Genomic Surveillance for SARS-CoV-2 Variants: Dominance of XBB Replacement - China, January-June 2023.

Introduction: In the first half of 2023, a global shift was observed towards the predominance of XBB variants. China faced a significant epidemic between late 2022 and early 2023 due to Omicron subvariants BA.5.2 and BF.7. This study aims to depict the evolving variant distribution among provincial-level administrative divisions (PLADs) in China and explore the factors driving the predominance of XBB replacement. Methods: Sequences from local and imported coronavirus disease 2019 (COVID-19) cases recorded between January 1 and June 30, 2023, were included. The study analyzed the changing distribution of viral variants and assessed how the prior dominance of specific variants, XBB subvariants, and imported cases influenced the prevalence of the XBB replacement variant. Results: A total of 56,486 sequences were obtained from local cases, and 8,669 sequences were from imported cases. Starting in April, there was a shift in the prevalence of XBB from imported to local cases, with varying dominance among PLADs. In PLADs previously high in BF.7, the rise of XBB was delayed. A positive correlation was found between XBB proportions in imported cases from January to March and local cases in April. The distribution pattern of XBB subvariants differed between local and imported cases within the same PLAD. No significant differences were noted in the replacement rates of XBB subvariants. Conclusions: The timing of XBB dominance differed among various PLADs in China in the first half of 2023, correlating closely with the prevalence of XBB variants among imported cases.

Predicting resting-state brain functional connectivity from the structural connectome using the heat diffusion model: a multiple-timescale fusion method.

Objective.Understanding the intricate relationship between structural connectivity (SC) and functional connectivity (FC) is pivotal for understanding the complexities of the human brain. To explore this relationship, the heat diffusion model (HDM) was utilized to predict FC from SC. However, previous studies using the HDM have typically predicted FC at a critical time scale in the heat kernel equation, overlooking the dynamic nature of the diffusion process and providing an incomplete representation of the predicted FC.Approach.In this study, we propose an alternative approach based on the HDM. First, we introduced a multiple-timescale fusion method to capture the dynamic features of the diffusion process. Additionally, to enhance the smoothness of the predicted FC values, we employed the Wavelet reconstruction method to maintain local consistency and remove noise. Moreover, to provide a more accurate representation of the relationship between SC and FC, we calculated the linear transformation between the smoothed FC and the empirical FC.Main results.We conducted extensive experiments in two independent datasets. By fusing different time scales in the diffusion process for predicting FC, the proposed method demonstrated higher predictive correlation compared with method considering only critical time points (Singlescale). Furthermore, compared with other existing methods, the proposed method achieved the highest predictive correlations of 0.6939±0.0079 and 0.7302±0.0117 on the two datasets respectively. We observed that the visual network at the network level and the parietal lobe at the lobe level exhibited the highest predictive correlations, indicating that the functional activity in these regions may be closely related to the direct diffusion of information between brain regions.Significance.The multiple-timescale fusion method proposed in this study provides insights into the dynamic aspects of the diffusion process, contributing to a deeper understanding of how brain structure gives rise to brain function.

Redirect Tropism of Fowl Adenovirus 4 Vector by Modifying Fiber2 with Variable Domain of Heavy-Chain Antibody.

The variable domain of a heavy-chain antibody (VHH) has the potential to be used to redirect the cell tropism of adenoviral vectors. Here, we attempted to establish platforms to simplify the screening of VHHs for their specific targeting function when being incorporated into the fiber of adenovirus. Both fowl adenovirus 4 (FAdV-4) and simian adenovirus 1 (SAdV-1) have two types of fiber, one of which is dispensable for virus propagation and is a proper site for VHH display. An intermediate plasmid, pMD-FAV4Fs, was constructed as the start plasmid for FAdV-4 fiber2 modification. Foldon from phage T4 fibritin, a trigger for trimerization, was employed to bridge the tail/shaft domain of fiber2 and VHHs against human CD16A, a key membrane marker of natural killer (NK) cells. Through one step of restriction-assembly, the modified fiber2 was transferred to the adenoviral plasmid, which was linearized and transfected to packaging cells. Five FAdV-4 viruses carrying the GFP gene were finally rescued and amplified, with three VHHs being displayed. One recombinant virus, FAdV4FC21-EG, could hardly transduce human 293 or Jurkat cells. In contrast, when it was used at a multiplicity of infection of 1000 viral particles per cell, the transduction efficiency reached 51% or 34% for 293 or Jurkat cells expressing exogenous CD16A. Such a strategy of fiber modification was transplanted to the SAdV-1 vector to construct SAdV1FC28H-EG, which moderately transduced primary human NK cells while the parental virus transduced none. Collectively, we reformed the strategy of integrating VHH to fiber and established novel platforms for screening VHHs to construct adenoviral vectors with a specific tropism.

