Association between residential greenness and depression symptoms in Chinese community-dwelling older adults.

BACKGROUND: Studies of residential greenness and depression symptoms among community-dwelling older adults in China are limited. However, understanding the role of greenness in depression symptoms among older adults can inform depression prevention and interventions. OBJECTIVE: This study explored the relationship between residential greenness and depression symptoms among community-dwelling older adults in China. METHODS: A cluster random sampling method was used to survey 7512 community-dwelling adults aged 60 and above from three towns in Shanghai. Depression symptoms were assessed using the Geriatric Depression Scale (GDS30). Residential greenness was measured using the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Long-term greenspace exposure was defined as the mean NDVI and EVI in the three years prior to the baseline survey. Controlling for the covariates, the relationship between greenness and depression symptoms was assessed using binomial logistic regression and mixed-effects linear regression. Interaction analysis was conducted to explore which covariates potentially alter the association. We also assessed the mediating role of physical activity. RESULTS: The prevalence of depression symptoms among the participants was 13.72%. Higher residential greenness was associated with lower odds of depression symptoms, after adjusting for covariates. In the logistic regression analysis, the odds of depression symptoms decreased with increasing NDVI and EVI. In linear regression analysis, GDS30 scores decreased with increasing NDVI and EVI. Interaction analyses revealed that higher NDVI and EVI were more protective against depression among male individuals and older adults living with others than among female individuals and older adults living alone. Additionally, physical activity had a masking effect on residential greenness and depression symptoms. CONCLUSION: Higher residential greenness is associated with lower odds of depression symptoms in community-dwelling Chinese older adults. Increasing urban and neighborhood green spaces may contribute to the prevention and intervention of depression symptoms in community-dwelling older adults.

Physical activity and health-related quality of life in older adults: depression as a mediator.

BACKGROUND: Physical activity(PA) is associated with health-related quality of life (HRQoL) among older adults, and both are associated with mood, such as depression. However, the indirect effects of PA on HRQoL in older adults have not been clearly established. This study explained how different types and intensities of PA were associated with HRQoL while considering the effects of depression in older adults. METHODS: A cross-sectional study was conducted with 7,518 community-dwelling older adults aged 60 years and older. PA (leisure-time, household, and work-related), depression, and HRQoL were measured using the Physical Activity Scale for the Elderly (PASE), the 30-item Geriatric Depression Scale (GDS-30), and the 36-Item Short-Form Health Survey (SF-36), respectively. Information on age, gender, education, monthly income, activities of daily living, smoking, and alcohol drinking was also collected. Regression analysis was used to explore the relationship between PA, depression and HRQoL, and a mediation effect test process was used to verify the mediating mechanism of the depression on this relationship. RESULTS: The study showed that after adjusting for a set of covariates, SF-36 Physical Component Summary (PCS) scores were negatively associated with depression (B = -2.046, 95% CI [2.584, -1.509]) and positively with PA (p < 0.001). Similarly, SF-36 Mental Component Summary (MCS) scores were negatively associated with depression (B = -11.657, 95% CI [-12.190, -11.124]). In mediation analyses, we found that depression partially mediated the relationship between different types and intensities PA and PCS (moderate leisure-time PA: B = 0.223, 95%CI [0.153,0.293], P < 0.001; vigorous leisure-time PA: B = 0.323, 95%CI [0.232,0.413], P < 0.001; moderate household PA: B = 0.092, 95%CI [0.045,0.139], P < 0.001; vigorous household PA: B = 0.137, 95%CI [0.085,0.190], P < 0.001; work-related PA: B = 0.193, 95%CI [0.658,0.190], P < 0.001) and MCS (moderate leisure-time PA: B = 1.243, 95%CI [1.008,1.479], P < 0.001; vigorous leisure-time PA: B = 1.800, 95%CI [1.585,2.015], P < 0.001; moderate household PA: B = 0.496, 95%CI [0.274,0.718], P < 0.001; vigorous household PA: B = 0.742, 95%CI [0.521,0.963], P < 0.001; work-related PA: B = 1.026, 95%CI [0.819,1.234], P < 0.001). CONCLUSIONS: This study suggested that leisure-time, household, and work-related PA were negatively associated with depression, while positively affecting HRQoL in Chinese older adults. The relationships between different types and intensities of PA and HRQoL were mediated by depression. Interventions aimed at promoting purposeful exercise and different types of PA may have mental health benefits. It is recommended that geriatric health managers and healthcare planners prioritize interventions to help improve PA intensities, alleviate depressive symptoms to promote beneficial effects on HRQoL in older adults.

