An intelligent quantification system for fetal heart rhythm assessment: A multicenter prospective study.

BACKGROUND: The motion relationship and time intervals of the pulsed-wave Doppler (PWD) spectrum are essential for diagnosing fetal arrhythmia. However, few technologies currently are available to automatically calculate fetal cardiac time intervals (CTIs). OBJECTIVE: The purpose of this study was to develop a fetal heart rhythm intelligent quantification system (HR-IQS) for the automatic extraction of CTIs and establish the normal reference range for fetal CTIs. METHODS: A total of 6498 PWD spectrums of 2630 fetuses over the junction between the left ventricular inflow and outflow tracts were recorded across 14 centers. E, A, and V waves were manually labeled by 3 experienced fetal cardiologists, with 17 CTIs extracted. Five-fold cross-validation was performed for training and testing of the deep learning model. Agreement between the manual and HR-IQS-based values was evaluated using the intraclass correlation coefficient and Spearman's rank correlation coefficient. The Jarque-Bera test was applied to evaluate the normality of CTIs' distributions, and the normal reference range of 17 CTIs was established with quantile regression. Arrhythmia subset was compared with the non-arrhythmia subset using the Mann-Whitney U test. RESULTS: Significant positive correlation (P <.001) and moderate-to-excellent consistency (P <.001) between the manual and HR-IQS automated measurements of CTIs was found. The distribution of CTIs was non-normal (P <.001). The normal range (2.5th to 97.5th percentiles) was successfully established for the 17 CTIs. CONCLUSIONS: Using our HR-IQS is feasible for the automated calculation of CTIs in practice and thus could provide a promising tool for the assessment of fetal rhythm and function.

Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults.

BACKGROUND: In China, diabetes prevalence is rising rapidly, but little is known about the associated risks and population burden of cardiovascular diseases. We assess associations of diabetes with major cardiovascular diseases and the relevance of diabetes duration and other modifiable risk factors to these associations. METHODS AND FINDINGS: A nationwide prospective study recruited 512,891 men and women aged 30-79 y between 25 June 2004 and 15 July 2008 from ten diverse localities across China. During ~7 y of follow-up, 7,353 cardiovascular deaths and 25,451 non-fatal major cardiovascular events were recorded among 488,760 participants without prior cardiovascular disease at baseline. Cox regression yielded adjusted hazard ratios (HRs) comparing disease risks in individuals with diabetes to those without. Overall, 5.4% (n = 26,335) of participants had self-reported (2.7%) or screen-detected (2.7%) diabetes. Individuals with self-reported diabetes had an adjusted HR of 2.07 (95% CI 1.90-2.26) for cardiovascular mortality. There were significant excess risks of major coronary event (2.44, 95% CI 2.18-2.73), ischaemic stroke (1.68, 95% CI 1.60-1.77), and intracerebral haemorrhage (1.24, 95% CI 1.07-1.44). Screen-detected diabetes was also associated with significant, though more modest, excess cardiovascular risks, with corresponding HRs of 1.66 (95% CI 1.51-1.83), 1.62 (95% CI 1.40-1.86), 1.48 (95% CI 1.40-1.57), and 1.17 (95% CI 1.01-1.36), respectively. Misclassification of screen-detected diabetes may have caused these risk estimates to be underestimated, whilst lack of data on lipids may have resulted in residual confounding of diabetes-associated cardiovascular disease risks. Among individuals with diabetes, cardiovascular risk increased progressively with duration of diabetes and number of other presenting modifiable cardiovascular risk factors. Assuming a causal association, diabetes now accounts for ~0.5 million (489,676, 95% CI 335,777-681,202) cardiovascular deaths annually in China. CONCLUSIONS: Among Chinese adults, diabetes is associated with significantly increased risks of major cardiovascular diseases. The increasing prevalence and younger age of onset of diabetes foreshadow greater diabetes-attributable disease burden in China.

[Effects of different feeding practices at 0-6 months and living economic conditions on anemia prevalence of infants and young children].

OBJECTIVE: In order to understand the anemic prevalence in the infants and young children and its relation to the feeding pattern at 0-6 months and on economic income. METHODS: A questionnaire survey were used to collect the information on nutritional and health status of infants and young children (6 to 23 months) living in poverty-rural areas of Gansu Province, and hemoglobin concentration was measured. RESULTS: The prevalence of anemia was 58.2% in the children aged from 6 months to 23 months. The rate of anemia in boys was higher than that of the girls (61.0% and 55.1%), but there was no significant difference. There were significant differences in hemoglobin levels among different age groups (F = 5.206, P < 0.01). The child's hemoglobin concentration was trend to significantly decrease from 6-month-old and more, and reach to the lowest level at 12 months of age and more. After that, the hemoglobin began to gradually increase with age. The change of hemoglobin concentration was consistent with anemic prevalence, the higher prevalence of anemia was the group aged 6-month-old and more, and the group aged 12-month-old and more had highest prevalence. There were significant difference among the different feeding pattern on the anemic prevalence (chi2 = 9.245, P < 0.05), and the prevalence of anemia in children fed with infant formula had the lowest anemic rate and was significantly lower than those of the mixed feeding and breastfeeding children (chi2 = 8.529 and 7.173, P < 0.05). The living economic conditions were a linear trend with the hemoglobin level of children, but there was no significant difference among the different feeding groups (F = 0.637, P > 0.05). The better household economic conditions, tends to have the lower in anemic prevalence, but there was no significant difference (chi2 = 1.666, P > 0.05). CONCLUSION: The children had lowest hemoglobin level and highest anemic prevalence in the group aged 12-month-old and more, the anemic prevalence of children fed with infant formula had significantly lower than those of the mixed feeding and breastfeeding children, and family economic status on the prevalence of anemia was not obvious. The present results showed that we should focus on the prevention and improvement of iron status and anemia in infants more than 6-months and young children.