Application of photoplethysmography for atrial fibrillation in early warning, diagnosis and integrated management / 生物医学工程学杂志

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Early diagnosis and effective management are important to reduce atrial fibrillation-related adverse events. Photoplethysmography (PPG) is often used to assist wearables for continuous electrocardiograph monitoring, which shows its unique value. The development of PPG has provided an innovative solution to AF management. Serial studies of mobile health technology for improving screening and optimized integrated care in atrial fibrillation have explored the application of PPG in screening, diagnosing, early warning, and integrated management in patients with AF. This review summarizes the latest progress of PPG analysis based on artificial intelligence technology and mobile health in AF field in recent years, as well as the limitations of current research and the focus of future research.

Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic.

BackgroundCardiovascular diseases(CVD) increase mortality risk from coronavirus infection(COVID-19), but there are concerns that the pandemic has affected supply and demand of acute cardiovascular care. We estimated excess mortality in specific CVDs, both "direct", through infection, and "indirect", through changes in healthcare. MethodsWe used population-based electronic health records from 3,862,012 individuals in England to estimate pre- and post-COVID-19 mortality risk("direct" effect) for people with incident and prevalent CVD. We incorporated: (i)pre-COVID-19 risk by age, sex and comorbidities, (ii)estimated population COVID-19 prevalence, and (iii)estimated relative impact of COVID-19 on mortality(relative risk, RR: 1.5, 2.0 and 3.0). For "indirect" effects, we analysed weekly mortality and emergency department data for England/Wales and monthly hospital data from England(n=2), China(n=5) and Italy(n=1) for CVD referral, diagnosis and treatment until 1 May 2020. FindingsCVD service activity decreased by 60-100% compared with pre-pandemic levels in eight hospitals across China, Italy and England during the pandemic. In China, activity remained below pre-COVID-19 levels for 2-3 months even after easing lockdown, and is still reduced in Italy and England. Mortality data suggest indirect effects on CVD will be delayed rather than contemporaneous(peak RR 1.4). For total CVD(incident and prevalent), at 10% population COVID-19 rate, we estimated direct impact of 31,205 and 62,410 excess deaths in England at RR 1.5 and 2.0 respectively, and indirect effect of 49932 to 99865 excess deaths. InterpretationSupply and demand for CVD services have dramatically reduced across countries with potential for substantial, but avoidable, excess mortality during and after the COVID-19 pandemic. FundingNIHR, HDR UK, Astra Zeneca

Development of an international standard set of outcome measures for patients with atrial fibrillation: a report of the International Consortium for Health Outcomes Measurement (ICHOM) atrial fibrillation working group.

AIMS: As health systems around the world increasingly look to measure and improve the value of care that they provide to patients, being able to measure the outcomes that matter most to patients is vital. To support the shift towards value-based health care in atrial fibrillation (AF), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international Working Group (WG) of 30 volunteers, including health professionals and patient representatives to develop a standardized minimum set of outcomes for benchmarking care delivery in clinical settings. METHODS AND RESULTS: Using an online-modified Delphi process, outcomes important to patients and health professionals were selected and categorized into (i) long-term consequences of disease outcomes, (ii) complications of treatment outcomes, and (iii) patient-reported outcomes. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, comorbidities, cognitive function, date of diagnosis, disease duration, medications prescribed and AF procedures, as well as smoking, body mass index (BMI), alcohol intake, and physical activity. Where appropriate, and for ease of implementation, standardization of outcomes and case-mix variables was achieved using ICD codes. The standard set underwent an open review process in which over 80% of patients surveyed agreed with the outcomes captured by the standard set. CONCLUSION: Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of chronic AF care. Their consistent definition and collection, using ICD codes where applicable, could also broaden the implementation of more patient-centric clinical outcomes research in AF.

Resistin might not be a risk factor for carotid artery atherosclerosis in elderly Chinese males / 老年心脏病学杂志（英文版）

Objective To investigate the correlation between the serum resistin level and carotid artery atherosclerosis in elderly Chinese males. Methods The study enrolled 235 elderly Chinese males [median age 76 (range 60-97) years] scheduled for ultrasound examination of carotid artery plaque and determination of carotid artery intima-media thickness (CIMT). They were divided into carotid atherosclerotic plaque (CAP) and carotid atherosclerotic plaque-free (CAP-free) groups according to the ultrasound results. Their clinical profiles were col-lected, and the serum resistin and other blood biochemistry levels were determined.Results The CAP group was older and had a thicker mean CIMT than the CAP-free group. However, there was no difference in the serum resistin level between the groups. CIMT was positively correlated with age (r = 0.299,P< 0.001). The serum resistin level was not correlated with CIMT, even after controlling for age. Multiple linear regression analysis revealed that age (β = 0.001,P< 0.001) and body mass index (β = 0.002,P= 0.015) were significantly and posi-tively correlated with the mean CIMT. Only age [odds ratio (OR): 1.159; 95% confidence interval (CI): 1.078-1.183,P< 0.001] was associ-ated with the presence of carotid artery atherosclerotic plaque. The serum resistin level was not correlated with the mean CIMT or associated with the presence of carotid artery atherosclerotic plaque.Conclusion The results suggest that resistin might not be a risk factor for atherosclerosis in elderly Chinese males.

