[Afferent baroreflex failure with hyponatremia: A case report].

Afferent baroreflex failure (ABF) is a rare disease. It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medulla. The recognized causes include trauma, surgery in related areas (radical neck tumor surgery, carotid endarterectomy), neck radiotherapy, brain stem stroke, tumor growth paraganglioma and hereditary diseases, among which the most common cause is extensive neck surgery or radiotherapy for neck cancer. The main manifestations are fluctuating hypertension, orthostatic hypotension, paroxysmal tachycardia and bradycardia. This case is a young man, whose main feature is blood pressure fluctuation, accom-panied by neurogenic orthostatic hypotension (nOH). After examination, the common causes of hypertension and nOH were ruled out. Combined with the previous neck radiotherapy and neck lymph node dissection, it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection, which was called ABF. At the same time, the patient was complicated with chronic hyponatremia. Combined with clinical and laboratory examination, the final consideration was caused by syndrome of in- appropriate antidiuretic hormone (SIADH). Baroreceptors controlled the secretion of heart rate, blood pressure and antidiuretic hormone through the mandatory "inhibition" signal. We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery, which leads to abnormal blood pressure regulation and nOH, while the function of inhibiting ADH secretion was weakened, resulting in higher ADH than normal level and mild hyponatremia. The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate, and to alleviate the onset of symptomatic hypotension. At present, drug treatment is still controversial, and non-drug treatment may alleviate some patients' symptoms, but long-term effective treatment still needs further study. The incidence of ABF is not high, but it may lead to serious cardiovascular and cerebrovascular events, and the mechanism involved is extremely complicated, and there are few related studies. The reports of relevant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complications.

Effect of altitude training on the aerobic capacity of athletes: A systematic review and meta-analysis.

Purpose: With a growing number of athletes and coaches adopting altitude training, the importance for rationalizing and optimizing such training has been emphasized. We conducted a meta-analysis to evaluate the influence of altitude training on athletes' aerobic capacity and to explore the best altitude training method to improve this capacity. Methods: We searched Web of Science, SpringerLink, Science Direct, EBSCO, and PubMed databases combined with manual search of the references to collect studies indexed from 1979 to September 2020 on the effect of altitude training on athletes' aerobic capacity. Data from experimental studies that reported hemoglobin levels and maximum oxygen uptake in athletes before and after altitude training, or in athletes performing altitude training in comparison with a control group were analyzed. Data of the populations, intervention, comparison, outcomes and study design were extracted. Review Manager software 5.3 was used for bias evaluation. Results: 17 publications were included. In our meta-analysis, altitude training led to higher maximum oxygen uptake [standardized mean difference (SMD) = 0.67, 95% confidence interval (CI) 0.35-1.00, P < 0.001] and hemoglobin level (SMD = 0.50, 95% CI 0.11-0.90, P = 0.013) than training at lower altitude. The result of sensitivity analysis showed that results of meta-analysis were relatively stable, and there was no bias or change in the result of effect size according to the bias test. The results of subgroup analysis showed that high-altitude living and low-altitude training ("Hi-Lo" regime), with a training cycle of about three weeks at an altitude around 2500 m, had better effects than other regimes on the athletes' aerobic capacity. Conclusions: Altitude training can improve athletes' aerobic capacity in terms of maximum oxygen uptake and hemoglobin level. Our results are limited by the number and quality of available studies. Therefore, more high-quality studies are needed to verify and extend these findings. Our study can provide scientific suggestions for the training of athletes.

A study on the behavior intention of university students participating in winter sports.

