Disease Risk Comorbidity Index for Patients Receiving Haploidentical Allogeneic Hematopoietic Transplantation

We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We identified the prognostic factors of disease-free survival(DFS)in a training subset(n=593),then assigned a weighted score using these factors to the remaining patients(validation subset;n=296).The multivariable model identified two independent predictors of DFS:DRI and HCT-CI before transplantation.In this scoring system,we assigned a weighted score of 2 to very high-risk DRI,and assigned a weighted score of 1 to high-risk DRI and intermediate-and high-risk HCT-CI(i.e.,haplo-DRCI).In the validation cohort,the three-year DFS rate was 65.2%(95%confidence interval(CI),58.2%–72.2%),55.8%(95%CI,44.9%–66.7%),and 32.0%(95%CI,5.8%–58.2%)for the low-,intermediate-,and high-risk group,respectively(P=0.005).Haplo-DRCI can also predict DFS in disease-specific subgroups,particularly in acute leukemia patients.Increasing score was also significantly predictive of increased relapse,increased non-relapse mortality(NRM),decreased DFS,and decreased overall survival(OS)in an independent historical cohort(n=526).These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT.

Dyslipidemia and cardiovascular disease risk factors in patients with type 1 diabetes:A single-center experience

BACKGROUND Type 1 diabetes(T1D)contributes to altered lipid profiles and increases the risk of cardiovascular disease(CVD).Youth with T1D may have additional CVD risk factors within the first decade of diagnosis.AIM To examine risk factors for dyslipidemia in young subjects with T1D.METHODS Longitudinal and cross-sectional retrospective study of 170 young subjects with T1D(86 males;baseline mean age 12.2±5.6 years and hemoglobin A1c 8.4%±1.4%)were followed in a single tertiary diabetes center for a median duration of 15 years.Predictors for outcomes of lipid profiles at last visit(total cholesterol[TC],triglycerides[TGs],low-density lipoprotein-cholesterol[LDL-c],and highdensity lipoprotein-cholesterol[HDL-c])were analyzed by stepwise linear regression models.RESULTS At baseline,79.5%of the patients had at least one additional CVD risk factor(borderline dyslipidemia/dyslipidemia[37.5%],pre-hypertension/hypertension[27.6%],and overweight/obesity[16.5%])and 41.6%had multiple(≥2)CVD risk factors.A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1%of the cohort.Predictors of elevated TC:family history of CVD(β[SE]=23.1[8.3],P=0.006);of elevated LDL-c:baseline diastolic blood pressure(DBP)(β[SE]=11.4[4.7],P=0.003)and family history of CVD(β[SE]=20.7[6.8],P=0.017);of elevated TGs:baseline DBP(β[SE]=23.8[9.1],P=0.010)and family history of CVD(β[SE]=31.0[13.1],P=0.020);and of low HDL-c levels:baseline DBP(β[SE]=4.8[2.1],P=0.022]).CONCLUSION Our findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD.It is of utmost importance to prevent and control modifiable risk factors such as these,as early as childhood,given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.

Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

DeepRisk:A deep learning approach for genome-wide assessment of common disease risk

The potential for being able to identify individuals at high disease risk solely based on genotype data has garnered significant interest.Although widely applied,traditional polygenic risk scoring methods fall short,as they are built on additive models that fail to capture the intricate associations among single nucleotide polymorphisms(SNPs).This presents a limitation,as genetic diseases often arise from complex interactions between multiple SNPs.To address this challenge,we developed DeepRisk,a biological knowledge-driven deep learning method for modeling these complex,nonlinear associations among SNPs,to provide a more effective method for scoring the risk of common diseases with genome-wide genotype data.Evaluations demonstrated that DeepRisk outperforms existing PRs-based methods in identifying individuals at high risk for four common diseases:Alzheimer's disease,inflammatory bowel disease,type 2diabetes,and breast cancer.

Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients

BACKGROUND Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events(MACCE).However,the relationship between prediabetes and MACCE in atrial fibrillation(AF)patients has not been extensively studied.Therefore,this study aimed to establish a link between prediabetes and MACCE in AF patients.AIM To investigate a link between prediabetes and MACCE in AF patients.METHODS We used the National Inpatient Sample(2019)and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes,excluding diabetics.The primary outcome was MACCE(all-cause inpatient mortality,cardiac arrest including ventricular fibrillation,and stroke)in AF-related hospitalizations.RESULTS Of the 2965875 AF-related hospitalizations for MACCE,47505(1.6%)were among patients with prediabetes.The prediabetes cohort was relatively younger(median 75 vs 78 years),and often consisted of males(56.3%vs 51.4%),blacks(9.8%vs 7.9%),Hispanics(7.3%vs 4.3%),and Asians(4.7%vs 1.6%)than the non-prediabetic cohort(P<0.001).The prediabetes group had significantly higher rates of hypertension,hyperlipidemia,smoking,obesity,drug abuse,prior myocardial infarction,peripheral vascular disease,and hyperthyroidism(all P<0.05).The prediabetes cohort was often discharged routinely(51.1%vs 41.1%),but more frequently required home health care(23.6%vs 21.0%)and had higher costs.After adjusting for baseline characteristics or comorbidities,the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort[18.6%vs 14.7%,odds ratio(OR)1.34,95%confidence interval 1.26-1.42,P<0.001].On subgroup analyses,males had a stronger association(aOR 1.43)compared to females(aOR 1.22),whereas on the race-wise comparison,Hispanics(aOR 1.43)and Asians(aOR 1.36)had a stronger association with MACCE with prediabetes vs whites(aOR 1.33)and blacks(aOR 1.21).CONCLUSION This population-based study found a significant association between prediabetes and MACCE in AF patients.Therefore,there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors:A decade-apart study of two nationwide cohorts

BACKGROUND Over the years,strides in colon cancer detection and treatment have boosted survival rates;yet,post-colon cancer survival entails cardiovascular disease(CVD)risks.Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.AIM To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.METHODS We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample,studying two colon cancer survivor groups for CVD risk factors,mortality rates,and major adverse events like pulmonary embolism,arrhythmia,cardiac arrest,and stroke,adjusting for confounders via multivariable regression analysis.RESULTS Of total colon cancer survivors hospitalized in 2007(n=177542)and 2017(n=178325),the 2017 cohort often consisted of younger(76 vs 77 years),male,African-American,and Hispanic patients admitted non-electively vs the 2007 cohort.Furthermore,the 2017 cohort had higher rates of smoking,alcohol abuse,drug abuse,coagulopathy,liver disease,weight loss,and renal failure.Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities,including hypertension,hyperlipidemia,diabetes,obesity,peripheral vascular disease,congestive heart failure,and at least one traditional CVD(P<0.001)vs the 2007 cohort.On adjusted multivariable analysis,the 2017 cohort had a significantly higher risk of pulmonary embolism(PE)(OR:1.47,95%CI:1.37-1.48),arrhythmia(OR:1.41,95%CI:1.38-1.43),atrial fibrillation/flutter(OR:1.61,95%CI:1.58-1.64),cardiac arrest including ventricular tachyarrhythmia(OR:1.63,95%CI:1.46-1.82),and stroke(OR:1.28,95%CI:1.22-1.34)with comparable all-cause mortality and fewer routine discharges(48.4%vs 55.0%)(P<0.001)vs the 2007 cohort.CONCLUSION Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events(stroke 28%,PE 47%,arrhythmia 41%,and cardiac arrest 63%).It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

The Importance of Setting Treatment Goals for Cardiovascular Diseases

Background: Guidelines are issued by most major organizations that focus on a specific disease entity. Guidelines should be a significant help to the practicing physician who may not be up-to-date with the recent medical literature. Unfortunately, when conflicting guidelines for a specific disease are published, confusion results. Purpose: This article provides a suggested guideline outcome measure that would benefit the physician and patient. Methods: A review of 19 different guidelines for cardiovascular disease treatment is one example of the lack of specific outcomes that currently exist. The basic problem with most guidelines is that they do not state the expected end result (i.e., the benefit to the patient) if that guideline is followed. When guidelines use cardiovascular disease risk factors to dictate therapy, the end benefit is never stated so that the patient can make an appropriate choice of which (if any) guideline to follow. Results: A good example is guidelines published by the American Heart Association for reducing cardiovascular disease. These guidelines are risk factor based and only indicate that cardiovascular disease would be reduced if followed. No specific percentage in the reduction of the incidence of disease is given. In contrast, when elimination of the disease is the stated goal of the guideline, the end result is clear. To date, this goal has been stated by only one organization devoted to eliminating cardiovascular disease. Conclusion: Guidelines need to be written to provide the physician and the patient with a specific end point that is expected when the guideline is followed. Patient acceptance and compliance will be much improved if the patient knows the risk/benefit of following the guideline’s recommendations.

