Association of admission serum calcium level with left ventricular dysfunction in patients with acute coronary syndrome.

Background: The relationship between serum calcium and left ventricular function in patients with acute coronary syndrome (ACS) has not been explored. Our aim was to investigate the correlation of admission serum calcium with left ventricular dysfunction in ACS patients. Methods: In this cross-sectional study, 658 ACS patients who were admitted in the Department of Cardiovascular Disease from June 1st, 2019 to December 31st, 2019 were enrolled in the present study. Serum calcium and B-type natriuretic peptide (BNP) were measured at admission. Left ventricular ejection fraction (LVEF) was assessed using echocardiography. The correlation between admission serum calcium and left ventricular dysfunction was analyzed. Results: When stratified by serum calcium quartiles calculated from all patients, patients with lower serum calcium quartile showed a markedly higher BNP and lower LVEF (P < 0.05). Patients with LVEF ≤ 50% showed a significantly lower serum calcium and higher BNP compared to those with LVEF> 50% (P < 0.05). Admission serum calcium was positively correlated with LVEF (P < 0.01) but negatively correlated with BNP (P < 0.01). Multivariate logistic regression analysis showed that lower serum calcium (adjusted OR: 0.720, 95% CI: 0.519-0.997, P = 0.048) was independently associated with BNP ≥ 300 pg/ml in ACS patients. Using LVEF as a dependent variable, no significant correlation between low serum calcium and left ventricular systolic dysfunction was found in ACS patients. Conclusions: In patients with ACS, admission serum calcium was positively correlated with LVEF and negatively with BNP. Lower admission serum calcium was an independent risk factor for elevated BNP.

Evaluation of redevelopment priority of abandoned industrial and mining land based on heavy metal pollution.

Heavy metal contamination in soil is an important factor affecting the determination of safe redevelopment methods for industrial and mining land. In this paper, the soil environment of a typical mining city in northern China was taken as the research object, 148 surface soil samples were collected and the contents of heavy metals were measured. The health risk classification criteria for heavy metal contamination of soils and the method of priority assessment for redevelopment were used. The results showed that: the risk of potential utilization types of heavy metals in the abandoned industrial and mining land is different. When the utilization type is agricultural land, the soil environmental quality is good as a whole, and a small number of plots are polluted by cadmium (Cd)and mercury (Hg); When the land use type is construction land, the risk of heavy metal pollution comes from chromium (Cr); The priority of development in this study area is as follows: agricultural land > construction land > ecological land.

Changes in trabecular bone score and bone mineral density in Chinese HIV-Infected individuals after one year of antiretroviral therapy.

OBJECTIVE: Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) have been associated with reduced bone mineral density (BMD) in persons with HIV (PWH). BMD provides information only about bone mineral quantity. Trabecular bone score (TBS) is a noninvasive tool that estimates bone microarchitecture. The aim of this study is to measure BMD and TBS of Chinese PWH after one-year ART. METHODS: We designed a retrospective study of adult Chinese PWH. Patients with a dual-energy X-ray absorptiometry (DXA) scan prior to ART initiation, and again 48 weeks later were included. Information regarding demographic and clinical history, HIV treatment history, BMD and TBS were collected. We analyzed differences in BMD and TBS over 48 weeks and associations between key risk factors and changes in BMD and TBS. RESULTS: Our study included 233 â€‹PWH (mean age â€‹= â€‹36.6 â€‹± â€‹11.1 years). Before ART initiation, 19.3% of PWH had normal BMD but abnormal TBS. Both BMD and TBS decreased after one-year ART. TDF and LPV/r-containing regimens were associated with greater declines in BMD at different site. Traditional risk factors such as old age, low BMI and female sex were associated with lower baseline TBS. Greater change in TBS over one year was associated with lower BMI and lower baseline CD4+ cell count, but unlike BMD measures, it was not correlated with treatment with TDF and LPV/r in our study population. CONCLUSIONS: We present the first longitudinal analysis of change in TBS over 48 weeks compared with BMD among Asian PWH receiving ART. Before ART initiation, approximately 20% of PWH with impaired bone microarchitecture would not have been identified if DXA were used alone to assess for bone damage. Both BMD and TBS decreased after one-year ART. Change in TBS was not associated with different antiretroviral agents. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: The trabecular microarchitecture measured indirectly by TBS may provide clinicians additional information about bone damage in PWH.