Residential surrounding greenness is associated with improved lung function in adults: a cross-sectional study in eastern China.

BACKGROUND: While benefits of greenness exposure to health have been reported, findings specific to lung function are inconsistent. The purpose of this study is to assess the correlations of greenness exposure with multiple lung function indicators based on chronic obstructive pulmonary disease (COPD) monitoring database from multiple cities of Anhui province in China. METHODS: We assessed the greenness using the annual average of normalized difference vegetation index (NDVI) with a distance of 1000-meter buffer around each local community or village. Three types of lung function indicators were considered, namely indicators of obstructive ventilatory dysfunction (FVC, FEV1, FEV1/FVC, and FEV1/FEV3); an indicator of large-airway dysfunction (PEF); indicators of small-airway dysfunction (FEF25%, FEF50%, FEF75%, MMEF, FEV3, FEV6, and FEV3/FVC). Linear mixed effects model was used to analyze associations of greenness exposure with lung function through adjusting age, sex, educational level, occupation, residence, smoking status, history of tuberculosis, family history of lung disease, indoor air pollution, occupational exposure, PM2.5, and body mass index. RESULTS: A total of 2768 participants were recruited for the investigations. An interquartile range (IQR) increase in NDVI was associated with better FVC (153.33mL, 95%CI: 44.07mL, 262.59mL), FEV1 (109.09mL, 95%CI: 30.31mL, 187.88mL), FEV3 (138.04mL, 95%CI: 39.43mL, 236.65mL), FEV6 (145.42mL, 95%CI: 42.36mL, 248.47mL). However, there were no significant associations with PEF, FEF25%, FEF50%, FEF75%, MMEF, FEV1/FVC, FEV1/FEV6, FEV3/FVC. The stratified analysis displayed that an IQR increase in NDVI was related with improved lung function in less than 60 years, females, urban populations, nonsmokers, areas with medium concentrations of PM2.5 and individuals with BMI of less than 28 kg/m2. Sensitivity analyses based on another greenness indice (enhanced vegetation index, EVI) and annual maximum of NDVI remained consistent with the main analysis. CONCLUSIONS: Our findings supported that exposure to greenness was strongly related with improved lung function.

Clinical and Imaging Indicators of Hemorrhagic Transformation in Acute Ischemic Stroke After Endovascular Thrombectomy.

BACKGROUND: Prior studies have investigated the clinical and imaging factors for hemorrhagic transformation (HT), especially symptomatic intracranial hemorrhage (sICH); however, whether alteplase increases the risk of HT after endovascular thrombectomy (EVT) is unknown. This study aimed to assess clinical and imaging features associated with HT, sICH, and parenchymal hematoma (PH) in patients with acute ischemic stroke after EVT, with and without intravenous alteplase in DIRECT-MT (Direct Intraarterial Thrombectomy to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial). METHODS: The DIRECT-MT trial is a randomized trial of EVT alone versus intravenous thrombolysis combined with EVT. HT, sICH, and PH was evaluated on follow-up computed tomography. Multivariable ordinal logistic regression analysis was used to test the association of stepwise selected determinants with HT, sICH, and PH. RESULTS: In total, 633 patients were analyzed; 261 (41.2%) had HT; 34 (5.4%) had sICH; and 85 (13.4%) had PH. The median age was 69, and 56.7% were men. The median National Institutes of Health Stroke Scale score was 18, and 320 patients were in combination-therapy group. Symptomatic intracranial hemorrhage was associated with higher baseline National Institutes of Health Stroke Scale score (adjusted odds ratio [OR], 1.06 [95% CI, 1.10-1.12]) and higher glucose level at hospital arrival (adjusted OR, 1.14 [95% CI, 1.00-1.29]). No association was found between alteplase treatment and HT, sICH, or PH. The independent predictor of sICH was higher baseline National Institutes of Health Stroke Scale score (adjusted OR, 1.09 [95% CI, 1.01-1.18]) in EVT alone group, and history of anticoagulant drugs (adjusted OR, 3.75 [95% CI, 1.07-13.06]), higher glucose level at hospital arrival (adjusted OR, 1.19 [95% CI, 1.03-1.38]), >3 passes of device (adjusted OR, 4.42 [95% CI, 1.36-14.32]) in combination-therapy group. CONCLUSIONS: In DIRECT-MT, independent predictors of sICH were baseline National Institutes of Health Stroke Scale score and glucose level at hospital arrival. Alteplase treatment did not increase the risk of HT, sICH, or PH after EVT. The independent predictor of sICH was different in EVT alone group and combination-therapy group. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03469206.