This study explored the relationship between university students' exercise efficacy and behavioral intention to participate in winter sports. Using a self-efficacy scale, exercise motivation scale, satisfaction with life scale, and the theory of planned behavior questionnaire, the intentions and behaviors of 862 university students were investigated. Based on the Health Action Process Approach (HAPA) model and customer satisfaction theories, a model of the relationship between university students' exercise efficacy and behavioral intention was constructed. The results showed that there was a significantly positive correlation between sports efficacy, motivation, satisfaction, experience perception, and behavioral intention. Sports efficacy had a direct and positive effect on university students' behavioral intention to participate in winter sports (SE = 0.052, Z = 10.673 > 1.96, P = 0.000); The indirect effect of sports efficacy on behavioral intention via motivation and satisfaction was 0.077 (SE = 0.016, Z = 4.813 > 1.96, P = 0.000); the indirect effect of sports efficacy on behavioral intention via experience perception, motivation, and satisfaction was 0.037 (SE = 0.009, Z = 4.111 > 1.96, P = 0.000). Our results not only verify and expand on the HAPA and customer satisfaction theories but also highlight the need for interventions targeting university students' behavioral intention of participating in winter sports from the perspective of improving their sports efficacy, improving the perception of winter sports participation experience, and enhancing their motivation for engaging in exercise and satisfaction with exercise.

Effect of mindfulness meditation on depression during pregnancy: A meta-analysis.

Purpose: This study systematically evaluates the effect of mindfulness meditation on depression during pregnancy. We provide evidence-based suggestions for preventing and reducing depression during pregnancy by exploring the most effective intervention mode, cycle, and frequency of mindfulness meditation. Methods: Records were retrieved from PubMed, Web of Science, EBSCO, and Science Direct. A total of 1,612 randomized controlled trial studies on the effect of mindfulness meditation on pregnancy depression were collected. 10 studies with 658 subjects meeting the inclusion criteria were extracted and analyzed by Revman 5.3 to evaluate study qualities. Stata 12.0 was used for the meta-analysis. Results: Mindfulness meditation had a positive effect on depression during pregnancy [standardized difference of the mean (SMD) = -0.786, 95% confidence interval (-1.289, -0.283), P < 0.001]. Subgroup analysis showed that mindfulness-based cognitive therapy (MBCT) had the best intervention effect on depression during pregnancy (SMD = 2.795), the best intervention duration was below 4 weeks (SMD = 1.756), applied from the first to the third stage of pregnancy (SMD = 1.024), the frequency guided by experts was less than six times a week (SMD = 2.055) of <60 min each time (SMD = 1.068), and completing homework by themselves every day for 30 mins (SMD = 1.822) was most significant for the improvement of depression during pregnancy. We found high heterogeneity across studies [q = 97.003, DF = 10, I2 = 88.0% (P < 0.001), I2 > 75%]. This may be caused by variance in measurement tools, among which Beck Depression Inventory-II was a significant source of heterogeneity. Conclusion: Mindfulness meditation can improve the prevention, remission, and reduction of depression during pregnancy and can be used as an auxiliary measure for the clinical treatment of pregnancy depression.

A Study on the Correlation Between Undergraduate Students' Exercise Motivation, Exercise Self-Efficacy, and Exercise Behaviour Under the COVID-19 Epidemic Environment.

The outbreak of COVID-19 epidemic has influenced human beings from various aspects including physical exercise behaviours. This study aims to explore the influence of the COVID-19 epidemic on exercise self-efficacy and exercise behaviour, as well as the intermediary effects of exercise motivation. A sample of 1,115 undergraduate students was investigated using the physical exercise behaviour scale, exercise self-efficacy scale, and exercise motivation scale, combined with the COVID-19 epidemic environment as an influencing factor. SPSS was used for statistical analysis and AMOS for the prediction model building. Logical analysis was undertaken to sort out and analyse the data. The structural equation model reveals that exercise self-efficacy has a positive effect on exercise motivation and exercise behaviour. Meanwhile, the COVID-19 epidemic environment negatively influences exercise behaviour through the intermediary role of exercise self-efficacy and exercise motivation. Moreover, the intermediary effect of exercise self-efficacy is greater than that of exercise self-efficacy and exercise motivation. This study provides both theoretical implications and practical guidelines for society and undergraduate students to improve their exercise behaviour during epidemic.

Satisfaction Levels of Young Urban Residents With Public Sports Services in China During the COVID-19 Epidemic.

