Objective To investigate the differences in clinical symptoms and risk factors between non-elderly and elderly patients with acute pulmonary thromboembolism(PTE).Methods Totally141 patients with acute PTE and 100 sex and age-matched healthy controls were enrolled in the study.The final diagnosis was confirmed by CT pulmonary angiography (CTPA) and/or pulmonary angiography and/or pulmonary perfusion imaging as well as medical history.The patients with acute PTE were divided into two groups according age:elderly group (n=78,age≥60 years),young group (n =63,age ＜ 60 years).Multivariate Logistic regression analysis was performed to identify independent risk factors of PTE and to confirm the risk of each factor.Results The morbidity rate of dyspnea,cough,chest distress and chest pain were 88.5％ (69 cases),76.9％ (60 cases),56.4％ (44 cases),15.4％ (12 cases) in elderly group,which was similar to 84.1％ (53 cases),69.8％ (44 cases),63.5％ (40 cases),25.4％ (16 cases) in young group (all P＞0.05)； while the morbidity rate of hemoptysis in elderly group [9.0％ (7 cases)] was lower than in young group [23.8％(15 cases)](P＜0.05).9％ (7 cases) in elderly patients without any symptoms were more than 1.6％ (1 cases) in young patients,but no significant differene (P＞0.05).There were more risk factors in the elderly group accompanying with diabetes (x2 =7.41,P ＜ 0.01),hypertension (x2 =14.51,P＜ 0.01),chronic obstructive pulmonary diseases (COPD) (x2 =7.42,P＜0.01) and previous stroke (x2 =4.91,P＜0.05)compared with young group.Independent risk factors for elderly acute PTE included COPD (OR:3.29,95％CI:1.04-10.46),previous deep veneus thrombosis(DVT) (OR:4.72,95％CI:1.68-13.27),cancers (OR:4.35,95％CI:1.00-18.13) and previous stroke (OR:5.13,95％CI:1.15-24.52).Independent risk factors for non-elderly PTE included previous DVT (OR:11.94,95％ CI:3.35-42.60)and cancers (OR:11.44,95％CI:1.44-89.92).Conclusions Much attention should be paid to the identification of diagnosis of acute PTE depending on the non-specific clinical features,although dyspnea may be the most frequency symptoms,but unexplained cough and chest distress should be alert for PTE.COPD,cancer,DVT and previous stroke are independent and important risk factors for elderly acute PTE.

Objective To investigate the role of oxidized low-density lipoprotein (oxLDL) and lectin-like oxidized low-density lipoprotein receptor-1 (LOX-I) in pre-ecalmpsia. Methods From June 2007 to January 2008,73 women with pre-eelampsia who delivered in the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College,were recruited, including 35 women with mild pre-eclampsia (MPE group) and 38 women with severe pre-eclampsia(SPE group). And 45 healthy pregnant women were taken as control group. Enzyme-linked immunosorbent assay (ELISA) was used to measure the plasma concentrations of oxLDL in these women. Semiquantitative RT-PCR and Western blot were used to investigate the expression of LOX-1 mRNA and protein in placenta. The expression of caspase-3 mRNA in placenta was determined using Semiquantitative RT-PCR. Results (1) The plasma concentrations of oxLDL in MPE group ( 0.42 ± 0.11 ) mg/L, SPE group ( 0.68 ± 0.12 ) mg/L, were significantly higher compared with control group (0.35 ± 0.14 )mg/L( P < 0.01 ) and the concentrations of oxLDL in MPE group were significantly higher compared with SPE group (P<0.01 ). (2) The expression of LOX-1 mRNA in placenta of MPE group(0.70 ±0.10) and SPE group(0.84 ±0.08) were significantly higher than that in control group(0.58 ± 0.11 ) ( P<0.01 ) and the expression of LOX-1 mRNA in MPE group was significantly higher than that of SPE group (P<0.01 ). (3) The expression of LOX-1 protein in placenta of MPE group (0.79±0.15 )and SPE group(0.90±0.12) were significantly higher compared with control group(0.68 ±0.11)( P<0.01 ), while the expression of LOX-1 protein of MPE group was significantly higher compared with SPE group (P <0.01 ). (4) The expression of caspase-3 mRNA in placenta of MPE group(3.82± 0.18) and SPE group(5.39±0.14) were significantly higher than that in control group(2.19±0.20) (P <0.01 ), and the expression of caspase-3 mRNA in MPE group was significantly higher than that of SPE group (P<0.01 ). (5) In pre-eclampsia groups, the levels of LOX-1 mRNA in placenta were positively correlated with the plasma concentrations of ox LDL ( r=0.93, P<0.05 ), and caspase-3 mRNA expression were positively correlated with the expression of LOX-1 mRNA in placenta( r=0.84, P<0.05). Conclusion Increased levels of oxLDL in plasma may induce excess expression of LOX-1 in placenta, which may be involved in the pathophysiological processes of pre-eclampsia.

Objective This case report describes the treatment of a patient with J-wave syndrome who experienced two cardiac arrests and discusses the potential role of mild hypothermia in cardiopulmonary and cerebral resuscitation.Methods A patient with J-wave syndrome was admitted to the department of emergency of Qingpu Branch of Zhongshan Hospital Affiliated with Fudan University.During the treatment,mild hypothermia was adopted for brain protection.The patient suffered cardiac arrest again in the hospital.After continuous cardiopulmonary resuscitation(CPR)for 230 minutes under mild hypothermia,sinus rhythm was restored.By sharing the diagnostic approach and treatment process,valuable insights can be gained to improve patient outcomes in similar cases.Results A 17-year-old female patient was admitted to department of emergency of Qingpu Branch of Zhongshan Hospital Affiliated with Fudan University on September 30,2021 due to sudden loss of consciousness for 30 minutes after running.She fainted 3 times in the past after excise and nervousness.CPR was performed immediately after the syncope,and an ambulance arrived at the scene 10 minutes later,and electrical defibrillation and tracheal intubation mechanical ventilation were conducted.When admitted to the intensive care unit(ICU),the patient continued to have tetanic convulsions.To manage these symptoms,the medical team administered sedation and anti-epileptic treatment while focusing on maintaining internal environment stability.Additionally,mild hypothermia treatment was initiated,controlling the patient's core body temperature at 34-36℃.With these interventions,the tetanic convulsions gradually subsided during the night.At 11:40 on October 1,the electrocardiogram(ECG)monitoring indicated ventricular fibrillation,and immediate rescue efforts such as CPR,electrical defibrillation,and blood pressure elevation were given.Due to recurrent ventricular fibrillation,the patient underwent repeated shock defibrillation and chest compressions with the CPR machine.Antiarrhythmic lidocaine was administered,and epinephrine and isoproterenol were administered to maintain the heart rate above 90 bpm.At around 15:30,the heart rate stabilized and blood pressure gradually improved.After successful resuscitation,mild hypothermia and other brain protection treatment were continued.On October 4,the mind was cleared,the muscle strength was restored to normal and the tracheal intubation was removed on October 6.Holter electrocardiogram examination indicated V1-V3 ST-segment elevation,combined with the patient's history of repeated syncope,previous electrocardiogram indicated early repolarization,considering the possibility of J-wave syndrome and Brugada syndrome,the patient was discharged after implantable cardioverter defibrillator(ICD)installation.Conclusions In this case,the patient was successfully resuscitated after two cardiac arrests.Among them,CPR after cardiac arrest in hospital was successfully performed for a long time under mild hypothermia without any neurological sequelae.The treatment experience provided a reference for clinical cardiopulmonary and brain resuscitation.