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Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

Chinese Medical Journal 2024年第2期137卷 172-180页

作者： Jing Lin Deyong Long Chenxi Jiang Caihua Sang Ribo Tang Songnan Li Wei Wang xueyuan guo Man Ning Zhaoqing Sun Na Yang Yongchen Hao Jun Liu Jing Liu Xin Du Louise Morgan Gregg C.Fonarow Sidney C.Smith Jr Gregory Y.H.Lip Dong Zhao Jianzeng Dong Changsheng Ma On behalf of CCC-AF investigators Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China Department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China International Quality Improvement Department American Heart AssociationDallasTX 07076USA Division of Cardiology Geffen School of Medicine at University of CaliforniaLos Angeles CA 90024USA Division of Cardiology University of North CarolinaChapel HillNC 27599USA Department of Cardiology Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart&Chest HospitalLiverpool L143PEUK Department of Clinical Medicine Aalborg UniversityAalborg 9000Denmark 不详

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.

关键词： Atrial fibrillation Oral anti-coagulants OAC Stroke prevention Contraindication

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ABC-AF-Stroke score predicts thromboembolism in nonanticoagulated patients following successful atrial fibrillation ablation: a report from the Chinese Atrial Fibrillation Registry

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Chinese Medical Journal 2023年第20期136卷 2451-2458页

作者： Yufeng Wang Chao Jiang Liu He Xin Du xueyuan guo Ribo Tang Caihua Sang Deyong Long Jianzeng Dong Ziad Hijazi Gregory YHLip Changsheng Ma Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityNational Clinical Research Centre for Cardiovascular DiseasesBeijing 100029China Heart Health Research Center Beijing 100029China The George Institute for Global Health Faculty of MedicineUniversity of New South WalesSydneyNSWAustralia Department of Cardiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhouHenan 450052China Department of Medical Sciences CardiologyUppsala UniversityUppsalaSweden Uppsala Clinical Research Center Uppsala UniversityUppsalaSweden Liverpool Centre for Cardiovascular Science Liverpool Heart and Chest HospitalUniversity of LiverpoolLiverpoolUK

Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-p

关键词： Atrial fibrillation ABC-AF-Stroke score CHAS2DS2-VASc Thromboembolism Catheter ablation

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正交胶合木-混凝土组合楼板单面受火耐火极限试验研究

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建筑结构学报 2024年第3期45卷 52-59,100页

作者：冷予冰王明谦许清风陈玲珠郭雪媛陈溪上海市建筑科学研究院有限公司、上海市工程结构安全重点实验室上海200032

为研究正交胶合木-混凝土组合楼板的耐火极限,设计并制作了4个正交胶合木-混凝土组合楼板试件和2个正交胶合木楼板对比试件,分别进行常温下受弯加载试验、持荷耐火极限试验和数值模拟。结果表明:常温下正交胶合木楼板的破坏模式主要包... 详细信息

为研究正交胶合木-混凝土组合楼板的耐火极限,设计并制作了4个正交胶合木-混凝土组合楼板试件和2个正交胶合木楼板对比试件,分别进行常温下受弯加载试验、持荷耐火极限试验和数值模拟。结果表明:常温下正交胶合木楼板的破坏模式主要包括底部规格材的顺纹受拉断裂破坏、上下两层规格材之间横纹劈裂破坏和中部规格材的滚剪破坏;常温下正交胶合木-混凝土组合楼板的破坏模式包括现浇混凝土层与正交胶合木板的界面发生剪切破坏和底部规格材顺纹受拉断裂破坏;常温下正交胶合木-混凝土组合楼板的初始刚度和受弯承载力比正交胶合木楼板的分别提高了237.8%和60.1%。受火后,正交胶合木板底发生了明显炭化,正交胶合木-混凝土组合楼板发生了明显的受弯变形。在荷载比相同的条件下,正交胶合木-混凝土组合楼板的耐火极限比正交胶合木楼板的提高了335.3%;随着荷载比由0.20增加至0.50时,试件耐火极限由74.1 min降低至30.6 min。正交胶合木-混凝土组合楼板耐火极限的数值模拟精度误差在14.1%以内,满足工程精度要求。

关键词：正交胶合木-混凝土组合楼板荷载比单面受火试验数值模拟耐火极限

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Mild Renal Dysfunction and Risk of Thromboembolism and Bleeding in Patients with Atrial Fibrillation:The Chinese Atrial Fibrillation Registry Study