The extensive changes in public and private life caused by the ongoing COVID-19 epidemic in China have created a "new normal." To understand urban residents' satisfaction with public sports services under these conditions and to identify factors that influence satisfaction, urban residents in several major Chinese cities were randomly sampled with an online questionnaire to measure their level of satisfaction with public sports services in China during the COVID-19 epidemic. With the response rate of 87.9%, 703 valid questionnaires out of 800 questionnaires distributed were analyzed. A structural equation model was constructed where health literacy and the residents' expectations were independent variables, residents' participation was a mediating variable, and residents' satisfaction was the dependent variable. Cronbach's α test and Kaiser-Meyer-Olkin test confirmed that the questionnaire was reliable and valid. Survey results suggest that young urban residents' participation in public sports services is influenced by personal health literacy and residents' expectations. Participation serves a mediating role between health literacy and residents' satisfaction, but not between residents' expectations and their satisfaction. Young urban residents' satisfaction with public sports services may be improved by increasing access to health information, improving hardware and software platforms to support those services, and catering the services to the interests of the population.

The Impact of Perceptions of Positive COVID-19 Information on Travel Motivation and Intention: Evidence From Chinese University Students.

The COVID-19 pandemic has influenced the tourism industry in various ways, including tourists' travel motivations and intentions. Unlike previous studies that have focused on the dark side of the pandemic, this study adds the dimension of perceptions of positive information on COVID-19 to the Theory of Planned Behavior to explore their influence on travel motivation and intention. A total of 470 valid questionnaires were collected from a sample of Chinese university students. The results showed that the students' perceptions of positive COVID-19 information positively impacted their travel intentions through the variables of perceived behavioral control, travel attitudes, and travel motivations. Perceived behavioral control was the mediating variable that most explained the impact of perceptions of positive COVID-19 information on travel motivation and intention. This study contributes to the understanding of the influence of the COVID-19 pandemic on tourism and of university students' travel motivations and intentions. It also offers implications for the tourism industry to formulate relevant recovery strategies during and after the pandemic.

Effect of hirudin on arterialized venous flap survival in rabbits.

Arterialized venous flap (AVF) is limited in clinical application because its survival remains inconsistent and its exact survival mechanism is still unclear. Hirudin is an effective thrombin specific inhibitor, which is isolated from the salivary gland secretions of the leech. Our study evaluated the impact of hirudin on the viability of AVFs in rabbits. Thirty-six rabbits were randomly divided into three groups: sham group (physiological perfusion), control group (AVF), and hirudin group (AVF + hirudin). In hirudin group, 20 antithrombin units (ATU) hirudin (2.5 ml) were injected into each flap. In sham group and control group, the same amount of normal saline was injected into each flap. Status of flap survival, water content, vascular perfusion, histopathology, expression of CD34, VEGF, eNOS and HIF-1α were analyzed in each group. Analysis of oxidative stress was performed by measuring the activity of superoxide dismutase (SOD) and malondialdehyde (MDA). Compared with flaps in sham group with physiological perfusion mode, results of survival rate, perfusion status, SOD activity, expression of CD34, VEGF, and eNOS of AVFs in control group were significantly lower, while water content, MDA level and expression of HIF-1α were higher. The flap condition of AVFs injected with hirudin in hirudin group was improved significantly, and the results were similar to sham group. Our findings revealed that hirudin can effectively improve survival of AVF.

The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia.