City-level greenness exposure is associated with COVID-19 incidence in China.

Accumulating studies have suggested an important role of environmental factors (e.g. air pollutants) on the occurrence and development of coronavirus disease 2019 (COVID-19). Evidence concerning the relationship of greenness on COVID-19 is still limited. This study aimed to assess the association between greenness and COVID-19 incidence in 266 Chinese cities. A total of 12,377 confirmed COVID-19 cases were identified through February 29th, 2020. We used the average normalized difference vegetation index (NDVI) during January and February 2020 from MOD13A2 product, to represent the city-level greenness exposure. A generalized linear mixed-effects model was used to estimate the association between NDVI exposure and COVID-19 incidence using COVID-19 cases as the outcome. We evaluated whether the association was modified by population density, GDP per capita, and urbanization rate, and was mediated by air pollutants. We also performed a series of sensitivity analyses to discuss the robustness of our results. Per 0.1 unit increment in NDVI was negatively associated with COVID-19 incidence (IRR: 0.921, 95% CI: 0.898, 0.944) after adjustment for confounders. Associations with COVID-19 incidence were stronger in cities with lower population density, lower GDP per capita, and lower urbanization rate. We failed to detect any mediation effect of air pollutants on the association between NDVI and COVID-19 incidence. Sensitivity analyses also indicated consistent estimates. In conclusion, our study suggested a beneficial association between city-level greenness and COVID-19 incidence. We could not establish which mechanisms may explain this relationship.

Effects of particulate matter on hospital admissions for respiratory diseases: an ecological study based on 12.5 years of time series data in Shanghai.

BACKGROUND: Previous epidemiological studies on the association between short-term exposure to particulate matter (PM) with hospital admission in major cities in China were limited to shorter study periods or a single hospital. The aim of this ecological study based on a 12.5-year time series was to investigate the association of short-term exposure to PM with aerodynamic diameter ≤ 2.5 µm (PM2.5) and aerodynamic diameter ≤ 10 µm (PM10) with hospital admissions for respiratory diseases. METHODS: Daily hospital admissions data were from the Shanghai Medical Insurance System for the period January 1, 2008 to July 31, 2020. We estimated the percentage change with its 95% confidence interval (CI) for each 10 µg/m3 increase in the level of PM2.5 and PM10 after adjustment for calendar time, day of the week, public holidays, and meteorological factors applying a generalized additive model with a quasi-Poisson distribution. RESULTS: There were 1,960,361 hospital admissions for respiratory diseases in Shanghai during the study period. A 10 µg/m3 increase in the level of each class of PM was associated with increased total respiratory diseases when the lag time was 0 day (PM2.5: 0.755%; 95% CI: 0.422, 1.089%; PM10: 0.250%; 95% CI: 0.042, 0.459%). The PM2.5 and PM10 levels also had positive associations with admissions for COPD, asthma, and pneumonia. Stratified analyses demonstrated stronger effects in patients more than 45 years old and during the cold season. Total respiratory diseases increased linearly with PM concentration from 0 to 100 µg/m3, and increased more slowly at higher PM concentrations. CONCLUSIONS: This time-series study suggests that short-term exposure to PM increased the risk for hospital admission for respiratory diseases, even at low concentrations. These findings suggest that reducing atmospheric PM concentrations may reduce hospital admissions for respiratory diseases.