The Biodistribution of Replication-Defective Simian Adenovirus 1 Vector in a Mouse Model.

The administration route affects the biodistribution of a gene transfer vector and the expression of a transgene. A simian adenovirus 1 vector carrying firefly luciferase and GFP reporter genes (SAdV1-GFluc) were constructed, and its biodistribution was investigated in a mouse model by bioluminescence imaging and virus DNA tracking with real-time PCR. Luciferase activity and virus DNA were mainly found in the liver and spleen after the intravenous administration of SAdV1-GFluc. The results of flow cytometry illustrated that macrophages in the liver and spleen as well as hepatocytes were the target cells. Repeated inoculation was noneffective because of the stimulated serum neutralizing antibodies (NAbs) against SAdV-1. A transient, local expression of low-level luciferase was detected after intragastric administration, and the administration could be repeated without compromising the expression of the reporter gene. Intranasal administration led to a moderate, constant expression of a transgene in the whole respiratory tract and could be repeated one more time without a significant increase in the NAb titer. An immunohistochemistry assay showed that respiratory epithelial cells and macrophages in the lungs were transduced. High luciferase activity was restricted at the injection site and sustained for a week after intramuscular administration. A compromised transgene expression was observed after a repeated injection. When these mice were intramuscularly injected for a third time with the human adenovirus 5 (HAdV-5) vector carrying a luciferase gene, the luciferase activity recovered and reached the initial level, suggesting that the sequential use of SAdV-1 and HAdV-5 vectors was practicable. In short, the intranasal inoculation or intramuscular injection may be the preferred administration routes for the novel SAdV-1 vector in vaccine development.

Tracking Age-Related Topological Changes in Individual Brain Morphological Networks Across the Human Lifespan.

BACKGROUND: Many studies have shown topological alterations associated with age in population-based brain morphological networks. However, it is not clear how individual brain morphological networks change with age across the lifespan. PURPOSE: To characterize age-related topological changes in individual networks and investigate the relationships between individual- and group-based brain networks at the nodal, modular, and connectome levels. STUDY TYPE: Retrospective analysis. POPULATION: One hundred seventy-nine healthy subjects (108 males and 71 females), aged 6-85 years with a median age of 32 years and an inter-quartile range (IQR) of 26 years. FIELD STRENGTH/SEQUENCE: T1-weighted images using the magnetization-prepared rapid gradient echo (MPRAGE) sequences. ASSESSMENT: Two nodal-level indicators (nodal similarity and node matching), five modular-level indicators (modularity, intra/inter-module similarity, adjusted mutual information [AMI], and module variation), and five connectome-level indicators (global efficiency, characteristic path length, clustering coefficient, local efficiency, and individual contribution) were calculated in brain morphological networks. Regression models for different indicators were built to examine their lifetime trajectory patterns. STATISTICAL TESTS: Single-sample t-test, Mantel's test, Pearson correlation coefficient. A P value <0.05 was considered statistically significant. RESULTS: Among 68 nodes, 34 nodes showed significant age-related patterns (all P < 0.05, FDR-corrected) in nodal similarity, including linear decline and quadratic trends. The lifespan trajectory of the connectome-level topological attributes of the individual networks presented U-shaped or inverse U-shaped trends with age. Between the individual- and group-based brain networks, the average nodal similarity was 0.67 and the average AMI of module partitions was 0.57. DATA CONCLUSION: The lifespan trajectories of the nodal similarity mainly followed linear decreasing and nonlinear trends, whereas the modularity and the global topological attributes exhibited nonlinear patterns. There was a high degree of consistency at both nodal similarity and modular division between the individual and group networks. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 1.

