Blood neural cell-derived small extracellular vesicles (sEVs) can directly reflect changes in brain tissue and are easier to obtain than cerebrospinal fluid. This article systematically reviews the alterations of proteins and miRNAs from neural cell-derived sEVs in patients with Alzheimer's disease (AD), and summarizes the biomarkers with clinical diagnostic and predictive value. PubMed, Web of Science, Embase, and Cochrane Library were searched for studies in blood neural cell-derived sEVs in AD patients up to May 2024. According to the inclusion and exclusion criteria, the literature was screened, the information was extracted and the quality was evaluated. Proteins and miRNAs from neural cell-derived sEVs were classified and summarized, focusing on target molecules with high diagnostic and predictive values for AD. A final 34 articles reporting 5601 participants were included. In cross-sectional studies, Aβ- and Tau-related proteins (Aβ42, Aβ42/40, p-S396-Tau, p-Tau181), p-S312-IRS-1, and cathepsin D were increased, conversely, synaptic proteins (neurogranin, synaptotagmin, synaptophysin, synaptopodin, NMDAR2A) and REST were decreased in blood neuron-derived sEVs (NDsEVs) of patients with AD. While miR-29c-3p was increased in blood NDsEVs and glial cell-derived sEVs. Each of these proteins and miRNAs demonstrated high AD diagnostic value. Additionally, blood astrocyte-derived sEVs (ADsEVs) showed increased complement effector proteins and decreased complement regulatory proteins with a moderate diagnostic value. In longitudinal cohort studies, three composite models displayed high predictive efficacy for early AD prediction, and could predict the occurrence of AD within 1-10 years. Therefore, Aβ- and Tau-related proteins, synaptic proteins, and miRNA in blood neural cell-derived sEVs demonstrate high AD diagnostic and predictive values serving as important biomarkers. Especially, synaptic proteins showed significant changes in the early clinical stage, which has early predictive value.

Background:Uncontrolled hypertension is a major global health concern. Aldosterone synthase inhibitors (ASIs) show promise as a new treatment approach for blood pressure management. Methods:A systematic review and meta-analysis were conducted on randomized controlled trials comparing ASIs versus placebo for uncontrolled hypertension. The search included PubMed, Cochrane Library, Web of Science, and Embase databases from inception to 7 July 2025, limited to English-language publications. Data extraction was performed independently by two authors. Results:Four randomized controlled trials involving 1,838 patients (mean age 62 years; 47% female) were analyzed. The results demonstrated that ASIs significantly reduced office systolic blood pressure by 8.21 mmHg (95% CI, -10.64 to -5.78; P < 0.0001) and diastolic blood pressure by 3.64 mmHg (95% CI, -5.65 to -1.63; P = 0.0004). The risk ratio for adverse events was 1.42 (95% CI, 1.25-1.60; P < 0.00001), with a similar trend observed for serious adverse events (risk ratio 1.17; 95% CI, 0.63-2.17; P = 0.61). No treatment-related deaths occurred. However, ASIs were associated with a significantly higher risk of hyperkalemia (risk ratio 7.97; 95% CI, 2.27-27.99; P = 0.001). Conclusion:ASIs significantly lower blood pressure in hypertensive patients with an acceptable safety profile, though hyperkalemia risk requires monitoring. These results suggest ASIs may be a viable hypertension treatment, but larger studies are needed.