Realizing the values of natural capital for inclusive, sustainable development: Informing China's new ecological development strategy.

A major challenge in transforming development to inclusive, sustainable pathways is the pervasive and persistent trade-off between provisioning services (e.g., agricultural production) on the one hand and regulating services (e.g., water purification, flood control) and biodiversity conservation on the other. We report on an application of China's new Ecological Development Strategy, now being formally tested and refined for subsequent scaling nationwide, which aims to mitigate and even eliminate these trade-offs. Our focus is the Ecosystem Function Conservation Area of Hainan Island, a rural, tropical region where expansion of rubber plantations has driven extensive loss of natural forest and its vital benefits to people. We explored both the biophysical and the socioeconomic options for achieving simultaneous improvements in product provision, regulating services, biodiversity, and livelihoods. We quantified historic trade-offs between rubber production and vital regulating services, finding that, over the past 20 y (1998-2017), there was a 72.2% increase in rubber plantation area, leading to decreases in soil retention (17.8%), water purification [reduced retention of nitrogen (56.3%) and phosphorus (27.4%)], flood mitigation (21.9%), carbon sequestration (1.7%), and habitat for biodiversity (6.9%). Using scenario analyses, we identified a two-pronged strategy that would significantly reduce these trade-offs, enhancing regulating services and biodiversity, while simultaneously diversifying and increasing product provision and improving livelihoods. This general approach to analyzing product provision, regulating services, biodiversity, and livelihoods has applicability in rural landscapes across China, South and Southeast Asia, and beyond.

Residential greenness is associated with disease severity among COVID-19 patients aged over 45 years in Wuhan, China.

Evidence regarding environmental factors associated with disease severity of COVID-19 remained scarce. This study aimed to investigate the association of residential greenness exposure with COVID-19 severity applying a retrospective cross-sectional study in Wuhan, China. We included 30,253 COVID-19 cases aged over 45 years from January 1 to February 27, 2020. Residential greenness was quantitatively assessed using normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). A multilevel generalized linear model using Poisson regression was implemented to analyze the association between greenness exposure and disease severity of COVID-19, after adjusting for potential covariates. A linear exposure-response relationship was found between greenness and COVID-19 severity. In the adjusted model, one 0.1 unit increase of NDVI and EVI in the 1000-m buffer radius was significantly associated with a 7.6% (95% confidence interval (CI): 4.0%, 11.1%) and 10.0% (95% CI: 5.1%, 14.7%) reduction of the prevalence of COVID-19 severity, respectively. The effect of residential greenness seemed to be more pronounced among participants with lower population density and economic levels. Air pollutants mediated 0.82~12.08% of the greenness and COVID-19 severity association, particularly to nitrogen dioxide. Sensitivity analyses suggested the robustness of the results. Our findings suggested that residential greenness exposure was beneficial to reduce the prevalence of COVID-19 severity.

Exploring the relationship between depression and different multimorbidity patterns among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Depression is common in patients with multimorbidity, but little is known about the relationship between depression and multimorbidity. The purpose of our research was to investigate multimorbidity patterns and their association with depression in a sample of older people covered by long-term care insurance in Shanghai, China. METHOD: This was a population-based cross-sectional study, with 1871 participants aged ≥60 years old who are covered by Shanghai long-term care insurance. Multimorbidity was defined as the presence of two or more chronic diseases at the same time. We collected information on chronic conditions using a self-reported medical history, and we used the 30-item Geriatric Depression Scale (GDS-30) to evaluate depressive symptoms. Patterns of multimorbidity were identified with exploratory factor analysis, using oblimin rotation. Logistic regression was used to estimate the relationship between multimorbidity patterns and depressive symptoms. RESULTS: Among the participants, the prevalence of multimorbidity was 64.7%, and the prevalence of depression was 64.6%. Hypertension, cardiovascular disease, cerebrovascular disease (CVD), and cataracts showed strong associations with depression when co-occurring with other conditions. Three patterns of multimorbidity were identified: a musculoskeletal pattern, cardiometabolic pattern, and degenerative disease pattern. Among these, the cardiometabolic (adjusted odds ratio (AOR) 1.223; 95% confidence interval (CI) 1.102, 1.357) and degenerative disease (AOR 1.185; 95% CI 1.071, 1.311) patterns were associated with a higher risk of depressive symptoms. CONCLUSION: Two of three multimorbidity patterns were found to be associated with depression. Physical and psychological dimensions require greater attention in the care of older adults who are covered by long-term care insurance.

