Ankle-brachial index and brachial-ankle pulse wave velocity are risk factors for ischemic stroke in patients with type 2 diabetes

The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity （BaPWV） and ankle-bra- chial index （ABI） are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group （n = 55） and a diabetes and ischemic stroke group （n = 62）. We then performed ABI and BaPWV examinations for all patients. Compared with the diabe- tes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.

Serum Calcium Level is Associated with Brachial-ankle Pulse Wave Velocity in Middle-aged and Elderly Chinese

Objective To study the relation between serum calcium level and elevated BaPWV in Chinese subjects. Methods The relation between serum calcium level and elevated BaPWV was studied in 9 615 subjects. The mean value of left and right BaPWV was analyzed. BaPWV was defined as high when it was31 752.5 cm/s （the upper quartile） either side. Results The BaPWV and its elevated percentage progressively increased across the quartiles of the serum calcium level （P〈0.05）. The prevalence of elevated BaPWV was significantly higher in subjects of the second, third and highest quartiles than in those of the lowest quartile （26.9%, 28.4%, and 33.2%vs 23.7%, P=0.0116, P=0.0004, and P〈0.0001）. Logistic regression analysis revealed that the risk of elevated BaPWV was 1.32- fold higher in subjects of the highest quartile than in those of the lowest quartile （OR=1.32, 95%CI：1.08-1.60）. Conclusion The elevated serum calcium level is related to an elevated BaPWV and a higher risk of arterial stiffness, independent of conventional risk factors, in middle-aged and elderly Chinese subjects.

Brachial-ankle pulse wave velocity is an independent predictor of carotid artery atherosclerosis in the elderly

Objective Brachial-ankle pulse wave velocity （baPWV） is widely used as a simple noninvasive measure of arterial softness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants （mean ~ SD age, 70.3 -4- 5.6years） were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis （CAS） was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P〈0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P〈0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P〈0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis （r=-0.39; p=0.001）. After adjusting for factors influencing, baPWV all the same correlated with IMT （r=-0.35; p=0.001）.Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly

The value of pulse wave velocity in the diagnosis of coronary heart disease

Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.

Relationship between brachial-ankle pulse wave velocity and metabolic syndrome components in a Chinese population

The purpose of this study was to assess the relationship between arterial stiffness, as measured by brachial-ankle pulse wave velocity （baPWV）, and the presence of the metabolic syndrome （MS） in a Chinese population. A total of 4,445 subjects were enrolled. The prevalence of MS in for the general population, males and females, respectively. our study population was 21.7%, 17.2% and 25.6% With adjustments for age, gender, cigarette smoking, heart rate, total cholesterol, low-density lipoprotein （LDL） cholesterol, and the use of anti-hypertensive drug, the stepwise regression analysis showed that baPWV had a significant relationship with components of MS, including systolic blood pressure （P 〈 0.001）, diastolic blood pressure （P 〈 0.001）, glucose （P 〈 0.001）, highdensity lipoprotein （HDL） cholesterol （P = 0.04）, and triglycerides （P 〈 0.001）, but no relationship with waist circumference （P = 0.25）. With an increase in the number of the MS components, baPWV increased significantly both in women and men. This study indicated that the MS is indeed a risk factor for arterial stiffness. Monitoring of baPWV in patients with MS may help in identifying persons at high risk for cardiovascular disease.

Relationship between the Plasma Fibulin-1 Levels,Pulse Wave Velocity,and Vascular Age in Asymptomatic Hyperuricemia

