenemase positive in mCIM and belonged to the sequence type 11 (ST11) clone, harbored a set of resistance genes and virulence genes. The phylogenetic tree of CRKP isolates based on two outbreaks revealed that the initial isolate A1 in our EICU ward belonged to one branch of isolates in another hospital, this introductive isolate evolved and caused a subsequent outbreak in our EICU.Conclusion:Integration of genomic and epidemiological data can yield a clear transmission map of CRKP outbreak. Monitoring the rapid evolution of CRKP at the early stage of outbreak, CRKP monitoring after patients are discharged, active surveillance of newly admitted patients, environmental hygiene and efficient antibiotic treatment may be the key to prevent and control of CRKP outbreak.

Acute lung injury (ALI) is the injury of alveolar epithelial cells and capillary endothelial cells caused by various factors. Complement system and pyroptosis have been proved to be involved in ALI, and inhibition of C5a/C5a receptor (C5aR) could alleviate ALI. This study aimed to investigate whether C5a/C5aR inhibition could protect against LPS-induced ALI via mediating pyroptosis. Rats were assigned into four groups: Control, LPS, LPS+W-54011 1mg/kg, and LPS+W-54011 5mg/kg. Beas-2B cells pretreated with or without C5a and W-54011, alone and in combination, were challenged with LPS+ATP. Results unveiled that LPS caused lung tissue injury and inflammatory response, increased pyroptotic and apoptotic factors, along with elevated C5a concentration and C5aR expressions. However, W-54011 pretreatment alleviated lung damage and pulmonary edema, reduced inflammation and prevented cell pyroptosis. In vitro studies confirmed that LPS+ATP reduced cell viability, promoted cell death, generated inflammatory factors and promoted expressions of pyroptosis-related proteins, which could be prevented by W-54011 pretreatment while intensified by C5a pretreatment. The co-treatment of C5a and W-54011 could blunt the effects of C5a on LPS+ATP-induced cytotoxicity. In conclusion, inhibition of C5a/C5aR developed protective effects against LPS-induced ALI and the cytotoxicity of Beas-2B cells, and these effects may depend on blocking pyroptosis.

In order to explore the effective diagnosis method of gynecological acute abdomen, this paper takes hospital gynecological acute abdomen patients as samples and selects gynecological acute abdomen patients admitted to the hospital to be included in this study. They are divided into transabdominal ultrasound group, intracavitary ultrasound group, and combined group. Moreover, this paper uses mathematical statistics to carry out sample statistics. The statistical data mainly include ectopic pregnancy, torsion of ovarian tumor pedicle, acute suppurative salpingitis, torsion of fallopian tube, hemorrhagic salpingitis, acute pelvic inflammatory disease, rupture of corpus luteum cyst, and diagnosis accuracy rate. In addition, this paper compares the diagnostic accuracy of the abdominal ultrasound group, the intracavitary ultrasound group, and the combined group. The experimental research shows that the combined ultrasound diagnosis method can effectively improve the accuracy of the diagnosis of gynecological acute abdomen.

Background This study analyzed the epidemiological characteristics and trends of trauma injuries in Ruijin Hospital North, Shanghai, China, and the feasibility of methods to prevent trauma. Material/Methods In this retrospective cross-sectional study, the electronic databases of Ruijin Hospital North were searched for patients who experienced severe trauma from 2013 to 2016. Characteristics of severe trauma were analyzed, including trauma mechanism, gender, reasons for injury, and injury-associated causes of death. Results Of the 17,093 patients who experienced trauma during the study period, 11,165 (65.3%) were male and 5,928 (34.7%) were female. Analysis by age showed that the highest incidence of traumatic injuries was in subjects aged 25–34 years, whereas analysis by occupation showed the highest incidence of injury in migrant workers without higher education. Classification by Injury Severity Score (ISS) showed that 12,563 (73.5%) subjects had minor injuries, 4,273 (25.0%) had serious injuries, and 256 (1.5%) had severe injuries. In addition, 256 (1.5%) subjects died, with traffic accidents and falling injuries being the main causes of death. The incidence of injury peaked at 9–11 am and 2–4 pm and was significantly higher in autumn and winter than in spring and summer. Conclusions Most trauma patients were young adults. Injuries due to traffic accidents and falling were the main causes of death, with disregard of driving regulations and other health and safety regulations being the main cause of trauma. Trauma injuries may be prevented by strengthening education and by obeying traffic laws and construction site safety regulations.

目的 观察简易尿道口清洁对尿常规检测结果的影响.方法 选取2019年1-6月的996例体检中心健康体检人群,考虑男女尿道口生理差别,以简单随机法将男性619例分为观察组309例和对照组310例,女性377例分为观察组182例和对照组195例.观察组使用简易尿道口清洁后留取尿液标本,对照组使用常规方法留取尿液标本.均在体检中心护士指导下留取中段尿液标本后及时送检,观察尿液干化学及沉渣结果并进行统计学分析,结果男性观察组与对照组尿常规结果差异无统计学意义(P>0.05).女性观察组与对照组尿液pH、尿胆原、隐血、尿蛋白、尿糖、胆红素、酮体、亚硝酸盐,差异无统计学意义(P>0.05);尿比重、白细胞酯酶、白细胞计数、红细胞计数、细菌计数、管型计数,差异有统计学意义(P<0.05).结论 尿常规标本留取前,女性患者行简易尿道口清洁,能降低尿常规尿液样本污染,降低假阳性发生率,提高医护质量.男性患者尿道口简易清洁与否对降低尿常规检验结果影响不大.