Long-term trabecular bone score and bone mineral density changes in Chinese antiretroviral-treated HIV-infected individuals.

This is the first 5-year analysis among persons with HIV (PWH) that reports both trabecular bone score (TBS), which is a novel index that estimates bone microarchitecture, and bone mineral density (BMD) over time to evaluate the long-term impact of antiretroviral therapy (ART) on bone health. PURPOSE: HIV infection and antiretroviral therapy (ART) have been associated with decreased bone mineral density (BMD). This study aims to evaluate long-term changes in trabecular bone score (TBS), a novel index that estimates bone microarchitecture, and BMD among Chinese persons with HIV (PWH) treated with ART. METHODS: We conducted a retrospective chart review of adult PWH at a large tertiary care hospital in China. Patients who had a DXA scan prior to ART and at least one follow-up DXA after ART initiation were included. Subgroup analyses examined the TBS and BMD changes in patients who switch from a non-TDF-containing regimen to one containing TDF, as compared to those who did not switch. RESULTS: Four hundred fifty-nine PWH were included. Among 68 patients ≥ 50 years, 13 patients (19.1%) had a normal BMD but partially degraded or degraded TBS. The mean percent decrease in lumbar spine (LS) BMD nadired at 48 weeks after ART initiation and then gradually improved. Percent decrease in femoral neck (FN) and total hip (TH) BMD nadired at 96 weeks and remained stably low thereafter. After switch to a TDF-containing regimen, only percent change in TH BMD was significant (-3.2%, p = 0.006). In the regression analyses, switch to a TDF-containing regimen was not associated with long-term change in TBS or BMD. CONCLUSION: This is the first study among PWH to evaluate the long-term impact of ART on TBS and BMD. At baseline, approximately 20% of patients had a normal BMD but impaired bone microstructure based upon TBS. For patients with 5 years of exposure to ART, there is a stabilization of TBS and BMD after initial nadir in the first 144 weeks. However, FN BMD, TH BMD, and TBS remained low at 5 years relative to baseline.

Ambulatory blood pressure profile and stroke recurrence.

OBJECTIVES: To establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients. METHODS: The prospective cohort consisted of 1996 IS/TIA patients enrolled for ABP monitoring and a 3-month follow-up for stroke recurrence as outcome. Profile groups of systolic blood pressure (SBP) were identified via an advanced functional clustering method, and the associations of the profile groups and conventional ABP parameters with stroke recurrence were examined in a Cox proportional hazards model. RESULTS: Three discrete profile groups (n=604, 781 and 611 in profiles 1, 2 and 3, respectively) in 24-hour ambulatory SBP were identified. Profile 1 resembled most to the normal diurnal blood pressure pattern; profile 2 also dropped at night, but climbed earlier and with higher morning surge; while profile 3 had sustained higher nocturnal SBP without significant nocturnal SBP decline. The incidence of stroke recurrence was 2.9%, 3.9% and 5.5% in profiles 1, 2 and 3, respectively. After adjustment for covariates, profile 3 was significantly associated with higher risk of stroke recurrence with profile 1 as reference (HR 1.76, 95% CI: 1.00 to 3.09), while no significant difference was observed between profiles 2 and 1 (HR 1.22, 95% CI: 0.66 to 2.25). None of conventional ABP parameters showed significant associations with the outcome. CONCLUSIONS: Ambulatory 24-hour SBP profile is associated with short-term stroke recurrence. Profiles of ABP may help improve identification of stroke recurrence by capturing the additive effects of individual ABP parameters.

Lumbar Vertebrae Morphological Analysis and an Additional Approach for Vertebrae Identification in Lumbar Spine DXA Images.

