Objective:To evaluate the effects of pulmonary embolism response team (PERT) on the quality of care and clinical outcomes in patients with acute pulmonary embolism.Methods:This was a single-center retrospective cohort study. Patients with acute pulmonary embolism treated in Beijing Anzhen Hospital Affiliated to Capital Medical University from July 5, 2016 to July 4, 2018 were enrolled. Patients with acute pulmonary embolism who had traditional care from July 5, 2016 to July 4, 2017 (before the implementation of PERT) were classified as PERT pre-intervention group. Patients with acute pulmonary embolism who started PERT care from July 5, 2017 to July 4, 2018 were divided into the PERT intervention group. The diagnosis and treatment information of patients was collected through the electronic medical record system, and the quality of care (time from visit to hospitalization, time from hospitalization to anticoagulation initiation, time from visit to definitive diagnosis, total hospital stay, time in intensive care unit (ICU), hospitalization cost) and clinical outcomes (in-hospital mortality and incidence of bleeding) were compared between the two groups.Results:A total of 210 patients with acute pulmonary embolism, aged (63.3±13.7) years old, with 102 (48.6%) female patients were included. There were 108 cases in PERT pre-intervention group and 102 cases in PERT intervention group. (1) Quality of diagnosis and treatment: there was a statistical significance between the two groups in the distribution of time from diagnosis to definitive diagnosis ( P=0.002). Among them, the rate of completion of diagnosis within 24 hours after PERT intervention was higher than that before PERT intervention (80.4% (45/56) vs. 50.0% (34/68), P<0.001). The time from treatment to hospitalization was shorter than that before PERT intervention (180.0 (60.0, 645.0) min vs. 900.0 (298.0, 1 806.5) min, P<0.001). The total length of hospital stay was less than that before PERT intervention (12 (10, 14) d vs. 14 (11, 16) d, P=0.001). There was no statistical significance in the time from hospitalization to anticoagulant therapy, the length of ICU stay and hospitalization cost between the two groups (all P>0.05). (2) Clinical outcomes during hospitalization: There was no statistical significance in the incidence of hemorrhage and mortality between the two groups during hospitalization (both P>0.05). Conclusion:PERT has improved the efficiency of diagnosis and treatment of patients with acute pulmonary embolism and significantly shortened the total hospital stay, but its impact on clinical outcomes still needs further study.

Objective:To detect the expression of angiogenic factor (AGGF1) with G-patch and FHA domain 1 in hepatocellular carcinoma (HCC), and to investigate its relationship with HCC angiogenesis, invasion and metastasis and its clinical significance.Methods:A total of 90 primary HCC patients were selected from the Huangshi Central Hospital and Hubei Province Cancer Hospital from January 2019 to September 2020. Clinicopathological data of all patients were collected. The expression of AGGF1 and CD34 in cancer tissues of 90 HCC patients was detected by immunohistochemistry, and microvascular density (MVD) was calculated. The patients were followed up for three years. The relationship between AGGF1 and serum angiopoietin-2 (Ang-2) content, MVD, clinicopathological parameters and postoperative prognosis was analyzed.Results:The positive rate, relative expression level and MVD value of AGGF1 in HCC tissues were significantly higher than those in adjacent tissues (all P<0.05). The relative expression of AGGF1 in cancer tissues was positively correlated with the MVD value ( r=0.716). Serum Ang-2 content and MVD in AGGF1-positive patients were significantly higher than those in AgGF1-negative patients (all P<0.01). AGGF1 expression in HCC tissues was significantly correlated with tumor differentiation, tumor size, (China Liver Cancer (CNLC) staging, lymph node metastasis, vascular invasion, and postoperative recurrence and metastasis (all P<0.01). Kaplan-Meier analysis showed that the 2- and 3-year survival rates of patients with high AGGF1 expression were significantly lower than those of patients with low AGGF1 expression (all P<0.01). Multivariate analysis showed that CNLC stage, lymph node metastasis, vascular invasion, AGGF1 expression, postoperative recurrence and metastasis were the influencing factors for postoperative survival of HCC patients (all P<0.05). Conclusions:The high expression of AGGF1 can promote the angiogenesis of HCC, and is significantly correlated with invasion and metastasis and poor prognosis, which can be a potential evaluation indicator of HCC clinical prognosis.