To evaluate the effect of age and parity on maternal cardiac diastolic function in second trimester among pregnant women with normal left ventricular ejection fraction. To analyze the correlation between impaired diastolic function and pre-eclampsia. It had been suggested that maternal cardiac adaptations during pregnancy differed between nulliparous and primiparous women and also varied according to age. Impaired cardiac function may precede pre-eclampsia. Therefore, we examined the effects of parity and age on cardiac diastolic function during pregnancy and whether impaired diastolic function during the second trimester correlates with pre-eclampsia. Women with singleton pregnancies at 13 + 0 to 27 + 6 weeks' gestation and left ventricular ejection fraction (LVEF) ≥ 50% were retrospectively identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records. The effect of age and parity on maternal cardiac diastolic function as well as the correlation between impaired diastolic function and occurrence rate of pre-eclampsia were examined. 376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 primiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women < 35 years compared with 28.6% of those ≥ 35 years (p = 0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC = 0.704, p = 0.000, sensitivity = 54.5%, specificity = 75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. Higher maternal age was an independent risk factor of declining Em (p < 0.05). Em < 13 cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI 3.40-21.57) after being adjusted for confounders. Maternal age is an independent risk factor for diastolic function decline. There is no difference in cardiac diastolic function between nulliparous women and primiparous women. Pre-eclampsia occurrence is significantly higher in patients with impaired diastolic function at mid-gestation. The application of risk grading using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.

Trans-Cinnamaldehyde Increases Random Pattern Flap Survival Through Activation of the Nitric Oxide Pathway.

BACKGROUND: The application of random pattern skin flaps is limited in plastic surgery reconstruction due to necrosis. Trans-cinnamaldehyde has antibacterial, anticancer, and antioxidant properties. In this study, we aimed to investigate the effect of trans-cinnamaldehyde on skin flap survival and its possible mechanism regarding nitric oxide. MATERIALS AND METHODS: One hundred forty male Sprague-Dawley rats were randomly divided into seven groups (n = 20 each group). After the dorsal flap was raised, different doses of trans-cinnamaldehyde (10, 20, and 30 mg/kg) were immediately given by oral gavage in the three different groups. To assess the possible involvement of the nitric oxide system, NG-nitro-L-arginine methyl ester (L-NAME, a nonselective nitric oxide synthase inhibitor) was used in this study. All flap samples were incised on postoperative day 7. RESULTS: Our results showed that flap survival was increased significantly in the 20 mg/kg (P < 0.001) trans-cinnamaldehyde (TC) group compared to the control group or 30 mg/kg TC group. This protective function was restrained by coadministration of L-NAME with 20 mg/kg TC. The results of histopathology, laser Doppler, arteriography mediated with oxide-gelatine, and fluorescent staining all showed a significant increase in capillary count, collagen deposition, angiogenesis, and flap perfusion. Immunohistochemistry results revealed a significant increase in the expression of CD34, eNOS, and VEGF. CONCLUSION: Trans-cinnamaldehyde increased flap survival through the nitric oxide synthase pathway and contributed to angiogenesis. A concentration of 20 mg/kg trans-cinnamaldehyde was recommended in this study.

Gastrodin Promotes the Survival of Random-Pattern Skin Flaps via Autophagy Flux Stimulation.

The random-pattern flap has a significant application in full mouth restoration (reconstructive surgery) and plastic surgery owing to an easy operation with no axial vascular restriction. However, distal necrosis after flap operation is still considered the most common complication which makes it the Achilles heel in the clinical application of random-pattern flaps. A Chinese medicinal herb named gastrodin is an effective active ingredient of Gastrodia. Herein, the existing study explored the significant potential of gastrodin on flap survival and its underlying mechanism. Our obtained results show that gastrodin will significantly improve flap survival, reduce tissue edema, and increase blood flow. Furthermore, our studies reveal that gastrodin can promote angiogenesis and reduce the apoptotic process as well as oxidative stress. The results of immunohistochemistry and immunoblotting revealed that gastrodin has a role in the elevation of autophagy flux which results in induced autophagy. The use of 3MA (3-methyladenine) for the inhibition of induced autophagy significantly weakened the underlying benefits of gastrodin treatment. Taken together, our obtained results confirmed that gastrodin is an effective drug that can considerably promote the survival rate of flaps (random pattern) via enhancing autophagy. Enhanced autophagy is correlated with the elevation of angiogenesis, reduced level of oxidative stress, and inhibition of cell apoptosis.

Plasma Catestatin in Patients with Acute Coronary Syndrome.

