Prediction of Adverse Outcomes in De Novo Hypertensive Disorders of Pregnancy: Development and Validation of Maternal and Neonatal Prognostic Models.

Effectively identifying high-risk patients with de novo hypertensive disorder of pregnancy (HDP) is required to enable timely intervention and to reduce adverse maternal and perinatal outcomes. Electronic medical record of pregnant women with de novo HDP were extracted from a birth cohort in Beijing, China. The adverse outcomes included maternal and fetal morbidities, mortality, or any other adverse complications. A multitude of machine learning statistical methods were employed to develop two prediction models, one for maternal complications and the other for perinatal deteriorations. The maternal model using the random forest algorithm produced an AUC of 0.984 (95% CI (0.978, 0.991)). The strongest predictors variables selected by the model were platelet count, fetal head/abdominal circumference ratio, and gestational age at the diagnosis of de novo HDP; The perinatal model using the boosted tree algorithm yielded an AUC of 0.925 (95% CI (0.907, 0.945]). The strongest predictor variables chosen were gestational age at the diagnosis of de novo HDP, fetal femur length, and fetal head/abdominal circumference ratio. These prediction models can help identify de novo HDP patients at increased risk of complications who might need intense maternal or perinatal care.

[Clinical features of unexpected sudden death clustered in 7 families in Yunnan Province].

OBJECTIVE: To investigate the clinical features of unexpected sudden death (SUD) clustered in families in Yunnan province. METHODS: This retrospective study analyzed the clinical features of SUD occurred between July to September 2005 in 7 families in Yunnan province. RESULTS: All 16 SUD patients shared common clinical features such as fatigue and repeated syncope and one group of SUD patients (n = 8 from 4 families) presented with the gastric intestinal tract manifestations including nausea, vomiting, abdominal pain and diarrhea with suspected dietary history and abnormal laboratory enzyme findings (GOT/GPT, CK/CKMB, LDH/LDH1 etc.). In SUD patients without gastric intestinal tract manifestations (n = 8 from 3 families), there were no clear symptoms before death and repeated ventricular tachycardia and ventricular fibrillation were recorded in one survivor. There was no clear evidence for the involvements of hereditary and infectious factors for observed SUD. CONCLUSION: The reason for the unexpected sudden death clustered in 7 families in Yunnan remains unclear. Repeated syncope and fatigue served as the common clinical features in the presence or absence of gastric intestinal tract manifestations in all SUD cases. Further studies are needed to clarify the pathology and detailed clinical manifestations of SUD occurred in this area.

Effects of aerobic exercise on body morphology in obese university students / Efeitos do exercício aeróbico na morfologia corporal de estudantes universitários obesos / Efectos del ejercicio aeróbico en la morfología corporal de estudiantes universitarios obesos

ABSTRACT Introduction The problem of obesity is relevant to the current social development model. In addition to the eminent physical health risks, obese university students also experience greater resistance to social development. Obese students participating in the national weight loss fitness program can perceive the benefits of aerobic exercise. Objective Explore the effect of aerobic exercise on body morphology in obese university students. Methods 60 obese university students were selected as study subjects and divided equally into a control and experimental group. The control group received no intervention, while the experimental group performed a battery of aerobic exercises of 60 minutes daily, four times a week for six weeks. Data before and after the experiment were compared. BMI, body fat rate, blood lipid monitoring, and blood glucose were also taken as body component monitoring indexes, and circumference measurements and proportions were taken as external body monitoring indexes. Results Aerobic exercise can effectively reduce the body weight, body mass index (BMI), body fat rate, and body circumference of college students, decrease body weight, make the body shape more symmetrical, and also improve lipid and glycemic components, thus reducing the complications caused by obesity. Conclusion University professors should perform aerobic training for university students to improve their physical fitness, regulate their physical function, and improve their physical appearance. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O problema da obesidade é um problema relevante no atual modelo de desenvolvimento social. Além dos riscos eminentes na saúde física, os estudantes universitários obesos também vivenciam uma maior resistência para o desenvolvimento social. Os alunos obesos que participam do programa nacional de condicionamento físico para a perda de peso podem perceber os benefícios do exercício aeróbico. Objetivo Explorar o efeito do exercício aeróbico na morfologia corporal de estudantes universitários obesos. Métodos 60 estudantes universitários obesos foram selecionados como sujeitos de estudo e divididos igualmente em grupo controle e experimental. O grupo controle não recebeu intervenção enquanto o experimental efetuou uma bateria de exercícios aeróbicos de 60 minutos diários, quatro vezes por semana, durante seis semanas. Dados antes e depois do experimento foram comparados. O IMC, a taxa de gordura corporal, monitoramento sanguíneo de lipídios e glicemia também foram tomados como índices de monitoramento dos componentes corporais, medidas de circunferências e proporções foram tomadas como índices de monitoramento corporal externo. Resultados O exercício aeróbico pode reduzir efetivamente o peso corporal, o índice de massa corporal (IMC), a taxa de gordura corporal e a circunferência corporal dos estudantes universitários, diminuir o peso corporal, deixando a forma corporal mais simétrica, além de melhorar os componentes lipídicos e glicêmicos, reduzindo assim as complicações causadas pela obesidade. Conclusão Os professores universitários devem realizar treinamento aeróbico de estudantes universitários a fim de melhorar seu condicionamento físico, regular sua função física e melhorar seu aspecto físico. Nível de evidência II; Estudos terapêuticos - investigação dos desfechos do tratamento.