Chronic Sacral Nerve Stimulation Inhibits Visceral Hypersensitivity in Diarrhea-Predominant Irritable Bowel Syndrome Rats Model.

OBJECTIVE: Sacral nerve stimulation (SNS) is emerging as a novel treatment for irritable bowel syndrome (IBS). However, its effects are limited, and the underlying mechanisms remain largely unknown. MATERIALS AND METHODS: In this study, rats were divided into three groups (n = 12 rats per group): 1) the SNS group; 2) the sham SNS group (the sham group for short); and 3) the control group. The SNS and sham groups were exposed to chronic and acute stress to establish an IBS model. Electrode implantation surgery was performed in rats with the IBS model. The SNS group received electrical stimulation for 30 minutes every day for seven days. Abdominal withdrawal reflex (AWR) was used to evaluate the effect of SNS on visceral sensitivity in diarrhea-predominant IBS (IBS-D) rats. The frequency domain of heart rate variability (HRV) was analyzed to assess the effect of SNS on regulating the autonomic function. The expression of transient receptor potential vanilloid 1 (TRPV1) in the colon, spinal cord, and hippocampus was detected by immunohistochemistry to explore the mechanism of SNS in IBS-D rats. RESULTS: Compared with the sham group, AWR scores were significantly decreased under different gas volumes of stimulation of 0.4, 0.6, and 0.8 ml for rectal distention in the SNS group (all p < 0.05). However, there was no significant difference <1.0 ml between the two groups (p > 0.05). Compared with the sham group, the frequency domain indexes of HRV were significantly altered. Normalized low-frequency power and low frequency-to-high frequency ratio were significantly decreased, and normalized high-frequency power was significantly increased in the SNS group (all p < 0.05). Moreover, the expression of TRPV1 in the spinal cord and colon in the SNS group was significantly decreased compared with the sham group (both p < 0.05). These results suggested that chronic SNS not only improved the visceral sensitivity and autonomic dysfunction but also decreased the expression of TRPV1 in the spinal cord-gut tissue in IBS-D rats. CONCLUSION: Chronic SNS was found to have an inhibitory effect on visceral hypersensitivity in IBS-D rats, providing experimental evidence for its potential clinical application in IBS.

The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer.

Background: Although computed tomography (CT)-defined emphysema is considered a predictor of lung cancer risk, it is not fully clear whether CT-defined emphysema is associated with the prognosis of lung cancer. We aimed to assess the clinical impact of CT-defined emphysema on the survival of lung cancer. Methods: In the prospective cohort study of nonsmall cell lung cancer (NSCLC), the correlation between CT-defined emphysema and clinical variables was analysed. A multivariable Cox regression model was built to assess the association between CT-defined emphysema and overall survival (OS) for up to 8.8 years. The differences in survival analyses were derived by Kaplan-Meier analysis and log-rank testing. Low attenuation area (LAA%) was defined as the per cent of voxels below -950 HU. Results: 854 patients were included and CT-defined emphysema was present in 300 (35.1%) at diagnosis. Epidermal growth factor receptor (EGFR) wild-type (OR 1.998; p<0.001) and anaplastic lymphoma kinase (ALK) wild-type (OR 2.277; p=0.004) were associated with CT-defined emphysema. CT-defined emphysema remained a significant predictor of prognosis adjusting for age, sex, smoking history, tumour histology and Eastern Cooperative Oncology Group Performance Status (ECOG PS), whether in I-IIIA stage (adjusted hazard ratio (HR) 1.745; p=0.017) or in IIIB-IV stage (adjusted HR 1.291; p=0.022). Stratified analyses showed that OS rate among the driver oncogene groups with different CT-defined emphysema status differed significantly (log-rank p<0.001). Furthermore, patients with centrilobular emphysema (CLE) with LAA% >17% displayed poorer survival than those with LAA% ≤17% (median 432 versus 670 days; HR 1.564; p=0.020). Conclusions: CT-defined emphysema, especially CLE with LAA%>17%, is an independent predictor of NSCLC prognosis. Moreover, prospective studies are needed to further explore this association.