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Cardiology Discovery 2021年第1期1卷 29-36页

作者： Jingye Li Sitong Li Chao Jiang Jing Du xueyuan guo Songnan Li Chenxi Jiang Ribo Tang Caihua Sang Deyong Long Xin Du Jianzeng Dong Changsheng Ma Department of Cardiology Beijing Anzhen HospitalCapital Medical University and National Clinical Research Center for Cardiovascular DiseasesBeijing 100029China Department of Cardiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Beijing Center for Disease Prevention and Control Beijing 100013China Heart Health Research Centre Beijing 100029China

Objective:Previous studies indicated that patients with atrial fibrillation(AF)and moderate-to-severe chronic kidney disease(CKD)are at a higher risk of thromboembolism and bleeding during anticoagulation.Whether mild CKD is associated with an increased risk of thromboembolism and bleeding in AF patients remains unknown.This study aimed to evaluate the impact of mild CKD on thromboembolism and major bleeding among patients with AF.Methods:Baseline serum creatinine was available in 17,559 of 25,512 patients enrolled in the China-AF study between August 2011 and December 2018.After excluding those who underwent AF ablation or with moderate-to-severe CKD,7191 non-valvular AF patients(2059 with mild CKD and 5132 with normal renal function)with regular follow-up for at least 6 months were included.Primary outcomes were the time to the first occurrence of thromboembolic and major bleeding events.Results:Over a mean follow-up of(44.4±23.4)months,639 thromboembolism and 231 major bleeding events occurred.The crude incidence rates of thromboembolism were higher in the mild CKD group than that of the normal renal function group(3.0/100 person-years vs.2.2/100 person-years,P<0.0001),while the crude incidence rates of major bleeding were comparable between the two groups(1.0/100 person-years vs.0.8/100 person-years,P=0.076).After multivariate analyses,mild CKD was not associated with an increased risk of thromboembolism(HR=1.05,95%CI:0.89-1.25,P=0.547)or major bleeding(HR=1.11,95%CI:0.84–1.47,P=0.476).Conclusions:Mild CKD was not an independent risk factor of thromboembolism or major bleeding in patients with AF.

关键词： Atrial fibrillation Chronic kidney disease Major bleeding Thromboembolism

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Postablation neutrophil/lymphocyte ratio correlates with arrhythmiarecurrence after catheter ablation of lone atrial fibrillation

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Chinese Medical Journal 2014年第6期127卷 1033-1038页

作者： guo xueyuan Zhang Sen Yan Xianliang Chen Yingwei Yu Ronghui Long Deyong Sang Caihua Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

Background Neutrophil/lymphocyte ratio(NLR) has been proposed as a novel marker of systemic inflammation and oxidative stress. The objective of this study was to ascertain the relationship between levels of NLR and recurrence of lone atrial fibrillation(AF) after catheter ablation.Methods A total of 379 lone AF patients who underwent catheter ablation were enrolled in the study. The NLR before and after catheter ablation was determined. Cox regression analyses were used to estimate the relationship between NLR and the recurrence of lone AF.Results After a mean follow-up of(30.5±5.3) months, 124(32.7%) patients had AF recurrences. The patients who developed AF recurrence had a higher postablation NLR(post-NLR) than patients with no recurrence(5.74±1.55 vs. 4.66±1.27, P <0.001). Multivariate Cox regression analysis revealed that post-NLR(hazard ratio(HR) 1.514, 95% confidence interval(CI) 1.364–1.680, P <0.001), left atrium diameter(HR 1.035, 95% CI 1.001–1.071, P=0.04) and body mass index(HR 1.028, 95% CI 1.002–1.054, P=0.03) were independent predictors of AF recurrence. Using a cut-off level of 5.15, post-NLR predicted AF recurrence with a sensitivity of 73% and specificity of 67%.Conclusions Our results indicate that an elevated post-NLR is associated with a high rate of lone AF recurrence. A simple measurement of NLR may help us to identify high-risk patients who need pharmacologic intervention to prevent recurrence.