Fibulin-1(FBLN-1),an elastin-associated extracellular matrix protein,has been found in blood and may play a role in the pathophysiological processes leading to cardiovascular disease(CVD).We aimed to investigate the relationship between fibulin-1 levels and the risk of CVD by evaluating vascular age derived from the Framingham Heart Study and brachial-ankle Pulse Wave Velocity(baPWV)in patients with asymptomatic hyperuricemia(AHU).In total,66 patients with AHU and 66 gender-and age-matched healthy individuals were enrolled.The plasma fibulin-1 levels were measured by immunochemistry.Patients with AHU presented significantly higher vascular age[median(interquartile range):54(22)vs.48(14)years,P=0.01]and baPWV[mean±SD:1373±223 vs.1291±177 cm/s,P=0.02]than the healthy subjects;however,no significant difference was observed in the plasma fibulin-1 level between the patients with AHU and healthy subjects[median(interquartile range):4018(3838)vs.3099(3405)ng/mL,P=0.31].A correlation between fibulin-1 levels and baPWV was observed only in patients with AHU(r=0.29,P=0.02);and there was also a suggestively statistically significant correlation between fibulin-1 levels and vascular age(r=0.22,P=0.08).However,these associations were rendered insignificant after adjustments for potential confounders.In healthy subjects,no correlation was observed between fibulin-1 levels and CVD risk.This study reveals that plasma fibulin-1 levels may reflect the CVD risk in patients with AHU,but the relationship is not robust.

Altered heart rate variability and pulse-wave velocity after spinal cord injury

BACKGROUND Heart rate variability(HRV) and pulse-wave velocity(PWV),indicators of cardiac function,are altered in patients with spinal cord injury(SCI),suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients.No study has simultaneously investigated HRV and PWV in the same patients.AIM To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.METHODS In this cross-sectional pilot study,patients with(n = 60) and without SCI(n = 60) were recruited from December 7,2019 to January 21,2020.Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000 P.Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.RESULTS We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals,square root of the mean sum of squared successive risk ratio interval differences,physical stress index,total power,very-low frequency,low frequency,high frequency,and arterial elasticity.CONCLUSION Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without,suggesting that SCI may increase cardiac function loading.

Association of Estimated Pulse Wave Velocity and the Dynamic Changes in Estimated Pulse Wave Velocity with All-Cause Mortality among Middle-Aged and Elderly Chinese

Objective We aimed to clarify the association between estimated pulse wave velocity(ePWV)and the changes in ePWV with all-cause mortality among middle-aged and elderly Chinese.Methods Data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)from 2011-2018.The ePWV was calculated using an equation that included age and mean blood pressure(MBP).The ΔePWV was assessed as the difference in ePWV between the first two waves.Cox proportional hazard models were used to determine the association between ePWV and ΔePWV with all-cause mortality after adjustment for potential confounders.Results Of 13,116 participants during a median follow-up of 7.0 years,1,356 deaths occurred.An increased ePWV was independently associated with all-cause mortality.The hazard ratio[95% confidence interval(CI)]for participants from the 1^(st)-4^(th) quartile groups was 1.00,1.69(1.31-2.18),3.09(2.44-3.91),and 8.54(6.78-10.75),respectively.Each standard deviation(SD)increment of ePWV increased the risk of all-cause mortality by 132%.Furthermore,theΔePWV was significantly associated with a 1.28-fold(95%CI,1.18-1.38)risk of all-cause mortality per SD increment.Conclusion This cohort study provided novel evidence from a Chinese population that an increased ePWV or progression of the ePWV was independently associated with all-cause mortality,which highlighted the importance of mitigating ePWV progression in clinical practice.

Local Pulse Wave Velocity Estimation in the Carotids Using Dynamic MR Sequences

The current study presents a new protocol for local pulse wave velocity (PWV) measurement using dynamic MR sequences, which have a high temporal resolution (TR < 6 ms). MR images were obtained at two positions along the common carotid artery, separated by a distance of 5 cm. In each phase of a MR series, carotid region was automatically extracted and then its area distension waveform could be obtained. Sixteen volunteers with no symptoms of cardiovascular diseases were studied. For local PWV estimation, three delay estimation principles were tested and produced the following values: intersecting tangents method (M1): 4.72 ± 1.40 m/s, second derivative method (M2): 4.94 ± 1.68 m/s and cross-correlation method (M3): 5.03 ± 1.17 m/s. The cross-correlation method showed a relative high reliability as its least standard deviation.