Discovery of TBX20 as a Novel Gene Underlying Atrial Fibrillation.

Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via whole-genome genotyping with genetic markers and a linkage assay in a family suffering from AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89 cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. An exome-wide sequencing assay unveiled that, at the defined locus, the mutation in the TBX20 gene, NM_001077653.2: c.695A>G; p.(His232Arg), was solely co-segregated with AF in the family. Additionally, a Sanger sequencing assay of TBX20 in another family suffering from AF uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations were observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while they had no effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-predisposing gene, shedding light on the mechanism underlying AF and suggesting clinical significance for the allele-specific treatment of AF patients.

The Role of Strain by Cardiac Magnetic Resonance Imaging in Predicting the Prognosis of Patients with Chronic Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by thrombotic obstruction of the pulmonary arteries, and right ventricular (RV) dysfunction is a major cause of death. Cardiac magnetic resonance (CMR) is the gold standard for assessing heart wall deformation; therefore, we aimed to determine the prognostic value of CMR strain in patients with CTEPH. Strain derived by CMR was measured at the time of diagnosis in 45 patients with CTEPH, and the relationship between RV strain and prognosis was determined through follow-up. The value of RV strain in the prognostic model was compared with that of pulmonary arterial hypertension (PAH) risk stratification. The RV global peak longitudinal strain (GLS) and global peak circumferential strain (GCS) in CTEPH patients were lower than the normal references of RV strain in the control group. GLS and longitudinal strain in the basal segment were independent risk factors for adverse events (P < .050). Adding CMR parameters to PAH risk stratification improved its predictive power in patients with CTEPH. GLS and GCS scores were impaired in patients with chronic RV overload. RV strain derived by CMR imaging is a promising noninvasive tool for the follow-up of patients with CTEPH.

Effects of pre-operative biopsy on recurrence and survival in stage I lung adenocarcinoma patients in China.

Background: Whether pre-operative biopsy affects post-operative recurrence and metastasis of lung cancer patients is still controversial. Methods: In order to clarify these disputes, we collected relevant literature to conduct a meta-analysis. To validate the results of the meta-analysis, we retrospectively analysed 575 patients with stage I lung adenocarcinoma who underwent surgical resection at our centre from 2010 to 2018 using propensity score matching and competing risk models. Results: 5509 lung cancer patients from 11 articles were included in the meta-analysis. Summary analysis showed that the total recurrence rate of the biopsy group was higher than that of the nonbiopsy group (risk ratio 1.690, 95% CI 1.220-2.330; p=0.001). After propensity score matching, we found that there was no significant correlation between biopsy and total recurrence (risk ratio 1.070, 95% CI 0.540-2.120; p=0.850). In our cohort, of 575 stage I lung adenocarcinomas, 113 (19.7%) patients underwent pre-operative biopsy. During a median (interquartile range) follow-up of 71 (57-93) months, multivariable analyses showed pre-operative biopsy in the overall observation cohort (subdistribution hazard ratio (SHR) 1.522, 95% CI 0.997-2.320; p=0.051) and in the propensity score-matched cohort (SHR 1.134, 95% CI 0.709-1.810; p=0.600) was not significantly correlated with the risk of recurrence and metastasis. Moreover, the pre-operative biopsy did not affect disease-free survival (SHR 0.853, 95% CI 0.572-1.273; p=0.438) or overall survival (SHR 0.647, 95% CI 0.352-1.189; p=0.161). Conclusion: Pre-operative biopsy might not increase the risk of recurrence and metastasis, suggesting that these procedures might be safe for patients with stage I lung adenocarcinoma whose diagnosis is difficult to determine before surgery.

The interaction and physicochemical properties of the starch-polyphenol complex: Polymeric proanthocyanidins and maize starch with different amylose/amylopectin ratios.

