[Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly].

Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

[Estimating the disease burden of seasonal influenza in China, 2006-2019].

Objective: To estimate the health impact and economic burden of seasonal influenza in mainland China. Methods: From systematic literature reviews, we collected the influenza-associated excess influenza-like-illness (ILI) outpatient consultation rates, hospitalization rates of severe acute respiratory infections (SARI) and respiratory excess mortality, 2006-2017. Using these data, as well as demographic data (2019), the number of influenza-associated excess ILI outpatient consultations, SARI hospitalizations and respiratory excess deaths were estimated. Then using per capita economic burden of influenza-associated outpatient consultations and hospitalizations, as well as the productivity loss of influenza-related premature deaths, the annual influenza-associated total economic burden was estimated. All costs were adjusted to 2019 using the consumer price index. Results: The annual influenza-associated excess ILI outpatient consultations, SARI hospitalizations and excess respiratory deaths were 3 million, 2.34 million, 0.09 million, respectively. The total economic burden was 26.38 billion CNY, accounting for 0.266‰ GDP in 2019, of which the hospitalization-related economic burden accounted for the highest proportion (86.4%, 22.79 billion CNY), followed by the outpatient-related economic burden (11.3%, 2.97 billion CNY), and the indirect economic burden of productivity loss of premature deaths was the lowest (2.4%, 0.62 billion CNY). Largest economic burden was observed in East China (10.51 billion CNY) and smallest observed in Northeast China (0.38 billion CNY). Conclusion: The health burden of influenza-related outpatient visits and hospitalizations were substantial. The economic burden of influenza-related SARI hospitalization was higher than that of influenza-related outpatients and pre-mature deaths. The highest economic burden of influenza occurred in the East China.

Feature tracking for assessment of diastolic function by cardiovascular magnetic resonance imaging.

AIM: To assess the agreement of cardiovascular magnetic resonance imaging (CMRI) feature-tracking (FT) parameters with echocardiography to diagnose diastolic dysfunction; to determine whether a similar parameter to mitral inflow early diastolic velocity to early diastolic tissue velocity ratio (E/e') can increase accuracy of imaging by dividing the phase contrast (PC) mitral inflow E-wave (E) with a CMRI-FT parameter; to compare the agreement between CMRI-FT and PC diastolic function assessment using echocardiography. MATERIALS AND METHODS: Patients (n=71; 43 abnormal diastolic function) undergoing both CMRI and echocardiography independently were included. Echocardiography was the reference standard. CMRI-FT analysed the short and long axis cine contours. PC images of mitral inflow, tissue velocity, pulmonary vein flow, and left atrial area were assessed. RESULTS: Using CMRI-FT, the area under the curve (AUC) for identifying diastolic dysfunction was >0.80 for radial and circumferential strain, systolic strain rate (SSR), and early diastolic strain rate (DSR). For cases with CMRI-determined left ventricular ejection fraction (LVEF) ≥50% (n=38), circumferential DSR was the only parameter with good accuracy (AUC=0.87; cut-off 0.93/s). E/circumferential DSR ratio and longitudinal strain had high accuracy in all patients (AUC=0.88 and 0.93 respectively) and CMRI-determined LVEF ≥50% (AUC=0.81; cut-off 76.7). Circumferential DSR showed the highest agreement with echocardiography (higher than E/circumferential DSR and PC assessment) in all cases (kappa 0.75; p<0001) and cases with CMRI LVEF ≥50% (kappa 0.73; p<0.0001). CONCLUSIONS: CMRI-FT circumferential DSR showed the highest accuracy for determining diastolic dysfunction with good agreement with echocardiography. Circumferential DSR had higher accuracy than E/circumferential DSR and PC.

[Value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension].

Objective: To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH). Methods: In this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration. Results: There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579, P<0.001),RVSP (r=-0.442, P=0.002) ,RVGLS (r=-0.521, P<0.001) , LASr (r=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4±2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively. Conclusions: RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent.

[Analysis on molecular genetic evolution of Banna virus based on the 12th segment].