关键词： atrial fibrillation catheter ablation neutrophil lymphocyte ratio

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Data-Driven Adaptive Predictive Control Method With Autotuned Weighting Factor for Nonlinear Systems Using Triangular Dynamic Linearization

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IEEE/CAA Journal of Automatica Sinica 2024年第8期 1880-1882页

作者： Zhong-Hua Pang Yumo Zhang xueyuan Sun Shengnan Gao guo-Ping Liu IEEE the Key Laboratory of Fieldbus Technology and Automation of Beijing North China University of Technology the School of Data Science Capital University of Economics and Business the Center for Control Science and Technology Southern University of Science and Technology

Dear Editor,In this letter, a novel data-driven adaptive predictive control method is proposed using the triangular dynamic linearization technique. The proposed method only contains one time-varying parameter with explicit physical meaning, which can prevent severe deviation in parameter estimation. Specifically, a triangular dynamic linearization (TDL) data model is employed to predict future system outputs, and then to correct inaccurate predictive outputs, a feedback regulator is designed.

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血流动力学不稳定的室性心动过速循环辅助支持下的导管消融治疗

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中华心血管病杂志 2024年第7期52卷 768-776页

作者：李梦梦杨扬龙德勇蒋晨曦汤日波桑才华王伟赵欣郭雪原李松南李昌义宁曼贾长琪冯莉温丹朱慧江岳鑫刘放刘佟董建增马长生首都医科大学附属北京安贞医院心律失常中心国家心血管疾病临床医学研究中心北京

目的探讨循环辅助支持在血流动力学不稳定的室性心动过速患者的标测及导管消融治疗中的作用, 对该类患者的单中心经验进行总结分析, 为临床提供循证医学证据。方法该研究为回顾性队列研究。纳入2021年8月至2023年12月于首都医科大学附... 详细信息

目的探讨循环辅助支持在血流动力学不稳定的室性心动过速患者的标测及导管消融治疗中的作用, 对该类患者的单中心经验进行总结分析, 为临床提供循证医学证据。方法该研究为回顾性队列研究。纳入2021年8月至2023年12月于首都医科大学附属北京安贞医院在循环辅助支持下接受导管消融手术的血流动力学不稳定的室性心动过速患者, 根据治疗目的分为挽救性治疗组和预防性治疗组, 对两组患者的人口学资料、围术期管理、导管消融情况及临床结局进行总结。结果共纳入15例血流动力学不稳定的室性心动过速患者(挽救性治疗组8例, 预防性治疗组7例), 所有患者手术均获得即刻成功。1例患者(挽救性治疗组)植入左心室辅助装置, 其余14例患者均采用体外膜肺氧合进行循环支持。术后在院期间, 12例患者临床和血流动力学稳定, 进行了体外膜肺氧合撤机, 其中6例术后即刻撤机, 其余在术后2.0(2.5)d撤机。挽救性治疗组中2例患者在院期间分别因顽固性心力衰竭和脑出血死亡。在30 d(1 d至12个月)的随访中, 植入左心室辅助装置的1例患者在出院后第6个月出现1次心室颤动, 经抗心律失常药物治疗后未再出现心室颤动和(或)室性心动过速。其余12例患者术后均未发生恶性室性心律失常事件。结论循环辅助支持有助于血流动力学不稳定的室性心动过速患者完成激动标测及精准消融;尤其是急诊条件下, 循环辅助支持是药物治疗无效的血流动力学不稳定的室性心动过速患者得以行急诊导管消融的唯一支持手段。

关键词：导管消融术室性心动过速循环辅助治疗血流动力学不稳定体外膜肺氧合左心室辅助装置

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道县国家重点保护野生植物资源调查与分析

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南方农业 2023年第20期17卷 23-25,32页

作者：郭学远道县林业局湖南道县425300

湖南省道县的野生植物资源种类繁多,包括各类珍稀濒危植物。为保护道县的野生植物资源,在道县生物多样性调查的基础上,深入调查和分析了该县国家重点保护野生植物资源现状,全县共有35种国家重点保护野生植物,国家一级、二级保护野生植... 详细信息

湖南省道县的野生植物资源种类繁多,包括各类珍稀濒危植物。为保护道县的野生植物资源,在道县生物多样性调查的基础上,深入调查和分析了该县国家重点保护野生植物资源现状,全县共有35种国家重点保护野生植物,国家一级、二级保护野生植物各有2、33种,隶属24科29属,梳理了其面临的主要问题,并提出了野生植物资源保护措施与对策,包括加大宣传力度、进一步完善保护措施、加强监测巡护、建立资源数据库、开展执法监督等。

