Multiscale simulation and experimental measurements of the elastic response for constructional steel.

The multiscale elastic response to the macroscopic stress was simulated to reveal the multi-scale correlation of elastic properties of the medium carbon steel. Based on the multiscale correlation constitutive equations derived from this constitutive model, the effective elastic constants (EECs) of medium carbon steel are predicted. In addition, the diffraction elastic constants (DECs) of the constituents of the medium carbon steel are also evaluated. And then, the simple in-situ X-ray diffraction experiments were performed for the measurements of DECs and EECs of treated 35CrMo steel during the four-point bending. Compared with the experimental measurements and different existing models, the results demonstrated that the developed constitutive model was in good agreement with the measured values of the EECs and DECs, and that the feasibility and reliability of the constitutive model used to simulate multiscale elastic response could reveal the correlation between the material and its constitutes.

Association between Serum Alkaline Phosphatase and Carotid Atherosclerosis in a Chinese Population: A Community-based Cross-sectional Study.

OBJECTIVE: This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS). METHODS: A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively. RESULTS: Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders. CONCLUSION: Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.

Serum Gamma-Glutamyltransferase Levels are Associated with Cardiovascular Risk Factors in China: A Nationwide Population-Based Study.

Serum gamma-glutamyltransferase (GGT), which is mainly derived from the liver, is a sensitive marker of liver cell damage and oxidative stress. More recently, it has been found that increased GGT plasma activity is also associated with cardiovascular disease (CVD). However, data on the relationship between GGT and cardiovascular risk factors (CRFs) are lacking in nationally representative samples of the Chinese population. Here, we aim to investigate both the association between GGT and CRFs and CRF clustering. A cross-sectional survey was conducted in a representative sample of 22897 adults aged 18 years and older from 2007 to 2011 nationally, which included a plurality of ethnic minorities. The participants were then divided into quartiles of sex-specific serum GGT. From the low to high GGT quartiles, the incidence of each CRF and clustered risk factors increased after adjusting for age, uric acid (UA), ethnicity, drinking, and all other risk factors. Individuals in the upper stratum (>75th percentile) had higher prevalence rates of CRFs than did those in the lower stratum (all P < 0.05). Furthermore, the subjects with clustering of 1, 2, or ≥3 CRFs were still more likely to belong to the upper GGT quartiles (75th percentiles) than were those without risk factors (all P < 0.05). In conclusion, our data highlight that there is an association between higher serum GGT levels and prevalence of CRFs, which tend to cluster with the increase in GGT activity in Chinese adults.

Arterial Stiffness and Cerebral Small Vessel Disease.

Background and Objective: Studies on relations between arterial stiffness and full spectrum of radiological features of cerebral small vessel disease (CSVD) are scarce. We aim to investigate the association of arterial stiffness with lacunes, white matter hyperintensities (WMH), microbleeds (CMBs), dilated perivascular spaces (PVS), and brain atrophy in a community-based sample. Methods: A total of 953 participants (55.7 ± 9.4 years) who underwent brachial-ankle pulse wave velocity (baPWV) and brain magnetic resonance imaging were included. Lacunes, CMBs, and PVS were visually rated. Brain structure and WMH were automatically segmented. Brain parenchyma fraction (BPF), a surrogate index of brain atrophy, was calculated as a ratio of brain parenchyma volume to total intracranial volume. Multivariable logistic and linear regressions were used to investigate the associations between baPWV and CSVD. Subsequently, we explored these associations in strata of age. Results: Increased baPWV was associated with severe PVS in white matter (OR, 1.09; 95%CI, 1.01-1.17; p = 0.022), larger WMH volume (ß, 0.08; 95%CI, 0.04-0.12; p < 0.001), lower BPF (ß, -0.09; 95%CI, -0.15- -0.03; p = 0.007), and marginally associated with strictly lobar CMBs (OR, 1.11; 95%CI, 1.00-1.23; p = 0.055), but not with lacunes. WMH volume mediated the relation between baPWV and BPF. In age subgroup analysis, the association of baPWV with PVS in white matter was stronger among those aged <55 years, whereas the association with brain atrophy was more prominent among those aged ≥55 years. Increased baPWV was associated with larger WMH volume in both younger and older individuals. Conclusions: Increased arterial stiffness was associated with most of imaging markers of CSVD, including PVS in white matter, larger WMH volume, strictly lobar CMBs, and brain atrophy, but not lacunes. The mechanisms underlying these associations and their potential clinical significances warrant further investigations.

Relationship between Neutrophil-to-Lymphocyte Ratio and Pulse Wave Velocity in Young Patients with Systemic Lupus Erythematosus.

