Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.

Heart failure with preserved ejection fraction and the first law of thermodynamics

In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.

Privacy-preserved learning from non-i.i.d data in fog-assisted IoT:A federated learning approach

With the prevalence of the Internet of Things(IoT)systems,smart cities comprise complex networks,including sensors,actuators,appliances,and cyber services.The complexity and heterogeneity of smart cities have become vulnerable to sophisticated cyber-attacks,especially privacy-related attacks such as inference and data poisoning ones.Federated Learning(FL)has been regarded as a hopeful method to enable distributed learning with privacypreserved intelligence in IoT applications.Even though the significance of developing privacy-preserving FL has drawn as a great research interest,the current research only concentrates on FL with independent identically distributed(i.i.d)data and few studies have addressed the non-i.i.d setting.FL is known to be vulnerable to Generative Adversarial Network(GAN)attacks,where an adversary can presume to act as a contributor participating in the training process to acquire the private data of other contributors.This paper proposes an innovative Privacy Protection-based Federated Deep Learning(PP-FDL)framework,which accomplishes data protection against privacy-related GAN attacks,along with high classification rates from non-i.i.d data.PP-FDL is designed to enable fog nodes to cooperate to train the FDL model in a way that ensures contributors have no access to the data of each other,where class probabilities are protected utilizing a private identifier generated for each class.The PP-FDL framework is evaluated for image classification using simple convolutional networks which are trained using MNIST and CIFAR-10 datasets.The empirical results have revealed that PF-DFL can achieve data protection and the framework outperforms the other three state-of-the-art models with 3%–8%as accuracy improvements.

Preserved egg white alleviates DSS-induced colitis in mice through the reduction of oxidative stress,modulation of inflammatory cytokines,NF-κB,MAPK and gut microbiota composition

Traditional Chinese preserved egg products have exhibited some anti-inflammatory effects,but their mechanisms of action remain unknown.This study aimed to investigate the anti-inflammatory effects of preserved egg white(PEW)treatment on dextran sulfate sodium(DSS)-induced colitis in mice and the underlying mechanisms.The results showed that treatment with PEW in mice with DSS-induced colitis for 14 days effectively improved the clinical signs,inhibited the secretion and gene expression of pro-inflammatory cytokines,and reduced myeloperoxidase(MPO)activity and oxidative stress levels.In addition,western blotting results showed that PEW significantly suppressed DSS-induced phosphorylation levels of nuclear factor-kappa B(NF-κB)p65 and p38 mitogen-activated protein kinase(MAPK)in colon tissues of mice with colitis.PEW also enhanced the production of short-chain fatty acids(SCFAs)and modulated gut microbiota composition in mice with DSS-induced colitis,including increasing the relative abundance of beneficial bacteria Lachnospiraceae,Ruminococcaceae and Muribaculaceae,and reducing the relative abundance of harmful bacteria Proteobacteria.Taken together,our study demonstrated that preserved egg white could alleviate DSS-induced colitis in mice through the reduction of oxidative stress,modulation of inflammatory cytokines,NF-κB,MAPK and gut microbiota composition.

Targeting epicardial adipose tissue:A potential therapeutic strategy for heart failure with preserved ejection fraction with type 2 diabetes mellitus

Heart failure with preserved ejection fraction(HFpEF)is a heterogeneous syndrome with various comorbidities,multiple cardiac and extracardiac pathophysiologic abnormalities,and diverse phenotypic presentations.Since HFpEF is a heterogeneous disease with different phenotypes,individualized treatment is required.HFpEF with type 2 diabetes mellitus(T2DM)represents a specific phenotype of HFpEF,with about 45%-50% of HFpEF patients suffering from T2DM.Systemic inflammation associated with dysregulated glucose metabolism is a critical pathological mechanism of HFpEF with T2DM,which is intimately related to the expansion and dysfunction(inflammation and hypermetabolic activity)of epicardial adipose tissue(EAT).EAT is well established as a very active endocrine organ that can regulate the pathophysiological processes of HFpEF with T2DM through the paracrine and endocrine mechanisms.Therefore,suppressing abnormal EAT expansion may be a promising therapeutic strategy for HFpEF with T2DM.Although there is no treatment specifically for EAT,lifestyle management,bariatric surgery,and some pharmaceutical interventions(anti-cytokine drugs,statins,proprotein convertase subtilisin/kexin type 9 inhibitors,metformin,glucagon-like peptide-1 receptor agonists,and especially sodium-glucose cotransporter-2 inhibitors)have been shown to attenuate the inflammatory response or expansion of EAT.Importantly,these treatments may be beneficial in improving the clinical symptoms or prognosis of patients with HFpEF.Accordingly,well-designed randomized controlled trials are needed to validate the efficacy of current therapies.In addition,more novel and effective therapies targeting EAT are needed in the future.

