Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:To analyze the correlation between serum glycated hemoglobin (HbA 1c), γ-glutamyltranspeptidase(γ-GT) and intercellular adhesion factor-1 (ICAM-1) levels and cognitive impairment in elderly patients with hyperlipidemia complicated with cardiovascular disease. Methods:In this retrospective cohort study, 158 elderly patients who underwent examination and were diagnosed with hyperlipidemia complicated with cardiovascular disease at Beijing Anzhen Hospital Affiliated with Capital Medical University from January to December 2022 were selected as study subjects. The simple mental state scale (MMSE) was assessed in the subjects in combination with the subject′s level of education. Illiteracy≤17 points, primary school≤20 points, middle school and above≤24 points were classified as cognitive impairment group (67 cases), the rest were were classified into the non-cognitive impairment group (91 cases); and another 50 healthy elderly people who received physical examination in the same period were selected as the control group. The blood samples in the three groups were extracted to measure serum HbA 1c, γ-GT and ICAM-1. The correlation between HbA 1c, γ-GT and ICAM-1 levels with cognitive impairment were analyzed. Results:The serum levels of HbA 1c, γ-GT and ICAM-1 in the cognitive impairment group were all significantly higher than those in the non-cognitive impairment group and the control group [5.41%±1.04% vs 4.82%±0.95%, 4.39%±0.86%; (52.01±10.96) vs (41.28±9.23), (25.03±7.17) U/L; (336.61±85.36) vs (286.93±72.53), (143.52±64.20) g/ml], and the MMSE score was significantly lower [(20.19±2.85) vs (25.30±1.24), (27.14±1.56) points] (all P<0.05). Serum levels of HbA 1c, γ-GT and ICAM-1 were all significantly negatively correlated with MMSE score ( r=-0.512, -0.498, -0.563) (all P<0.05). The areas under the receiver operating characteristic curves (AUCs) for serum HbA 1c, γ-GT, and ICAM-1 levels in the assessment of cognitive dysfunction were 0.657, 0.816, and 0.691, respectively (all P<0.05). The optimal cut-off values were 5.115%, 47.65 U/L, and 304.58 g/ml, respectively. Conclusion:Serum HbA 1c, γ-GT and ICAM-1 levels in elderly patients with hyperlipidemia complicated with cardiovascular disease are negatively correlated with cognitive impairment, and have certain value for the evaluation and early diagnosis of cognitive impairment.

Objective:To assess the risk of venous thromboembolism (VTE) and anticoagulation-related bleeding of acute critical emergency patients staying in the emergency department at least 72 h, so as to improve the ability of emergency physicians to identify risk factors of VTE and their awareness of safety prevention in these patients.Methods:Multicenter emergency internal medicine patients meeting the inclusion criteria at the same time were collected. Padua and Caprini scores were used to evaluate the risk of VTE and the HAS-BLED score was used to assess the risk of anticoagulation-related bleeding.Results:A total of 930 emergency patients from 7 medical centers were enrolled in our study from January 15, 2021 to March 15, 2021. The proportion of high-risk population with VTE was 50.22% with Padua score and 78.49% with Caprini score, respectively. The proportion of high-risk bleeding (HAS-BLED score) was 40.43%.Conclusions:More than half of the acute critical ill patients who stay in emergency department for more than 72 h are at high risk of VTE. This group of patients have a relatively low risk of anticoagulation-related bleeding.

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To observe the effect of out-hospital standardized treatment on the recurrence of the first onset of acute unprovoked pulmonary thromboembolism (PE) after discontinued anticoagulant therapy or during anticoagulation therapy in PE patients after treatment and discharged from hospital.Methods A prospective study of patients with acute PE admitted into emergency ICU for training in out-hospital standardized anticoagulation treatment was carried out from January 2015 to December 2016 (observation group).Another cohort of EP patients without training in out-hospital standardized anticoagulation treatment admitted from January 2010 to December 2014 was enrolled for retrospective analysis(control group).The out-hospital standardized anticoagulation treatment strategy included the guidance of anticoagulation therapy,record all of the patients' symptoms related with recurrent EP both during and discontinuous anticoagulant treatment,V/O scan at 3 months,6 months and 12 months follow-up,respectively.The patients with ceased anticoagulant therapy would be followed up for at least one year.Patients with signs of recurrence would have a definite diagnosis at once.The anticoagulation status and outcome of the patients in control group found in out-patient department were recorded.Results ① There were 129 patients with acute unprovoked PE in observation group and 246 in control grouThere were no significance difference both in mean age and gender between two groups (P ＜0.05).② Recurrence rate was 11.63％ in observation group and 22.36％ in control group (P ＜0.01);③ There was significance difference in mortality rate between observation group (3.1％) and control group (10.85％) (P ＜0.05).There was also significant difference in rate of missing follow-up between observation group (10.85％) and control group (21.54％) (P＜0.001),and.there was significant difference in rate of discontinuous anticoagulation therapy between observation group (1.55％) and control group (8.5％) (P ＜0.01).④ There was no significance difference seen in the rate of patients exposed to multiple risk factors of arteriosclerosis between observation group (82.25％) and control group (77.64％) (P＜0.05).But the target rate of controlling various risk factors of arteriosclerosis was 79.31％ in observation group and 54.97％ in control group respectively (P＜0.05).Conclusions Standardized treatment can effectively reduce the recurrent rate of the venous episodes of the patients with first episode of acute unprovoked pulmonary thromboembolism;Recurrent venous episodes of the PE patients who exposed to the multiple risk factors of arteriosclerosis require more attentions.