RESUMEN Introducción La cuestión de la obesidad es un problema relevante en el modelo actual de desarrollo social. Además de los riesgos eminentes en la salud física, los universitarios obesos también experimentan una mayor resistencia al desarrollo social. Los estudiantes obesos que participan en el programa nacional de acondicionamiento físico para la pérdida de peso pueden obtener los beneficios del ejercicio aeróbico. Objetivo Explorar el efecto del ejercicio aeróbico sobre la morfología corporal en estudiantes universitarios obesos. Métodos Se seleccionaron 60 estudiantes universitarios obesos como sujetos de estudio y se dividieron por igual en el grupo de control y el experimental. El grupo de control no recibió ninguna intervención, mientras que el grupo experimental realizó una batería de ejercicios aeróbicos de 60 minutos diarios, cuatro veces por semana durante seis semanas. Se compararon los datos antes y después del experimento. El IMC, el índice de grasa corporal, la monitorización de lípidos y de glucosa en sangre también se tomaron como índices de monitorización de los componentes corporales, las medidas de circunferencia y las proporciones se tomaron como índices de monitorización corporal externa. Resultados El ejercicio aeróbico puede reducir eficazmente el peso corporal, el índice de masa corporal (IMC), el índice de grasa corporal y la circunferencia corporal de los estudiantes universitarios, disminuir el peso corporal, hacer que la forma del cuerpo sea más simétrica, y también mejorar los componentes lipídicos y glucémicos, reduciendo así las complicaciones causadas por la obesidad. Conclusión Los profesores universitarios deberían realizar un entrenamiento aeróbico de los estudiantes universitarios para mejorar su estado físico, regular su función física y mejorar su aspecto físico. Nivel de evidencia II; Estudios terapêuticos - investigación de los resultados del tratamiento.

[Pathological study of unexpected sudden death clustered in family or village in Yunnan province: report of 29 cases of autopsy].

OBJECTIVE: To investigate the pathological features and causes of sudden death clustered in family or village in Yunnan province so as to provide the morphological basis for exploring its etiology and medical intervention. METHODS: Autopsy was performed on 29 cases of clustered in family or village in Yunnan province during the period 1991-2006, 16 males and 13 females, aged 32 (8-69), accounting for 10.2% of whole sudden unexpected deaths occurring in the same period. The heart, lung, liver, spleen, brain, kidney, intestinal tract, and other organs were examined macroscopically and histologically, including a study of cardiac conduction system in 5 cases. Pathological diagnosis of myocarditis was based on the Dallas Criteria and World Heart Federation's consensus while the histological evaluation of Keshan disease referred the China national guideline for pathological diagnosis of Keshan disease. RESULTS: Based on the main pathological changes and the causes of death, these cases were classified into seven groups (group A-G). Group A comprised 11 cases (38%) with lymphocytic myocarditis accompanied with focal myocardial necrosis or degeneration. Group B comprised 3 cases (10%) with neutrophil myocarditis accompanied with focal myocytolysis or coagulation necrosis. Group C comprised 4 cases (14%) with arrhythmogenic right ventricle cardiomyopathy in which fatty infiltration of myocardium was the only pathological finding. Group D comprised 2 cases (7%) with ischemic heart disease in which fresh or old foci of myocardial infarction were found but coronary stenosis was shown only in one case. Group E comprised 2 cases (7%) with left ventricle hypertrophy and obstructive muscle bundle in the outflow of left ventricle. Group F comprised 2 cases (7%) with allergic bronchitis or chronic bronchitis and pulmonary emphysema. Group G comprised the remaining 5 cases (17%) without any pathological finding that could explain sudden death. No cases suffered with Keshan disease and dilated cardiomyopathy. Focal but not diffuse inflammatory infiltration was the prominent histological feature of myocarditis in Yunnan cases. Among the five cases with histological examination of cardiac conduction system, 2 cases were detected to suffer from acute hemorrhage in His bundle and its left branching site, and the atrioventricular node of 1 case was involved. Different pathological changes coexisted in 4 pairs of family members as a cluster of sudden deaths. 3 of 4 first deaths had focal myocarditis and the other one had chronic infection. But 3 secondary deaths had myocardial ischemia and the other one had arrhythmogenic right ventricle cardiomyopathy. Pulmonary edema, acute respiratory infection and congestive or ischemic liver necrosis were found in some cases simultaneously. CONCLUSION: The pathological changes of the cases of clustered sudden death in Yunnan province are various, such as myocarditis, myocardial dysplasia and the other lethal heart-lung disorders. No case of Keshan disease has been found. Arrhythmogenic right ventricle cardiomyopathy and other foundational heart diseases might act as a background. It is very hard to contribute only one etiological factor to the clustering of sudden death in Yunnan. It was most likely that multiple factors cluster and trigger an outbreak of death in a definite time and space.