Objective: To understand the evolution characteristics of Banna viruses (BAVs) isolated worldwide from 1980 to 2012. Methods: In this study, a phylogenetic analysis using Bayesian Markov Chain Monte Carlo simulations was conducted on all available 12th segment of genes of BAVs isolated worldwide from 1980 to 2012 to investigate the evolutionary and epidemiologic dynamics of BAVs. Results: The Bayesian phylogenetic analysis of BAVs revealed that the common ancestor of BAVs appeared 315 (95%HPD: 63-619) years ago. The evolutionary rate of BAV based on the 12th segment gene was estimated to be 2.33×10-3 (95%HPD: 2.84× 10-4-8.52×10-3) substitution per site per year, indicating BAV belong to an emerging arbovirus with rapid evolution. Conclusion: The evolution of emerging BAVs is rapid and the distribution of BAVs has expanded with new variant being detected, so it is necessary to enhance the surveillance to fully understand the natural distribution and pathogenicity of BAVs.

Factors associated with bed and room sharing in Chinese school-aged children.

BACKGROUND AND OBJECTIVES: Co-sleeping (bed or room sharing) has potential implications for children's development. Previous studies showed that co-sleeping was more prevalent in non-Western countries than in Western countries, which demonstrated that co-sleeping was marked with ethnic and socio-cultural background characteristics. The purpose of this study was to survey the prevalence of bed and room sharing and to examine related factors among school-aged children in an Asian country - China. METHODS: A cross-sectional questionnaire survey was conducted in 10 districts of Shanghai, China from November to December 2005. A total of 4108 elementary school children, 49.2% boys and 50.8% girls with a mean age of 8.79 years, participated. Parent-administered questionnaires were used to collect information about children's sleeping arrangements and socio-demographic characteristics. RESULTS: The prevalence of routine bed sharing, room sharing and sleeping alone in Chinese school-aged children was 21.0%, 19.1% and 47.7%, respectively. Bed and room sharing didn't show significant gender difference but gradually decreased with increasing age. Multivariate logistic regression identified those factors associated with bed and room sharing: younger age, large family, children without their own bedroom and parents' approval of a co-sleeping arrangement. CONCLUSION: Co-sleeping arrangement was a common practice in Chinese school-aged children. Associated factors were characterized by intrinsic socio-cultural values and socio-economic status in China.

Bayesian modelling of the dynamics of hepatotoxicity.

Hepatotoxicity (liver damage) is a common problem in drug treatment trials but is observed only indirectly through biomarkers measured in the blood. This creates the need to infer an individual's unobserved liver function dynamically using blood tests and other patient baseline characteristics. Major statistical challenges include high dimensionality, irregular time observation points over patients, presence of missing observations, and noise involved in measurement and biological processes. This article introduces a class of multivariate Bayesian dynamic stochastic models for detecting and forecasting changes in an individual's liver function in two situations: without and with drug. These models separate measurement error from variation inherent in a biological process, and describe the underlying process of liver detoxification, whereby, drug affects liver function which in turn induces changes in observed analytes. We apply the Bayesian methodology to make an inference. A clinical toxicity study is examined, together with simulated data. The results suggest that changes in observed analytes can be captured by the proposed models.

Assessment of bone lead during pregnancy: a pilot study.

More than 85% of American children raised in the 1970s had blood lead (BPb) levels >/=10 microg/dL, the level that currently defines childhood Pb poisoning. With exposure and absorption Pb accumulates in bone. Bone Pb release back to blood also occurs, particularly when kinetic rates of bone turnover are elevated. We examined a group of childbearing age, urban African American and Hispanic women to determine whether they had measurable bone Pb and whether bone Pb levels changed during pregnancy. Tibial bone Pb content was assessed sequentially 3 times over 4 months by L-line X-ray fluorescence (LXRF); for pregnant enrollees this occurred during the second and third trimesters and 1-2 months postpartum. LXRF is a noninvasive, low-dose radiation technique that measures superficial cortical bone Pb. Other measures included age, years living in New York City, BPb and a home Pb assessment employing KXRF methodology. Of 53 women evaluated 34 were pregnant. Of these 34, 2 had blood Pb levels >/=10 microg/dL; 2 had bone Pb levels above the minimum detection limit of the instrumentation at the time of enrollment. A case report is presented in which a declining bone Pb level was accompanied by an increase in BPb concentration. We surmise that the prevalence of elevated bone Pb levels will be low in Bronx women despite long-term exposure to leaded paint. However, fetuses of those with elevated bone Pb are at risk of excessive in-utero Pb exposure.