INTRODUCTION: Bone mineral density measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosis of osteoporosis. However, DXA interpretation can be influenced by analytic errors which can, in turn, interfere with diagnostic accuracy. One such source of potential error is the accurate identification of specific lumbar vertebrae on lumbar spine DXA images. Although the International Society for Clinical Densitometry has introduced several approaches to aid with this process, there remain individuals whose lumbar vertebrae cannot be labeled with certainty using these approaches. We designed the present study to systematically evaluate lumbar spine DXA images among a large cohort of Chinese patients and present an additional simple strategy for identifying L5 named the "em dash"-shaped L5 or "-"-shaped L5, based upon the two-dimensional relationship between the bilateral pedicles with the central spinous process on DXA images. METHODOLOGY: Lumbar spine posteroanterior DXA images from adult patients receiving care at a large tertiary hospital in Beijing, China from May to August 2016 were retrospectively reviewed. For each patient, data were collected regarding key anatomic features seen on DXA (positions of the most superior portions of the iliac crests, the lowest vertebra with ribs, and the longest transverse processes) and the proportion of patients presenting with "H"-shaped L4 and "-"-shaped L5. Chi-squared analyses were used to compare proportions across age strata. RESULTS: DXA images from 1125 patients (79.6% female) were evaluated. The mean age of patients was 52.5 ± 14.8 yr (range: 19-90 yr). A horizontal line drawn across the superior-most portions of the iliac crests crossed the disk space between L4 and L5 among 78.3% of patients. The lowest ribs were most frequently (83.9%) observed at T12. Almost 80% of individuals had the longest transverse processes at L3. L4 was predominantly "H"-shaped (73.3%), however we found that the proportion of individuals with "H"-shaped L4 decreased steadily after 50 yr of age (p < 0.001). By contrast we observed that L5 was predominantly "-"-shaped (80.3%), with no significant differences in proportions across all age strata (p = 0.063). CONCLUSIONS: The "-"-shaped L5 can be incorporated as an additional reference tool for lumbar spine DXA image analysis and may be particularly helpful for lumbar vertebrae identification among patients over 50 yr of age.

Application and Selection of Remediation Technology for OCPs-Contaminated Sites by Decision-Making Methods.

The production and use of organochlorine pesticides (OCPs) for agricultural and industrial applications result in high levels of their residues, posing a significant risk to environmental and human health. At present, there are many techniques for OCP-contaminated soil remediation. However, the remediation of contaminated sites may suffer from a series of problems, such as a long recovery cycle, high costs, and secondary pollution, all of which could affect land redevelopment and reuse. Therefore, the selection of an appropriate technology is crucial for contaminated sites. In order to improve and support decision-making for the selection of remediation techniques, we provide a decision-making strategy for the screening of remediation techniques of OCP-contaminated sites. The screening procedure is proposed based on combining the analytic hierarchy process (AHP) and the technique for order preference by similarity to ideal solution (TOPSIS). The screening indexes include economic indicator, environmental indicator, and technical indicator. The assessment results show that co-processing in cement kiln obtained the highest overall score and was thus considered to be the most sustainable option. This suggested remediation technology was similar to the practical remediation project, indicating that the screening method could be applied for the selection of remediation technologies for sites contaminated with persistent organic pollutants.

Effect of Peritoneal Transport Characteristics on Clinical Outcome in Nondiabetic and Diabetic Nephropathy Patients with Peritoneal Dialysis.

INTRODUCTION: This study aimed to investigate the influence of peritoneal transport characteristics on clinical outcome in nondiabetic and diabetic nephropathy peritoneal dialysis (PD) patients. MATERIALS AND METHODS: All 112 patients were from the PD Center. Peritoneal transport characteristic was assessed by peritoneal equilibration test. The patients were divided into 2 groups of high-transport group (HT) and non-high-transport group (non-HT) and followed-up till December 31st, 2010. The primary outcomes were all-cause death and technique failure. RESULTS: The patients were followed-up for 65.9 ± 23.9 months. Diabetic nephropathy patients with HT had a higher all-cause mortality (P = .04) and technique failure (P = .04) than those with non-HT. There were no differences in outcomes between HT and non-HT subgroups without diabetic nephropathy. Cox regression demonrtrated that high peritoneal transport (HR, 2.369; 95% CI, 1.056 to 5.311), diabetic nephropathy (HR, 2.499; 95% CI, 1.134 to 5.508), age (HR, 1.081; 95% CI, 1.032 to 1.133), and peritoneal creatinine clearance (HR, 0.962; 95% CI, 0.929 to 0.997) independently predicted all-cause mortality in continuous ambulatory PD patients. Moreover, high peritoneal transport (HR, 2.299; 95% CI, 1.079 to 4.899) and age (HR, 1.070; 95% CI, 1.026 to 1.116) predicted technique failure in continuous ambulatory PD patients. CONCLUSIONS: Diabetic nephropathy PD patients with HT had a higher all-cause mortality and technique failure than those with non-HT, but we did not find the correlation between peritoneal transport and outcome in nondiabetic patients. The peritoneal transport was an independent predictor for outcomes in continuous ambulatory PD patients.