AbstractAlthough surgical and interventional therapy has emerged as the primary treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), there remains a subset of patients who need medication therapy. This study aimed to evaluate the efficacy and safety outcomes of prostacyclin pathway vasodilators, providing further insight for clinical decision‐making. A literature search was conducted in PubMed, Embase, and CENTRAL databases from inception to December 2023. Literature screening and quality assessment were carried out with the Cochrane Risk of Bias Tool. Data analysis was conducted using RevMan 5.4 software. We included 6 randomized controlled trials with 387 patients. Prostacyclin pathway vasodilators demonstrated a significant improvement in PVR (−125.26 dynes·sec·cm−5, 95%CI: −219.29 to −31.23, Z = 2.61, and p < 0.009), RAP (−0.78 mmHg, 95%CI: −1.52 to −0.04, Z = 2.06, and p = 0.04), cardiac index (0.62, 95%CI: 0.54 to 0.69, Z = 16.13, and p < 0.00001), and the number of patients showing improvement in WHO functional class (3.86, 95%CI: 1,92 to 7.77, Z = 3.79, and p = 0.0002) compared to controls, moreover, a trend towards improvement was observed in mPAP, 6MWD, and NT‐proBNP. Regarding the safety endpoints, no significant difference was found in both groups in terms of serious adverse events and all‐cause deaths. The prostacyclin pathway vasodilators present therapeutic potential for CTEPH patients with inoperable or persistent/recurrent PH after PEA/BPA primarily characterized by distal small‐vessel and microvasculopathy. However, the current clinical evidence remains insufficient and controversial, necessitating further validation.

目的 探究高龄女性射血分数保留的心力衰竭(HFpEF)患者的临床特点及其影响因素.方法 连续入选2017年1月至2020年12月就诊于北京中医药大学东直门医院心血管科年龄≥80岁的女性心力衰竭患者292例,根据LVEF分为射血分数减低的心力衰竭(HFrEF)组87例HFpEF组205例.比较2组临床资料,采用多因素logistic回归分析.结果 HFpEF组心房颤动比例、血钾和LVEF明显高于HFrEF组,高脂血症、心肌梗死病史、冠心病血运重建比例及心率明显低于HFrEF组(P<0.05,P<0.01).多因素logistic回归分析显示,心率(95％CI:1.008～1.056,P=0.009)、心肌梗死病史(95％CI:2.718～9.950,P=0.000)、冠心病血运重建(95％CI:1.042～3.648,P=0.037)、高脂血症(95％CI:1.615～6.068,P=0.001)是心力衰竭发作的独立危险因素.结论 心肌梗死病史、高脂血症、冠心病血运重建术、心率是高龄女性心力衰竭的危险因素.

1 病例 患者男性,51岁,主因"发作心悸伴恶心呕吐1 d"入院.患者1 d前用力搬重物后自觉心悸不适,持续数分钟不缓解,无胸痛及放射痛,伴乏力,意识淡漠,恶心,呕吐胃内容物2次后,意识丧失,脉搏不能测出,由同事呼叫120送至就近卫生院,途中随车医生判断为心脏骤停,行心肺复苏及电除颤1次,患者意识恢复,自诉心悸症状较前稍缓解.

目的:系统评价稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常的有效性和安全性.方法:计算机检索The Cochrane Library、PubMed、Embase、国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、SinoMed数据库,搜集稳心颗粒治疗慢性心力衰竭合并室性心律失常的相关随机对照试验(RCT),检索时限均从建库至2021年4月.由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果:共纳入19个RCT,包括1605例患者.Meta分析结果显示:在常规西药治疗基础上联用稳心颗粒,可显著提升临床疗效(RR=1.25,95％CI为1.19～1.32,P<0.00001)、提高左室射血分数(WMD=7.46,95％CI为6.91～8.00,P<0.0001)、减少24 h室性早搏总数(SMD=-2.05,95％CI为-3.73～-0.37,P=0.02)、降低静息心率(WMD=-7.97,95％CI为-10.51～-5.42,P<0.0001)、降低N端脑利尿钠肽前体水平(SMD=-1.29,95％CI为-1.66～-0.93,P<0.0001)、减小左室舒张末期内径(WMD=-3.31,95％CI为-5.15～-1.47,P=0.0004).2组患者不良反应发生率比较,观察组优于对照组,差异有统计学意义(RR=0.49,95％CI为0.34～0.71,P=0.0002).结论:稳心颗粒联合常规西药治疗慢性心力衰竭合并室性心律失常可提高临床疗效,且安全性较高.受纳入研究的数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实.