Computer Forensics Framework for Efficient and Lawful Privacy-Preserved Investigation

Privacy preservation(PP)in Digital forensics(DF)is a conflicted and non-trivial issue.Existing solutions use the searchable encryption concept and,as a result,are not efficient and support only a keyword search.Moreover,the collected forensic data cannot be analyzed using existing well-known digital tools.This research paper first investigates the lawful requirements for PP in DF based on the organization for economic co-operation and development OECB)privacy guidelines.To have an efficient investigation process and meet the increased volume of data,the presented framework is designed based on the selective imaging concept and advanced encryption standard(AES).The proposed framework has two main modules,namely Selective Imaging Module(SIM)and Selective Analysis Module(SAM).The SIM and SAM modules are implemented based on advanced forensic format 4(AFF4)and SleuthKit open source forensics frameworks,respectively,and,accordingly,the proposed framework is evaluated in a forensically sound manner.The evaluation result is compared with other relevant works and,as a result,the proposed solution provides a privacy-preserving,efficient forensic imaging and analysis process while having also sufficient methods.Moreover,the AFF4 forensic image,produced by the SIM module,can be analyzed not only by SAM,but also by other well-known analysis tools available on the market.

Privacy Preserved Brain Disorder Diagnosis Using Federated Learning

Federated learning has recently attracted significant attention as a cutting-edge technology that enables Artificial Intelligence(AI)algorithms to utilize global learning across the data of numerous individuals while safeguarding user data privacy.Recent advanced healthcare technologies have enabled the early diagnosis of various cognitive ailments like Parkinson’s.Adequate user data is frequently used to train machine learning models for healthcare systems to track the health status of patients.The healthcare industry faces two significant challenges:security and privacy issues and the personalization of cloud-trained AI models.This paper proposes a Deep Neural Network(DNN)based approach embedded in a federated learning framework to detect and diagnose brain disorders.We extracted the data from the database of Kay Elemetrics voice disordered and divided the data into two windows to create training models for two clients,each with different data.To lessen the over-fitting aspect,every client reviewed the outcomes in three rounds.The proposed model identifies brain disorders without jeopardizing privacy and security.The results reveal that the global model achieves an accuracy of 82.82%for detecting brain disorders while preserving privacy.

Preserved amplitude migration based on the one way wave equation in the angle domain

Traditional pre-stack depth migration can only provide subsurface structural information. However, simple structure information is insufficient for petroleum exploration which also needs amplitude information proportional to reflection coefficients. In recent years, pre-stack depth migration algorithms which preserve amplitudes and based on the one- way wave equation have been developed. Using the method in the shot domain requires a deconvolution imaging condition which produces some instability in areas with complicated structure and dramatic lateral variation in velocity. Depth migration with preserved amplitude based on the angle domain can overcome the instability of the one-way wave migration imaging condition with preserved amplitude. It can also offer provide velocity analysis in the angle domain of common imaging point gathers. In this paper, based on the foundation of the one-way wave continuation operator with preserved amplitude, we realized the preserved amplitude prestack depth migration in the angle domain. Models and real data validate the accuracy of the method.

Research on in-situ condition preserved coring and testing systems

As shallow resources are increasingly depleted,the mechanics'theory and testing technology of deep insitu rock has become urgent.Traditional coring technologies obtain rock samples without retaining the in-situ environmental conditions,leading to distortion of the measured parameters.Herein,a coring and testing systems retaining in-situ geological conditions is presented:the coring system that obtains in-situ rock samples,and the transfer and testing system that stores and analyzes the rocks under a reconstructed environment.The ICP-Coring system mainly consists of the pressure controller,active insulated core reactor and insulation layer and sealing film.The ultimate bearing strength of 100 MPa for pressurepreservation,temperature control accuracy of 0.97%for temperature-retained are realized.CH_(4)and CO permeability of the optimized sealing film are as low as 3.85 and 0.33 ppm/min.The average tensile elongation of the film is 152.4%and the light transmittance is reduced to 0%.Additionally,the pressure and steady-state temperature accuracy for reconstructing the in-situ environment of transfer and storage system up to 1%and±0.2 is achieved.The error recorded of the noncontact sensor ring made of lowdensity polymer is less than 6%than that of the contact test.The system can provide technical support for the deep in-situ rock mechanics research,improving deep resource acquisition capabilities and further clarifying deep-earth processes.