Change in lipoprotein-associated phospholipase A2 and its association with cardiovascular outcomes in patients with acute coronary syndrome.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) probably plays an important role in the development of acute coronary syndrome (ACS). However, alterations of Lp-PLA2 levels during ACS and its association with cardiovascular outcome are unclear. Our aim was to investigate the change in Lp-PLA2 and its association with cardiovascular outcome in patients with ACS.A total of 79 patients with ACS came from the coronary care unit (CCU) between June 1, 2015 and August 31, 2016 in this longitudinal study. Serum levels of Lp-PLA2, troponin I, and creatine kinase isoenzymes MB (CK-MB) were measured at admission, on the first morning (D1), on the second morning of hospitalization (D2), and on the last second morning before discharge (D4). The patients were followed up till November 30, 2016. The primary outcomes were cardiovascular death and cardiovascular rehospitalization. Kaplan-Meier analysis and Cox proportional hazard models were used to identify risk factors for poor outcome in patients with ACS.All patients were followed up for 10.6 ±â€Š4.7 months. The patients were divided into 2 groups according to the median of Lp-PLA2: lower Lp-PLA2 group and higher Lp-PLA2 group. Elevated levels of Lp-PLA2 significantly decreased during the early phases of ACS in higher Lp-PLA2 group. And Lp-PLA2 level increased at first and then decreased in lower Lp-PLA2 group. Kaplan-Meier analysis showed that patients with elevated Lp-PLA2 had a lower cardiovascular event-free survival (log-rank χ = 4.736, P = .030) than those with lower Lp-PLA2. Cox regression analysis indicated that high Lp-PLA2 level (hazard ratio [HR] = 1.005, 95% confidence interval [CI] = 1.002-1.008, P = .003), time delay from symptom onset to admission (HR = 1.088, 95% CI = 1.038-1.139, P < .001) independently predicted cardiovascular event in patients with ACS after adjusting for potential confounders.Serum level of Lp-PLA2 altered considerably during the early phase of ACS and increased Lp-PLA2 independently predicted cardiovascular outcome in patients with ACS after adjustment for potential confounders.

The impact of visit-to-visit systolic blood pressure variability on residual renal function and left ventricular hypertrophy in peritoneal dialysis patients

Background/aim: Blood pressure (BP) variability is more closely associated with adverse outcomes than 'usual' BP in the general population. Residual renal function (RRF) and left ventricular hypertrophy (LVH) are thought to be predictors of poor outcome in dialysis patients. However, only a few studies have focused on BP variation and its link to RRF, LVH, and outcome in peritoneal dialysis (PD) patients. Therefore, we aimed to explore the effect of visit-to-visit BP variability on RRF and LVH in continuous ambulatory PD (CAPD) patients. Materials and methods: We performed an observational study that included all prevalent PD patients between 1 February 2006 and 31 January 2007. All patients underwent BP measurements, pulse wave velocity (PWV), cardiac ultrasound, and biochemical examination during the 1-year observation. Patients were divided into the HBPV group (higher BP variability) and LBPV group (lower BP variability) based on the standard deviation of systolic BP (SBP). Results: There were 70 patients recruited for the final analysis. Patients with HBPV had a higher SBP as compared to patients with LBPV at baseline. Renal Kt/V decreased significantly from 0.50 ± 0.49 to 0.32 ± 0.35 (P < 0.01) in HBPV group (but not in the LBPV group) during follow-up. Patients with HBPV also showed a higher left ventricular mass index (LVMI) and PWV than those with LBPV at the end of follow-up. Conclusion: Our study suggests that BP variability may affect RRF in PD patients. PD patients with HBPV had a faster decline in RRF and higher PWV and LVH.

The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients.

PURPOSE: The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. METHODS: All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. RESULTS: All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR  3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR  2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. CONCLUSION: The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.

Value of CT Density Measurements in Distinguishing Parathyroid Adenoma,Thyroid,and Lymph Node.