The clinical analysis of 18 children with neurogenic pulmonary edema / 中国基层医药

Objective To investigate the etiology clinical diagnosis and treatment of pediatric neurogenic pulmonary edema(NPE).Methods The clinical data of 18 hospitalized children with NPE were retrospectively analyzed.Results 18 cases of NPE children with traumatic brain injury 2 cases( 11.1％ ),cervical spinal cord injury 1 case(5.5％ ) and,subarachnoid hemorrhage 2 cases( 11.1％ ),and epilepticus states 2 cases( 11.1％ ),non-HFMD caused encephalitis 3 cases( 16.6％ ),NPE caused hand,foot and mouth disease 8 cases(45.6％ ),survival 6 cases (33.3％) and 12 patients died (66.7％)in 18 hospitalized children with NPE.Conclusion The common cause of pediatric NPE was central nervous system infections and poor prognosis,early diagnosis and early treatment could improve the efficacy and prognosis.

The Unmet Need of Stroke Prevention in Atrial Fibrillation in the Far East and South East Asia

The prevalence of atrial fibrillation (AF) is high in both community- and hospital-based studies in the Far East and South East Asia. Hypertension is the most common risk factor, but coronary heart disease and diabetes mellitus are other important co-morbidities in these countries. Anticoagulant therapy use was low, being 0.5%–28% in Malaysia, Singapore, and China. The reported rate of stroke related to AF was 13.0%–15.4% based on community studies in those countries and was 3.1%–24.2% of stroke rate in hospital-based cohorts. Better assessment of thromboembolic and bleeding risks is important. International guidelines now recommend the use of the CHA2DS2-VASc score to identify the ‘‘truly low-risk’’ AF patients, who do not need antithrombotic therapy, whilst those with ≥ 1 stroke risk factors can be offered oral anticoagulation. Aspirin is ineffective and may not be any safer than oral anticoagulants, especially in the elderly. It is anticipated that the availability of the new oral anticoagulant drugs would improve our efforts for stroke prevention in the Far East and South East Asia, especially where anticoagulation monitoring for warfarin is suboptimal.

Enhancement of cardiac function of chronic heart failure rats by marrow stromal cell-based sarcoplasmic reticulum Ca2+ adenosine triphosphatase gene therapy / 中国组织工程研究

