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Objective:This study aimed to investigate temporal trends in Event survival after OHCA from 2015 to 2019 in Jiading district Shanghai. And analysis the influencing factors.Methods:This was a population based observational cohort study evaluating the temporal trends in survival after OHCA, we included consecutive patients who experienced an OHCA between January 1,2015 and December 31, 2019, we included all adult patients aged ≥ 18 years who presumed medical cause and were treated by emergency medical services (EMS) in Jiading District. The Data was obtained from Dispatch software system, The emergency case registration system, paper-based treatment records, dispatcher's telephone recording and in-hospital records, This Data organized according to the Utstein template using standard data element definitions. Temporal changes were measured by chi-square trend test. we constructed a multilevel logistic regression model to identify factors independently associated with event survival arrival at hospital and survival to hospital discharge.Results:A total of 1305 patients with OHCA met study inclusion criteria during the study period. Survival to hospital admission was 4.14% increased from 1.87% in 2015 to 7.31% in 2019 for trend ( P=0.009), survival to hospital discharge was 1.23%, increased from 0.37% in 2015 to 3.32% in 2019 ( P=0.003). But there was no evidence of a temporal change in survival to hospital discharge with good neurologic function (0.37 in 2015 to1.33% in 2019, P=0.339 for trend). In the subgroup, the rate of Recognition was increased from 7.49% in 2015 to 19.27% in 2019 ( P< 0.01). The proportion of cases receiving bystander CPR was 17.39%, which increased from 9.36% in 2015 to 25.19% in 2019 ( P= 0.000). The proportion of shockable rhythm was 4.06%, there was no evidence of a temporal change in the proportion of the overall rhythm (3.00%-4.65%, P=0.323 for trend), There were no cases of bystanders using automated external defibrillators (AEDs) in patients with cardiac arrest, The EMS response time (min) were15.45±8.71, which decreased from 15.10±8.12 in 2015 to 13.41±6.47 in 2019 ( P< 0.0001). Multiple regression analysis showed that Male ( OR= 0.315, 95% CI: 0.168-0.519, P =0.000), Not Shockable rhythm ( OR= 0.096, 95% CI: 0.043-0.012, P=0.000), and public location ( OR=2.411, 95% CI: 1.302-4.463, P=0.005) were independent predictor of Factors Associated with survival at hospital admission. Male ( OR= 0.247, 95% CI: 0.070-0.866, P=0.029), Not Shockable rhythm ( OR= 0.072, 95% CI: 0.016-0.318, P=0.001), and No Epinephrine administration ( OR=5.953, 95% CI:1.222-29.012, P=0.005) were independent predictor of Factors Associated with Survival to Hospital Discharge. Conclusions:Survival after OHCA has improved over time. Several targeted initiatives established along the chain of survival of OHCA during the past 5-years may help explain the improvement in survival outcome observed in Jiading District, including improved the rate of Recognition, improved participation rates in bystander CPR and a reduction in EMS response time.In the future, more resources should be improving the quality of CPR training and expanding AEDs coverage and encouraging the public to have the courage to use them.
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Objective:To assess the association between the different prehospital transfer pathways to the hospital and reperfusion delay in patients with ST segment elevation myocardial infarction (STEMI).Methods:We retrospective collected 320 STEMI patients aged 18 years or older who underwent primary percutaneous coronary intervention (PPCI) from June 1, 2016 to July 31, 2018. They were divided into three groups according to different prehospital transfer pathways: patients directly transferred from the field by ambulance to PCI-capable center hospital (field transfer group, n=29); patients transferred by ambulance from PCI-incapable hospitals to PCI-capable center hospital (inerhospital transfer group, n=111); patients transferred by friends or relatives to PCI-capable center hospital (self-transfer group, n=180). The basic characteristic attributes, reperfusion time and fatal complications such as acute left heart failure cases (ALHF) cases, ventricular fibrillation (VF) cases, and in hospital death were collected and compared. In addition, logistic regression analysis was used to analyze uni- and multivariate of door-to-balloon (D2B) time less than 90 min. Results:The S2FMC interval were 118 min (50, 377) min , FMC-to-balloon interval were 87 min (66, 120.5) min and the onset-to-balloon time were 221 min (135, 482.5) min. The above three interval in the interhospital transfer group were longer than those in the field transfer and self-transfer groups ( P<0.05). S2FMC accounted for 51.14% of onset-to-balloon time in the field transfer group, 63.29% in the interhospital transfer group and 55.26% in the self transfer group. The door-to-catheter room interval were 33 min (9, 53.5) min. The interval in the interhospital transfer group were shorter than those in the field transfer and self-transfer groups ( P<0.05). The interval in the self-transfer group were longer than those in the interhospital transfer and field transfer groups ( P<0.05). Multiple regression analysis showed that the interhospital transfer group ( OR=15.251, 95% CI: 5.328-43.657, P<0.01), field transfer group ( OR=8.219, 95% CI: 1.861-36.307, P=0.005), FMC2ECG time ( OR=0.975, 95% CI: 0.962-0.989, P<0.01), and smoking ( OR=2.099, 95% CI: 1.015-4.341, P=0.045) were independent predictor of goal time less than 90 min ( P<0.05 for all variables). Adverse events in STEMI patients mainly occurred within 6 h of the initial symptoms. The incidence of VF was 3.75% (95% CI: 3.73%-3.77%), ALHF was 10.94% (95% CI: 7.52%-14.36%) and in-hospital mortality was 2.5% (95% CI: 0.79%-4.21%). There was no significant difference in the incidence of adverse events among the three groups ( P>0.05). Conclusions:The symptoms of STEMI patients are at risk in the early stage. Ambulances can shorten the reperfusion time, but the ambulance system is less used by patients. It is necessary to further optimize the treatment process of non-PCI hospitals and strengthen the popularity of emergency knowledge related to chest pain among residents, so as to shorten the reperfusion time.
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Objective:To study the dental and skeletal changes after orthodontic treatment for malocclusion patients with rapid maxil-lary and mandibular expansion companied with fixed appliance.Methods:36 patients underwent the treatment with rapid maxillary and mandibular expansion companied with straight wire appliance.Pre-and post-treatment dental casts and lateral cephalometric radiographs were measured and compared.Results:After treatment,the maxillary and mandibular arch width perimeters increased(P 0.05).U1-SN and U1-NA decreased,L1-MP and L1-NB increased(P <0.05).Conclusion:Dental crowding can be solved effectively and occlusion re-lationship can be kept well with rapid maxillary and mandibular expansion companied with straight wire appliance without influence on the vertical skeletal relationship.