Background: Cardiac rehabilitation is an important part of the therapeutic regimen for chronic heart failure. Acute decompensated heart failure (ADHF) in hospitalized patients were usually excluded from cardiac rehabilitation programs. The initiation of cardiac rehabilitation with ADHF usually occurs after hospital discharge. This study included recent clinical trials in patients beginning early exercise-based rehabilitation during their hospitalization and compared the efficacy and safety of early cardiac rehabilitation to ADHF patients who didn't receive cardiac rehabilitation. Methods: Clinical trials were searched from the EMBASE, PubMed, CENTRAL, and WAN FANG. We included randomized controlled trials (RCTs) in which early exercise-based rehabilitation started during the index hospitalization, from the establishment of the database to July 2022. RevMan 5.4 was used for the statistical analysis. Results: Six studies, with a total of 668 patients were included; 336 patients in the early rehabilitation group and 332 patients in the control group. Exercise capacity was significantly improved in the 6-minute walk distance [mean difference (MD): 32.97, 95% CI: 31.03 to 34.90, p < 0.00001], and the Short Physical Performance Battery (MD: 1.40, 95% CI: 1.35 to 1.44, p < 0.00001). The rate of all-cause rehospitalization was significantly decreased in the early rehabilitation group (OR: 0.67, 95% CI: 0.45 to 0.99, p = 0.04). Conclusions: Early exercise-based rehabilitation for eligible ADHF in-patients starting during, or early after, hospitalization could significantly improve exercise capacity. A transitional, individualized, progressive, exercise-based rehabilitation program during hospitalization combined with post-discharge clinic rehabilitation is an integrated rehabilitation strategy for acute decompensated heart failure.

Objective Pulmonary hypertension (PH) in context with interstitial lung disease (ILD) portends serious clinical consequences and a high rate of mortality. Recently published randomized controlled trials (RCTs) which assessed the pulmonary arterial hypertension (PAH)-specific drugs for pulmonary hypertension and interstitial lung disease (PH-ILD) revealed inconsistent clinical outcomes with previous studies. We conducted a systemic review and meta-analysis to further investigate the effect of PAH-specific therapies for PH-ILD. Methods Clinical trials were searched from the EMBASE, PUBMED, and CENTRAL databases. The duration from the establishment of the database to June 2022 for RCTs evaluates the effect of PAH-specific therapy in patients with PH-ILD. RevMan 5.4 was used for the meta-analysis. Results A total of six articles (with a total of 791 patients) were included, including 412 patients in the treated group and 379 patients in the control group. As compared to placebo, the change of 6MWD was a significant improvement with PAH-specific therapy in the six RCTs (23.09; 95% CI, 12.07–34.12 P < 0.0001); but when the study with inhaled treprostinil was excluded, the significant improvement in the change of 6MWD from baseline was not present anymore (MD 11.01, 95%CI−6.43–28.46 P = 0.22). There was no significant improvement in the change in lung function, hemodynamic parameters, clinical worsening, all-cause death, and serious adverse effects in the treated group compared to placebo. Conclusion PAH-specific therapy significantly improved exercise capacity in the patients with PH-ILD, but this is due to the greater contribution of the study with inhaled treprostinil. Therefore, our findings still did not support the routine use of the whole PAH-specific drugs for PH-ILD.