This study investigated the impact of polymeric proanthocyanidins (PPC) on the physicochemical characteristics of maize starch with varying amylose content, and their potential interaction mechanism. PPC with a lower content (1 %) reduced the viscoelasticity of the high amylose maize starch (HAM) system, inhibited amylose rearrangement, and enhanced its fluidity. However, excessive PPC restrained the interaction between PPC and amylose. In contrast to HAM, PPC improved the gelation ability of waxy maize starch (WAM) as PPC concentration was raised. PPC suppressed the recrystallization of starch during storage, and PPC had a superior inhibition influence on the retrogradation of WAM in comparison to HAM. This indicated that amylopectin was more likely to interact with PPC than amylose. Hydrogen bonds were the main driving force between PPC and starch chains, which was clarified by Fourier transform-infrared, nuclear magnetic resonance, X-ray diffraction, iodine bonding reaction, and dynamic light scattering data. Additionally, the mechanism of interaction between PPC and the two starch components may be similar, and variance in physicochemical attributes can be primarily credited to the percentage of amylose to amylopectin in starch.

Public acceptability of lumbar puncture in the diagnosis of Alzheimer's disease: a questionnaire-based single center study in China.

AIM: To investigate public acceptability of lumbar puncture in the diagnosis of Alzheimer's disease and to find out the factors influencing patient decision. METHODS: We administered a questionnaire to participants who were native to Xi'an using the "Sojump" application. Participants were required to answer the questionnaire on their cell phones following the instructions. The questions of the questionnaire were divided into four categories, including demographic data, awareness of lumbar puncture, attitudes toward lumbar puncture for the diagnosis of Alzheimer's disease, and reasons for negative attitude. Logistic regression was used to analyze the factors influencing the attitude toward lumbar puncture testing. RESULTS: A total of 1050 valid questionnaires were collected, including 403 (38.4%) from non-medical personnel and 647 (61.6%) from medical personnel. Among them, 35.7% of the participants knew about lumbar puncture examinations. Regarding the attitude, 862 participants (82.1%) had a positive attitude toward lumbar puncture in the diagnosis of Alzheimer's disease, and 508 (58.9%) of them considered lumbar puncture to be helpful in confirming the diagnosis. Multivariate analysis revealed that factors associated with a positive attitude in the non-medical group included age (OR=0.963, P=0.003, 95% CI: 0.939-0.987), education level (OR=2.073, P=0.037, 95% CI: 1.044-4.114), monthly income (OR=1.340, P=0.031, 95% CI: 1.028-1.748), and type of occupation (OR=1.569, P=0.038, 95% CI: 1.026-2.400). Factors associated with a positive attitude in the medical group included place of residence (OR=9.182, P=0.036, 95% CI: 1.151-73.238), monthly income (OR=4.008, P=0.002, 95% CI: 1.689-9.511), and hospital level (OR=38.311, P < 0.001, 95% CI: 14.323-102.478). CONCLUSIONS: More than 80% of the public has a positive attitude towards lumbar puncture in the diagnosis of Alzheimer's disease, suggesting high acceptability. However, the attitude toward lumbar puncture is depend on age, education level, economic status, and type of occupation.

Echocardiographic Characteristics of Pulmonary Artery Intimal Sarcoma: Comparison With CTPA.

OBJECTIVES: This study examined the echocardiographic characteristics of patients with pulmonary artery intimal sarcoma (PAIS) and compared the results with those from computed tomographic pulmonary angiography (CTPA). METHOD: Twenty-six (26) patients were diagnosed with PAIS at the current institution during the study period, and 23 were eligible for analysis. Echocardiography and CTPA examinations were performed in all enrolled patients. RESULTS: The echocardiography results showed that most lesions had expansive growth in the left pulmonary artery (PA); the right PA; or a combination of the left PA, right PA, and main PA, with extension to the pulmonary valve and/or right ventricular outflow tract. These lesions also had distinctive sieve-like echogenic signals. Echocardiography also showed that some lesions had lobulated shapes, were nearly round and echolucent or with calcifications, and moved during imaging. The lesion distribution was similar in CTPA and echocardiography (p=0.361), but CTPA was more sensitive in detection of the complete shape (p=0.023). CONCLUSIONS: The unique echocardiographic characteristics of PAIS, especially the "sieve sign", could help in the diagnosis of this cancer. Transthoracic echocardiography is a non-invasive technique that appears effective in detecting PAIS.