Correlations between ultrasonic pulse wave velocities and rock properties of quartz-mica schist

Physico-mechanical properties are critically important parameters for rocks. This study aims to examine some of the rock properties of quartz-mica schist（QMS） rocks in a cost-effective manner by establishing correlations between non-destructive and destructive tests. Using simple regression analysis, good correlations were obtained between the pulse wave velocities and the properties of QMS rocks. The results were further improved by using multiple regression analysis as compared to those obtained by the simple linear regression analysis. The results were also compared to the ones obtained by other empirical equations available. The general equations encompassing all types of rocks did not give reliable results of rock properties and showed large relative errors, ranging from 23% to 1146%. It is suggested that empirical correlations must be investigated separately for different types of rocks. The general empirical equations should not be used for the design and planning purposes before they are verified at least on one rock sample from the project site, as they may contain large unacceptable errors.

A Nonparametric Derivative-Based Method for R Wave Detection in ECG

QRS detection is very important in cardiovascular disease diagnosis and ECG (electrocardiogram) monitor, because it is the precondition of the calculation of correlative parameters and diagnosis. This paper presents a non-parametric derivative-based method for R wave detection in ECG signal. This method firstly uses a digital filter to cut out noises from ECG signals, utilizes local polynomial fitting that is a non-parametric derivative-based method to estimate the derivative values, and then selects appropriate thresholds by the difference, and the algorithm adaptively adjusts the size of thresholds periodically according to the different needs. Afterwards, the position of R wave is detected by the estimation of the first-order derivative values with nonparametric local polynomial statistical model. In addition, in order to improve the accuracy of detection, the method of redundant detection and missing detection are applied in this paper. The clinical experimental data are used to evaluate the effectiveness of the algorithm. Experimental results show that the method in the process of the detection of R wave is much smoother, compared with differential threshold algorithm and it can detect the R wave in the ECG signals accurately.

Position difference regularity of corresponding R-wave peaks for maternal ECG components from different abdominal points

We collected 343 groups of abdominal electrocardiogram(ECG) data from 78 pregnant women and deleted the channels unable for experts to determine R-wave peaks from them; then, based on these filtered data, the statistics of position difference of corresponding R-wave peaks for different maternal ECG components from different points were studied. The resultant statistics showed the regularity that the position difference of corresponding maternal R-wave peaks between different abdominal points does not exceed the range of 30 ms. The regularity was also proved using the fECG data from MIT–BIH PhysioBank. Additionally, the paper applied the obtained regularity, the range of position differences of the corresponding maternal R-wave peaks, to accomplish the automatic detection of maternal R-wave peaks in the recorded all initial 343 groups of abdominal signals, including the ones with the largest fetal ECG components, and all 55 groups of ECG data from MIT–BIH PhysioBank, achieving the successful separation of the maternal ECGs.

Predictive Value of Carotid-femoral Pulse Wave Velocity for Major Adverse Cardiovascular Events and All-cause Mortality in Different Age Groups of a Chinese Community

Objective:To investigate the predictive value of carotid-femoral pulse wave velocity(cf-Pw)for assessing major adverse cardiovascular events(MACE)and all-cause mortality in different age groups of a Chinese community.Methods:This is an observational study which enrolled 1,325 individuals from a community in Beijing from September 2007 to October 2018.They were classified based on age into<65-year-old(n=572)and≥65-year-old(n=753)groups,and on cf-PWV into cf-PWV<12 m/s(n=501)and cf-PWV≥12 m/s(n=824)group.The incidence rates of MACE and all-cause mortality were recorded for both the groups during the follow-up period of 9.5 years.The predictive value of cf-PWV for MACE and all-cause mortality in the 2 age groups was estimated using the Cox proportional hazards regression models.Results:The baseline cf-PWV showed positive correlation with age(r=0.462,P<0.001).During the follow-up period,191 MACE and 84 all-cause mortality cases were recorded in the study population.The incidence rates of MACE(χ^(2)=27.196,P<0.001)and all-cause mortality(χ^(2)=9.473,P=0.002)were significantly higher in subjects with cf-PWV≥12 m/s than in subjects with cf-PWV<12 m/s.Cox proportional hazards regression model analyses demonstrated that cf-PWV was an independent risk factor in the<65-year-old group for MACE(hazard ratio:1.310;95%confidence interval:1.007-1.560;P=0.038)and all-cause mortality(hazard ratio:1.412;95%confidence interval:1.133-1.936;P=0.005)after adjusting for several risk factors.However,both univariate and multivariate analyses demonstrated that cf-PWV was not an independent risk factor for MACE or all-cause mortality in the≥65-year-old group(P>0.05).Conclusion:cf-PWV,a measure of arterial stifness,emerged as an independent risk factor for MACE and all-cause mortality insubjectsbelow65yearsofage.