Enhancement Characteristics of Middle Cerebral Arterial Atherosclerotic Plaques Over Time and Their Correlation With Stroke Recurrence.

BACKGROUND: The progression of atherosclerotic plaque is a dynamic process; however, the natural evolution process of plaque enhancement on MRI remains unclear. PURPOSE: To evaluate changes in enhancement characteristics of middle cerebral arterial (MCA) atherosclerotic plaques over time using MRI and to explore the relationship between the changes in plaque enhancement and stroke recurrence. STUDY TYPE: Prospective. POPULATION: Fifty-four patients with MCA atherosclerotic plaque underwent initial and follow-up examinations with a median interval of 519 days (range 84-1820 days), including 37 males and 16 patients with recurrent stroke. FIELD STRENGTH/SEQUENCE: Time-of-flight magnetic resonance angiography, diffusion-weighted imaging, T2 -weighted imaging, pre- and postcontrast T1 -weighted imaging at 3 T. ASSESSMENT: Clinical characteristics and differences in the changes in plaque enhancement among acute, subacute and chronic stroke groups and the changes in the degree of stenosis and plaque enhancement between the patients with and without recurrent stroke were compared. Risk factors for patients with recurrent stroke were assessed. Intra- and interobserver agreement in initial and the changes in plaque enhancement and stenosis, and the correlation between changes in plaque enhancement and recurrent stroke, were evaluated. STATISTICAL TESTS: Independent-samples t-test, Mann-Whitney U-test, chi-squared test, Spearman correlation, logistic regression and Cohen's kappa test. RESULTS: There were significant differences in the changes in stenosis and plaque enhancement (P < 0.05) between the patients with and without recurrent stroke. A significant correlation was observed between the changes in plaque enhancement and stroke recurrence (r = 0.415, P < 0.05). Multivariate regression analysis showed that a change in plaque enhancement was an independent factor for stroke recurrence after adjusting for confounding factors (odds ratio [OR] = 5.797, P < 0.05). There was excellent intra- and interobserver agreement in evaluating plaque enhancement and stenosis. DATA CONCLUSION: Stable or increased enhancement of MCA plaque was related to recurrent stroke events at follow-up. Change in plaque enhancement on MRI may be an important indicator for predicting recurrent stroke. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black-Blood MRI: Comparison With 3D Time-of-Flight MRA and DSA.

BACKGROUND: Noninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black-blood MRI with 3D time-of-flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment. PURPOSE: To compare 3D black-blood MRI and 3D TOF-MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs). STUDY TYPE: Prospective, cohort study. POPULATION: One hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other. FIELD STRENGTH/SEQUENCE: 3D fast-spin-echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T. ASSESSMENT: Two radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis-free on DSA. STATISTICAL TESTS: Shapiro-Wilk's test, Student's t-test, Mann-Whitney U-test, Spearman correlation, Bland-Altman analysis, and interclass correlation coefficient (ICC). RESULTS: A total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities. DATA CONCLUSION: 3D black-blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques. Level of Evidence 1 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:469-478.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. METHODS: We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. RESULTS: Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72). CONCLUSIONS: Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

Quantitative Histogram Analysis on Intracranial Atherosclerotic Plaques: A High-Resolution Magnetic Resonance Imaging Study.