Two-Way Reversible Shape Memory Behavior of Chitosan/Glycerol Film Triggered by Water.

Reversible shape memory polymers (SRMPs) have been identified as having great potential for biomedical applications due to their ability to switch between different shapes responding to stimuli. In this paper, a chitosan/glycerol (CS/GL) film with a reversible shape memory behavior was prepared, and the reversible shape memory effect (SME) and its mechanism were systematically investigated. The film with 40% glycerin/chitosan mass ratio demonstrated the best performance, with 95.7% shape recovery ratio to temporary shape one and 89.4% shape recovery ratio to temporary shape two. Moreover, it shows the capability to undergo four consecutive shape memory cycles. In addition, a new curvature measurement method was used to accurately calculate the shape recovery ratio. The suction and discharge of free water change the binding form of the hydrogen bonds inside the material, which makes a great reversible shape memory impact on the composite film. The incorporation of glycerol can enhance the precision and repeatability of the reversible shape memory effect and shortens the time used during this process. This paper gives a hypothetical premise to the preparation of two-way reversible shape memory polymers.

Analysis of clinical features between active and inactive patients of Takayasu's arteritis with pulmonary arteries involvement.

BACKGROUND: The aim of this study was to investigate the clinical characteristics of patients between active and inactive Takayasu's arteritis with pulmonary artery involvement (PTA) and to identify better markers of disease activity in these patients. METHODS: Sixty-four PTA patients in Beijing Chao-yang hospital (2011 to 2021) were included. According to National Institutes of Health criteria, 29 patients were in active stage and 35 were in inactive stage. Their medical records were collected and analyzed. RESULTS: Compared with inactive group, patients in active group were younger. More patients in active stage presented fever (41.38% vs 5.71%), chest pain (55.17% vs 20%), increased C-reactive protein (2.91 vs 0.46 mg/L), erythrocyte sedimentation rate (35.0 vs 9 mm/h), and platelet count (291 vs 221 × 109/L). Pulmonary artery wall thickening was more common in active group (51.72% vs 11.43%). These parameters were restored after treatment. The incidence of pulmonary hypertension was comparable between groups (34.48% vs 51.43%), but patients in active group had lower pulmonary vascular resistance (PVR) (361.0 vs 891.0 dyn·s·cm-5) and higher cardiac index (2.76 ± 0.72 vs 2.01 ± 0.58 L/min/m2). On multivariate logistic regression analysis, chest pain [odds ratio (OR) 9.37, 95%CI (1.98-44.38), P = 0.005], increased platelet count (>242.5 × 109/L) [OR 9.03, 95%CI (2.10-38.87), P = 0.003] and pulmonary artery wall thickening [OR 7.08, 95%CI (1.44-34.89), P = 0.016] were independently associated with disease activity. CONCLUSION: Chest pain, increased platelet count, and pulmonary artery wall thickening are potential new indicators of disease activity in PTA. Patients in active stage may have lower PVR and better right heart function.

Application of a hospital-community-family trinity rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction.

BACKGROUND: Rehabilitation nursing is considered an indispensable part of the cerebral infarction treatment system. The hospital-community-family trinity rehabilitation nursing model can provide continuous nursing services across hospitals, communities, and families for patients. AIM: To explore the application of a hospital-community-family rehabilitation nursing model combined with motor imagery therapy in patients with cerebral infarction. METHODS: From January 2021 to December 2021, 88 patients with cerebral infarction were divided into a study (n = 44) and a control (n = 44) group using a simple random number table. The control group received routine nursing and motor imagery therapy. The study group was given hospital-community-family trinity rehabilitation nursing based on the control group. Motor function (FMA), balance ability (BBS), activities of daily living (BI), quality of life (SS-QOL), activation status of the contralateral primary sensorimotor cortical area to the affected side, and nursing satisfaction were evaluated before and after intervention in both groups. RESULTS: Before intervention, FMA and BBS were similar (P > 0.05). After 6 months' intervention, FMA and BBS were significantly higher in the study than in the control group (both P < 0.05). Before intervention, BI and SS-QOL scores were not different between the study and control group (P > 0.05). However, after 6 months' intervention, BI and SS-QOL were higher in the study than in the control group (P < 0.05). Before intervention, activation frequency and volume were similar between the study and the control group (P > 0.05). After 6 months' intervention, the activation frequency and volume were higher in the study than in the control group (P < 0.05). The reliability, empathy, reactivity, assurance, and tangibles scores for quality of nursing service were higher in the study than in the control group (P < 0.05). CONCLUSION: Combining a hospital-community-family trinity rehabilitation nursing model and motor imagery therapy enhances the motor function and balance ability of patients with cerebral infarction, improving their quality of life.

