OBJECTIVE: To investigate the current status of pre-hospital and in-hospital emergency medical information connectivity in China and provide evidence for optimizing the emergency medical system. METHODS: A multi-center cross-sectional study was conducted using a multi-level convenience sampling method to select provincial-level administrative regions and their corresponding capital cities, prefectural cities, and county-level emergency medical institutions. The questionnaire included basic information about respondents, the institutions, the current status of pre-hospital and in-hospital emergency information connectivity, and the satisfaction with the connectivity. The questionnaire has undergone reliability testing and split-half reliability testing, supplemented by semi-structured interviews. Data collection was carried out from January to May 2024, with one responsible person from each institution completing the questionnaire. Multiple Logistic regression analysis to investigated the relevant factors of pre-hospital and in-hospital information connectivity. RESULTS: A total of 225 questionnaires were distributed, and 199 valid responses were collected, with a response rate of 88.4%. Participants were from 199 emergency medical institutions across 13 provincial-level administrative regions. Of the institutions, 112 (56.3%) could achieve pre-hospital and in-hospital information connectivity. The proportion of pre-hospital to in-hospital information connection between emergency institutions in different provinces varies (χ² = 39.398, P < 0.001), with Beijing and Zhejiang having the highest proportion of information connection (both at 100%), and Hainan having the lowest (11.8%). The proportion of information integration in county-level emergency institution was lower than that of provincial and municipal level emergency institutions [40.4% (19/47) vs. 61.7% (29/47), 61.0% (64/105), χ² = 6.304, P = 0.043]. Provinces with high per capita disposable income have a higher proportion of information connectivity than provinces with low per capita disposable income [77.3% (34/44) vs. 50.3% (78/155), χ² = 10.122, P = 0.001]. The information connection ratio of independent pre-hospital emergency centers was higher than that of hospital emergency departments/hospital records [74.6% (47/63) vs. 47.8% (65/136), χ² = 12.581, P < 0.001]. The proportion of information integration in advanced provinces with digital development was higher than that in other provinces [77.6% (38/49) vs. 49.3% (74/150), χ² = 11.849, P = 0.001]. Logistic regression analysis showed that the per capita disposable income of residents in the province was an independent risk factor for the information connection between pre-hospital and in-hospital emergency institutions [odds ratio (OR) = 3.21, 95% confidence interval was 1.56-6.62, P < 0.01]. 72.3% institutions used the information connection mode for less than 5 years. Telephone and WeChat were the main communication methods (83.0%), and 17.0% of emergency institutions use dedicated APP for communication. 52.7% of respondents were very or relatively satisfied with the information integration before and after the hospital. The main deficiencies in current information integration were insufficient, untimely, inaccurate communication and delayed feedback between pre-hospital and in-hospital information. Optimizing top-level design and improving network quality are the directions for improving the integration of pre-hospital and in-hospital information in the future. CONCLUSIONS Pre-hospital and in-hospital emergency information connectivity in some provinces in China remains underdeveloped, with significant regional and institutional disparities. Future efforts should focus on integrating digital technologies and strengthening grassroots-level connectivity systems.
Cross-Sectional Studies ; China ; Humans ; Surveys and Questionnaires ; Emergency Medical Services ; Emergency Service, Hospital ; Hospital Information Systems

Objective To investigate the association between the proportion of peripheral blood intermediate monocyte subset(Mon2)and prognosis in patients with acute myocardial infarction(AMI)receiving percutaneous coronary intervention(PCI).Methods A total of 100 AMI patients who underwent PCI between March 2021 and June 2022 were enrolled.Peripheral venous blood sam-ples were collected within 24 hours of onset in all patients,and monocyte subsets were analyzed using three-color flow cytometry.Patients were followed up for at least 1 year after discharge,and major ad-verse cardiovascular events(MACE)were recorded.Results The optimal cut-off point for predic-ting MACE occurrence 1 year after PCI in AMI patients based on the Mon2 proportion was 25.65％(area under the curve=0.758,95％CI,0.607 to 0.909,P=0.002),with a sensitivity of 64.3％and a specificity of 86.0％.Patients were divided into high Mon2 proportion group and low Mon2 proportion group according to the optimal cut-off value.There were significant differences in globu-lin,creatinine,fasting blood glucose,left ventricular end-systolic diameter,and Mon2 proportion between the two groups(P＜0.05).After adjusting for potential confounding factors using Cox re-gression,Mon2 proportion was found to be an important indicator for predicting poor prognosis after AMI.Kaplan-Meier survival analysis showed that the Mon2 proportion had a significant impact on the incidence of MACE in AMI patients with different risk stratifications.Conclusion Mon2 can improve the accuracy of predicting MACE after PCI,providing a new perspective for prognostic as-sessment in AMI patients.It is helpful for guiding clinical treatment decisions and improving patient prognosis.