BACKGROUND: The incidence of atherosclerosis-related myocardial infarction can be as much as 50-fold greater in young patients with systemic lupus erythematosus (SLE) than in age-matched controls. There are several explanations for this phenomenon, all of which result in a chronic state of low-grade inflammation. Recently, the neutrophil-to-lymphocyte ratio (NLR) has been proposed as a useful biomarker of inflammation. Pulse wave velocity (PWV) is a reliable indicator of vascular damage and atherosclerosis. There is a paucity of data concerning the relationship between NLR and atherosclerosis as measured by PWV in patients with SLE. This study aimed to verify whether there is a positive correlation between NLR and PWV and to explore factors that influence PWV in young SLE patients. METHODS: A total of 90 female patients with SLE were enrolled in this cross-sectional investigation. Traditional and nontraditional cardiovascular risk factors were assessed on the same day that brachial-ankle PWV (baPWV) was examined. The patients were divided into three groups according to their mean baPWV values: patients whose mean baPWV value was lower than the first tertile were placed in Group 1; patients whose mean baPWV value was between the first tertile and the second tertile were placed in Group 2; and patients whose mean baPWV value was higher than the second tertile were placed in Group 3. SPSS 20.0 was used to perform all statistical analyses in this study. Both univariate linear regression and multivariate regression models were utilized to analyze the association between NLR and arterial stiffness. RESULTS: Systolic blood pressure, diastolic blood pressure (DBP), and triglycerides were all significantly different among Groups 1, 2, and 3 (111.90 ± 12.85 mmHg vs. 114.60 ± 12.88 mmHg vs. 129.43 ± 16.21 mmHg, P < 0.001; 68.77 ± 8.63 mmHg vs. 71.87 ± 9.77 mmHg vs. 82.57 ± 14.89 mmHg, P < 0.001; and 1.44 [0.91-2.47] mmol/L vs. 0.98 [0.78-1.26] mmol/L vs. 2.20 [0.94-3.66] mmol/L, P = 0.030; respectively), as were creatinine (57.50 [52.00-69.00] µmol/L vs. 55.50 [49.00-64.00] µmol/L vs. 64.00 [56.00-86.00] µmol/L, P = 0.045) and blood urea nitrogen (4.27 [3.79-6.22] mmol/L vs. 4.16 [3.47-4.84] mmol/L vs. 5.88 [4.04-8.19] mmol/L, P = 0.011). NLRs were significantly different among Groups 1, 2, and 3 (2.16 [1.56-3.42] vs. 3.12 [1.91-4.19] vs. 5.29 [2.63-7.25], P = 0.001). NLR, together with DBP and the SLE disease activity index, independently predicts PWV. CONCLUSIONS: This study demonstrated that there was a positive correlation between NLR and PWV. Moreover, we found that disease activity and DBP were also positively correlated with PWV.

Hyperuricemia and clustering of cardiovascular risk factors in the Chinese adult population.

Hyperuricemia is common in China and the relevance of hyperuricemia and cardiovascular disease (CVD) risk has been highlighted, but to date there has been rarely nation-wide study in China. Here, we aim to estimate the current prevalence of hyperuricemia and evaluate the associations between hyperuricemia and cardiovascular risk factors (CRFs) clustering in a large sample of China adults including a plurality of ethnic minorities. Generally, a nationally representative sample of 22983 adults aged ≥18 years was recruited from 2007 to 2011. Questionnaire data and information on anthropometric characteristics, and laboratory measurements were collected. We define hyperuricemia as SUA ≥416 mmol/L for men and SUA ≥357 mmol/L for women. We found that the prevalence of hyperuricemia was 13.0% (18.5% in men and 8.0% in women). To our estimation, hyperuricemic subjects had higher prevalence rates of CRFs clustering than non-hyperuricemic subjects. Furthermore, there was a dose-response association between the number of CVD risk factors clustering and hyperuricemia. Our study revealed a high prevalence of hyperuricemia and CVD risk factors clustering among Chinese adults, and hyperuricemia was significantly associated with coexistence of more CVD risk factors. Therefore, guidance and effective lifestyle intervention are required to prevent hyperuricemia and CVD risk factors in China.

Prognostic factors for mortality in patients with bullous pemphigoid: a meta-analysis.

Bullous pemphigoid (BP) is a chronic debilitating autoimmune blistering disease that frequently occurs in the elderly population. Previous studies have suggested a high morbidity and mortality associated with BP. However, relatively few studies have investigated prognostic factors of BP mortality, and they showed considerably various results. This meta-analysis aimed to quantitatively assess the association between several potential prognostic factors and risk of mortality in bullous pemphigoid. A comprehensive search was performed using Pubmed, Embase, and Cochrane Library. Cohort studies that assessed prognostic factors of BP mortality were included. Random-effects model was utilized to calculate the pooled hazard ratio (HR). Publication bias was evaluated qualitatively by constructing a funnel plot and quantitatively by conducting Egger's test. 14 studies were included comprising 2499 patients. Combined HRs suggested that advanced age (HR 1.63, 95% CI 1.34-1.97), presence of circulating antibodies (HR 1.77, 95% CI 1.20-2.62), concomitant dementia (HR 2.01, 95% CI 1.22-3.33), and concomitant stroke (HR 1.86, 95% CI 1.29-2.67) have an unfavorable impact on patient survival. Gender, disease extent, mucosal involvement, and indirect immunofluorescence result were not shown to be linked to mortality by our analysis. This study indicated that BP patients with older age, circulating antibodies, dementia, and stroke are at greater risk of mortality. Clinicians should be aware of this association and utilize this information in patient education and treatment process.