Introduction The Shenqisuxin granule (SQSX), a novel Chinese herbal formula, has the effect of preventing in-stent restenosis and improving angiogenesis. We intend to evaluate the efficacy and safety of SQSX to provide a possible therapeutic strategy for complex coronary artery disease (CCAD) after percutaneous coronary intervention (PCI). Methods/design The study is a multi-center, randomized, double-blinded, parallel, placebo-controlled trial. A total of 120 participants will be randomized 1:1 into the intervention group and the control group. Based on standardized treatment, the intervention group and control group will receive SQSX and placebo for 2 months, respectively. The primary outcomes, metabolic equivalents (METS) and peak oxygen uptake (Peak VO2), and the secondary outcomes, including other indicators of cardiorespiratory fitness (CRF), the European Quality of Life Questionnaire (EQ-5D-5L), the Seattle Angina Scale (SAQ), etc., will be assessed at baseline and 2 months ± 3 days. In addition, the survey scales will also be tested at 1 month ± 3 days. Trimethylamine N-oxide (TMAO), high-sensitivity C-reactive protein (hs-CRP), and gut microbiota features will be assessed at baseline and 2 months ± 3 days to probe possible mechanism. The major adverse cardiac and cerebrovascular events (MACCE) and bleeding events will be monitored until the 12-month follow-up. Discussion This study is launched to assess the efficacy and safety of SQSX in CCAD after PCI and probe the possible mechanism. Clinical trial registration China Clinical Trial Registry, ChiCTR2200060979, Registered on June 14, 2022.

Objective To assess the value of left atrium volume index（LAVI）for diagnosing heart failure with preserved ejection fraction (HFpEF) based on the invasive determination of left ventricular end-diastolic pressure (LVEDP). Methods A total of 710 cases of patients with dyspnea (LVEF≥50%) were enrolled in this retrospective study. Left ventricular end-diastolic pressure (LVEDP) was measured through selective coronary angiography. According to the value of LVEDP, cases were divided into the HFpEF group ( LVEDP≥15mmHg) and the control group (LVEDP<15mmHg). LAVI was calculated based on cardiac compartment diameter, as measured by echocardiography, and body surface area (BSA). Differences of LAVI between the HFpEF group and the control group, and between subgroups in the HFpEF group were analyzed. Results The difference in LAVI between the control group and the HFpEF group was statistically significant (41.35±2.28vs.46.78±2.63ml/m 2 , p=0.008). LVEDP was positively correlated with LAVI (Pearson: r=0.787, P＜0.001). When LAVI took the best cutoff value of 43.7 mm/m 2 , the sensitivity and specificity of diagnosis of HFpEF were 92.0% and 88.9%. When the boundary value of LAVI was from 41.7 to 45.7 mm/m 2 , the sensitivity of the diagnosis of ejection fraction retention heart failure was from 97.4% to 64.4% and the specificity was from 51.2.0% to 92.2%. Conclusion In patients with dyspnea after exclusion of heart failure with reduced ejection fraction (HFrEF), LAVI is positively correlated with LVEDP. LAVI can be used to diagnose HFpEF when HFrEF is excluded.

Background: Congestive renal failure commonly result from cardiorenal syndrome related renal venous hypertension(RVH)，which is more linked to the renal venous pressure than mean arterial pressure and systematic vascular resistance. But its mechanism and treatment strategy is still being explored. Methods: We did an investigator-initiated,open-label study to explore a novel treatment strategy and mechanism of renal venous hypertension related acute kidney injury(AKI).A patient with acute kidney injury(AKI) due to cardiorenal syndrome related renal venous hypertension was enrolled.The estimated pressure of renal vein (ePrv) was measured by ultrasound. Prior to the trial,residual urinary was detected by bedside ultrasound so as to rule out lower urinary tract obstruction.A three-lumen catheter was inserted into bladder for elevating tubular pressure and monitor intrabladder pressure.In the first phase,pressure of intrabladder was maintained equal to ePrv+8mmHg for 3 hours.In the second phase, intrabladder pressure was adjusted and maintained equal to ePrv for 21 hours. The urine volume is equal to the fluid expelled from bladder minus infused 0.9% Sodium chloride. Result: 130 milliliter urine output was secreted in the first phase and 370 milliliter in the second phase.A total of 500 milliliter urine output was secreted during the trial period (24 hours). 5 days after treatment, the patient's creatinine level dropped significantly. Conclusions: We first proposed a new therapeutic exploration, acute kidney injury secondary to cardiorenal syndrome related renal venous hypertension can be treated by increasing tubular pressure.Tubular compressed or even collapsed under renal venous hypertension may be an important mechanism of acute kidney injury due to RVH.