Cardiovascular disease(CVD)is a major cause of human death and a serious threat to people's health.Therefore,it is very important to explore the early identification,diagnosis and effective treat-ment of CVD.The expression level of microRNA(miRNA)is related to many pathophysiological processes related to CVD,such as myocardial cell metabolism disorder,myocardial cell injury and myocardial fibrosis,which makes miRNA an important entry point for the diagnosis and treatment of CVD.MicroRNA-126(miR-126)is one of the most important biological markers in the miRNA family.It plays a role in protecting the myocardium by participating in angiogenesis,endothelial cell repair,and inhibition of inflammatory responses.This article reviewed the latest research progress on the mechanism,diagnostic significance and potential ther-apeutic value of miR-126 in the occurrence and development of various types of CVD.

Objective:To explore the risk factors of in hospital death in patients with acute circulatory failure, and to further construct the prediction model.Methods:This study retrospectively analysed clinical data of 224 shock patients admitted to Xinjiang Uygur Autonomous Region People’s Hospital from January 2014 to January 2023, and patients were eligible for shock diagnosis according to the expert consensus of emergency clinical practice in China for acute circulatory failure. Including age, gender, admission diagnosis and other basic information, as well as platelet, lactic acid, lymphocyte count, NK cell count, CD4, CD8 and other indicators completed within 24 hours of admission.They were divided into survival group and death group according to the condition at discharge.Variables with P<0.1 in the univariate analysis were included in the LASSO regression model to screen out the most important predictors of hospital death in ACF patients, and the prediction model was constructed by Logistic regression.The model differentiation was evaluated by receiver operator characteristic (ROC) curve and area under the curve (AUC). Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model. Finally, clinical decision curve analysis (DCA) was used to test the clinical benefit and application value of the model. Results:A total of 224 ACF patients, 113 survived and 111 died. The results of the univariate analysis showed statistically significant differences between the two groups in age, mental status, type of shock, respiratory rate, APACHE score, lymphocyte count, lactate, CD4, CD8 and qsofa ( P<0.05).The Logistic regression prediction model was constructed according to the 4 predictors and outcome variables selected by LASSO method,in which increased delirium, coma, respiratory rate and APACHE score were risk factors and increased CD4 was a protective factor.The above indicators were used to construct a line graph model for predicting in-hospital death in ACF patients, with a probability cut-off value of 0.4404 for predicting in-hospital death, corresponding to a total line graph score of approximately 136.This model had an AUC of 0.830 (0.764-0.895), a sensitivity of 81.25% and a specificity of 68.83%.The Hosmer-Lemshow test for the modelling set showed χ 2=712 and P=0.624, suggesting good accuracy of the model predictions.The assessment of the DCA analysis showed that the net benefit of the model was significantly higher than the two extreme conditions and had good clinical applicability. Conclusions:Mental status, respiratory rate, APACHE score as risk factors for in-hospital mortality in patients with acute circulatory failure and CD4 as a protective factor. The predictive model constructed from this may predict the risk of in-hospital death in patients and has certain clinical application value.