目的:分析创伤患者流行病学特征,为预防创伤发生提供科学依据.方法:回顾分析2013年1月至2016年1月上海瑞金医院北院急诊外科收治的17093例创伤患者临床资料,包括创伤患者性别、年龄、学历、病情严重度、原因等.结果:17093例创伤患者中,男性11165例(65.32％),女性5928名(34.68％).25～34岁是创伤发病率最高年龄段.高中及以下学历的外来务工人员为创伤高发群体.在创伤患者中,轻症创伤患者12563名(73.50％),重症创伤患者4273名(25.0％),严重创伤患者256名(1.50％).死亡1179名(6.90％),24小时内死亡患者274例,占死亡患者78.38％.死亡主要原因是交通事故伤和坠落伤.在9～11时和14～16时出现两个发生创伤的高峰时段,秋季和冬季发生率较高.结论:低学历的外来务工者是创伤高发群体,交通事故伤和坠落伤是主要的死亡原因.

目的:探讨脑钠肽前体(pro-BNP)水平与急性脑梗死危险因素的关系.方法:检测并比较66名正常健康人与125例急性脑梗死患者发病后24 h内pro-BNP和C反应蛋白(CRP)水平.采用Pearson相关分析和多因素逐步回归分析pro-BNP水平与急性脑梗死常见危险因素的相关性.结果:与正常对照组相比,脑梗死组患者血pro-BNP和CRP水平显著升高[(48.72±13.44) ng/L比(267.03±131.83) ng/L,(4.14±5.27) mg/L比(30.96±24.53) mg/L,均P＜0.01].pro-BNP水平与脑梗死常见危险因素相关(P＜0.01).多因素逐步回归分析显示,pro-BNP水平随收缩压及CRP的增加而增加(偏回归系数分别为5.291和1.052,均P＜0.01).结论:pro-BNP水平与急性脑梗死患病显著相关,CRP和收缩压是影响pro-BNP水平的独立因素.

Objective To evaluate the effects of bisoprolol fumarate(Concor?)and atenolol on sympathetic nervous system’s activity(SNA)in essential hypertensive patients who had resting heart rate(RHR)≥70beats/min.Methods This was a randomized,parallel and controlled study(registered at the Clinicaltrial.Gov;NCT01251146).A total of177 hypertensive subjects were enrolled from outpatient clinics of RuiJin Hospital Affiliated to Shanghai Jiaotong University and Beijing Shijingshan Hospital from October 2010 to March 2012,and they were randomized to the treatment of bisoprolol fumarate(5.0,7.5,10mg/d,n=86)or atenolol(50,75,100mg/d,n=91)for 4-8weeks. RHR was measured by 12-lead electrocardiography with patient at supine position for 2 minmutes. To evaluate SNA,baroreflex sensitivity(BRS),heart rate variability(HRV)including the low-frequency(LF),high frequency(HF)and LF/HF ratio,and blood pressure variability(BPV)were measured by power spectral analyses using a Finometer,30 minutes were needed to collect these data. Results Eighty patients in bisoprolol fumarate group achieved target heart rate(RHR≤65beats/min),while 78 patients in atenolol group achieved target heart rate. In these patients,the distribution of different doses in bisoprolol fumarate group(5.0,7.5,10.0mg/d)was90.0%,8.8%,1.2%,respectively,and in atenolol group(50,75,100mg/d)was 92.3%,7.7%,0%,respectively. Compared with the baseline,24 hmean systolic and diastolic blood pressure,24 hmean arterial pressure,RHR and LF/HF ration were significantly reduced,while HF waa increased at the last visit(all P <0.05).Compared with the baseline,LF of HRV was significantly increased in patients from the bisoprolol fumarate group[(360.8±334.9)vs(261.8±208.4)ms2,P<0.05],while no significant change was observed for patients from the atenolol group. Compared with the baseline,the index of BRS of both groups was greatly improved after RHR control and in the last visit(all P<0.05). In patients from the bisoprolol group,no drug-related adverse events occurred,while 5events of 2patients from the atenolol group were drug-related. Conclusion Both bisoprolol fumarate and atenolol could effectively control BRS,RHR,HRV and inhibit the sympathetic nervous activity.

OBJECTIVE:β-blockers (BBs) with different pharmacological properties may have heterogeneous effects on sympathetic nervous activity (SNA) and central aortic pressure (CAP), which are independent cardiovascular factors for hypertension. Hence, we analyzed the effects of bisoprolol and atenolol on SNA and CAP in hypertensive patients. METHODS:This was a prospective, randomized, controlled study in 109 never-treated hypertensive subjects randomized to bisoprolol (5 mg) or atenolol (50 mg) for 4-8 weeks. SNA, baroreflex sensitivity (BRS) and heart rate (HR) variability (HRV) were measured using power spectral analysis using a Finometer. CAP and related parameters were determined using the SphygmoCor device (pulse wave analysis). RESULTS:Both drugs were similarly effective in reducing brachial BP. However, central systolic BP (-14±10 mm Hg vs -6±9 mm Hg; P<0.001) and aortic pulse pressure (-3±10 mm Hg vs +3±8 mm Hg; P<0.001) decreased more significantly with bisoprolol than with atenolol. The augmentation index at a HR of 75 bpm (AIxatHR75) was significantly decreased (29%±11% to 25%±12%; P = 0.026) in the bisoprolol group only. Furthermore, the change in BRS in the bisoprolol group (3.99±4.19 ms/mmHg) was higher than in the atenolol group (2.66±3.78 ms/mmHg), although not statistically significant (P>0.05). BRS was stable when RHR was controlled (RHR≤65 bpm), and the two treatments had similar effects on the low frequency/high frequency (HF) ratio and on HF. CONCLUSION:BBs seem to have different effects on arterial distensibility and compliance in hypertensive subjects. Compared with atenolol, bisoprolol may have a better effect on CAP. TRIAL REGISTRATION:ClinicalTrials.gov NCT01762436.