关键词：国家重点保护野生植物资源调查与分析湖南省道县

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道县自然保护地现状及整合优化策略探析

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南方农业 2023年第18期17卷 55-58页

作者：郭学远道县林业局湖南道县425300

近年来,自然保护地整合优化备受国家重视。为确保自然生态系统、自然遗迹、景观及生物多样性得到全面保护,以湖南省道县为例,在了解自然保护地现状的基础上,对存在的管理区域交叉重叠、矛盾冲突较多、科学化程度不够、空间布局不合理及... 详细信息

近年来,自然保护地整合优化备受国家重视。为确保自然生态系统、自然遗迹、景观及生物多样性得到全面保护,以湖南省道县为例,在了解自然保护地现状的基础上,对存在的管理区域交叉重叠、矛盾冲突较多、科学化程度不够、空间布局不合理及管理体制不完善等问题进行分析,按照分级分类、整合归并、分区优化、调入、矛盾冲突处理等规则,将道县原有总面积为33 850.60 hm^(2)的7个自然保护地调整为总面积28 724.53 hm^(2)的5个自然保护地;调整后共有1个自然保护区、4个自然公园,面积占比分别为35.17%和64.83%;调整后核心保护区和一般控制区的面积分别为5 989.16 hm^(2)和22 735.37 hm^(2);调入面积为714.00 hm^(2),其中调入的森林生态用地面积665.68 hm^(2);调出面积为1 968.45 hm^(2),其中人工商品林、耕地、城镇村庄面积分别为1 469.32 hm^(2)、335.61 hm^(2)、163.52 hm^(2)。

关键词：自然保护地整合优化湖南省道县

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心房颤动患者及家属焦虑的相关因素分析

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中华医学杂志 2023年第28期103卷 2151-2156页

作者：郭雪原王震李思彤蒋超桑才华马长生首都医科大学附属北京安贞医院心内科、北京市心肺血管疾病研究所北京100029

目的分析心房颤动患者及其家属发生焦虑的相关因素。方法回顾性纳入2020年9月至2021年3月就诊于首都医科大学附属北京安贞医院的心房颤动住院患者,及每例患者的1名家属。收集患者及其家属的基本资料,并应用广泛性焦虑障碍量表(GAD‑7)评... 详细信息

目的分析心房颤动患者及其家属发生焦虑的相关因素。方法回顾性纳入2020年9月至2021年3月就诊于首都医科大学附属北京安贞医院的心房颤动住院患者,及每例患者的1名家属。收集患者及其家属的基本资料,并应用广泛性焦虑障碍量表(GAD‑7)评估患者及家属的焦虑情况。本研究最终入选374例心房颤动患者及374名家属。采用多因素logistic回归模型分析患者及家属发生焦虑的相关因素。结果患者的年龄为(58.3±10.6)岁,女性为124例(33.2%);家属的年龄(53.6±11.6)岁,女性247名(66%)。69例(18.4%)患者及38名(10.2%)家属存在轻度焦虑(GAD‑7:5~9分),13例(3.5%)患者及9名(2.4%)家属存在中度及以上焦虑(GAD‑7:10~21分)。多因素分析显示,心房颤动患者焦虑的相关因素包括欧洲心律协会(EHRA)评分≥3(OR=1.73,95%CI:1.03~2.89,P=0.039)及女性(OR=1.90,95%CI:1.06~3.40,P=0.032),而患者EHRA评分≥3(OR=2.11,95%CI:1.05~4.24,P=0.036)、患者焦虑(OR=2.76,95%CI:1.36~5.60,P=0.005)则家属发生焦虑的可能性更高。此外,年龄≥65岁(OR=3.97,95%CI:1.68~9.38,P=0.002)、女性(OR=3.83,95%CI:1.64~8.93,P=0.002)、家属合并疾病数≥2个(OR=2.57,95%CI:1.03~6.41,P=0.043)也是家属焦虑的相关因素。结论症状较重的心房颤动患者合并焦虑的比例更高,且其家属焦虑可能性也更高。焦虑状态的心房颤动患者,其家属焦虑比例更高。

关键词：心房颤动焦虑家属

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