目的探讨大黄导泻与增加利尿剂干预策略对继发于Ⅰ型心肾综合征的利尿剂抵抗的疗效。方法连续纳入2017年3月至2019年3月入住北京中医药大学东直门医院Ⅰ型心肾综合征伴利尿剂抵抗患者202例,应用随机数字表法分为大黄导泻组（99例）和增加利尿剂组（103例）,大黄导泻组给予20 g大黄加100 ml开水泡水,分次口服;增加利尿剂组根据对利尿剂的反应给予呋塞米10~40 mg/h持续泵入,2组均持续干预72 h后进行心力衰竭整体症状评估,比较干预72 h后心力衰竭整体症状评分积分曲线下面积、心力衰竭持续或恶化比例、肌酐升高≥26. 5μmol/L比例、体液净丢失量,以及干预后体质量、血肌酐、血尿素氮、N末端B型脑钠肽前体水平与基线的差值。结果干预72 h后,大黄导泻组心力衰竭整体症状评分积分从基线至干预72 h的曲线下面积高于增加利尿剂组[（4 779±306）比（4 533±169）],心力衰竭持续或恶化比例低于增加利尿剂组[12. 1%（12/99）比27. 2%（28/103）],血肌酐升高≥26. 5μmol/L比例低于增加利尿剂组[25. 2%（25/99）比68. 9%（71/103）],N末端B型脑钠肽前体与基线的差值明显高于增加利尿剂组[（-2 957±1 161） ng/L比（-1 511±581） ng/L],血肌酐和血尿素氮水平在大黄导泻组轻度下降而在增加利尿剂组却明显升高,组间比较差异均有统计学意义（均P ＜0. 05）。2组体质量与基线的差值和体液净丢失量比较差异均无统计学意义（均P＞ 0. 05）。结论大黄导泻治疗策略对于伴发利尿剂抵抗的Ⅰ型心肾综合征患者的疗效优于增加利尿剂。

Objective To explore the influence factors of abnormal blood pressure fluctuation in elderly patients with hypertension.Methods A total of 1 768 hypertensive patients aged 60 years or older admitted to Dongzhimen Hospital,Beijing University of Chinese Medicine between March 2016 to March 2017 were enrolled.Patients without abnormal blood pressure fluctuation were assigned to control group(n =1 553) and patients with abnormal blood pressure fluctuation were observation group(n =215).Comorbidities and risk factors of abnormal blood pressure fluctuation were analyzed.Results Logistic regression indicated that cerebral hemorrhage (odds ratio =29.37,P =0.01),cerebral infarction(odds ratio =21.35,P =0.01),lacunar infarction(odds ratio =17.44,P =0.01),cervical spondylosis(odds ratio =12.89,P =0.01),neurotic headache(odds ratio =9.32,P =0.03),emotional stress(odds ratio =11.83,P =0.01) and angina attack(odds ratio =6.41,P ＜ 0.01) were influence factors of abnormal blood pressure fluctuation.Conclusion Ischemic stroke,cervical spondylosis and hemorrhagic stroke are associated with abnormal blood pressure fluctuation in the elderly.