Objective To investigate the molecular mechanism of miR-126-EPC-MPs in ameliorating oxygen glucose deprivation/reoxygenation (OGD/R) injury in cardiomyocytes.Methods The cardiomyocytes were used to establish the control and OGD/R injury models,and EPC-MPs and miR-126 mimic EPC-MPs treatments were administered respectively.The structural changes in cardiomyocyte organelles were assessed by transmission electron microscopy.ELISA was used to detect the expression levels of IL-6,TNF-α and HMGB-1 in cardiomyocytes.The protein and mRNA expression levels of Ang Ⅱ,caspase-6,eNOS,FOXO1,MPO,NF-κB,ERK1,LKB1,SIRT1,GRP78,GM130 and PGC-1α in cardiomyocytes after different treatments were detected by Western blot and quantitative PCR.Results The mitochondria structure in some cardiomyo-cytes of the OGD/R+miR-126 mimic EPC-MPs group was complete,the size of some mitochondria was in-creased,the surface of the endoplasmic reticulum had fewer ribosomes,and some of the Golgi vesicles gath-ered.Compared with the OGD/R+EPC-MPs group,the expression levels of IL-6,TNF-α and HMGB-1 in the OGD/R+miR-126 mimic EPC-MPs group were down-regulated.Compared with the OGD/R+EPC-MPs group,the expression levels of Ang Ⅱ,caspase-6,p-ERK1/2 and GRP78 protein in the OGD/R+miR-126 mimic EPC-MPs group were down-regulated,and the expression levels of p-LKB1,GM130 and PGC-1α protein in the OGD/R+miR-126 mimic EPC-MPs group were up-regulated.The quantitative PCR(qPCR) results showed that compared with the OGD/R+EPC-MPs group,the expression levels of Ang Ⅱ,MPO and GRP78 in the OGD/R+miR-126 mimic EPC-MPs group were down-regulated,and the expression levels of eNOS,GM130 and PGC-1α were up-regulated.Conclusion When OGD/R injury occurs in cardiomyocytes,miR-126 mimic EPC-MPs regulates PGC-1α/GM130 expression and inhibits Ang Ⅱ-induced stress injury response,thereby reduces the OGD/R damage in cardiomyocytes.

Objective To study the diagnostic value of miR-126 and ICAM-1 in peripheral blood endo-thelial microparticles(EMPs)of the patients with acute myocardial infarction(AMI).Methods A total of 45 patients with definitely diagnosed AMI in this hospital from September 2021 to June 2022 were selected as the AMI group.Other 45 healthy subjects in the same age group and sex were selected as the control group.Be-fore coronary angiography,the patient's peripheral blood was collected,and the flow cytometry was used to conduct the qualitative and quantitative analysis on EMPs.The expression levels of miR-126 and ICAM-1 in EMPs were determined by using fluorogenic quantitative PCR and ELISA.The receiver operating characteristic(ROC)curve was adopted to evaluate the diagnostic value of the related indicators for AMI.Results There was no statistically significant difference in the general data such as age,gender and BMI between the two groups(P＞0.05).The biochemical indicators such as PLT,BUN,TC,TG and HDL-C had no statistical difference between the two groups(P＞0.05).The expression level of miR-126 in the AMI group was significantly lower than that in the control group,the expression level of ICAM-1 in the AMI group was higher than that in the control group,and the differences were not statistically significant(P＜0.05).The miR-126 expression level in the AMI group was lower than that in the control group,the ICAM expression level was higher than that in the control group,and the differences were statistically significant(P＜0.05).The multivariate logistic regression results showed that miR-126,ICAM-1 and CK-MB had the independent correlation with the AMI occurrence(P＜0.05).The area under the curve(AUC)of mir-126 for diagnosing AMI was 0.813(95％CI:0.725-0.903,P＜0.001),which of ICAM-1 was 0.848(95％CI:0.764-0.933,P＜0.001),and which of miR-126 and ICAM-1 combination diagnosis was 0.922(95％CI:0.870-0.946,P＜0.001).Conclusion The miR-126 and ICAM-1 expression levels in EMPs have the independent correlation with AMI,and the both have the di-agnostic value for AMI.

Objective To investigate the effects of endothelial progenitor cells(EPC)-derived microp-articles(MPs)with different injury treatments on EPC.Methods EPC cells were cultured and EPCs were i-dentified by flow cytometry.EPCs were treated with high glucose(HG)and tumor necrosis factor(TNF)-a recombinant protein,and MPs were extracted.The structural changes of microtubules,Golgi bodies and other organelles in EPC were observed by transmission electron microscopy.MTT assay was used to detect cell pro-liferation.Cell scratch assay was used to evaluate cell migration ability.Cell lumen formation assay was used to detect lumen formation.The expression levels of endothelial nitric oxide synthase(eNOS),silent informa-tion regulator 1(SIRT1),rat sarcoma(RAS)and extracellular regulated protein kinase(ERK)in EPC after different treatments were detected by quantitative real-time fluorescence PCR(qPCR)and Western blot.Re-sults Compared with the control-EPC-MPs group,the microtubule structure of the HG-EPC-MPs group and the TNF-α-EPC-MPs group was complete,the length was shortened,and the Golgi structure was relatively complete.Compared with the control-EPC-MPs group,the proliferation rate of EPC in the HG-EPC-MPs group and the TNF-α-EPC-MPs group was down-regulated,the cell migration ability was decreased,and the tube formation was decreased(P＜0.05).Compared with the control-EPC-MPs group,the mRNA and protein expressions of eNOS,SIRT1,RAS and ERK in the HG-EPC-MPs group and the TNF-α-EPC-MPs group were down-regula-ted(P＜0.05).Conclusion HG and TNF-α mediated MPs derived from EPC injury may change the structure of organelles in EPC by regulating the expression of SIRT1/ERK1 pathway proteins,thus affecting the biolog-ical function of EPC.