Colorectal cancer in inflammatory bowel disease:What is the real magnitude of the risk?

The association between inflammatory bowel disease(IBD) and colorectal cancer(CRC) has been recognised since 1925 and still accounts for 10%-15% of deaths in IBD.IBD-associated CRC(IBD-CRC) affects patients at a younger age than sporadic CRC.The prognosis for sporadic CRC and IBD-CRC is similar,with a 5-year survival of approximately 50%.Identifying at risk patients and implementing appropriate surveillance for these patients is central to managing the CRC risk in IBD.The increased risk of colorectal cancer in association with IBD is thought to be due to genetic and acquired factors.The link between inflammation and cancer is well recognised but the molecular biology,immune pathobiology and genetics of IBD-CRC are areas of much ongoing research.This review examines the literature relating to IBD-CRC,focusing on the incidence of IBD-CRC and examining potential risk factors including age at diagnosis,gender,duration and extent of colitis,severity of inflammation,family history of sporadic CRC and co-existent primary sclerosing cholangitis(PSC).Confirmed risk factors for IBD-CRC are duration,severity and extent of colitis,the presence of co-existent PSC and a family history of CRC.There is insufficient evidence currently to support an increased frequency of surveillance for patients diagnosed with IBD at a younger age.Evidence-based guidelines advise surveillance colonoscopy for patients with colitis 8 to 10 years after diagnosis,with the interval for further surveillance guided by risk factors(extent of disease,family history of CRC,post-inflammatory polyps,concomitant PSC,personal history of colonic dysplasia,colonic strictures).There is a move away from using random colonic biopsies towards targeted biopsies aimed at abnormal areas identified by newer colonoscopic techniques(narrow band imaging,chromoendoscopy,confocal microendoscopy).

Aging is a risk factor of nonalcoholic fatty liver disease in premenopausal women

AIM: To clarify the relationship between age, menopause, and nonalcoholic fatty liver disease (NAFLD) in women. METHODS: We conducted a follow-up study on non-alcoholic fatty liver disease by using abdominal ultrasonography, and investigated the relationship of age and menopause with the development of NAFLD in women. We followed 1829 women and 2572 men (response rate, 86%) selected in 2001 to represent the non-institutionalized adult population of Gifu, Japan. Data collected included self-reported medical history, lifestyle factors, and menopausal status. The postmenopausal state was defined as beginning 1 year after the cessation of menses. We diagnosed NAFLD with the aid of abdominal ultrasonography by using diagnostic criteria describedRESULTS: The prevalence of NAFLD in women increases with age, but does not alter with age in men. Furthermore, the prevalence of NAFLD in premenopausal women (6%) was lower than that in men (24%) and in postmenopausal women (15%). The associations of the postmenopausal state and hormone replacement therapy with NAFLD were statistically significant in a univariate logistic regression model. At the follow-up examination, 67 women (5%) were newly diagnosed with NAFLD. The incidence of NAFLD was 3.5% (28/802) in premenopausal women, 7.5% (4/53) in menopausal women, 6.1% (24/392) in postmenopausal women, and 5.3% (11/206) in women receiving hormone replacement therapy. The weight gain in premenopausal women was equal to that in postmenopausal women. Metabolic syndrome and weight gain were independent risk factors for NAFLD in pre-and postmenopausal women, but age was an independent risk factor in premenopausal women only. CONCLUSION: Aging is a risk factor for NAFLD in premenopausal women, independent of weight gain or influence of metabolic syndrome.

Construction of Risk Assessment Application Model of Epidemic Disease in Large-scale Pig Farms

The application model of epidemic disease assessment technology for Web-based large-scale pig farm was expounded from the identification of epidemic disease risk factors, construction of risk assessment model and development of risk assessment system. The assessed pig farm uploaded the epidemic disease risk data information through on-line answering evaluating questionnaire to get the immediate evaluation report. The model could enhance the risk communication between pig farm veterinarian, manager and veterinary experts to help farm system understand and find disease risk factors, assess and report the potential high risk items of the pig farm in the three systems of engineering epidemic disease prevention technology, biological safety and immune monitoring, and promote the improvement and perfection of epidemic disease prevention and control measures.