Assessment of mitral valve volume by quantitative three-dimensional echocardiography in patients with rheumatic mitral valve stenosis.

BACKGROUND: Thickening of mitral leaflets in rheumatic mitral valve stenosis is well described in necropsy studies; however, volume computation of the thickening mitral leaflets has not been attempted. 4trial fibrillation is one of the complications of rheumatic mitral stenosis. Quantitative assessment of thickened mitral valve and its relation to clinical complications is clinically desirable. HYPOTHESIS: The study was undertaken to compare measurement of mitral valve volume in normal subjects and in patients with rheumatic mitral valve stenosis. METHODS: An HP Sonos 2500 echocardiographic system with 5 MHz multiplane transesophageal transducer was used for data acquisition, and TomTec Echoscan computer setup was used to off-line volume computation. Study subjects included 10 normal subjects (mean age 44.8 years) and 36 patients with rheumatic mitral valve stenosis (22 female, 14 male) with an age range of 25 to 69 years (mean age 47 +/- 9.6 years). Mitral valve volumes were compared between the normal subjects and patients with mitral valve stenosis, and further comparison was made between the sinus rhythm (SR) and atrial fibrillation (AF) groups in patients with mitral valve stenosis. In all study subjects, the mitral valve area (MVA) was determined by two-dimensional echocardiography. RESULTS: Quantitative three-dimensional (3-D) echocardiography showed that mitral valve volume was significantly larger in patients with mitral valve stenosis than in normal subjects (9.0 +/- 2.2 and 4.5 +/- 0.7 ml, respectively, p < 0.001). When patients with mitral valve stenosis were divided into the SR and AF groups, mitral valve volume was found to be significantly larger in the AF group than in the SR group (9.76 +/- 2.2 ml. and 7.72 +/- 1.5 ml, respectively, p < 0.01) and patients in the AF group tended to be older (p < 0.05) with larger left atrial diameter (LAD) (p < 0.01). However, MVA between the two groups showed no statistical significance (1.1 +/- 0.43 and 1.0 +/- 0.34 cm2, respectively, p > 0.2). When the study subjects were divided into two groups (< 50 and > or = 50 years) according to age, the comparison of mitral valve volume between these two groups (9.37 +/- 2.18 and 8.56 +/- 2.14 ml, p > 0.2) showed no statistical significance. CONCLUSIONS: Quantitative 3-D echocardiography can be applied for the measurement of mitral valve volume in vivo. Patients with rheumatic mitral valve stenosis with atrial fibrillation have a propensity to have a larger mitral valve volume and are older than the patients with sinus rhythm; however, the age per se does not seem to be a cause for larger mitral valve volume.

[Quantitative assessment of pulmonary arterial diastolic and mean pressure using continuous wave Doppler].

Continuous wave Doppler echocardiographic study was performed almost simultaneously with right heart catheterization in 24 patients with a variety of cardiovascular disorders and evidence of pulmonary regurgitation detected by pulsed wave Doppler. Their pulmonary arterial diastolic and mean pressure (PADP and PAMP) measured during catheterization were ranging from 5 to 70.6 (mean 30.26 +/- 18) mmHg and from 6.7 to 91.14 (mean 42.41 +/- 23.23) mmHg, respectively. The right ventricular end-diastolic pressure was within normal limit in all but one. The peak, mean and end-diastolic pressure gradients of pulmonary regurgitation (PPRPG, MPRPG and PRPGed) were calculated using simplified Bernoulli Equation and their correlations with PADP and PAMP were analysed using linear regression method. There were close correlations between all PRPGs and PADP or PAMP (r = 0.85 - 0.94, P less than 0.0001). The best equation for assessing PADP was MPRPG + 6 mmHg (r = 0.94, P less than 0.0001), for PAMP was PPRPG + 8 mmHg (r = 0.92, P less than 0.0001). It is evident that those constants in the equations should be adjusted in individual patient who has coexisting right heart failure.