Objective To study the correlation between smoking and levels of endothelial microparticles(EMPs)in patients with acute myocardial infarction(AMI).Methods A total of 74 patients with AMI who were admittedto Xinjiang Uighur Autonomous Region People's Hospital from January 2020 to December 2020 were selected to be included in AMI group,and 72 patients with non-AMI chest tightness/pain were included in the non-AMI group.The general information of the patients in the two groups was collected,and the pe-ripheral venous bloodof the two groups was extracted.The EMPs levels and other clinical biochemical indexes were detected by flow cytometry.Results The proportion of males,WBC,proportion of smokers,and EMPslevel in patients in the AMI group were higher than those in the non-AMI group,and the difference was statistically significant(P＜0.05).The results of univariate logistic analysis showed that gender,WBC,EMPs,and smoking were risk factors for the development of AMI,and the difference was statistically signifi-cant(P＜0.05).Further multifactorial logistic regression results showed that high levels of elevated EMPs and smoking were independently associated with the occurrence of AMI.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of EMPs in predicting AMI,and the area under the curve(AUC)between EMPs and AMI was 0.877(95％CI:0.824-0.929,P＜0.001).Logistic regression with EMPs as the dependent variable showed that low high-density lipoprotein(HDL)levels and smoking were independent risk factors for increased levels of EMPs.Conclusion High levels of EMPs and smoking were in-dependently associated with the development of AMI,and smoking-induced release of EMPs may be one of the reasons why patients are more likely to develop AMI.

Along with the further aging of Chinese population, the number of elderly patients with heart failure is mounting rapidly, while hemodynamic monitoring plays an important role in the treatment of elderly patients with complex hemodynamic states and multiple diseases. Pulse indicated continuous cardiac output (PICCO) can quickly, effectively, continuously and safely perform hemodynamic monitoring and guide precise treatment, which is of great practical significance for improving the quality of life, prognosis and prolonging the effective life time of elderly patients with heart failure. This article reviews the characteristics of senile heart failure, the clinical application, safety and characteristics of PICCO.

Objective To investigate the the level of red blood cell microparticls in patients with acute coronary syndromes and the correlation with severity of coronary artery disease and with its influencing factors.Methods A total of 140 patients were sdected into our study from Jun 2016 to Feb 2017.All patiens were identified through coronary angiography.There were 108 patients with acute coronary syndromes (ACS) mentioned as experimental group,which including 25 patients with single vessel disease,27 patients with double vessel disease,27 patients with triple vessel disease and 29 cases of multi-vessel disease,and 32 patients of non-coronary heart disease group mentioned as control group.Each patient was fasting and drawn the periheral venous blood after the next day of hospitalized then analyzing blood lipids,blood routine and biochemical indicators.The expression of CD235a in erythrocyte derived microparticles was quantitatively analyzed by flow cytometry.The Gensini score was calculated based on the Results of coronary angiography.Results Compared with the non-CHD group,the levels of red blood cells microparticles (44.37％ ± 15.48％),low density lipoprotein cholesterol (3.18 ± 1.16mg/L),lipoprotein a (215.23 ± 183.10mg/L) and high sensitivity C Protein (19.58 ± 26.94mg/L) were significantly increased,and the difference was statistically significant (P ＜ 0.05).The levels of erythrocyte microparticles and low-density lipoprotein cholesterol in the subgroups of acute coronary syndromes were statistically significant (P ＜ 0.05),with erythrocyte microparticles levels and low-density lipoprotein cholesterol levels (P ＜ 0.05).There was a positive correlation between Gensini score and erythrocyte drived microparticls (β =2.157,P ＜ 0.05),and negatively correlated with high density lipoprotein (β =-15.579,P ＜ 0.05).Conclusion The level of Gensini scores were calculated based on the results of coronary angiography.That in patients with acute coronary syndrome is significantly higher than that in patients with non-coronary heart disease.The level of erythrocyte derived microparticls is closely related to the severity of coronary artery disease.The level of erythrocyte derived microparticls has a high value in predicting the severity of coronary artery disease in acute coronary syndromes.