Girls' Diets Affect Puberty,Later Disease Risk

本刊上期刊登了吴春拂选注的一篇文章,题目是:Dieting May HarmGirl’s IQs。该文标题中的Dieting的意思是“节食”,节食,会降低女孩的智商;而本文标题中的Diets却是“饮食”的意思。本文的主题句就亮出一个或多或少与前文相左的意见: Young girls who consume diets rich in animal protein and fat may be eatingtheir way to an early puberty(青春期)and possibly increasing their risk for chronicdisease later in life. 女孩如果多吃富含动物蛋白质和动物脂肪的食物将过早进入青春期,并可能日后患上慢性疾病的风险。 根据专家的意见,女孩的“健康饮食”应该是:to reduce intakes of saturated(饱和的)fat and red meat and excess calories and to increase fruit/vegetable intakesin children. 如此饮食,其收效是:result in lower breast cancer rates,along with otherhealth benefits. 也许读者不会料到,如此饮食同样存在着“负面作用”:but the risk ofosteoporosis,and perhaps of other diseases,might increase. 两文并读,或者就单读此文,读者朋友就会深感左右为难,无所适从。 其实,深入一步想,这些意见并不矛盾,世界上许多事情都应该一分为二地去看,去思考。

Inflammatory bowel disease:Epidemiology,pathology and risk factors for hypercoagulability

Hypercoagulability observed in patients with inflammatory bowel diseases (IBD) may lead to thromboembolic events (TE), which affect the venous and arterial systems alike and are an important factor in patients&#x02019; morbidity and mortality. The risk of TE in IBD patients has been demonstrated to be approximately three-fold higher as compared to the general population. The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained. The most commonly listed factors include genetic and immune abnormalities, disequilibrium between procoagulant and anticoagulant factors, although recently, the role of endothelial damage as an IBD-triggering factor is underlined. Several studies report that the levels of some coagulation enzymes, including fibrinogen, factors V, VII, VIII, active factor XI, tissue factor, prothrombin fragment 1 + 2 and the thrombin-antithrombin complex, are altered in IBD patients. It has been demonstrated that there is a significant decrease of tissue plasminogen activator level, a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor, a significantly lower level of antithrombin III and tissue factor pathway inhibitor. IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies. Hyperhomocysteinemia, which is a potential risk factor for TE was also observed in some IBD patients. Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.

Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Disease in Women in China: Surveillance Efforts

In this study, we aimed to assess the relationship of socioeconomic status and acculturation with cardiovascular disease （CVD） risk profiles and CVD and examine the CVD risk factors associated with CVD. We used data from the 2010 China Chronic Disease and Risk Factor Surveillance surveys, which consisted of a nationally representative sample of women. The following prevalence was found： myocardial infarction （MI）：

Interleukin-17A gene variants and risk of coronary artery disease:a large angiography-based study

Background Recent studies have also revealed that interleukin(IL)-17A plays a key role in atherosclerosis and its complication,but the relationship of its common variants with coronary artery disease(CAD) has not been extensively studied.Methods We systematically screened sequence variations in the IL17A gene and designed an angiog-raphy -based case-controlled study consisting of 1031 CAD patients and 935 control subjects to investigate the association between the selected polymorphisms of IL-17A gene and CAD risk in Chinese Han population.Results Frequencies of IL17A rs8193037 GG homozygote and G allele were significantly higher in the patient group than those in the control group(P【0.001;OR=0.68;95%CI=0.54-0.85).Stratification analysis showed that the IL17A rs8193037 G allele significantly increased the risk of CAD only among male subjects (P=0.001;OR=0.63;95%CI=0.47-0.83).After adjustment for conventional risk factors,binary logistic regression analysis showed that the G allele carriers(GG +AG) had significantly increased CAD risk compared with the AA homozygotes (adjusted P【0.001;OR 0.43;95%CI,0.33- 0.58).ELISA showed augmented IL17A production in plasma of the AMI patients.Conclusions Based on our data,we speculated that the SNP rs8193037 of IL17A gene is significantly associated with CAD risk in Chinese Han population and the rs8193037 G allele which is associated with increased expression of IL17A in AMI patients may be an independent predictive factor for CAD.

Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases

Inflammatory bowel diseases(IBD)are idiopathic chronic diseases of the gastrointestinal tract well known to be associated with both genetic and environmental risk factors.Permissive genotypes may manifest into clinical phenotypes under certain environmental influences and these may be best studied from migratory studies.Exploring differences between first and second generation migrants may further highlight the contribution of environmental factors towards the development of IBD.There are few opportunities that have been offered so far.We aim to review the available migration studies on IBD,evaluate the known environmental factors associated with IBD,and explore modern migration patterns to identify new opportunities and candidate migrant groups in IBD migration research.

Obesity and the risk of cardiovascular disease and diabetes mellitus

The increasing prevalence of obesity worldwide has many experts concerned about the worsening health of a large proportion of the population. It is well recognized that obesity is associated with a higher mortality, an increased risk of hypertension and hyperlipidemia, cardiovascular disease, diabetes mellitus, osteoarthritis, gall bladder disease and possibly some cancers. Currently it is estimated that over two thirds of adults in the United States are overweight and nearly one third are clinically obese.1 Of special concern is the rapid increase in obesity among children. Other countries both developed and developing are experiencing similar trends.……

Risk factors for the occurrence and development of Binswanger disease: A controlled observation

BACKGROUND： Some scholars think that hypertension is the major risk factor to cause Binswanger disease （BD）, however, BD is also found in some persons with normal blood pressure, so we presume that some other factors, such as diabetes mellitus, hyperlipemia, coronary heart disease and transient ischemic attacks and so on, might participant in the onset of BD. OBJECTIVE： To comparatively observe the difference in accompanying diseases, transcranial doppler （TCD） performance, blood glucose and blood lipid level between BD patients and healthy subjects who received health examination, and between BD patients with different disease condition. DESIGN ： Case-control analysis SETTING ： Department of Emergency, Qingdao Municipal Hospita PARTICIPANTS： Totally 126 patients with BD, 65 male and 61 female, aged from 67 to 85 years old, who hospitalized in the Medical School Hospital of Qingdao University and Qingdao Municipal People＇s Hospital, were chosen, serving as BD patients group. All the patients met the clinical diagnostic criteria of BD introduced by Bennett et al. Another 126 persons, 65 male and 61 female, aged ranging from 67 to 80 years, who received health examination in the same hospital, were homeochronously chosen, serving as control group. Informed consents were obtained from all the subjects. METHODS ： After being admitted, all the subjects including BD patients and persons who homeochrenously received health examination in the same hospital were given examinations of blood pressure, blood lipid, blood glucose, electrocardiogram （ECG） and TCD. Fifty-seven patients with BD were in the stable period and 69 in the progressive period （Stable period： no local or subcortical function disorder found, and no changes in the range of white matter lesion showed by CT and/or MRI in recent 3 months; Progressive period： with local or subcortical function disorder and increase in the range of white matter lesion showed by CT and/or MRI in recent 3 months）. According to intimal thickening of carotid artery and vertebral artery preformed by TCD, BD was graded as mild intimal thickening （〈 1.1 mm）, moderate intimal thickening （1.1 to 1.2 mm） and severe intimal thickening （〉 1.2 mm）. MAIN OUTCOME MEASURES ： Comparison of the ratio of BD patients with accompanied diabetes mellitus, hypedipemia, coronary heart disease and transient ischemic attacks, TCD performance, blood glucose and blood lipid level between BD patients group and control group, and among BD patients with vadous disease conditions. RESULTS： Totally 126 BD patients and 126 subjects who received health examination all participated in the result analysis. Intergroup comparison： ①The ratio of BD patients with accompanied hypertension, diabetes mellitus, hypedipemia, transient ischemic attacks and coronary heart disease was 91.3%, 46.8%, 42.9%, 81.7% and 46.0% respectively in the BD patients group, and that was 36.5%, 17.5%, 15.9%, 34.1% and 34.1%, respectively in the control group. Significant difference existed between two groups （x^2=86.201, 24.907,25.660,58.620,9.900, P 〈 0.01 ）.②Compared with control group, anterior, middle cerebral and vertebrobasilar arteriosclerosis and insufficient cerebral blood supply existed significantly in BD patients with different disease condition （x^2=40.34,7.585,15.429, P 〈 0.01 ）.③Compared with control group, the level of blood glucose, total cholesterol and triglyceride of BD patients increased significantly （t=6.939,3.891,3.711 ,P 〈 0.01 ）. Comparison among BD patients with different disease condition： ① Compared with stable period, transient ischemic attacks and coronary heart disease were found much in the BD patients at progressive period, with significant difference （x^2=7.196,13.517,P 〈 0.01 ）.② Mild arteriosclerosis at stable period was found in 17 cases, and significant difference existed compared with progressive period （x^2=6.523,P 〈 0.05）.③ There was no significant difference in the blood glucose and blood lipid level （t=-1.755 6,0.583 1,0.824 6, P 〉 0.05）. CONCLUSION： Hypertension, cerebral arteriosclerosis, diabetes mellitus, hypedipemia, coronary heart disease and transient ischemic attacks have important effects on the onset of BD; Transient ischemic attacks and coronary heart disease can worsen the symptoms of BD patients.

Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

Objectives To evaluate the effect of different styles of coronary heart disease （CHD）, different regions of acute myocardial infarction （AMI）, its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD （NoCHD） were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris （SAP） 26, unstable angina pectoris（UAP） 53, acute myocardial infarction （AMI） 140 and old myocardial infarction （OMI） 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct （Aa,n = 53）, acute inferior myocardial infarction （Ai, n=54） and Aa＋Ai （n=33） based on ECG. Cardiac parameters： end-diastolic interventricular septum thickness（IVSd）, end-diastolic left ventricular internal diameter （LVd）, left ventricular mass （LM）, end-diastolic left ventricular volume （EDV）, end-systolic left ventricular volume （ESV） and left ventricular ejection fraction（LVEF） were measured by ACUSON 128XP/10 echocardiography. Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP （P〈0.05-0.0001）. LM was mainly increased in patients with OMI （P〈0.01） and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa＋Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF was significantly decreased, and LVd and LM increased in AMI patients with antecedent hypertension, compared to patients without hypertension （P〈0.001）. Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction, especially Aa and Aa＋Ai, is one of the most important causes of left ventricular remodeling and cardiac dysfunction. Multiple vessel stenosis and systolic blood pressure at the onset of myocardial infarction reduce LVEF in AMI patients. Antecedent hypertension may accelerate the effect of AMI on cardiac remodeling and dysfunction. Therefore primary and secondary preventions of CHD are critical for protecting heart from remodeling and dysfunction.

Apolipoprotein AI gene polymorphisms and risk for coronary artery disease in Chinese Xinjiang Uygur and Han population

Objective To analyze the relationship between polymorphism at the Apolipoprotein AI (Apo AI) gene and the risk for coronary artery disease. Methods A total of 107 patients (mean age 56 ±11 years) diagnosed as having stable angina pectoris (SAP) (23 cases), unstable angina pectoris (UAP) (23 cases) or myocardial infarction (MI) (61 cases) were prospectively evaluated. DNA was obtained from the 107 patients and 50 controls. In order to determine the Apo AI genotypes at two polymorphic sites (G/A at -75 bp, and C/T at+83 bp), DNA was PCR amplified and digested with MspI. Results The frequency of carriers of the rare allele at the - 75 bp site (M1-) was 0.49 in cases and 0.30 in controls (P<0. 05). The frequencies of the M1-allele among patients with SAP, UAP, MI and controls were 0. 37 (vs. controls, P > 0. 05), 0.54 (vs. controls, P < 0.05), 0.52 (vs. controls, P<0. 05) and 0. 30, respectively. The frequencies for carriers of the rare allele at the + 83bp polymorphism (M2) were observed among patients with SAP (0. 09, vs. controls, P > 0.05), UAP (0.11, vs. controls, P>0.05) or MI (0. 12, vs. controls, P>0. 05) and controls (0. 12). There was an slightly increase in the frequency of the Ml - allele in patients with SAP to UAP or MI (0. 37 vs. 0. 54 vs. 0. 52; all P>0. 05) and Ml polymorphism as a risk factor for CAD ( OR = 3. 74, P < 0. 05). In the + 83bp polymorphism there was no difference in the allelelic frequencies in cases and controls (0. 11 vs. 0. 12; P > 0. 05). There was no significantdifference in the frequency of the M2 - allele in patients with SAP to UAP or MI (0.09 vs. 0. 11 vs. 0. 12; all P>0. 05) and M2 polymorphism not as a factor for CAD (OR=0.80, P>0. 05).Plasma lipoprotein values in patients with the allele M1-and M2 - had no different levels than those homozygous for the M1+and M2+(P>0.05). Conclusion Ml polymorphism (M1 - ) may be as a risk factor for CAD and M2 polymorphism (M2 - ) not as a factor for CAD in Chinese Xinjiang Uygur and Han population.