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简介：AbstractObjective:This study aimed to evaluate the incidence and associated clinical risk factors for preeclampsia (PE) and its subtypes in a large multicentre retrospective study of Beijing, China.Methods:This study was conducted as a secondary analysis from the Gestational diabetes mellitus Prevalence Survey (GPS), a multicentre retrospective cohort study, which included 15 hospitals in Beijing, China. This analysis included 15,003 pregnant women who delivered in Beijing from June 20th to November 30th, 2013. The incidence of PE was calculated. Risk factors for PE, including maternal age, pre-gestational body mass index (BMI), parity, chronic hypertension, pre-existing diabetes, and gestational diabetes mellitus, were assessed. PE was defined as early- or late-onset PE based on clinical manifestations during the week of delivery, and mild or severe PE based on the severity of the disease. Logistic regression analysis was used to quantify the association with the risk factors, and data were displayed as odds risks (OR) and 95% confidence interval (CI).Results:The overall incidence of PE was 2.65% (397/15,003). The prevalence of early-onset and late-onset PE was 0.36% (54/15,003) and 2.29% (343/15,003), respectively. The prevalence of mild and severe PE was 0.91% (137/15,003) and 1.73% (260/15,003), respectively. Risk factors including high BMI considered overweight (adjusted odds risk (aOR): 1.48; 95% CI: 1.06-2.05; P= 0.02) and obesity (aOR: 2.15; 95% CI: 1.50-3.08; P < 0.001), nulliparity (aOR: 1.73; 95% CI: 1.32-2.25; P < 0.001), multiple gestation (aOR: 4.58; 95% CI: 2.86-7.32; P < 0.001), and chronic hypertension (aOR: 34.95; 95% CI: 26.60-45.93; P < 0.001), were associated with increased risk for PE. Only chronic hypertension (aOR: 13.75; 95% CI: 4.78-39.58; P < 0.001) was a significant risk factors for early-onset PE, whereas high BMI considered both overweight (aOR: 1.54; 95% CI: 1.09-2.18; P= 0.01) and obesity (aOR: 2.23; 95% CI: 1.53-3.27; P < 0.001), nulliparity (aOR: 2.00; 95% CI: 1.49-2.68; P < 0.001), multiple gestation (aOR: 4.11; 95% CI: 2.40-7.05; P < 0.001), and chronic hypertension (aOR: 35.57; 95% CI: 26.66-47.47; P < 0.001) were more relevant risk factors for late-onset PE. Risk factors including obesity (aOR: 2.20; 95% CI: 1.28-3.76; P < 0.01 and aOR: 1.80; 95% CI: 1.16-2.80; P= 0.01), nulliparity (aOR: 2.28; 95% CI: 1.44-3.60; P < 0.001 and aOR: 1.48; 95% CI: 1.09-2.02; P= 0.01), multiple gestation (aOR: 5.50; 95% CI: 2.87-10.67; P < 0.001 and aOR: 3.51; 95% CI: 1.93-6.41; P < 0.001), and chronic hypertension (aOR: 33.98; 95% CI: 22.20-52.01; P < 0.001 and aOR: 35.03; 95% CI: 25.40-48.31; P < 0.001) were associated with mild and severe PE. Moreover, we found that women with an increasing number of these risk factors had a higher risk of developing PE than pregnant women without any identified risk factors.Conclusion:The incidence of PE in this study is consistent with previous reported studies. Our findings indicate chronic hypertension and multiple gestation are the most important risk factors for PE in Chinese pregnant women. The risk for developing PE is associated with both the type and abundance of risk factors. These factors are valuable when monitoring patients at risk for PE, as this can help ensure an earlier diagnosis and prediction in women who are more likely to develop PE.

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简介：AbstractBackground:An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China.Methods:Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS).Results:A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (-0.1, 95% CI - 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019-March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (-0.3, 95% CI - 1.4 to 0.9, P = 0.653).Conclusions:Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.

简介：AbstractBackground:Sexual transmission among men who have sex with men (MSM) is the dominant route of HIV transmission in China. Extensive use of geosocial networking (GSN) smartphone application (app) has dramatically changed the pattern of sexual behaviors and HIV risk among MSM, but data on HIV incidence and the changing risk behaviors of GSN app-using MSM are limited. We aims to assess the HIV incidence and its correlates among gay GSN app-using MSM in China.Methods:We constructed an open cohort which was initiated and maintained using a GSN app to assess the HIV incidence among app-using MSM, recruited from June 2017 to December 2018. MSM completed an online questionnaire on their sociodemographic characteristics, sexual behaviors, recreational drug use and sexually transmitted infections status. Then each man had an HIV test, and those tested negatives were enrolled into the cohort. Participants completed follow-ups with additional HIV tests though the app during the study period, and were censored at HIV seroconversion or study end date. HIV incidence was calculated by dividing the sum of observed HIV seroconversions by the observed person-time. Univariate (Chi-square test and Fisher’s exact test) and multivariate (proportional hazards regression) analyses were used to examine correlates of HIV incidence.Results:A total of 6957 HIV negative MSM were enrolled in the open cohort, 37 seroconversions occurred among 1937 men contributing 1065 observed person-years: HIV incidence was 3.47 per 100 person-years [95% confidence interval (CI): 2.37-4.57]. More than five sexual partners [hazard ratio (HR) = 2.65, 95% CI: 1.04-6.67], and sex with HIV positive partners (HR = 3.82, 95% CI: 1.16-12.64) in the preceding six months were positively associated with HIV seroconversion. Consistent condom use for anal sex (HR = 0.27, 95% CI: 0.07-0.96), and reporting insertive anal sex only (HR = 0.23, 95% CI: 0.08-0.62) in the preceding six months were protective factors for HIV seroconversion.Conclusions:Tailored interventions targeting app-using MSM are urgently needed given their high risk of HIV. As a new tool for accessing MSM at higher HIV risk, GSN smartphone app could play an important role in HIV research among MSM.

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简介：AbstractBackground:Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023-1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958-0.983), fatigue (HR: 1.127, 95% CI: 1.009-1.258), ascites (HR: 1.190, 95% CI: 1.057-1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140-1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291-1.769), heart rate (HR: 1.003, 95% CI: 1.001-1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993-0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008-1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220-1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223-1.690), serum sodium (HR: 0.980, 95% CI: 0.972-0.988), serum albumin (HR: 0.981, 95% CI: 0.971-0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073-1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183-1.614), diabetes (HR: 1.118, 95% CI: 1.010-1.237), stroke (HR: 1.252, 95% CI: 1.121-1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626-0.814), β-blockers (HR: 0.673, 95% CI: 0.588-0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604-0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646-0.965), spironolactone (HR: 0.814, 95% CI: 0.663-0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531-0.733), nitrates (HR: 0.715, 95% CI: 0.631-0.811), and digoxin (HR: 0.579, 95% CI: 0.465-0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.

简介：AbstractBackground:Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.Methods:Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.Results:Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.Conclusion:Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.

简介：摘要：本文结合北京大兴国际机场语音记录仪工程项目，详细介绍了语音记录仪E1技术原理和应用，分析和总结了E1录音的功能性和稳定性，对比了相对于传统模拟录音技术的优势，对未来E1技术的扩展提供了参考思路和方向。