Portal vein pulsatility index is a more important indicator than congestion index in the clinical evaluation of right heart function

AIM： To study the changes of portal blood flow in congestive heart failure. METHODS： We studied the congestion index （CI） and portal vein pulsatility index （PI） in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure （RA） 〈10 mmHg were classified as group 1 and the remaining 10 patients with RA〉 10 mmHg as group 2. RESULTS： There were no difference on cardiac index （HI, P= 0.28）, aortic pressure （AO, P= 0.78）, left ventricular end-diastolic pressure （LVED, P=0.06）, maximum portal blood velocity （Vmax, P= 0.17）, mean portal blood velocity （Vmean, P=0.15） and portal blood flow volume （PBF, P= 0.95） between the two groups. Group 2 patients had higher pulmonary wedge pressure （PW, 29.9 ± 9.3 mmHg vs 14.6±7.3 mmHg, P=0.002）, pulmonary arterial pressure （PA, 46.3± 13.2 mmHg vs 25.0±8.2 mmHg, P=0.004）, RA （17.5±5.7 mmHg vs 4.7±2.4 mmHg, P〈 0.001）, right ventricular end-diastolic pressure （RVED, 18.3±5.6 mmHg vs 6.4±2.7 mmHg, P〈0.001）, CI （8.7±2.4 vs 5.8± 1.2, P=0.03）, and PI （87.8±32.3% vs 27.0±7.4%, P〈0.001） than Group 1. CI was correlated with PI （P〈0.001）, PW （P〈0.001）, PA （P〈0.001）, RA （P=0.043）, RVED （P=0.005）, HI （P〈0.001）, AO （P〈0.001）, CO （P〈0.001）, LVED （P〈0.001）, Vmax （P〈0.001）, Vmax （P〈0.001）, cross-sectional area of the main portal vein （P〈0.001） and PBF （P〈0.001）. CI could be as high as 8.3 in patients with RA〈 10 mmHg and as low as 5.9 in those with RA≥10 mmHg.CONCLUSION： Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.

Relationship Between Serum Leptin Concentration and Lipids & Body Mass Index in Patients With Chronic Congestive Heart Failure

Objectives To investigate the relationship of serum leptin concentration with the lipids and body mass index （BMI） in patients with chronic congestive heart failure（CHF）. Methods The serum concentration of leptin in 39 patients with CHF （14 in cardiac function class Ⅱ , 21 in class Ⅲ, 4 in classⅣ , NYHA） and in 46 patients with cardiac function class Ⅰ （NYHA） were assessed by radioimmunoassay. Results The serum concentration of leptin were 9.018±4.519 μg/l in CHF group （cardiac function class Ⅱ 11.492±5.649 μg/l, class Ⅲ 7.763±3.321 μg/l, class Ⅳ 6.100±2.657 μg/l）; 11.674± 6.911 μg/l in class Ⅰ group. The serum concentrations of leptin were significantly lower in CHF group, as compared with class Ⅰ group （P〈 0.05）. Moreover, the decrease of serum leptin concentration was significantly correlated with the decreased serum concentrations of total cholesterol, triglyceride, body mass index and left ventricular ejection fraction in CHF group, respectively （P 〈 0.05）. Conclusions The significance of the decrease in serum leptin in CHF patients needs further study.

Study of macroscopic fundamental diagram on Shanghai urban expressway network in China

The macroscopic fundamental diagram（ MFD） is studied to obtain the aggregate behavior of traffic in cities. This paper investigates the existence and the characteristics of different types of daily MFD for the Shanghai urban expressway network. The existence of MFD in the Shanghai urban expressway network is proved based on two weeks＇ data.Moreover, the hysteresis phenomena is present in most days and the network exhibits different hysteresis loops under different traffic situations. The relationship between the hysteresis phenomena and the inhomogeneity of traffic distribution is verified. The MFDs in the years of 2009 and 2012 are compared. The hysteresis loop still exists in 2012, which further verifies the existence of the hysteresis phenomenon. The direct relationship between the length of the hysteresis loop（ ΔO） and the congestion is proved based on sufficient data. The width of the hysteresis loop, i. e., the drop in network flow（ ΔQ） has no relationship with the congestion, and it varies from day to day under different traffic situations.

β-arrestin-2 predicts the clinical response to β-blockers in cirrhotic portal hypertension patients: A prospective study

BACKGROUND Portal hypertension,a common complication associated with liver cirrhosis,can result in variceal bleeding,which greatly impacts patient survival.Recently,β-arrestin-2 has been shown to predict the acute hemodynamic response to nonselectiveβ-blocker therapy for cirrhotic portal hypertension.However,more data is needed on the long-term effects of and changes inβ-arrestin-2 following nonselectiveβ-blocker therapy.AIM To investigate the expression and role ofβ-Arrestin-2 in predicting the long-term response to nonselectiveβ-blockers in cirrhotic portal hypertensive patients.METHODS We prospectively enrolled 91 treatment-naïve patients with cirrhotic portal hypertension.Baseline clinical and laboratory data were obtained.Gastroscopy was performed for grading and treating varices and obtaining gastric antral biopsies.We measured the serum and antral expression ofβ-arrestin-2 and obtained Doppler measurement of the portal vein congestion index.Treatment with nonselectiveβ-blockers was then started.The patients were followed up for 18 mo,after which they have undergone a repeat antral biopsy and re-evaluation of the portal vein congestion index.RESULTS A higher serum level and antral expression ofβ-arrestin-2 was associated with longer bleedingfree intervals,greater reduction in the portal vein congestion index,and improved grade of varices.Among patients with a lowβ-arrestin-2 expression,17.6%were nonselectiveβ-blocker responders,whereas,among those with high expression,95.1%were responders(P<0.001).A serumβ-arrestin-2 value≥2.23 ng/mL was associated with a lower likelihood of variceal bleeding(90%sensitivity and 71%specificity).β-arrestin-2 expression significantly decreased after nonselectiveβ-blocker therapy.CONCLUSIONβ-arrestin-2 expression in cirrhotic portal hypertension predicts the clinical response to long-term nonselectiveβ-blocker treatment.Serumβ-arrestin-2 is a potential noninvasive biomarker for selecting the candidate patients for nonselectiveβ-blockers.

Dynamic evaluation of traffic flows on city roads

This paper presents an analysis of the random fluctuations, deferred conduction effect and periodicity of road traffic based on the basic features of road networks. It also discusses the limitations of road network evaluation theories based on road "V/C". In addition, it proposes a set of theoretical and technical methods for the real-time evaluation of traffic flows for entire road networks, and for solving key technical issues, such as real-time data collection and processing in areas with no blind zones, the spatial-temporal dynamic analysis of road network traffic, and the calibration of key performance index thresholds. It also provides new technical tools for the strategic transportation planning and real-time diagnosis of road traffic. The new tools and methodology presented in this paper are validated using a case study in Beijing.