OBJECTIVES: To measure plasma catestatin levels in patients with acute coronary syndrome and investigate whether there is an association between catestatin levels and long-term outcome. METHODS: Patients (n = 170) with suspected acute coronary syndrome who underwent emergency coronary angiography were enrolled, including 46 with acute ST-segment elevation myocardial infarction (STEMI), 89 with unstable angina pectoris (UAP), and 35 without coronary artery disease (CAD). All patients were followed for 2 years to measure the occurrence of major adverse cardiovascular events (MACEs), including death from a cardiovascular cause, recurrent acute myocardial infarction, or hospital admission for heart failure or revascularization. RESULTS: On average, the plasma catestatin levels in patients with STEMI (0.80 ± 0.62 ng/ml) and UAP (0.99 ± 0.63 ng/ml) were significantly lower than the levels seen in the control group with no evidence of CAD (1.38 ± 0.98 ng/ml; p = 0.001). In multivariable linear regression, body mass index, presence of hypertension, and type of CAD were independently related to the plasma catestatin level. However, there were no significant differences in MACEs between patients with high and low levels of catestatin. CONCLUSIONS: The plasma catestatin levels in patients with STEMI and UAP were lower than the levels seen in patients without CAD.

Relationship between exercise induced elevation of left ventricular filling pressure and exercise intolerance in patients with atrial fibrillation.

BACKGROUND: Elevated left ventricular filling pressure (LVFP) is an important cause of exercise intolerance in patients with atrial fibrillation (AF). Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. METHODS: This study included 145 consecutive patients (81 men and 64 women; mean age 65.5 ± 8.0 years) with persistent non-valvular AF and normal left ventricular systolic function (left ventricular ejection fraction ≥ 50%). All patients underwent a symptom-limited cardiopulmonary exercise test (CPET). Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') were taken and averaged. E/e' ratio was calculated. Elevated LVFP was defined as E/e' > 9, and patients with elevated LVFP at rest were excluded. RESULTS: Patients were classified into two groups according to LVFP estimated by E/e' ratio after exercise: 39 (26.9%) with elevated LVFP after exercise and 106 (73.1%) with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake (VO2 peak) (21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P < 0.001), lower anaerobic threshold (19.9 ± 2.5 vs. 26.0 ± 4.0 mL/min per kilogram, P < 0.001), and shorter exercise time duration (6.2 ± 0.8 vs. 7.0 ± 1.3 min, P < 0.001). Multivariate analysis showed that age, gender and E/e' after exercise were significantly correlated with VO2 peak. CONCLUSION: Elevated LVFP estimated by E/e' ratio after exercise is independently associated with reduced exercise capacity in AF patients.

Correlation between growth differentiation factor-15 and collagen metabolism indicators in patients with myocardial infarction and heart failure.

BACKGROUND: Growth differentiation factor (GDF)-15, a divergent member of the transforming growth factor beta super-family does appear to be up-regulated in response to experimental pressure overload and progression of heart failure (HF). HF frequently develops after myocardial infarction (MI), contributing to worse outcome. The aim of this study is to assess the correlation between GDF-15 levels and markers related to collagen turnover in different stages of HF. METHODS: The study consists of a cohort of 179 patients, including stable angina pectoris patients (AP group, n = 50), old MI patients without HF (OMI group, n = 56), old MI patients with HF (OMI-HF group, n = 38) and normal Control group (n = 35). Both indicators reflecting the synthesis and degradation rates of collagen including precollagen I N-terminal peptide (PINP), type I collagen carboxy-terminal peptide (ICTP), precollagen III N-terminal peptide (PIIINP) and GDF-15 were measured using an enzyme-linked inmunosorbent assay. RESULTS: The plasma GDF-15 level was higher in OMI-HF group (1373.4 ± 275.4 ng/L) than OMI group (1036.1 ± 248.6 ng/L), AP group (784.6 ± 222.4 ng/L) and Control group (483.8 ± 186.4 ng/L) (P < 0.001). The indicators of collagen turnover (ICTP, PINP, PIIINP) all increased in the OMI-HF group compared with Control group (3.03 ± 1.02 µg/L vs. 2.08 ± 0.95 µg/L, 22.2 ± 6.6 µg/L vs. 16.7 ± 5.1 µg/L and 13.2 ± 7.9 µg/L vs. 6.4 ± 2.1 µg/L, respectively; P < 0.01). GDF-15 positively correlated with ICTP and PIIINP (r = 0.302, P < 0.001 and r = 0.206, P = 0.006, respectively). GDF-15 positively correlated to the echocardiographic diastolic indicators E/Em and left atrial pressure (r = 0.349 and r = 0.358, respectively; P < 0.01), and inversely correlated to the systolic indicators left ventricular ejection fraction and the average of peak systolic myocardial velocities (Sm) (r = -0.623 and r = -0.365, respectively; P < 0.01). CONCLUSION: Plasma GDF-15 is associated with the indicators of type I and III collagen turnover.