血清Adropin浓度与踝臂指数、肱-踝动脉脉搏波传导速度的相关性

目的研究血清Adropin浓度与踝臂指数(ankle brachial index,ABI)、肱-踝动脉脉搏波传导速度(brachial ankle pulse wave velocity,Ba-PWV)的相关性。方法纳入2022年1月至2023年6月心内科住院治疗的患者179例,酶联免疫吸附法检测血清Adropin浓度,测量肱、踝动脉收缩压及Ba-PWV,计算ABI。根据ABI分组:ABI较低组(ABI<0.9,n=71)和ABI较高组(ABI≥0.9,n=108)。根据Ba-PWV分组:Ba-PWV较高组(Ba-PWV≥1400 cm/s,n=118),Ba-PWV较低组(Ba-PWV<1400 cm/s,n=61)。结果与ABI较高组比较,ABI较低组高血压发病率高、血清Adropin浓度低(P<0.001)。Logistic回归分析显示:血清Adropin浓度与低ABI呈负相关(偏相关系数为-0.715,P=0.027,OR=0.529,95%CI:0.342~0.987)。ROC分析:血清Adropin浓度<2998 pg/mL可预测低ABI及动脉粥样硬化(P<0.001),ROC曲线下面积:0.864;95%CI:(0.804~0.925),灵敏度:89.8%,特异性:81.7%。与Ba-PWV较低组比较,Ba-PWV较高组空腹血糖水平高、高血压病发病率高、血清Adropin浓度低(P<0.05)。Logistic回归分析:血清adropin浓度与高Ba-PWV呈负相关(偏相关系数为-0.562,P=0.002,OR=0.587,95%CI:0.398~0.837)。ROC分析:血清Adropin浓度<3019 pg/mL可预测高Ba-PWV及动脉粥样硬化(P<0.001),ROC曲线下面积:0.861;95%CI:(0.792~0.929),灵敏度:86.9%,特异性:53.4%。结论血清Adropin浓度与大动脉硬化及外周动脉粥样硬化相关。

Epidural pressure measurement using a fiber-optic sensor(proof-of-principle in vivo animal trial)

Background:An increase in epidural pressure around the stenosis has been observed in patients with lumbar spinal stenosis(LSS)with positive signs of sedimentation or redundant nerve roots.Further analysis of the pressure conditions in the stenotic area would be of great interest.We hypothesized that it would be possible to determine the physiological parameters of the epidural pulse wave and its course in pathological stenosis as a basis for objective identification of LSS based on pressure using a new measuring method with continuous spatial and temporal resolution.Methods:We performed a single-case proof-of-principle in vivo animal trial and used a newly developed hybrid pressure-measurement probe with a fiber-tip Fabry-Pérot interferometer and several fiber Bragg gratings(FBG).Results:With reproducible precision,we determined the mean epidural pressure to be 7.5 mmHg and the peak-to-peak value to be 4-5 mmHg.When analyzing the pres-sure measured by an FBG array,both the heart and respiratory rates can be precisely determined.This study was the first to measure the pulse wave velocity of the cer-ebrospinal fluid pressure wave as 0.97 m/s using the newly developed pressure probe.A simulated LSS was detected in real time and located exactly.Conclusions:The developed fiber-optic pressure sensor probe enables a new objec-tive measurement of epidural pressure.We confirmed our hypothesis that physiologi-cal parameters of the epidural pulse wave can be determined and that it is possible to identify an LSS.