Objective:To observe the clinical characteristics of female patients with ST-segment elevation myocardial infarction (STEMI) complicated with multivessel disease (MVD) undergoing direct percutaneous coronary intervention (PCI), and to explore the factors affecting the prognosis of female patients.Methods:In this retrospective cohort study. 1 033 patients (196 women) with STEMI combined with MVD who were admitted to our hospital from 2005 to 2015 and successful completed direct PCI within 24 h onset of symptom were enrolled. Patients’ baseline data, PCI data and follow-up results were recorded. Kaplan-Meier method was used to plot the survival curve. Cox regression model was used to screen the prognostic factors of STEMI patients with multivessel disease.Results:Compared with male patients, the age of female patients was significantly older, while the proportion of smoking history, family history of coronary heart disease, and stent implantation history was significantly lower, the time from onset to PCI was significantly longer, and the proportion of intraoperative slow blood flow/no-reflow was significantly higher among female patients. The mean follow-up time was 4 years, and the incidence of major adverse cardiovascular events (MACE) was higher in women than in men. The main factor affecting the prognosis of female patients was Killip cardiac function grade Ⅱ~Ⅳ ( HR=1.804, 95% CI: 1.060~3.071, P<0.05). The number of lesions with >50% occlusion ( HR=1.808, 95% CI 1.123-2.912, P < 0.01) was a common risk factor for both men and women. Conclusions:Compared with male patients, there is more treatment delay among female patients with STEMI and MVD, the incidence of MACE is higher, and cardiac insufficiency is the main factor affecting the prognosis of female patients.

Objective:To analyze the effect of elevated pulmonary artery pressure measured by echocardiography on clinical characteristics and adverse events in patients with acute pulmonary embolism.Methods:Retrospective analysis hospitalized patients with acute pulmonary embolism diagnosed in Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1, 2018 to December 31, 2020 were divided into elevated pulmonary artery pressure group and control group according to pulmonary artery pressure measured by echocardiography. The differences between the two groups in admission baseline data, admission basic situation, admission hematology examination, admission imaging examination, in-hospital medication and in-hospital adverse events were compared.Results:A total of 568 patients with acute pulmonary embolism were included, including 178 in the elevated pulmonary artery pressure group and 390 in the control group. The data analysis of the two groups showed that the proportion of height, weight, body mass index, smoking history, coronary heart disease history, stroke history, diabetes history, chronic heart failure history, chronic obstructive pulmonary disease history and chronic renal insufficiency history in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. The proportion of fracture in the group with elevated pulmonary artery pressure was significantly lower than that in the control group, and the proportion of tumor and heart rate were significantly higher than those in the control group. The hemoglobin, international standardized ratio, D-dimer, PaO 2, SaO 2, etc. of patients with elevated pulmonary artery pressure were significantly lower than those of the control group, and TnI, B-type natriuretic peptide, etc. were significantly higher than those of the control group. The left ventricular ejection fraction of patients with elevated pulmonary artery pressure was significantly lower than those of the control group, and the left ventricular end diastolic diameter, the proportion of mitral regurgitation, the proportion of tricuspid regurgitation, and the proportion of pulmonary artery embolism were significantly higher than those of the control group. The use proportion of rivaroxaban in patients with elevated pulmonary artery pressure was significantly lower than that in the control group, and the use proportion of aspirin and warfarin was significantly higher than that in the control group. The incidence of all-cause death, acute heart failure and in-hospital hemorrhage in the group with elevated pulmonary artery pressure was significantly higher than that in the control group. There was no significant difference in other indexes between the two groups. Conclusions:There are some differences in clinical characteristics and prognosis between patients with acute pulmonary embolism complicated with elevated pulmonary artery pressure and patients with normal pulmonary artery pressure. The increase of pulmonary artery pressure may increase the risk of all-cause death, acute heart failure and nosocomial bleeding to a certain extent.

Objective: To analyle prevalence and trend of substance abuse behaviors among adolescents in Guangdong province and to provide theoretical evidence for effective interventions. Methods: Data regarding smoking, drinking, drugs abuse from Adolescents Health Risk Behavior Survey in 2007, 2010, 2013 and 2016 were collected and comparatively analyzed. Results: The incidences of tried smoking(27.37%), current smoking(8.32%), passive smoking(45.52%), current drinking(27.97%) and drug using(0.75%) in 2016 were lower than that in 2007(32.40%, 10.81%, 52.69%, 31.97%, 1.35%), and the average annual decrease rate were 1.89%, 2.95%, 1.64%, 1.50%, 6.75%, respectively(χ2=152.73, 92.50, 313.92, 46.48, 46.64, P<0.01). During the past decate, the incidences of current smoking in rural adolescents(12.02%, 10.64%, 9.99%, 10.10%) were significantly higher than that in urban adolescents(8.88%, 8.52%, 8.17%, 6.56%)(χ2=54.46, 26.62, 25.23, 100.43, P<0.01); the incidences of current drinking in urban adolescents(33.57%, 30.37%, 35.76%, 30.46%) were significantly higher than that in rural adolescents(30.97%, 28.48%, 28.47%, 25.32%)(χ2=16.71, 10.13, 153.47, 81.76, P<0.01); the incidence of current drinking was the highest among college students in each monitoring year(47.71%, 41.76%, 42.36%, 37.77%)(χ2=583.37, 681.25, 610.04, 729.02, P<0.01); the incidence of current smoking was the highest among vocational school students in each monitoring year(16.36%, 17.00%, 14.90%, 16.71%)(χ2=256.45, 515.61, 339.63, 742.52, P<0.01); In addition to the incidence of drug abuse was the highest among college students in 2010(2.02%), vocational school students were the highest in other years(χ2=66.92, 34.38, 23.08, 20.55, P<0.01). Conclusion Smoking and drug abuse among adolescents in Guangdong showed a declining trend by years, as well as the prevalence of drinking behavior. Strengthened intervention should be targeted on smoking behavior among rural students, drinking behavior among urban students, and smoking behavior and drug abuse among vocational school students.