[Anorexia with sinus bradycardia: a case report].

As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus bradycardia and hypothyroidism have good prognosis. And asymptomatic sinus bradycardia with reversible causes, because of the great prognosis, they do not need special treatment. Multiple medical and psychiatric disciplines were consulted, and then, family care, nutritional support and psychiatric therapy were given, and she did not need thyroid hormone replacement therapy. The patient's overall clinical status improved gradually during her hospital stay and her heart rate was recovered to 55 beats per minute.

High-sensitivity CRP: possible link between job stress and atherosclerosis.

BACKGROUND: Chronic inflammation may play an important role in linking job stress to atherosclerosis. We sought to investigate the relationship between job stress and high-sensitivity C-reactive protein (hs-CRP) among Chinese workers. METHODS: A total of 731 subjects (506 men and 225 women) were analyzed. Job stress was evaluated by effort-reward imbalance (ERI) model. RESULTS: Among men, after adjustment for confounders, effort, overcommitment, and ERI were significantly positively correlated with hs-CRP; and reward was significantly inversely related with hs-CRP; high level of effort, overcommitment, or ERI, respectively, significantly increased the odds of high hs-CRP with ORs of 2.0, 3.5, and 3.3 (all P<0.001), compared with the corresponding low level groups. Among women, high overcommitment or ERI also increased risk of high hs-CRP with ORs of 2.8, and 4.1 (P<0.05). CONCLUSIONS: High effort, overcommmitment, and ERI were positively associated with hs-CRP. Inflammation indicated by hs-CRP may be one of important mediators linking job stress and atherosclerosis.

[Relationship between ambulatory blood pressure and myocardial performance index in hypertensive patients].

OBJECTIVE: To explore the relationship between ambulatory blood pressure and myocardial performance index (MPI) in hypertensive patients. METHODS: A total of 76 hospitalized patients with untreated hypertension from January to June 2013 were recruited. They received the examinations of office blood pressure, 24 h ambulatory blood pressure and echocardiography. MPI was determined by the following formula: MPI=(isovolumic contraction time+isovolumic relaxation time)/ejection time. Based upon left ventricular MPI, they were divided into two groups of MPI>0.47 (n=38) and MPI≤0.47 (n=38). The mean levels of office blood pressure, ambulatory blood pressure, blood pressure load, morning blood pressure surge (early morning blood pressure minus the lowest night-time blood pressure) and nocturnal blood pressure changes were compared between two groups. And the determinants of MPI were identified by multivariate regression analysis. RESULTS: As compared to those with MPI≤0.47, patients with MPI>0.47 had higher 24 h and daytime systolic blood pressures, 24 h, daytime and nighttime diastolic blood pressures, 24 h, daytime and nighttime systolic blood pressure loads, 24 h, daytime and nighttime diastolic blood pressure loads and morning systolic blood pressure surges (all P<0.05). No inter-group differences existed in the mean levels of office blood pressure, nighttime systolic blood pressure, morning diastolic blood pressure surge, nocturnal systolic or diastolic blood pressure changes (all P>0.05). Multivariate regression analysis showed that nocturnal diastolic blood pressure (ß=0.285, P=0.005) and daytime systolic blood pressure load (ß=0.397, P<0.001) were independently associated with MPI. And other factors independently associated with MPI were left ventricular mass index (LVMI) and early diastolic mitral annular velocity (Em). CONCLUSION: The increases of blood pressure level and blood pressure load are associated with an elevation of left ventricular MPI.