Left ventricular strain in patients with Takayasu arteritis with preserved ejection fraction: an analysis using cardiac magnetic resonance imaging feature tracking.

Background: The alteration of myocardial strain in patients with Takayasu arteritis (TAK) remains unclear. This study aimed to evaluate left ventricular (LV) stain in patients with TAK and preserved left ventricular ejection fraction (pLVEF) using cardiac magnetic resonance imaging feature tracking (CMR-FT) to analyze risk factors for impaired LV strain and to compare the baseline difference of LV strain between patients with reduced and nonreduced LVEF at 6-month follow-up. Methods: In all, 51 patients with TAK and 30 healthy controls were prospectively enrolled. All participants underwent multiple short- and long-axis cine scans with true fast imaging with steady-state precession sequence. In this observational study, LV global and regional longitudinal, circumferential, and radial strain and their strain rates were analyzed with FT on cine images. The relationship between LV strain and clinical data was explored. The baseline LV strain between patients with TAK and reduced and nonreduced LVEF was compared using transthoracic echocardiography (TTE) at the 6-month follow-up. Results: Patients with TAK with pLVEF showed a decline in baseline global longitudinal peak strain (GLS) [TAK (-13.35%±3.11%) vs. controls (-14.77%±1.74%), P=0.021] and circumferential peak strain (GCS) [TAK (-21.46%±2.66%) vs. controls (-22.75%±2.57%), P=0.027] in comparison with normal controls. The longitudinal peak strain (LPS) in the apical (P=0.003) and midventricular regions (P=0.027) and the circumferential peak strain (CPS) in the basal (P=0.021) and midventricular regions (P=0.008) also decreased in patients with TAK. Patients with pulmonary hypertension (PH) or myocardial late gadolinium enhancement (LGE) showed a greater reduction in strain compared with those without PH or LGE. GLS showed a negative association with erythrocyte sedimentation rate (ESR), while GCS showed a positive association with disease duration. In the 30 patients who were followed up, the baseline global and apical circumferential diastolic peak strain rates (DPSR) in patients with reduced LVEF were higher than those in patients without reduced LVEF. Conclusions: In patients with TAK and pLVEF, CMR-FT indicated that both global and segmental myocardial strain decreased. PH, male gender, long disease duration, elevated ESR, and myocardial LGE were associated with declined LV strain. Baseline increased circumferential DPSR may be associated with the decline in LVEF during follow-up.

Delayed contrast-enhanced magnetic resonance imaging enables detection of pulmonary artery lesions in Takayasu's arteritis.