The difference between pulmonary and cardiac causality in the diagnosis of acute dyspnea is critical to the outcomes of patients since dyspnea is correlated to severe conditions, such as pneumothorax or pulmonary embolism and progressive chronic conditions. The B-type natriuretic peptide (BNP) has been widely used to diagnose heart failure but with low diagnostic specificity. The arterial blood gas analysis has been suggested as a viable and cost-effective diagnostic marker, although the optimal implementation parameters and values remain unclear. The present study evaluated the diagnostic accuracy of oxygen content-based index and the estimated shunt fraction (FShuntE) for the differential diagnosis between the pulmonary and acute cardiac dyspnea. A total of 1,077 patients with acute dyspnea were enrolled from April 2012 to August 2014 consecutively in this cross-sectional study. The FShuntE values and the levels of N-terminal pro-B type NP (NT-proBNP) were measured. A total of 42, or 42 of 1,077 patients were excluded due to incomplete data. The final clinical diagnoses included 464 pulmonary cases (M/F=239/225, median age 68 years) and 571 cardiac cases (M/F=256/315, median age 67 years) of acute dyspnea. A significant FShuntE elevation was observed in the pulmonary cases. An FShuntE threshold of 8.35% exhibited a sensitivity and specificity of 63.57% and 90.09%, respectively (positive likelihood ratio of 3.116). The alternative thresholds ranged from 6.35-10.35% with the sensitivity increasing progressively from 57.09 to 68.30% and the specificity decreasing progressively from 92.67 to 84.48%. The area under the curve (AUC) of the combination of the FShuntE and the NT-proBNP parameters was 0.942 with a 95% confidence interval (CI) of 0.928-0.955, whereas the sensitivity and specificity were 88.97% and 88.36%, respectively. The FShuntE was demonstrated as useful in the differential diagnosis of the pulmonary and cardiac involvement in acute dyspnea.

A 39-year-old Chinese woman presented to the department of emergency with chest pain radiating to the left shoulder and arm accompanied with sweating and nausea for 4 h. Her blood pressure was 120/70 mmHg symmetrically over both arms and her pulse was 70 beats per minute. Her physical examination was normal. Electrocardiography showed sinus rhythm with ST-segment elevation in leads II and aVF. Laboratory data revealed cardiac troponin I of 3.0 ng/ml (relative index < 0.02 ng/ml), creatine kinase MB of 106.0 ng/ml (relative index < 7.0 ng/ml), and myoglobin of 117.0 ng/ml (relative index < 112.0 ng/ml).

Objective To investigate the relationship between severity of coronary lesion and left ventricular end-diastolic pressure (LVEDP) in patients with coronary heart disease (CHD). Methods CHD patients (n=359) with coronary angiography (CAG) were divided into CHD group (n=135) and non-CHD group (n=224). All patients were given CAG and LVEDP detection at the same time. SYNTAX integrals of coronary lesion were calculated according to CAG outcomes, and correlation between SYNTAX integral and LVEDP was studied. Results The difference in LVEDP had statistical significance between 2 groups [(21.72±3.21) mmHg vs.(3.71±0.46) mmHg, P<0.01], and LVEDP was greatly correlated to SYNTAX integral (r=0.89, P<0.01). Conclusion The left ventricular diastolic function is positively correlated to severity of coronary lesion in CHD patients.

目的:探讨高龄老年心力衰竭患者的临床特征.方法:收集304例,60岁以上心力衰竭患者的发病诱因、基础心脏疾病、症状体征、相关化验检查及并发临床情况.将304例心力衰竭患者按年龄分为两组,60～79岁为老年组,≥80岁为高龄组.对以上资料在两组间进行对比分析,了解高龄心力衰竭患者的临床体征.结果:①高龄组导致心力衰竭的首要病因是冠心病,但较老年组冠心病所占比例低(38.1％ vs.62.8％,P=0.001);高血压、退行性心脏瓣膜病、无基础心脏疾病比例较老年组明显增加,(分别为29.5％ vs.19.1％,P=0.013;37.1％ vs.10.1％,P=0.000;7.6％ vs.2.0％,P=0.016).②心力衰竭发作诱因中,高龄组首位是呼吸道感染,较老年组增加(43.8％ vs.23.6％,P=0.001),输液快、外科手术及无明显诱因较老年组比例明显增加,两组比较差异有统计学意义.③高龄组心力衰竭类型及临床特点与相应的基础疾病及诱因相关.④老年心力衰竭并发多种临床情况,低蛋白血症和贫血在高龄组中比例明显增高比例(分别是38.1％ vs.14.1％,P=0.000;20.0％ vs.11.6％,P=0.046).结论:高龄心力衰竭患者诱因首位是呼吸道感染,另外诱因多样或诱因不明显;部分患者基础心脏病史不明确;舒张功能不全为主的心力衰竭比例偏高;症状不典型;合并有多种临床情况,尤其低蛋白血症、贫血、胸腔积液及栓塞比例增加;肺部X线检查、心脏彩超对早期诊断有帮助.