[Study on clustering of Yunnan unexplained sudden death in household and village].

OBJECTIVE: To discuss the clustering of Yunnan unexplained sudden death (YUSD) in household and village. METHODS: Fifty-two cases were found by YUSD surveillance system in 2005. Poisson distribution and beta-binomial distribution (BBD) were employed in studying the household distribution of the disease. Poisson distribution and negative binomial distribution (NBD) were employed in studying the village distribution of the disease. RESULTS: BBD were fitted household distribution of YUSD very well (chi(2) = 0.25, P = 0.62), while Poisson distribution was consistent with it (chi(2) = 46.01, P < 0.001). And NBD were fitted village distribution of YUSD very well (chi(2) = 0.05, P = 0.58), however the consistency in Poisson distribution was not observed (chi(2) = 110.57, P < 0.001). CONCLUSION: Household and village clustering of YUSD does exist.

[Morphologic features of sudden cardiac death in Yunnan province, with emphasis on myocarditis].

OBJECTIVES: To study the pathologic feature of sudden cardiac death in Yunnan province and to investigate the role of myocarditis. METHODS: During the period from 1991 to 2006, there were 29 cases of sudden cardiac death with autopsy performed. Fourteen of these cases were diagnosed to have myocarditis based on Dallas criteria and World Heart Federation's consensus. The clinical and pathologic findings were reviewed. The cardiac conduction system was examined in details by serial sectioning in 3 cases. RESULTS: Fourteen cases suffered with myocarditis, which accounted for 48% of all cases of sudden cardiac death studied. The age of the deceased ranged from 8 to 68 years (mean = 30 years), with male-to-female ratio equaled to 9:5. Lymphocytic myocarditis and neutrophil myocarditis were the two major types, affecting 11 and 3 cases, respectively. The inflammatory infiltrates were often patchy rather than diffuse. The inflammatory foci were detected only in 8% to 42% (average = 20%) of the paraffin sections of the heart tissue. These lesions were usually located in the lateral wall of left ventricle and occasionally in interventricular septum and right ventricular wall. Myocardial injury was mild in most cases while patchy myocytolysis or coagulation necrosis was observed only in a few cases. Most of the lesions were relatively new and histologic evidence of myocardial repairing sometimes coexisted. Pericarditis and subacute endocarditis were also identified in 4 and 1 cases, respectively. Atrioventricular node was involved by myocarditis in 1 of the 3 cases examined for cardiac conduction system. Two cases showed gross evidence of cardiac dilatation (either left ventricle or biventricular). Respiratory tract and pulmonary infection was present in 5 cases. CONCLUSIONS: Myocarditis represents one of the major pathologic changes of sudden cardiac death occurring in Yunnan province. The inflammation is usually focal. Further studies are required for delineation of possible etiologies which may include virus, bacteria or exogenous toxin.

[Electrocardiogram analysis in high risk population of unexplained sudden death in Yunnan province].