Objective To explore the value of multi-phase contrast-enhanced computed tomography in the differential diagnosis of parathyroid adenoma,lymph node,and thyroid. Methods The enhanced multi-slice CT (MSCT) results of 21 parathyroid adenoma patients were analyzed,and their postoperative pathological specimens were examined. During the MSCT,the plain CT scan was recorded,along with the density of thyroid adenoma,lymph nodes,and thyroid at 35 s and 65 s (D0,D35,D65) following the injection of contrast medium. Results During the D0 phase,there was significant difference in CT values between the parathyroid adenoma and thyroid parenchyma[(45?12) HU vs.(90?15)HU,P=0.007]. According to ROC curve,75 HU,with 95.2% sensitivity and specificity,was the critical value for distinguishing the density of parathyroid adenoma and that of thyroid parenchyma. At 35 s following the injection of contrast medium,there was significant difference in the enhancement degree between parathyroid adenoma and lymph node[(182?39) HU vs.(80?20)HU,P=0.004]. According to ROC curve,111 HU,with 95.2 % sensitivity and specificity,was the critical value for distinguishing the density of parathyroid adenoma and that of lymph node 35 s following the injection of contrast medium. At 35 s to 65 s following the injection of contrast medium,the parathyroid adenoma experienced a decline in density,which was dramatically different from parathyroid adenoma,however,lymph node experienced a rise in density. Conclusion Enhanced CT measurements at different time points enable the differentiation among parathyroid adenomas,lymph nodes,and thyroid.

[Carotid plaque characteristics detected with 3.0T high resolution nuclear magnetic resonance imaging in patients with coronary artery disease].

OBJECTIVE: To assess the value of detecting the compositional features of carotid atherosclerotic plaques by 3.0T high resolution magnetic resonance imaging (MRI) in patients with coronary artery disease (CAD). METHODS: Consecutive 104 patients with coronary atherosclerosis confirmed by coronary angiography were prospectively recruited from January 2013 to January 2015 in Tiantan hospital. All patients were imaged with 3.0T high resolution MRI system. After exclusion patients with poor image quality, 97 patients were divided into 3 groups according to the degree of coronary artery stenosis: coronary atherosclerosis group (coronary stenosis between 1%-49%, n=16); single-vessel lesion group (single vessel lesion with stenosis between 50%-100%, n=48); multi-vessel lesion group (two or three vessel lesions with stenosis between 50%-100% or left main stem disease, n=33). The prevalence of total carotid plaque, calcified plaque, lipid-rich necrotic core, intra-plaque hemorrhage, plaque ulcer and rupture were compared among 3 groups. RESULTS: The prevalence of total carotid plaque (81.3%(13/16), 72.9%(35/48), and 93.9%(31/33)) and calcified plaque (50.0%(8/16), 35.4%(17/48), and 42.4%(14/33)) were similar among the 3 groups (both P>0.05). The prevalence of carotid lipid-rich necrotic core in coronary atherosclerosis group was significantly lower than in single-vessel lesion group (18.8%(3/16) vs. 64.6%(31/48), P<0.01) and multi-vessel lesion group(18.8%(3/16) vs. 69.7%(23/33), P<0.01), but there was no significant difference between single-vessel lesion group and multi-vessel lesion group(P>0.05). Intra-plaque hemorrhage was detected in 2 patients of multi-vessel lesion group. There was no plaque ulcer or rupture in this cohort. CONCLUSION: Carotid plaque features are associated with the severity of coronary atherosclerosis in CAD patients.

[To evaluate the changes in body composition in male human immunodeficiency virus-related lipodystrophy after different treatment regimens by dual-energy X-ray absorptiometry].

OBJECTIVE: To evaluate the changes of body composition in male patients with human immunodeficiency (HIV)-related lipodystrophy (LD) syndrome (HIV-LD) switching from stavudine (d4T) to zidovudine (AZT) or tenofovir (TDF) by Dual-energy X-ray absorptiometry (DXA). METHODS: A total of 47 men with HIV-LD who had been exposed to stavudine (d4T) were enrolled in our study from May 2007 to September 2013 in Peking Union Medical College Hospital. Twice DXA assessments were administrated with interval of at least 12 months. All patients were divided into two different treatment regimens, either AZT group switching from d4T to zidovudine (AZT) or TDF group switching from d4T to TDF. Parameters of body composition in two groups were evaluated by DXA. RESULTS: Compared with baseline level, lower limb lean mass increased significantly after treatment [(15.4 ± 1.7) kg vs (16.0 ± 1.7) kg, t = 2.781, P < 0.01] and lower limb fat mass had a small decrease(P = 0.05) in AZT group. In TDF group, there were significant increases both in upper limb fat mass [(0.6 ± 0.3) kg vs (1.0 ± 0.7) kg, t = 2.422, P < 0.05] and lower limb fat mass [(1.8 ± 0.8) kg vs (2.6 ± 1.7) kg, t = 2.369, P < 0.05]. In AZT group, change of lower limb fat mass was generally small (median -0.04 kg, -4.55%). In TDF group, increase of lower limb fat mass and percentage of lower limb fat gain were even greater (median 0.46 kg, 27.41%). In a visual comparison of DXA results between AZT and TDF recipients, more fat gain of leg fat mass was seen in patients who switched from d4T to TDF (U = 2.954, P < 0.01). CONCLUSIONS: Compared with AZT group, TDF group led to a more increase in leg fat mass. Replacing d4T with TDF translates into an improvement of lipodystrophy. Although fat mass did not show a significant increase in AZT group, lean mass had improved after switching treatment, indicating AZT as a possible alternative agent of d4T. Body composition in men patients with HIV-LD can help to adjust the treatment regimen.