Association between Gene Polymorphisms and SNP-SNP Interactions of the Matrix Metalloproteinase 2 Signaling Pathway and the Risk of Vascular Senescence

Objective This study aimed to explore the association of single nucleotide polymorphisms(SNP)in the matrix metalloproteinase 2(MMP-2)signaling pathway and the risk of vascular senescence(VS).Methods In this cross-sectional study,between May and November 2022,peripheral venous blood of151 VS patients(case group)and 233 volunteers(control group)were collected.Fourteen SNPs were identified in five genes encoding the components of the MMP-2 signaling pathway,assessed through carotid-femoral pulse wave velocity(cf PWV),and analyzed using multivariate logistic regression.The multigene influence on the risk of VS was assessed using multifactor dimensionality reduction(MDR)and generalized multifactor dimensionality regression(GMDR)modeling.Results Within the multivariate logistic regression models,four SNPs were screened to have significant associations with VS:chemokine(C-C motif)ligand 2(CCL2)rs4586,MMP2 rs14070,MMP2rs7201,and MMP2 rs1053605.Carriers of the T/C genotype of MMP2 rs14070 had a 2.17-fold increased risk of developing VS compared with those of the C/C genotype,and those of the T/T genotype had a19.375-fold increased risk.CCL2 rs4586 and MMP-2 rs14070 exhibited the most significant interactions.Conclusion CCL2 rs4586,MMP-2 rs14070,MMP-2 rs7201,and MMP-2 rs1053605 polymorphisms were significantly associated with the risk of VS.

Pilot study on the effect of flavonoids on arterial stiffness and oxidative stress in chronic kidney disease

BACKGROUND Flavonoids,the main class of polyphenols,exhibit antioxidant and antihypertensive properties.AIM To prospectively investigate the impact of flavonoids on arterial stiffness in patients with chronic kidney disease(CKD)stagesⅠ-Ⅳ.METHODS In this prospective,single-arm study,CKD patients with arterial hypertension and diabetes mellitus were enrolled.Baseline demographic,clinical,and laboratory variables were recorded.Patients received daily treatment with a phenol-rich dietary supplement for 3 months.Blood pressure,arterial stiffness(carotidfemoral pulse wave velocity,central pulse pressure),and oxidative stress markers(protein carbonyls,total phenolic compound,total antioxidant capacity)were measured at baseline and at study end.RESULTS Sixteen patients(mean age:62.5 years,87.5%male)completed the study.Following intervention,peripheral systolic blood pressure decreased significantly by 14 mmHg(P<0.001).Carotid-femoral pulse wave velocity decreased from 8.9 m/s(baseline)to 8.2 m/s(study end)(P<0.001),and central pulse pressure improved from 59 mmHg to 48 mmHg(P=0.003).Flavonoids also reduced oxidative stress markers including protein carbonyls(P<0.001),total phenolic compound(P=0.001),and total antioxidant capacity(P=0.013).CONCLUSION Flavonoid supplementation in CKD patients shows promise in improving blood pressure,arterial stiffness,and oxidative stress markers.

Changes in pulse pressure × heart rate, hs-CRP, and arterial stiffness progression in the Chinese general population: a cohort study involving 3978 employees of the Kailuan Company

Background Pulse wave velocity(PWV) is a marker of arterial stiffness, which represents sub-clinical atherosclerosis. Pulsatile stress and high-sensitivity C-reactive protein(hs-CRP) are associated with arteriosclerosis. However, there is no prospective data confirming whether changes in pulsatile stress and inflammatory markers affect the progression of arterial stiffness. The aim of this study was to investigate the relationships over time between the effects of changes in pulsatile stress and hs-CRP, and arterial stiffness progression during a 2-year follow-up. Methods We performed a longitudinal study involving 3978 participants. All participants underwent a physical examination in 2010–2011 and 2012–2013, during which we measured participants’ hs-CRP levels, brachial–ankle pulse wave velocity(ba PWV), and pulsatile stress. Results Baseline hs-CRP was correlated with ba PWV(r = 0.18, P = 0.000);however the correlation was weaker than that with systolic blood pressure(r = 0.65), pulsatile stress(r = 0.57), and rate-pressure product(r = 0.58). Multiple linear regression analysis demonstrated that changes in pulsatile stress, mean arterial pressure, and low-density lipoprotein-C(LDL-C) were positively correlated with changes in ba PWV, with correlation coefficients of 0.27, 0.25, and 0.07, respectively, but not with changes in hs-CRP. Moreover, each 100-a U increase in pulsatile stress, 1 mm Hg increase in mean blood pressure, and 1 mmol/L increase in LDL-C was associated with a 3 cm/s, 4.78 cm/s, and 17.37 cm/s increase in ba PWV, respectively. Conclusions Pulsatile stress increases are associated with arterial stiffness progression, but that changes in hs-CRP had no effect on arterial stiffness progression. Hs-CRP may simply be a marker of inflammation in arterial stiffness and has no association with arterial stiffness progression.