Objective To investigate the value of pulmonary ventilation/ perfusion (V/ Q) SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism (PE) and identify factors which may affect the therapy. Methods From July 2014 to December 2016, sixty-three patients (23 males, 40 females, age (60±14) years), who were clinically diagnosed as PE and underwent V/ Q SPECT before and after anticoagulant therapy, were recruited retrospectively in this study. According to the percentage of lung perfusion defect (PD) out of total lung volume, the patients were divided into mild (<20％) PE, moderate (20％-50％) PE, and severe (>50％) PE groups. The lung PD decreased≥50％ after anticoagulant thera-py and no new PD detected was defined as the standard of effective therapy, otherwise the treatment were defined as ineffective. Data of different groups were compared. Factors that may predict the severity of PD or affect the treatment were analyzed. χ2 test and logistic regression were used for data analysis. Results PE were detected in 476 pulmonary segments and sub segments. The distribution of PE in different lung lobes had no statistically significant difference ( χ2 = 4. 995, P > 0. 05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80％, 12/ 15) and moderate PE (66.7％,16/ 24) in comparison with patients with mild PE (41.7％,10/ 24; χ2 = 7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95％ CI: 1.115-6.446, P<0. 05).PAH was an independent risk factor for treatment effect (OR value: 3.134(95％ CI: 1.341-7. 324), P<0. 05). Conclusions V/ Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagu-lant therapy may be ineffective in PE patients with moderate or severe PAH.

Objective To investigate the clinical characteristics of pulmonary artery sarcoma (PAS) and pulmonary thromboembolism(PTE), to improve doctors' awareness and the early diagnosis of PAS.Methods The clinical data of 10 PAS cases confirmed with biopsy were retrospectively analyzed,and 10 cases with PTE were selected as control group.Results (1) Main clinical manifestations of the two groups were chest tightness, shortness of breath, intermittent syncope, palpitations, chest pain and cough, and there were no statistical significance differences between the two groups (P＞0.05).(2)There were 2 cases (20.0％) PaO2 ＜80 mmHg in patients with PAS.However, there were 8 cases (80.0％)PaO2 ＜ 80 mmHg in control group.The two groups had statistically significant difference (x2 =7.200, P =0.023).(3) Wells score : the cases with PAS was in low risk (80.0％ and 10.0％),however, the cases of control group was in medium and high risk(90.0％ and 20.0％).The two groups had statistically significant difference (P =0.005, 0.001).(4) The two groups had no statistically significant difference in ECG, UCG, X-ray, lung ventilation/perfusion (P＞ 0.05).(5) There had statistically significant difference in terms of LDH and CRP between PAS and PET group (100％ vs.0, x-2 =10.796,P=0.003;100％ vs.0, x2 =15.000, P =0.000).There was faster ESR in PAS group than control group,and the two groups had statistically significant difference (75％ vs.0, x2=1.400, P =0.011).There was no case of D-Dimer＞500 μg,/L in PAS group, while 10 cases in control group, and the two groups had significant statistical difference (x2 =17.000, P =0.000).(6) There was 1 case (12.5％) with DVT in PAS group, 6 cases (60.0％) in PTE group, and the two groups had significant statistical difference (x2=10.568, P =0.001).(7) The CTPA in PAS group showed filling defect in the main pulmonary artery trunk (85.7％ vs.0) ,left pulmonary artery (85.7％ vs.10.0％) ,right pulmonary artery(100％ vs.10.0％) and both left and right pulmonary artery (85.7％ vs.10.0％), the two groups had significant statistical difference (x2 =13.247, P =0.001;x2 =9.746, P=0.004;x2 =13.388, P =0.000;x2 =9.746, P =0.004).Conclusion PAS and PTE can' t be distinguished from the clinical symptoms, ECG, UCG, X-ray,lung ventilation/perfusion imaging.PAS is easily misdiagnosed as PTE.More attention should be given.PAS can be identified early through the blood gas analysis, hypoxemia,Wells score, LDH, CRP, ESR, D-Dimer, DVT and CTPA.