Effect of blood pressure variability on cardiovascular outcome in diabetic and nondiabetic patients with stroke.

BACKGROUND: The association between blood pressure (BP) variability and stroke outcome is controversial, and there are few studies that have focused on the impact of BP variability in diabetic patients with stroke. Therefore, we aimed to examine the impact of BP variability on cardiovascular outcome in diabetic and nondiabetic patients with stroke. METHODS: A total of 373 ischemic stroke patients with large artery atherosclerosis were recruited and followed up. Ambulatory BP monitoring was performed in all patients and divided according to the 25th and 75th percentiles interval of SD of daytime systolic BP (SBP). Kaplan-Meier analysis and Cox regression were used to assess the relationship between BP variability and cardiovascular outcomes including stroke recurrence, vascular events and cardiovascular death. RESULTS: The 339 patients were included in the final analysis. During an average follow-up of 19.0 ± 5.1 months (.6-26.8 months), 69 (20.4%) cardiovascular events occurred in all patients. Kaplan-Meier analysis found that there were no differences in cardiovascular events-free survival among the different BP variability groups in diabetic patients (P = .995); however, nondiabetic patients with greater BP variability showed a lesser cardiovascular events-free survival (P = .039). Through Cox regression we found the SD of daytime SBP (hazard ratio 1.103; 95% CI 1.011-1.203) was associated with cardiovascular outcomes in nondiabetic patients with stroke. CONCLUSIONS: We show that SBP variability is associated with cardiovascular outcomes in stroke patients without diabetes, but we didn't find a correlation between SBP variability and cardiovascular outcomes in stroke patients with diabetes.

Diagnostic value of combined parameters derived from ambulatory electrocardiography for detecting coronary artery disease in non-active chest pain patients.

BACKGROUND AND OBJECTIVE: The diagnostic value of ST-segment deviation detected by ambulatory electrocardiography (AECG) is controversial in identifying coronary artery disease (CAD) referred for coronary angiography (CAG). Recently, many parameters which evaluate CAD can be derived from AECG. Therefore, we aimed to investigate the diagnostic value of AECG in screening CAD referred for CAG when several parameters were combined. METHODS: We studied the 104 chest pain inpatients. All patients received the CAG and AECG. A lumen diameter reduction of ≥ 50% was considered CAD according to CAG. The parameters derived from AECG included ST-segment deviation, apnea hypopnea index (AHI), QT interval dispersion (QTd) and heart rate variability (HRV). The diagnostic value of AECG in screening CAD was evaluated. RESULTS: Of the 104 patients, 57 (54.8%) had CAD according to CAG. The sensitivity of ST-segment deviation in screening CAD was 64.9%; the specificity was 89.4%; and the Kappa value was 0.528. The sensitivity of at least three combined parameters including ST-segment deviation, AHI, QTd and HRV was 89.5%; the specificity was 87.2%; and the Kappa value was 0.767. CONCLUSION: AECG is very useful in screening CAD referred for CAG, especially while several parameters including ST-segment deviation, AHI, HRV and QTd are combined.

A graphene and multienzyme functionalized carbon nanosphere-based electrochemical immunosensor for microcystin-LR detection.