Background: Delayed contrast-enhanced magnetic resonance imaging (DE-MRI) is a useful technique to identify arterial wall inflammation. The aim of this study was to explore the value of DE-MRI in the evaluation of pulmonary artery (PA) lesions in Takayasu's arteritis (TAK) compared with 18F-fuorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods: Patients with TAK were recruited for this prospective, observational study. Imaging and clinical assessments were performed concurrently. Only thoracic arteries were evaluated, and they were divided into 18 segments per person. All arterial lesions were evaluated using both PET/CT and DE-MRI. Correlations between both methods were assessed in the PA and thoracic aorta. A receiver operating characteristic (ROC) curve was used to analyze the value of imaging features in detecting disease activity based on National Institutes of Health (NIH) criteria. Results: A total of 24 patients contributed 432 arterial segments. Using PET/CT, correlations between arterial wall DE, thickening, and edema in the PA were 84.52%, 67.92%, and 58.33%, respectively, with Cohen's kappa =0.69, 0.30, and 0.13, respectively; for the thoracic aorta, the values were 86.38%, 80.00%, and 75.92%, respectively, with Cohen's kappa =0.71, 0.52, and 0.372, respectively. There was a significant difference in the incidence of wall DE between the PA and thoracic aorta in patients with clinically active TAK (χ2=6.85, P=0.009). DE-MRI presented a higher area under the curve [area under the curve (AUC); 0.729, P=0.047] than wall thickening and edema in the detection of TAK activity. The wall DE combined with erythrocyte sedimentation rate (ESR) showed improved efficiency (AUC: 0.858, P=0.003). Conclusions: DE-MRI displays appreciable correlations with PET/CT findings and allows for the detection of PA inflammation in patients with TAK; it shows higher values in the thoracic aorta than in the PA. The combination of wall DE and ESR can improve the efficiency of assessing disease status.

Changes in expression levels of immune cells and inflammatory cytokines in pre-eclampsia patients before and after delivery.

OBJECTIVE: By analyze the expression levels of immune cells and cytokines secreted by preeclampsia patients before and after delivery. Furthermore, to determine the inflammatory and immunological mechanism responsible for preeclampsia, to provide better future prevention and treatment. METHODS: Twenty-one preeclampsia-diagnosed pregnant women were involved in this study as an observation group. Twenty pregnant women with no history of PE, age-matched, were added to the control group. Thirty NP women, age-matched were included as the reference. The levels of cytokines secreted by T, B, NK and Treg immune cells and Th1, Th2 and Th17 cells were detected before and after delivery. RESULTS: The number of CD3 + cells in women without preeclampsia before delivery was not statistically different from that in PE patients, but the number of CD4 + and CD8 + cells was lower than that in women without preeclampsia. After delivery, CD4 + cells were larger than those in pregnant women without preeclampsia, while CD8 + cells were smaller than those in pregnant women without preeclampsia. The level of cytokines secreted by Th1 in pregnant women without preeclampsia before delivery was higher than that in PE patients. The levels of cytokines produced by Th1, Th2 and Th17 cells before and after delivery were higher in pregnant women without preeclampsia than in NP women, while Th2 and Th17 were in PE group. CONCLUSION: PE patients may reduce CD4 + cells and CD8 + cells, and down-regulate the level of cytokines (especially TNF-ß) secreted by Th1 cells to reduce the maternal rejection of embryos, thereby reducing the risk of premature delivery, which is a protective adaptive compensation mechanism in favor of embryos.

Difference in meal-related esophageal intraluminal impedance change between gastroesophageal reflux disease and functional disorders.

OBJECTIVES: Gastroesophageal reflux disease (GERD) has overlapping symptoms with functional disorders such as functional heart burn. Twenty-four-hour pH with impedance monitoring is useful for differentiation. The intraluminal impedance change with meal in distal esophagus is not investigated. METHODS: We performed a retrospective investigation of clinical files, 24-hour pH with intraluminal impedance monitoring in patients with GERD and functional disorders. The post-reflux swallow induced peristaltic wave (PSPW) index as well as the impedance in distal esophagus before the first meal and 30 min and 60 min after the meal were measured and analyzed. RESULTS: A significant decrease of intraluminal impedance in distal esophagus was noted at 30 min (ΔI30min -301.5 [747.5] Ω, p = 0.018) and recovered at 60 min (ΔI60min -194.6 [766.0] Ω, p = 0.126) after meals in GERD patients. On the other hand, there was no significant change of impedance in patients with functional disorders. There were positive correlations between ΔI30min and PSPW index (correlation = 0.232, p = 0.038). Comparing GERD to functional disorders, the best cut-off value for ΔI30min was -212Ω with 74.4% sensitivity and 60.5% specificity. CONCLUSIONS: The intraluminal impedance in distal esophagus was lowered after meals in GERD patients other than functional disorders. This impedance change was correlated with PSPW index and could help differentiate GERD from functional disorders.