BACKGROUND AND PURPOSE: Intracranial atherosclerosis is one of the main causes of stroke, and high-resolution magnetic resonance imaging provides useful imaging biomarkers related to the risk of ischemic events. This study aims to evaluate differences in histogram features between culprit and nonculprit intracranial atherosclerosis using high-resolution magnetic resonance imaging. METHODS: Two hundred forty-seven patients with intracranial atherosclerosis who underwent high-resolution magnetic resonance imaging sequentially between January 2015 and December 2016 were recruited. Quantitative features, including stenosis, plaque burden, minimum luminal area, intraplaque hemorrhage, enhancement ratio, and dispersion of signal intensity (coefficient of variation), were analyzed based on T2-, T1-, and contrast-enhanced T1-weighted images. Step-wise regression analysis was used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs. RESULTS: In total, 190 plaques were identified, of which 88 plaques (37 culprit and 51 nonculprit) were located in the middle cerebral artery and 102 (57 culprit and 45 nonculprit) in the basilar artery. Nearly 90% of culprit lesions had a degree of luminal stenosis of <70%. Multiple logistic regression analyses showed that intraplaque hemorrhage (OR, 16.294 [95% CI, 1.043-254.632]; P=0.047), minimum luminal area (OR, 1.468 [95% CI, 1.032-2.087]; P=0.033), and coefficient of variation (OR, 13.425 [95% CI, 3.987-45.204]; P<0.001) were 3 significant features in defining culprit plaques in middle cerebral artery. The enhancement ratio (OR, 9.476 [95% CI, 1.256-71.464]; P=0.029), intraplaque hemorrhage (OR, 2.847 [95% CI, 0.971-10.203]; P=0.046), and coefficient of variation (OR, 10.068 [95% CI, 2.820-21.343]; P<0.001) were significantly associated with plaque type in basilar artery. Coefficient of variation was a strong independent predictor in defining plaque type for both middle cerebral artery and basilar artery with sensitivity, specificity, and accuracy being 0.79, 0.80, and 0.80, respectively. CONCLUSIONS: Features characterized by high-resolution magnetic resonance imaging provided complementary values over luminal stenosis in defined lesion type for intracranial atherosclerosis; the dispersion of signal intensity in histogram analysis was a particularly effective predictive parameter.

The association between BMI and health-related physical fitness among Chinese college students: a cross-sectional study.

BACKGROUND: Existing studies reporting on the levels of physical fitness among college students used relatively few fitness tests as a reflection of physical fitness, which could not comprehensively evaluate the levels of physical fitness. Thus, the current study aimed to investigate the cross-sectional relationship between body mass index (BMI) and a physical fitness index (PFI) based on six indicators of fitness in Chinese college students. METHOD: Anthropometric measurements and six measures of physical fitness (Vital capacity, 50-m sprint, sit and reach, standing long jump, 800/1000-m run, pull-up/bent-leg sit-up) were measured. BMI was calculated to classify individuals into underweight, normal weight, overweight, and obesity groups. Z-scores based on sex-specific mean and standard deviation were calculated, and the sum of z-scores for the six fitness tests was used as a PFI. Three models (a linear regression model, polynomial regression model with a second-order BMI term and a restricted cubic spline regression model) were fitted to discuss the potential relation between BMI and PFI. We compared the models using Akaike Information Criterion (AIC) and R square. RESULTS: Totally, 8548 freshmen from the years 2014 to 2016 in a medical college completed the physical fitness tests. There was a decreasing trend of physical fitness index from the years 2014 to 2016 (P for trend < 0.01). More male than female students were overweight or obese (23.5% vs. 11.9%), but more female than male students were normal weight (74.7% vs. 64.8%). A restricted cubic spline regression model was superior to linear and polynomial regression model with lower AIC and higher R square. CONCLUSIONS: The relationships between BMI and PFI in college students were non-linear. Underweight, overweight and obese students had poorer performance in physical fitness index than normal weight students. Future prospective, longitudinal cohort studies to identify the causal relations and potential mechanism in a good manner are required.

Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic approach.