Amplitude preserved VSP reverse time migration for angle-domain CIGs extraction

An improved method of generating angle-domain common-image gathers（ADCIGs） by VSP reverse time migration（RTM） is introduced in this paper.The formula which is used to compute the receiver wavefield for VSP RTM is modified by adding an amplitude correction term in order to conveniently output amplitude-preserved ADCIGs.Compared with the surface seismic data,VSP data contains much richer wavefields.However,the direct and downgoing waves can bring about serious imaging artifacts in ADCIGs,especially the direct wave.The feasibility and validity of this method is demonstrated by both numerical and real VSP data from western China.Thus,the ADCIGs from this method can provide reliable basic data for VSP migration velocity analysis,VSP AVO/AVA analysis,and inversion.

Diagnostic and prognostic value of circulating micro RNAs in heart failure with preserved and reduced ejection fraction

micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.

Therapeutic interventions for heart failure with preserved ejection fraction:A summary of current evidence

Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.

Challenging aspects of treatment strategies in heart failure with preserved ejection fraction: “Why did recent clinical trials fail?”

Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.

Risks of incident heart failure with preserved ejection fraction in Chinese patients hospitalized for cardiovascular diseases

Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.

Biomechanical Manifestations of Diastolic and Systolic Function in Rats with Heart Failure with Preserved Ejection Fraction

Objective Heart failure(HF)is divided into two types:Heart failure with reduced ejection fraction(HFrEF)and heart failure with preserved ejection fraction(HFpEF).The latter always results in diastolic dysfunction,characterized by changes in mechanical properties.The objective of this study is to build a finite element(FE)model of HFpEF and analyze diastolic and systolic function in rats.Methods Ten Dahl salt-sensitive rats were fed either a low-salt(LS)(n=5)or highsalt(HS)(n=5)diet beginning at 7 weeks of age and scanned by ultrasonic machine at 14 weeks of age.A non-linear FE model of the left ventricle(LV)was built from cardiac echo images at end-diastole and passive material properties of the LV were prescribed using Fung’s transversely isotropic constitutive law.Fiber angles of the endocardium and epicardium were prescribed as 53°°and-52°,respectively,with respect to the circumferential direction and varied linearly through the LV wall.The method developed by Krishnamurthywas used to determine the unloaded geometry to estimate the Fung passive material parameters.LV end-diastolic pressure(EDP)was determined from the measured pressure waves and applied to the endocardium at the unloaded geometry to simulate passive filling.Active material properties of the LV were prescribed using Guccione’s time-varying elastance model and maximum isometric tension was scaled to match the measured peak systolic pressure.The finite element model was then coupled to the Windkessel model,whose parameters were adjusted to the measured hemodynamics.Results Measured LVEDPs of LS and HS rats were 4.9±3.4 mmHg and 13.2±5.4 mmHg(P-0.030 8),respectively.End-diastolic Cauchy stress along the fiber direction for LS rats was significantly lower than for HS rats(0.91±0.60 kPa vs 3.00±0.63 kPa,P=0.001 4)and there was a similar trend in end-diastolic Green Strain along the fiber direction(0.058±0.003 vs 0.072±0.010,P=0.012 8,Figure 1b),as well.There was no distinctive difference between end-systolic Cauchy stress along the fiber direction for LS rats and HS rats(17.2±4.3 kPa vs 17.2±5.5 kPa,P=0.991 9)but end-systolic Green Strain along the fiber direction for LS rats was significantly higher than for HS rats(-0. 108±0.017 vs-0.065±0.024,negative sign represents direction).Conclusions For rats with HFpEF,it is the elevated LVEDP that induces the increase in end-diastolic stress and strain,thereby leading to diastolic dysfunction.Because of the preserved ejection fraction,HFpEF has less effect on systolic function.