OBJECTIVE: The purpose of this study was to analyze the electrocardiographic features of the people living in the area with high incidence of unexplained sudden deaths in Yunnan province. METHOD: The electrocardiograms of 338 residents from three villages (Dayao, Ninglang, Heqing) with high incidence of unexplained sudden deaths and one control village (Dali) were analyzed [averaged age was (33.4 +/- 11.7) years, 175 men and 163 women]. RESULTS: The incidence of cardiac arrhythmias was similar low in all groups. The left ventricular hypertrophy was observed in 34.6% of residents from Dayao. QTc significantly prolonged in the residents from all 3 high incidence areas compare the control area of Dali [control (386.8 +/- 27.22) ms, Ninglang (428.92 +/- 25.71) ms, Heqing (440.67 +/- 28.03) ms, Dayao (417.7 +/- 24.00) ms, P < 0.05 vs. control]. Incidence of U wave was significantly higher in Heqing village than that in control village (P < 0.05). The QUc of these 3 villages was: (613.67 +/- 37.34) ms, (597.19 +/- 46.47) ms, (608.59 +/- 39.59) ms respectively, and also significantly longer than the control village of Dali (589.33 +/- 41.27) ms (P < 0.05). The typical pattern of U wave presents as enlarged U wave and apparent T-U complex. In the 7 residents who have the family history of unexplained sudden death, 6 residents have U wave, and 4 of them present typical U wave pattern. CONCLUSION: The significant ECG changes in villages with high incidence of unexplained sudden death in Yunnan province were prolonged QTc, enlarged U wave and apparent T-U complex and these ECG features suggested the repolarization abnormalities of the heart in these subjects.

Effect of chinese medicine on muscle fatigue of athletes / O efeito da medicina chinesa na fadiga muscular de atletas / El efecto de la medicina china en la fatiga muscular de atletas

ABSTRACT Introduction: Traditional Chinese medicine has a very good effect on the treatment of exercise fatigue. However, if it is not handled actively and effectively, it can cause serious adverse effects on the body and lead to many diseases. Objective: To study the effect of TCM diagnosis and treatment on athletes' exercise-induced muscle fatigue. Methods: The results of the study were analyzed by comparing the experimental data in the experimental group and the control group. Results: A paired t test was conducted on the experimental results of the experimental intervention group and the data of the control group. It was found that regardless of individuals being male or female, the paired t test results of the experimental group and the data of the control group were all P < 0.05, showing significant differences in the paired data. Conclusions: In the experiment, all the treatment methods of traditional Chinese medicine had an obvious effect in the treatment of exercise fatigue, and reduced the recovery time of exercise fatigue at different degrees. Contrastive analysis shows that traditional Chinese medicine is effective in the treatment of exercise fatigue. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A medicina tradicional chinesa é muito eficaz no tratamento de fadiga por exercícios. No entanto, se não for manejada de forma ativa e eficaz, pode causar sérios efeitos adversos no corpo e levar a muitas doenças. Objetivo: Estudar o efeito do diagnóstico e tratamento da MTC na fadiga muscular causada pelo exercício em atletas. Métodos: Os resultados do estudo foram analisados comparando os dados experimentais de um grupo experimental e um de controle. Resultados: O teste t pareado foi realizado nos resultados experimentais do grupo de intervenção experimental e os dados do grupo de controle. Foi verificado que, independentemente do sexo dos indivíduos, os resultados do teste t pareado do grupo experimental e os dados do grupo de controle eram todos P<0,05, o que demonstra diferenças significativas entre os dados pareados. Conclusões: No experimento, todos os métodos da medicina tradicional chinesa tiveram efeitos evidentes no tratamento da fadiga por exercícios e podem reduzir o tempo de recuperação da fadiga causada por exercícios em graus variados. A análise contrastiva mostra que a medicina tradicional chinesa é eficaz no tratamento de fadiga por exercícios. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Introducción: La medicina tradicional china es muy eficaz en el tratamiento de fatiga por ejercicios. Sin embargo, si no se la maneja de forma activa y eficaz, puede ocasionar serios efectos adversos en el cuerpo y conllevar varias enfermedades. Objetivo: Estudiar el efecto del diagnóstico y tratamiento de la MTC en la fatiga muscular causada por ejercicio en atletas. Métodos: Los resultados del estudio se analizaron comparando los datos experimentales de un grupo experimental y uno de control. Resultados: La prueba t pareada se realizó en los resultados experimentales del grupo de intervención experimental y los datos del grupo de control. Se verificó que, independientemente del sexo de los individuos, los resultados de la prueba t pareada en el grupo experimental y los datos del grupo de control eran todos P<0,05, lo que demuestra diferencias significativas entre los datos pareados. Conclusiones: En el experimento, todos los métodos de la medicina tradicional china obtuvieron efectos evidentes en el tratamiento de la fatiga por ejercicios y pueden reducir el tiempo de recuperación de la fatiga causada por ejercicios en variados grados. El análisis contrastivo muestra que la medicina tradicional china es eficaz en el tratamiento de fatiga por ejercicios. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Type 2 diabetes mellitus non-genetic Rhesus monkey model induced by high fat and high sucrose diet.