BACKGROUND: There are still few effective methods to repair injured myocardium after myocardial failure and pathologically rebuild reverral myocardium. As a new therapy, normal myocytes and therapeutic gene to interfere injured myocardium have advantageous effects in improving heart function.OBJECTIVE: To observe the efficiency and stability of adenovirus-medicated gene transferred into different passages of bone marrow mesenchymal stem cell (MSC) and investigate the effect of MSC-based sarcoplasmic reticulum Ca2+ ATPase gene (SERCA2a) gene therapy for rats with chronic heart failure. To compare the effects of gene therapy, cell transplantation and MSC-based SERCA2a gene therapy for chronic heart failure. DESIGN: Randomized controlled study.SETTING: Department of Senile Angiocardiopathy, General Hospital of Chinese PLA; Department of Biochemistry, Beijing Medical University. MATERIALS: Male Sprague-Dawley (SD) rats with 4 weeks old, clean grade and weighing 45-50 g provided by the Animal Experimental Center, Peking Medical University were used as donators of bone marrow. Other female SD rats of 12 weeks old, clean grade and weighing 200-250 g were used as receptors of cell transplantation and gene therapy. Sry gene of Y chromosome in male rats was used to evaluate whether transplanted cells of donators lived in myocardium of receptor rats. Ad-SERCa2a and Ad-EGFP were constructed by Doctor Lu Xiao-chun; MSC in the 3rd and 8th generations was isolating cultured on its own. METHODS: The experiment was carried out in the Zhou CY Laboratory (BSL-2), Department of Biochemistry, Beijing Medical University from July 2004 to December 2005. Thirty female SD rats received ligation at the left coronary artery to make models with chronic cardiac failure following acute myocardial infarction. And then, 29 rats were randomly divided into four groups, including gene therapy group (n=7), MSC group (n=7), gene-modified MSC group (n=8) and control group (n=7). Rats in the four groups were given the interventions of SERCA2a gene, MSC transplantation, MSC+Ad/SERCa2a and empty adenoviral vector, respectively. MSCs were separated and cultured, and then Ad-SERCA2a-GFP was used to transfer MSC in the 3rd and 8th generations.MAIN OUTCOME MEASURES: Ad-SERCA2a-GFP transfection rate of MSC was measured by using flow cytometer. Before and at 14 and 21 days after treatment, cardiac function was evaluated by ultrasonic echocardiogram. Expression of cytokine Ⅷ was tested by immunohistochemical staining. SERCA2a gene and protein expression were evaluated by RT-PCR and Western blot respectively, as well as SERCA2a enzyme activity. RESULTS: ① Transfection rate: The infection efficiency of adenovirus-medicated gene into different passages of MSC was over 80%, and there was no difference between passage three (P3) MSC and P8 MSC (P > 0.05). ② Heart function: Left ventricle wall was thickened obviously in group MSC and group MSC+Ad/SERCa2a on the 21st day after treatment, while volume was shortened and gradually rounded. Compared to control group, ejection fraction (EF) and shortening fraction (FS) of group Ad-SERCa2a, group MSC and group MSC+Ad/SERCa2a were elevated significantly on the 14th day after therapy (P < 0.01). While the elevation values of EF and FS began to reduce in group Ad-SERCa2a on 14th day after therapy, it continued to increase in both group MSC and group MSC+Ad/SERCa2a (P < 0.01). Improvement rate of EF at 21 days after therapy (EF D21) increased in group MSC and group MSC+Ad/SERCa2a respectively, but decreased in group Ad-SERCa2a. Compared to group Ad-SERCa2a, peak systolic flow velocity of anterior wall and interventricular septum in group MSC+Ad/SERCa2a increased significantly on the 21st day after therapy, and peak diastolic flow velocity of anterior wall and interventricular septum elevated in group MSC+Ad/SERCa2a, too (P < 0.01). ③ SERCA2a gene, protein expression and enzyme activity in group MSC+Ad/SERCa2a were significantly stronger in group MSC and control group. Parts of MSC transplanted into scar zone expressed Ⅷ.CONCLUSION: ① MSC is an effective platform for the targeted delivery of therapeutic gene. It suggests that different passages of MSC from P3 MSC to P8 MSC are regarded as high-effectively gene vehicles. MSC-based SERCA2a gene therapy showed much strong and lasting beneficial effect on exhausted myocardium. ② Effect of MSC transplantation on improving heart function may be related to promoting vascular neogenesis.

Expression levels of matrix metalloproteinases and tissue inhibitor of metalloproteinase in rats with myocardial infarction-caused chronic heart failure following bone marrow mesenchymal stem cell transplantation / 中国组织工程研究

BACKGROUND: The content of type Ⅰ and Ⅲ collagen and the ratio of both are crucial factors to promote heart geometric morphology change,and ventricular systolic and diastolic myocardial performance.Matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase 1 (TIMP1) are primary regulatory substances of collagen metabolism.After myocardial infarction,chronic heart failure rats were subjected to bone marrow meseuchymal stem cell transplantation.What changes in MMP-2 and TIMPI would occur?OBJECTIVE: To observe the content of type Ⅰ and Ⅲcollagen and the ratio between both,as well as expression levels of MMP-2 and TIMP1 in the left ventricular tissue of rats with myocardial infarction-caused chronic heart failure following bone marrow mesenchymal stem cell (MSC) transplantation.DESIGN: A randomized controlled experiment.SETTING: Department of Senile Angiocardiopathy,General Hospital of Chinese PLA & Department of Biochemistry,Peking University Health Science Center.MATERIALS: This study was performed at the laboratory of Department of Biochemistry,Peking University Health Science Center between July 2004 and December 2005.Male Sprage Dawley rats of clean grade,aged 4 weeks old,were provided by the Laboratory Animal Center,Beijing Medical University and used for preparation of MSCs.Fourteen female rats,weighing 200-250g,were developed into models of heart failure-caused by myocardial infarction.METHODS: MSCs were isolated and,purified by gradient centrifugation and adherent cells were allowed to proliferate.Female rats underwent coronary artery ligation to induce chronic ischemic heart failure.Four weeks later,the rats were randomly divided into 2 groups: (1) experimental group (n=7),rats received transplantation of MSCs harvested from male rats [5×106 in 50 μL phosphate buffered saline(PBS)]by injection into the ischemic myocardium; (2) control group (n=7),rats received the same volume of PBS.MAIN OUTCOME MEASURES: Twenty-one days after therapy,(1) left ventricular fusion was tested by hematoxylin-eosinstaining and Masson staining; (2) Expression of MMP-2 and 1TMPI as well as contents of type I and llI collagen was analyzed by immunohistochemistry; (3) MMP-2 and TIMP1 expression levels were examined by Western blot.RESULTS: Fourteen rats were included in the final analysis.Type Ⅰ collagen expression in the scar area was much higher in theexperimental group than in the control group,while type Ⅲ collagen expression was much lower in the experimental group.MMP-2 expression was reduced and TIMPI expression was increased in the experimental group compared with the control group.Together,ventricular wall was thickened,ventricular chamber was reduced,and heart function was strengthened in the experimental group compared with the control group.CONCLUSION: MSC transplantation alleviated left ventricular remodeling in chronic ischemie heart failure,which results from dynamic regulation of MMP-2/TIMP1.