Use of atorvastatin in lipid disorders and cardiovascular disease in Chinese patients.

OBJECTIVE: Statins are still underused for the prevention of cardiovascular disease (CVD) in China. Hence, we conducted a systemic review on the pharmacology, clinical efficacy, and adverse events of atorvastatin, as well as on patient adherence. DATA SOURCES: We conducted a systemic search in PubMed with the following keywords: "atorvastatin" (Supplementary concept) or "atorvastatin" (All field) and ("China" [AD] or "China" [all field] or "Chinese" [All field]). STUDY SELECTION: Clinical or basic research articles on atorvastatin were included. RESULTS: Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis. The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population. Several international multiple-center randomized control trials have demonstrated the benefit of atorvastatin for primary and secondary prevention of CVD. None of them, however, included the Chinese, and current evidence in the population is still inadequate, due to the small sample size, low study quality, short study duration, and the use of surrogate endpoints instead of clinical endpoints. The overall incidence of adverse events observed with atorvastatin did not increase in the 10-80 mg dose range, and was similar to that observed with placebo and in patients treated with other statins, which makes atorvastatin well-tolerated in the Chinese population. Moreover, high patient adherence was observed in clinical studies. CONCLUSIONS: Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety. High-quality evidence is still needed to support the use of atorvastatin in high-risk Chinese population.

Premature atherosclerosis in patients with acquired immunodeficiency syndrome.

BACKGROUND: Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV) infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients. METHODS: One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41 HAART-treated and 41 antiretroviral therapy (ART) naïve patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage. RESULTS: A higher PWV ((1358.3 ± 117.8) cm/s vs. (1270.2 ± 189.2) cm/s, P = 0.010) was found in ART naïve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART naïve patients ((1283.8 ± 181.4) cm/s vs. (1358.0 ± 117.8) cm/s, P = 0.033). Multiple regression analysis revealed that age (B = 5.218, 95% confidence interval (CI) 1.420 - 9.016, P = 0.008), current smoking (B = -74.671, 95%CI -147.003 to -2.339, P = 0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B = -169.169, 95%CI -272.508 to -65.831, P = 0.010) were associated with reduced PWV in HIV-infected patients. CONCLUSIONS: Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.

[Cardiac manifestations in Sjogren syndrome].

OBJECTIVE: To analyze the cardiac manifestations of patients with primary and secondary Sjogren syndrome. METHODS: Clinical data (clinical manifestations, serologic measurements, echocardiogram) of 396 patients with Sjogren syndrome who admitted to our hospital from 2004--2007 were retrospectively analyzed. Patients with congenital, rheumatic and coronary heart diseases, hypertension and diabetes (n = 221) and patients with incomplete clinic data (n = 51) were excluded. RESULTS: A total of 124 cases were included in this analysis (mean age 47.4 years old; 5 males; average disease duration 85.5 months). Cardiac involvement in Sjogren syndrome is usually asymptomatic. Pericardial effusion (PE) were evidenced in 20.2%, left ventricular diastolic dysfunction (LVDD) in 13.7%, pulmonary artery hypertension (PAH) in 12.9%, left atrium enlargement/in 7.3%, mitral insufficiency in 4.8%, aortic dilation in 5.6%, tricuspid insufficiency in 3.2%, left ventricular enlargement in 2.4% and left ventricular systolic dysfunction in 0.8% patients by echocardiography examinations. Patients with PE had significantly lower CH50, C3, C4 levels and significantly higher C reactive protein level (CRP) and SSA positive rate than patients without PE (all P < 0.05). The serum level of CRP was significantly associated with PE (OR 0.976, 95% CI 0.956 - 0.997, P < 0.05). Age is positively correlated to LVDD (OR 0.884, 95% CI 0.811 - 0.964, P < 0.005). The gammaglobulin level is significantly higher in the PAH group than that in the non-PAH group (P < 0.05). CONCLUSIONS: Cardiac involvement is not rare in patients with Sjogren syndrome. PE, LVDD and PAH are usual cardiac manifestations in these patients. The serum level of CRP is positively related to PE in these patients with Sjogren syndrome.