To build an ideal animal model for studying the mechanism of occurrence, developing and treating of diabetes become a more important issue, facing with the fact that the big threat of diabetes to human health has been worsen. First, we used the normal control diets or the high-fat/high-sucrose diets to feed the adult rhesus monkeys and the macaques induced by the high-fat/high-sucrose diets in the high-fat/high-sucrose group and the type 2 diabetes mellitus (T2DM) group developed the hyperglycemia, hyperinsulinemia at 6 months in accordance with the precious researches that reported that minipigs, rats and mice could develop hyperglycemia, hyperinsulinemia, hyperlipidemia and obesity after being induced with high-fat/high-carbohydrate diets. Second, the rhesus monkeys in T2DM group were injected STZ at a low dosage of 35 mg/kg BW to induce glucose persistent elevation which maintained pretty well after 12 months. Third, we took the assay of glucose tolerance test and insulin resistance index, assessed the changing tendency of serum resistin and analysed the pathological characteristics of the tissues like pancreas and liver by staining in different ways. The results indicate the rhesus monkeys in T2DM group have lots of clinical features of T2DM. The experimental non-genetic T2DM rhesus monkeys model not only contribute to simulating of clinical manifestations and pathological features of human T2DM, but also may be a good kind of model for research on the treatment of T2DM and for new drugs evaluation.

[Retrospective study on 116 unexpected sudden cardiac deaths in Yunnan, China].

OBJECTIVE: To identify the epidemiological and clinical features of unexpected sudden cardiac deaths (SUD) in Yunnan. METHODS: Choosing the old SUD cases from Xiangyun, Heqing, Nanjian and Dayao counties and using the standardized verbal autopsy Form, we interviewed the family members of the cases, witnesses and doctors as well as reviewing their medical files to get relative information. RESULTS: We identified 116 SUDs in 21 villages from 1984 to 2004. The village-specific annually standardized incidence rates were ranged from 0.2/1000 to 8.9/1000 (median = 0.8/1000). 66% and 29% of the SUDs occurred in July and August respectively. The incidence rates of SUD were higher (1.6/1000, chi(2) = 16, P < 0.01) in 10 - 39 year-olds, and higher in females than in males (RR = 1.6, 95% CI: 1.1 - 2.3). Seventy percent of SUD occurred in families having clustering nature and 60% of the additional cases in the family were occurred within 24 hours (median = 20 hours) after the first SUD identified in the family. SUD occurred in 23 families followed the first affected family in a village during the same season. In these 23 families, 61% of the first SUD occurred within 8 days after the first SUD in the first affected family. 68% and 66% of the SUDs did not have any complaints or signs during the last 3 weeks or from 3 weeks to 2 days prior to the onset of the disease. 63% of the SUDs had cardiac symptoms within the last 2 days prior to the onset with major symptoms as dizziness, nausea, faintness, unconsciousness, weakness and palpitation. The median duration from acute onset to death was 2 hours. CONCLUSIONS: The extreme time-space clustering of SUD in families and in villages suggested that the risk factors occurred in specific time and location. Familial clustered SUD cases had common exposure pattern. Sudden onset of acute cardiac symptoms often followed by sudden death. Epidemiological study on new cases was necessary to identify risk factors and to develop hypothesis for causation. In July 2005, we instituted a special SUD surveillance system for all the affected counties together with 10 counties which had no reported cases.

Daily short-term head-up tilt can prevent structural changes in arteries of tail-suspended rats.

The aim of the present study was to investigate the effectiveness of daily 4-h head up tilt (HUT) in preventing the structural changes in arteries from rats induced by tail-suspension (TS). TS rat model was used to simulate the physiological effects of microgravity. Daily 4-h HUT was used to simulate the effect of intermittent artificial gravity (IAG). The results showed that TS alone induced an increase in the vessel media layer cross-sectional area (CSA), media wall thickness (T), mean number of smooth muscle cell layers (NCL) in basilar artery, and a decrease in these parameters in anterior tibial artery. Both the hypertrophic and atrophic changes in these arteries that might occur due to TS alone can be prevented by a 4h/d HUT treatment.