OBJECTIVES: To evaluate a quantitative radiomic approach based on high-resolution magnetic resonance imaging (HR-MRI) to differentiate acute/sub-acute symptomatic basilar artery plaque from asymptomatic plaque. METHODS: Ninety-six patients with basilar artery stenosis underwent HR-MRI between January 2014 and December 2016. Patients were scanned with T1- and T2-weighted imaging, as well as T1 imaging following gadolinium-contrast injection (CE-T1). The stenosis value, plaque area/burden, lumen area, minimal luminal area (MLA), intraplaque haemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted and compared between acute/sub-acute and asymptomatic patients. Multi-variate logistic analysis and a random forest model were used to evaluate the diagnostic performance. RESULTS: IPH, MLA and enhancement ratio were independently associated with acute/subacute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute/subacute symptoms, but the features from T2 images were not. The combined IPH, MLA and enhancement ratio had an area under the curve (AUC) of 0.833 for identifying acute/sub-acute symptomatic plaques, and the combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.936 (p = 0.01). Combining all features achieved an AUC of 0.974 and accuracy of 90.5%. CONCLUSIONS: Radiomic analysis of plaque texture on HR-MRI accurately distinguished between acutely symptomatic and asymptomatic basilar plaques. KEY POINTS: • High-resolution magnetic resonance imaging can assess basilar artery atherosclerotic plaque. • Radiomic features in T1 and CE-T1 images are associated with acute symptoms. • Radiomic analysis can accurately distinguish between acute symptomatic and asymptomatic plaque. • The highest accuracy may be achieved by combining radiomic and conventional features.

Comparison of two different measurement methods in evaluating basilar atherosclerotic plaque using high-resolution MRI at 3 tesla.

BACKGROUND: To compare the Self-referenced and Referenced measurement methods in assessing basilar artery (BA) atherosclerotic plaque employing dark blood high-resolution MRI at 3 Tesla. METHODS: Forty patients with > 20% stenosis as identified by conventional MRA were recruited and evaluated on a 3 Tesla MRI system. The outer wall, inner wall and lumen areas of maximal lumen narrowing site and the outer wall and lumen areas of sites that were proximal and distal to the maximal lumen narrowing site were manually traced. Plaque area (PA), stenosis rate (SR) and percent plaque burden (PPB) were calculated using the Self-referenced and Referenced measurement methods, respectively. To assess intra-observer reproducibility, BA plaque was measured twice with a 2-week interval in between measurements. RESULTS: Thirty-seven patients were included in the final analysis. There were no significant differences in PA, SR and PPB measurements between the two methods. The intra-class coefficients and coefficient of variations (CV) ranged from 0.976 to 0.990 and from 3.73 to 5.61% for the Self-referenced method and ranged from 0.928 to 0.971 and from 4.64 to 9.95% for the Referenced method, respectively. Both methods are effective in the evaluation of BA plaque. However, the CVs of the Self-referenced method is lower than the Referenced measurement method. Moreover, Bland-Altman plots showed that the Self-referenced method has a narrower interval than the Referenced measurement method. CONCLUSIONS: The Self-referenced method is better and more convenient for evaluating BA plaque, and it may serve as a promising method for evaluation of basilar atherosclerotic plaque.

Social Support as a Mediator of Physical Disability and Depressive Symptoms in Chinese Elderly.

The relationship between physical disability and depressive symptoms has been associated with social support. Different aspects of social support may play distinct roles in health-related quality of life. The aim of this study was to examine the mediation of social support in the relationship between physical disability and depressive symptoms among old people in Mainland China. Subjective support and utilization of support mediated the relationship between ADL and depressive symptoms, with the indirect effect of subjective support and utilization of support at 0.038 and 0.030 respectively (the total effect was 0.180). Subjective support was negatively associated with depressive symptoms in independent elderly people, utilization of support was negatively associated with depressive symptoms in partially dependent elderly people, and utilization of support had a greater association with geriatric depressive symptoms than subjective support in severely dependent elderly people. Social support mechanism and positive psychological intervention should be established and introduced in accordance with the physical disability of the elderly people, to protect them from depressive symptoms.