[Association between ambulatory blood pressure levels and blood pressure variability with myocardial performance index in untreated hypertensive patients].

OBJECTIVE: To observe the association between ambulatory blood pressure levels and blood pressure variability (BPV) with myocardial performance index (MPI) in untreated hypertensive patients. METHODS: From January to September 2013, a total of 81 untreated hypertensive patients were included in this study. All patients received ambulatory blood pressure monitoring and echocardiography measurements. MPI was determined in all patients by the following formula: MPI = (isovolumic contraction time + isovolumic relaxation time)/ejection time. The patients were divided into two groups according to left ventricular MPI: patients with MPI < 0.47 (n = 39) and patients with MPI ≤ 0.47 (n = 42). The mean levels and standard deviation (SD) of 24 h, daytime and nighttime blood pressures were compared between the two groups. SD was used to express BPV. Determinants of MPI were identified by multivariate regression analysis. RESULTS: 24 h and daytime systolic blood pressure, 24 h, daytime and nighttime diastolic blood pressure, as well as SD of 24 h and daytime systolic blood pressure ((130.1±8.7), (134.0±8.2), (89.1±6.3), (90.9±6.4), (83.1±9.9), (13.7±3.3) and (14.2±3.5) mmHg (1 mmHg = 0.133 kPa), respectively) were significantly higher in patients with MPI > 0.47 than those ((124.8±8.7), (126.7±8.8), (84.5±7.1), (86.2±7.4), (76.4±7.5), (11.8±2.1) and (10.4±1.9) mmHg, respectively) in patients with MPI ≤ 0.47 (all P < 0.05). Multivariate regression analysis showed that 24 h diastolic blood pressure (ß = 0.239, P = 0.007) and SD of 24 h systolic blood pressure (ß = 0.333, P < 0.001), left ventricular mass index and early diastolic mitral annular velocity were independently associated with MPI. CONCLUSION: The increase of diastolic blood pressure and systolic BPV are associated with the deterioration of left ventricular function.

[Relationship between E/Em ratio and exercise capacity in patients with atrial fibrillation].

OBJECTIVE: To explore the relationship between the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) and exercise capacity in patients with atrial fibrillation. METHODS: A total of 94 consecutive patients with non-valvular atrial fibrillation and preserved left ventricular ejection fraction admitted into our department from December 2011 to June 2013 were included. Echocardiography and cardiopulmonary exercise test were performed. According to E/Em, they were divided into two groups of normal E/Em (E/Em ≤ 9) and elevated E/Em (E/Em>9). The parameters of exercise capacity, including VO2max/kg, anaerobic threshold/kg (AT/kg) and exercise time duration were compared between two groups. And the determinants of VO2max/kg were identified by multivariate regression analysis. RESULTS: The number of patients was 57(60.6%) with normal E/Em and 37 (39.4%) with elevated E/Em. As compared to those with normal E/Em, the patients with elevated E/Em had lower VO2max/kg [(26 ± 4) vs (20 ± 4) ml × min⁻¹ × kg⁻¹, P < 0.001], lower AT/kg [(25 ± 4) vs (19 ± 5) ml ×min⁻¹ × kg⁻¹, P < 0.001] and shorter exercise time duration [(7.2 ± 1.3) vs (5.8 ± 1.3) min, P < 0.001]. Multivariate regression analysis revealed that three significant variables were independently associated with VO2max/kg: age (r = -0.412, P < 0.001), gender ((25 ± 5) and (21 ± 4) ml × min⁻¹ × kg⁻¹ for males and females separately, P < 0.001) and E/Em (r = -0.535, P < 0.001). CONCLUSION: E/Em was independently associated with exercise capacity in patients with atrial fibrillation.