Observation of the Additional Efficiency of Aldosterone Blockers During Angiotensin Ⅱ Receptor Blockers Treatment on Hypertensive Left Ventricle Hypertrophy / 医学研究杂志

Objective To evaluate the additional efficiency of aldosterone blockers (AB) during angiotensin Ⅱ receptor blockers (ARB) treatment on hypertensive left ventricle hypertrophy in the elderly. Methods Forty-five cases of hypertensive left ventricular hypertrophy detected by Doppler ultrasonic cardiogram examination were enrolled,and were randomized to receive treatment with ARB plus AB (Group A) or ARB plus diuretics (Group B) for 48 weeks. The indicators of left ventricle hypertrophy were checked before and after the treatment. Results The both regimens could significantly decrease the blood pressure,and there was significant difference in the effects on lowering blood pressure between the regimens. Both regimens could alleviate left ventricle hypertrophy,but the regimen of ARB plus AB was superior to the regimen in Group B. Conclusion The addition of AB treatment during the ARB treatment was a good antihypertensive regimen for reducing left ventricle hypertrophy.

Study on the growth hormone axis in aged patients with congestive heart failure / 中华老年医学杂志

Objective To observe the changes of growth hormone axis(GH axis) and to study the mechanism of acquired growth hormone resistance in aged patients with congestive heart failure (CHF). Methods Ninety-five patients with congestive heart failure were divided into three groups (Grade Ⅱ , n = 28; Grade Ⅲ , n = 36;and Grade Ⅳ , n = 31) according to New York Heart Association criterion. Another 30 healthy people were used as controls. The concentrations of plasma GH , insulin growth factor 1 (IGF-1) and insulin growth factor binding protein 3 (IGFBP-3) were measured by radioimmunoassay, and growth hormone sensitivity was assessed by log(IGF-1 /GH). Results Plasma concentration of GHC[(5. 83 ? 1. 41) mlU/L vs (1. 56 ? 0. 97) mlU/L were higher in grade Ⅳ group than those in normal subjects ( P

Discussion of the Operative Timing and Cause of Death in the Patients with Acute Cholangitis of Severe Type / 中国医师杂志

Objective To explore the operative timing and cause of death in the patients with acute cholangitis of severe type(ACST). Methods The clinical data on the treatment and the prognosis of 116 patients with ACST were analyzed retrospectively. Results 10 cases died during perioperative period.The patients who received operation within 6 hours after toxic shock all survived.Of 8 cases who received operation after 24 hours,7cases died from toxic shock and multiple organ deficiency of function (MODF) within 4 days of post-operation. Conclusion Operation should be performed before toxic shock or mental symptom occurred in the patients with ACST. The earlier the operation was performed, and the better the prognosis was. The main causes of death were delayed operative time,severe complications and senility.

Gene transfer into different passages of bone marrow mesenchymal stem cells / 中国病理生理杂志

0.05). Flow cytometry analysis by diff erent gates showed the transfection ratio was high in BMSCs in the period of pro d uctive metabolism. The mRNA expression of CAR in P3, P6 and P8 was similar, and the same change was observed in the protein expression of CAR in P3 and P8 BMSCs . CONCLUSION: Ad-CMV-GFP is transferred to BMSC effectively and sustained about 28 days. It is suspected that BMSCs in mitotic phase are easy to be transferred by Ad-CMV-GFP and different passages of BMSCs from P3 to P8 BMSCs can be as high-effectively g ene vehicle.