应用ARFI技术探讨肝豆汤治疗湿热内蕴型Wilson病肝纤维化的临床研究

目的:应用声脉冲辐射力成像技术(Acoustic radiation force impulse, ARFI)测量肝豆状核变性(Wilson’s disease, WD)患者肝脏剪切波速度(Shear wave velocity, SWV),探讨SWV与肝纤维化血清学指标Ⅳ型胶原(typeⅣcollagen,CⅣ)、透明质酸(hyaluronic acid,HA)、Ⅲ型前胶原N端肽(type Ⅲ procollagen peptide,PⅢNP)、层黏连蛋白(laminin,LN)及APRI评分(Aspartate Aminotransferase to Platelet Ratio Index)、FIB-4指数(Fibrosis-4 index)的相关性,并观察肝豆汤(Gandou Tang, GDT)治疗湿热内蕴型WD肝纤维化的临床疗效。方法:将符合纳入标准的80例WD患者分为治疗组和对照组,每组40例,对照组给予二巯丙磺钠(Sodium Dimercaptopropylsulfonate, DMPS)治疗,治疗组在对照组基础上加用中药方剂肝豆汤,8 d 1个疗程,共6个疗程。对比治疗前后SWV与肝纤四项(PⅢNP、HA、CⅣ、LN)水平及APRI评分、FIB-4指数,采用Pearson相关性检验分析探讨SWV与HA、CⅣ、LN、PⅢNP及APRI评分、FIB-4指数的相关性,并根据治疗方案评估肝豆汤干预治疗对SWV、肝纤四项及APRI、FIB-4的影响。结果:(1)肝脏剪切波速度(SWV)与FIB-4(r=0.83)、APRI(r=0.82)、HA(r=0.87)、CⅣ(r=0.71)、LN(r=0.85)、PⅢNP(r=0.77)呈正相关。(2)治疗前两组患者SWV水平、血清PⅢNP、HA、CⅣ、LN、APRI、FIB-4水平比较,差异均无统计学意义(P>0.05);治疗后两组PⅢNP、HA、LN、SWV、APRI、FIB-4水平均明显下降(P<0.05, P<0.01),且治疗组各项水平低于对照组。CⅣ水平无明显特异性变化(P>0.05)。结论 :SWV值可反应WD肝纤维化程度,与血清HA、PⅢNP、CⅣ、LN及FIB-4指数、APRI评分成正相关。在西医保肝驱铜治疗的基础上加用中药肝豆汤治疗,能有效改善湿热内蕴型WD患者肝纤维化程度。

心电R波检测及控制左心辅助装置

心衰是一种威胁人类生命的主要疾病之一,左心室辅助装置作为心脏移植前的过渡支持治疗使用,对心衰终末期患者的生活质量和生存率有明显提升;在对心电图实现自动的检测中,QRS波群的检测是最关键的环节,它影响着后续数据分析和处理的正确性及准确性;设计利用数据库数据和人体心电采集数据作为原始待处理源,通过高阶低通滤波与香农能量的创新算法结合进行处理数据,在硬件上增加使用高阶自适应中值滤波算法,使得处理后的实时数据噪声降到最低,有利于准确提取到R波,最后使用测试后的心电R波驱动左心室辅助装置,达到对心衰患者进行辅助治疗的作用,并且通过Matlab和Modelsim软件仿真成功后,在FPGA硬件上实现了实时心电信号控制血泵系统的方案;经试验测试此方法可以准确地提取R波,并且可以控制左心辅助装置同步进行泵血。