A graphene-based immunosensor was fabricated for the detection of microcystin-LR using a horseradish peroxidase-carbon nanosphere-antibody system for signal amplification. Graphene and chitosan were used as immobilization materials to improve the electrochemical performance of the electrode. Signal amplification was achieved using multienzyme functionalized carbon nanosphere. This approach provided a linear range from 0.05 to 15 µgL(-1) microcystin-LR with a detection limit of 0.016 µgL(-1). Analytical detection of microcystin-LR in environmental water samples were demonstrated by comparing the results obtained using immunosensor and high-performance liquid chromatography. This electrochemical immunosensor showed good performance with high sensitivity, acceptable stability, repeatability and the potential for use in routine water quality monitoring for various toxins.

The electrocardiographic changes in acute brain injury patients.

BACKGROUND: Electrocardiographic (ECG) changes occurring during the course of acute brain injury (ABI) have been described frequently, but their significances remain uncertain. The present study was designed to investigate the relation of ECG abnormalities to outcome in the patients with ABI. METHODS: We performed a retrospective, observational study on the ABI patients admitted to the Department of Neurosurgery of the Beijing Tiantan Hospital between December 2005 and December 2007. All the patients accepted 12-lead electrocardiographic examination within 24 hours after injury, then divided into three groups according to the Glasgow coma score (GCS). In-hospital mortality and one-month outcome assessed by the Glasgow outcome score (GOS) were investigated. RESULTS: Of 335 ABI patients (mean ages 32.4 years), 246 patients (73.4%) had abnormal ECGs. The most common abnormality was ST-T changes (41.5%), followed by sinus tachycardia (23.6%). ECG changes had a significant association with the severity and outcome. Logistic regression analysis showed the presence of ST-T changes (OR 2.587, 95%CI 1.009 to 6.629, P = 0.048) and QT dispersion prolongation (OR 4.656, 95%CI 1.956 to 11.082, P = 0.001) significantly associated with short outcomes. CONCLUSIONS: ABI can lead to myocardial damage and ECG changes had a significant association with the severity. ST-T changes and QT dispersion prolongation were the independent prognosis factors for the negative outcome of ABI patients.

Detection of influenza A virus based on fluorescence resonance energy transfer from quantum dots to carbon nanotubes.

In this paper, a simple and sensitive approach for H5N1 DNA detection was described based on the fluorescence resonance energy transfer (FRET) from quantum dots (QDs) to carbon nanotubes (CNTs) in a QDs-ssDNA/oxCNTs system, in which the QDs (CdTe) modified with ssDNA were used as donors. In the initial stage, with the strong interaction between ssDNA and oxCNTs, QDs fluorescence was effectively quenched. Upon the recognition of the target, the effective competitive bindings of it to QDs-ssDNA occurred, which decreased the interactions between the QDs-ssDNA and oxCNTs, leading to the recovery of the QDs fluorescence. The recovered fluorescence of QDs was linearly proportional to the concentration of the target in the range of 0.01-20 µM with a detection limit of 9.39 nM. Moreover, even a single-base mismatched target with the same concentration of target DNA can only recover a limited low fluorescence of QDs, illustrating the good anti-interference performance of this QDs-ssDNA/oxCNTs system. This FRET platform in the QDs-ssDNA/oxCNTs system was facilitated to the simple, sensitive and quantitative detection of virus nucleic acids and could have a wide range of applications in molecular diagnosis.

Forearm bone mineral density measurement with different scanning positions: a study in right-handed Chinese using dual-energy X-ray absorptiometry.

The purpose of our study was to determine whether different scanning positions influence forearm bone mineral density (BMD) measurements and to evaluate the association between forearm BMDs in different scanning positions and those of other skeleton sites. The study population consisted of 30 right-handed healthy Chinese volunteers. BMD was measured with GE Lunar Prodigy at the left forearm in both sitting and supine positions, and at lumbar spine and the right femur. All subjects received repeated measurements in the same day (repositioning), and the average of repeated BMD results was used for analysis. The BMD precision errors of the nondominant forearm in the sitting and supine positions varied from 1.13% to 2.46%. There were no statistically significant differences between BMD precision errors for each region of interest (ROI) between sitting and supine positions (all the p values were greater than 0.05). When comparing BMDs on the same side in the sitting position with those in the supine position, there were significant differences at both the 1/3 radius level and in the total radius (p<0.05). The BMD values at these ROIs obtained in the supine position were lower than those in the routine sitting position. The BMDs of the ultradistal radius in the both 2 different scanning positions were significantly associated with lumbar spine and femoral neck BMD, respectively. The total radius BMD in the different positions was associated with the BMD of the femoral neck. A change in body scanning position from sitting to supine will significantly influence forearm BMD results.