Objective:To explore effects of WeChat intervention on medication compliance and lifestyle of patients with acute myocardial infarction (AMI) after discharge.Methods:By the convenient sampling method, a total of 400 patients who were diagnosed of AMI and treated in Beijing Anzhen Hospital affiliated to Capital Medical University from February 2018 to April 2019 were selected as research objects. According to the random number table method, they were divided into the control group and the observation group, with 200 cases in each group. The control group was given routine discharge education while the observation group was given health education on the basis of routine health education with the help of WeChat platform. Morisky Medication Adherence Scale (MMAS-8) and Lifestyle Scale were used to evaluate the effect of intervention.Results:At 5 and 6 months after intervention, the MMAS-8 score of the observation group was higher than that of the control group, and the differences were statistically significant ( P<0.05) . At 4, 5 and 6 months after intervention, the scores of the lifestyle scale of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:Health education through the WeChat platform helps to improve the medication compliance of patients with AMI and improve their lifestyle.

Objective To explore the risk factors and prognoses of new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI).Methods A total of 468 patients with AMI were admitted into Beijing Anzhen Hospital for emergency pereutaneous coronary intervention (PCI).According to the NOAF occurred during hospitalization,the patients were divided into two groups:the NOAF (n=37) group and the non-NOAF (n=431) group.Parameters including general clinical conditions,coronary lesions,echocardiography,biochemical markers,C-reactive protein (CRP),N-terminal pro-brain natriuretic peptide (NT-pro-BNP),and myocardial markers were collected.In-hospital mortality and incidence of in-hospital main adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two groups.Logistic multivariate regression analyses were performed for the association between the risk factors and NOAF.Results The incidence of NOAF was 7.9％ in AMI patients undergoing emergency PCI.There were no significant differences in door-to-balloon time,weight,platelet counts,baseline serum creatinine (SCr),postoperative SCr,triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,uric acid,glycosylated hemoglobin A1c,preoperative medication,number of lesions,thrombus aspiration,location of myocardial infarction,and history of hypertension,diabetes,peripheral vascular disease and old myocardial infarction between the two groups.The percentage of women was in the NOAF group (32.4％ vs.16.7％,P＜0.05) and subjects in this group were significantly elder than those in the non-NOAF groups [(66±10) years vs.(571±11) years,P＜0.001].Moreover,the levels of no-reflow rate (40.5％ vs.12.6％,P＜0.001),CRP [25.2 (15.43,29.97)mg/L vs.5.21 (2.33,16.98) mg/L,P＜0.001],white blood cell counts [(11.19±3.44)× 109 vs.(9.91 ±3.23)× 109,p=0.022],NT-pro-BNP [(652.6± 108.8) ng/L vs.(258.3±105.9) ng/L,P＜0.001],and troponin I (TnI) [20.41(1.78,87.89) μg/L vs.7.72(1.29,36.39) μg/L,P=0.006] were significantly higher in the NOAF group than in the non-NOAF group,while left ventricular ejection fraction [(47.70± 7.34)％ vs.(53.35 ± 8.05)％,P＜0.001],and hemoglobin [137.0(125.5,146.0) g/L vs.144.0(133.0,156.0) g/L,P=0.042] were significantly lower in the NOAF group than the non-NOAF group.Patients in the NOAF group had significantly longer hospital stay than those in the non-NOAF group [(8.7± 5.6) d vs.(6.0± 2.3) d,P=0.007].The in-hospital mortality (8.1％ vs 1.4％ P=0.004) and the incidence of in-hospital MACCE (37.8％ vs.7.7％,P＜0.001) in the NOAF group were significantly higher than those in the non-NOAF group.Logistic multivariate regression analyses showed that age (HR 1.083,95％CI 1.028-1.141,P=0.003),CRP (HR 1.116,95％CI 1.049-1.187,P=0.001),NT-pro-BNP (HR 1.463,95％CI 1.001-4.064,P=0.001) and no-reflow (HR 4.388,95％CI 1.006-19.144,P=0.049) were independent predictors of NOAF after AMI.Conclusions Age,elevated levels of CRP,NT-pro-BNP,and the absence of no-reflow are risk factors for incident NOAF in patients with AMI in hospital.