An assessment on the incremental value of high-resolution magnetic resonance imaging to identify culprit plaques in atherosclerotic disease of the middle cerebral artery.

OBJECTIVE: Although certain morphological features depicted by high resolution, multi-contrast magnetic resonance imaging (hrMRI) have been shown to be different between culprit and non-culprit middle cerebral artery (MCA) atherosclerotic lesions, the incremental value of hrMRI to define culprit lesions over stenosis has not been assessed. METHODS: Patients suspected with MCA stenosis underwent hrMRI. Lumen and outer wall were segmented to calculate stenosis, plaque burden (PB), volume (PV), length (PL) and minimum luminal area (MLA). RESULTS: Data from 165 lesions (112 culprit and 53 non-culprit) in 139 individuals were included. Culprit lesions were larger and longer with a narrower lumen and increased PB compared with non-culprit lesions. More culprit lesions showed contrast enhancement. Both PB and MLA were better indicators than stenosis in differentiating lesion types (AUC were 0.649, 0.732 and 0.737 for stenosis, PB and MLA, respectively). Combinations of PB, MLA and stenosis could improve positive predictive value (PPV) and specificity significantly. An optimal combination of stenosis ≥ 50 %, PB ≥ 77 % and MLA ≤ 2.0 mm(2) produced a PPV = 85.7 %, negative predictive value = 54.1 %, sensitivity = 69.6 %, specificity = 75.5 %, and accuracy = 71.5 %. CONCLUSIONS: hrMRI plaque imaging provides incremental information to luminal stenosis in identifying culprit lesions. KEY POINTS: • High resolution MRI provides incremental information in defining culprit MCA atherosclerotic lesions. • Both plaque burden and minimum luminal area are better indicators than stenosis. • An optimal combination includes stenosis ≥ 50 %, PB ≥ 77 % and MLA ≤ 2.0 mm (2) .

Local blood pressure associates with the degree of luminal stenosis in patients with atherosclerotic disease in the middle cerebral artery.

The mechanism underlying atherosclerotic ischemic events within the middle cerebral artery (MCA) is unclear. High structural stress induced by blood pressure might be a potential aetiology as plaque rupture occurs when such mechanical loading exceeds its material strength. To perform reliable analyses quantifying the mechanical loading within a plaque, the local blood pressure is needed. However, data on MCA blood pressure is currently lacking. In this study, the arterial pressure proximal to the stenotic site in the MCA was measured in 15 patients scheduled for intervention. The relationships between these local measurements and pre-intervention and intra-intervention non-invasive arm measurements were assessed. The impact of luminal stenosis on the local blood pressure was quantified. Compared with the pre-intervention arm measurement, the intra-intervention arm pressure decreased significantly by 23.9 ± 11.8 and 9.3 ± 14.7 % at diastole and systole, respectively. The pressure proximal to the stenosis was much lower than the pre-intervention arm measurement (diastole: 65.3 ± 15.7 vs 82.0 ± 9.7, p < 0.01; systole: 81.1 ± 15.9 vs 133.9 ± 18.7, p < 0.01; unit: mmHg). The systolic pressure in the MCA in patients with stenosis <70 % (n = 6) was significantly higher than the value in patients with stenosis ≥70 % (n = 9) (92.0 ± 7.3 vs 73.9 ± 16.1, p = 0.02; unit: mmHg), as was pulse pressure (22.8 ± 6.4 vs 11.1 ± 8.3, p = 0.01; unit: mmHg). However, diastolic pressure remained unaffected (69.2 ± 9.3 vs 62.8 ± 19.0, p = 0.58; unit: mmHg). In conclusion, the obtained results are helpful in understanding the local hemodynamic environment modulated by the presence of atherosclerosis. The local pressure measurements can be used for computational analysis to quantify the critical mechanical condition within an MCA lesion.

Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). MATERIAL AND METHODS: PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. RESULTS: A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74-86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg's test p=0.05 and Egger's test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. CONCLUSIONS: EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.