Objective To investigate the risk factors of ischemic stroke in elderly patients with atrial fibrillation.Methods Totally 268 elderly patients with atrial fibrillation who had no history of stroke from January 2011 to December 2012 were enrolled.The general data were collected.Taking stroke as endpoint event,all patients were followed up to the endpoint.The risk factors of ischemic stroke were analyzed.Results After 2 years of follow-up,ischemic stroke occurred in 36 patients,with overall incidence of 13.4％.The incidence of ischemic stroke in ＞ 75 years old patients was obviously higher than that in ≤75 years old patients [20.7％ (24/116) vs 7.9％ (12/152),x2 =9.26,P ＜0.05].The incidence of ischemic stroke in patients with diabetes and dyslipidemia were obviously higher than that in patients without diabetes and dyslipidemia [25.0％ (23/92) vs 7.4％ (13/176),18.8％ (22/117) vs 9.3％ (14/151)] (x2 =16.12,5.94,P ＜ 0.05).The incidence rates of ischemic stroke in patients with persistent atrial fibrillation was significantly higher than that in patients with paroxysmal atrial fibrillation [19.1％ (31/162) vs 4.7％ (5/106)] (x2 =11.45,P ＜0.01) ; the incidence of ischemic stroke in patients with valvular atrial fibrillation was obviously higher than in patients with nonvalvular atrial fibrillation [18.2％ (28/154) vs 7.0％ (8/114)] (x2 =7.02,P ＜ 0.01).Multivariate Logistic analysis showed that the age,diabetes,peripheral vascular disease,smoking and without anticoagulation therapy were independent risk factors of ischemic stroke in elderly patients with atrial fibrillation (OR =1.308,2.227,2.704,1.554,3.248).Conclusions Age,diabetes,peripheral vascular disease,smoking and without anticoagulation therapy were independent risk factors of ischemic stroke in elderly patients with atrial fibrillation.

Objective To explore the correlations among carbohydrate antigen 125 (CA125),cardiac function and edema in the elderly patients with chronic heart failure content (CHF).Methods Totally 144 elderly patients (＞ 60 years) with CHF (CHF group) from January 2011 to June 2014 were enrolled.According to New York Heart Association (NYHA) classification,there were 48 of cardiac function grade l,41 of grade Ⅲ (41 cases) and 55 of grade Ⅳ.Thirty had simple peripheral edema,55 were complicated with serous effusion edema and 59 had no edema.In addition,42 healthy people were enrolled as control group.The N-terminal pro brain natriuretic peptide (NT-proBNP),CA125 and left ventricular ejection fraction (LVEF) were measured and compared between the two groups,the correlations between CA125 and cardiac function,edema were analyzed.Results The patients with cardiac function grade Ⅱ,Ⅲ and Ⅳ in CHF group had significantly higher NT-proBNP and CA125 compared with control group [NT-proBNP:(1 646 ±963),(4 133 ± 1 112),(4 927 ± 1 596) ng/L vs (298±287) ng/L;CA125:(30±10),(44±11),(52±19) kU/Lvs (17±-5) kU/L] (P＜ 0.01).In observation group,the level of CA125 was positively correlated with NT-proBNP (r =0.77,P ＜ 0.01),the levels of CA125 and NT-proBNP were both negatively correlated with LVEF (r =-0.57,r =-0.53,P ＜0.01).The levels of CA125 in patients with simple peripheral edema and serous effusion edema were both significantly higher than that in patients with no edema[(53 ± 18),(44 ± 12) kU/L vs (32 ± 11) kU/L] (P ＜ 0.01).Conclusion The CA125 level increases along with the degree of heart failure in the elderly patients with CHF and is related with serous cavity effusion and peripheral edema.