Objective To examine the prevalence of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS),and to evaluate the relationship of OSA with inflammatory biomarkers in ACS patients.Methods Patients with ACS treated at Beijing Anzhen Hopital from June 2015 to May 2017 were enrolled.Subjects were evaluated for OSA by sleep study,and were divided into a normal-mild OSA group (Apnea Hypopnea Index,AHI ＜ 15 times/h) and a moderate-severe OSA group (AHI ≥ 15 times/h).Laboratory examination and sleep study were monitored to analyze the effects of OSA on biomarkers by LSD-t test,Mann-whitney U test,or Chi-square test.Correlation analysis was performed to analyze the association of OSA with high sensitivity C-reactive protein (hs-CRP) by Spearman correlation anaylsis.Results A cohort of 836 patients with ACS were enrolled including 408 patients in the normal-mild OSA group and 428 patients in the moderate-severe OSA group.The levels of leukocyte(x 109L) [7.78 (6.33,9.86) vs 7.29 (6.01,9.16),P=0.006],neutrophils(× 109L) [5.05 (3.84,7.23)vs 4.80 (3.74,6.66),P=0.044],monocytes(x 109L) [0.42 (0.33,0.54) vs 0.39 (0.31,0.51),P=0.033],hsCRP(mg/L) [3.18 (1.10,11.52) vs 1.78 (0.65,6.46),P＜0.01],fibrinogen(g/L) [3.17 (2.87,3.74) vs 2.97 (2.59,3.50),P=0.002],and uric acid(μmol/L) [360 (302,422) vs 341(283,407),P=0.006] in the moderatesevere OSA group were significant higher than those in the normal-mild OSA group.AHI (correlation coefficient=0.171,R2=0.020,P＜0.01),ODI (correlation coefficient =0.201,R2=0.027,P＜0.01),and TSaO2 ＜ 90％ (correlation coefficient =0.105,R2=0.005,P＜0.01) were positively correlated with hs-CRP;minimal SaO2 (correlation coefficient=-0.100,R2=0.001,P=0.008) and mean SaO2 (correlation coefficient =-0.127,R2=0.006,P＜0.01) were negatively correlated with hs-CRP.Conclusions For patients with ACS,the level of inflammatory markers in the moderate-severe OSA group is significantly higher than that in the normal-mild OSA group.Hs-CRP is significantly associated with the severity of OSA.Diagnosis and monitoring of OSA should be considered in ACS management in the future.

Objective To illustrate the clinical characteristics of elderly patients with Stanford type A aortic dissection and to discuss the incidence of such inpatients' adverse events. Methods A retrospective study was conducted, 588 patients with definite diagnosis of Stanford type A aortic dissection admitted to Beijing Anzhen Hospital of Capital Medical University from January 2013 to December 2015 were enrolled, and they were divided into an elderly group (≥60 years, 79 cases) and a non-elderly group (< 60 years, 509 cases). The differences of general clinical data, results of hospitalization-related examinations, medication for treatment, surgical intervention and inpatient adverse events between the two groups were compared. Results Compared with non-elderly group, the proportion of male, age, stature, body mass index (BMI), proportion of alcohol history, hemoglobin (Hb), incidence of acute liver failure in hospital in elderly group were decreased significantly [proportion of male: 60.8% (48/79) vs. 80.6% (410/504), age (years):64.81±4.66 vs. 45.05±8.63, stature (cm): 169.41±8.09 vs. 173.39±7.59, BMI (kg/m2): 24.24±2.93 vs. 25.50±3.82, proportion of alcohol history: 12.7% (10/79) vs. 22.4% (114/509), Hb (g/L): 122.62±21.14 vs. 128.42±23.44, incidence of acute liver failure: 0 (0/79) vs. 5.3% (21/509), all P < 0.05], the proportion of diabetes history, proportion of cerebrovascular diseases, all-cause mortality in this hospital in elderly group were increased significantly [proportion of diabetes history: 24.1% (62/79) vs. 8.8% (45/509), proportion of cerebrovascular diseases: 6.3% (5/79) vs. 2.2% (11/509), all-cause mortality: 16.5% (13/79) vs. 7.1% (36/509), all P < 0.05], and the left ventricular end diastolic internal diameter (LVEDD) in elderly group decreased significantly (mm: 48.38±6.11 vs. 50.77±7.56, P <0.05). Conclusion The elderly patients with Stanford type A aortic dissection suffer from more complications and higher mortality, therefore, the risk consciousness should be strengthened for the senile patients and more attention should be paid on the prevention of the elderly inpatients' adverse events.