Thirty-day readmission in patients with heart failure with preserved ejection fraction:Insights from the nationwide readmission database

BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.

Morphological Characteristics of the Endothelial Ceils of Corneas of Rabbits Preserved by Desiccation

The endothelial cells of the corneas of rabbits preserved by desiccation for vari-ous duration showed no hexagonal form of normal cells but broad bean-like nuclci afterdouble staining with alizarin red and trypan blue.Scanning electron microscopic examina-tion revealed interdigitation at the intercellular junction together with intercellularvacuoles and cellular edema.Transmission electron microscopic examination showedincomplete nuclear membrane,karyopyknosis,vacuoles and remnant organellae in thecytoplasm.Partial penetrating keratoplasties were done in 37 rabbits(37 eyes)with pre-served corneas.The grafts remained transparent for a minimum of 4 days to a maximumof over 1 year,and 7 grafts remained transparent for more than 30 days.Staining ofthe transparent grafts revealed normal hexagonal endothelial cells in mosaic arrange-ment.We assumed that after transplantation of the preserved cornea the endothelial cellsregained their activities owing to the nutrient effect of the aqueous humor.

Heart failure with preserved ejection fraction: A distinct heart failure phenotype?

The present work discusses the serious confusion resulting from the arbitrary nomenclature of heart failure with preserved ejection fraction(HFpEF),the presumed underlying pathophysiology,and the supposed features.A consequence of this misconception is that HFpEF trials have recruited patients with entirely different characteristics rendering the extrapolation of the results of one study to the other infeasible and dramatically affecting diagnosis and treatment.

The Relationship between Abnormal Circadian Blood Pressure Rhythm and Risk of Readmission in Patients with Heart Failure with Preserved Ejection Fraction

Objective:Abnormal circadian blood pressure rhythm has been revealed to be associated with hypertensive target organ damage and cardiovascular events,but its association with readmission risk in patients with heart failure with preserved ejection fraction(HFpEF)remains unknown.We conducted a retrospective study to explore the relationship between circadian blood pressure rhythm and readmission risk in HFpEF patients.Methods:We retrospectively collected baseline and follow-up data on HFpEF patients who underwent ambulatory blood pressure monitoring(ABPM)from May 2015 to October 2019.Patient circadian blood pressure rhythms defi ned by ABPM were grouped as dipper,nondipper,or riser patterns.Univariate and multivariate linear regression analyses were performed to assess the association between circadian blood pressure rhythm and readmission risk.Results:A total of 122 patients were enrolled in this study.The mean age and ejection fraction were 69.87 years and 61.44%,respectively,with mean the N-terminal pro-B-type natriuretic peptide(NT-proBNP)level being 1048.15 pg/mL.There were signifi cant differences in the 24-hour systolic blood pressure(SBP),sleep SBP,and sleep diastolic blood pressure(DBP)among the three groups,where the 24-hour SBP,sleep SBP,and sleep DBP in the riser pattern group were markedly higher than in the dipper pattern group.Notably,serum NT-proBNP levels,the proportion of patients readmitted for heart failure and the mean number of admissions differed markedly among three groups.Instructively,multivariate linear regression analysis showed that the riser pattern was a signifi cant and independent risk factor for increased serum NT-proBNP level(β=929.16,95%confi dence interval 178.79–1679.53,P=0.016).In multivariate logistic regression analysis,the riser pattern was demonstrated to be a signifi cant risk factor for readmission(odds ratio 11.23,95%confi dence interval 2.01–62.67,P=0.006)in HFpEF patients.Conclusion:The riser blood pressure pattern is a potential risk factor for elevated serum NT-proBNP level and readmission in HFpEF patients.

Exceptionally Preserved Punctatus triangulicostalis and Its Post-embryonic Development

Objective The putative coronatean Punctatus flourished at the beginning of the Cambrian explosion, and is significant in the exploration of the origin and evolution of early life. Liu Yunhuan established a new species： Punctatus triangulicostalis Liu, 2006. Two questions remain： how was the special body plan of P. triangulicostalis formed？ How does P. triangulicostalis transform from embryo to the long cylindrical mature individual？ Although the study of Steiner et al. in 2004 involved the above questions, they did not explain them clearly due to the lack of fossil materials at that time. This article aims to consider the above questions based on new information from several rare specimens.