Purpose
Robot-assisted cardiovascular intervention has been recently developed, which enables interventionists to avoid x-ray radiation and improve their comfort. However, there are still some ...challenges in the robotic design, such as the inability of the interventionist to freely perform natural clinical techniques and the limited motion travel of the interventional tool. To overcome these challenges, this paper proposes an ergonomically designed dual-use mechanism for cardiovascular intervention (DMCI).
Methods
DMCI can work as an ergonomic interface or a compact slave robot with unlimited motion travel. Our kinematic analysis of DMCI includes motion decoupling and coupling. Motion decoupling decomposes the translation and rotation from the interventionist’s natural clinical actions at the master side. Motion coupling can calculate the input pulses of motors according to the desired rotation and translation, thus composing the motion of the intervention tool at the slave side.
Results
Our kinematic analysis of DMCI has been experimentally verified, where the overall mean rotational errors are all less than 1° and translational errors are all less than 1 mm. We also evaluated the performance of the DMCI-based master–slave system, where the overall rotational and translational errors are 0.821 ± 0.753° and 0.608 ± 0.512 mm. Moreover, operators were found to be generally more efficient when using the DMCI-based interface compared to the conventional joystick.
Conclusion
We have validated our kinematic analysis of DMCI. The master–slave teleoperation experiment demonstrated that operators can freely perform natural clinical techniques through the DMCI-based interface, and the slave robot can replicate the operators’ manipulation at the master side well.
While benefits of greenness exposure to health have been reported, findings specific to lung function are inconsistent. The purpose of this study is to assess the correlations of greenness exposure ...with multiple lung function indicators based on chronic obstructive pulmonary disease (COPD) monitoring database from multiple cities of Anhui province in China.
We assessed the greenness using the annual average of normalized difference vegetation index (NDVI) with a distance of 1000-meter buffer around each local community or village. Three types of lung function indicators were considered, namely indicators of obstructive ventilatory dysfunction (FVC, FEV
, FEV
/FVC, and FEV
/FEV
); an indicator of large-airway dysfunction (PEF); indicators of small-airway dysfunction (FEF
, FEF
, FEF
, MMEF, FEV
, FEV
, and FEV
/FVC). Linear mixed effects model was used to analyze associations of greenness exposure with lung function through adjusting age, sex, educational level, occupation, residence, smoking status, history of tuberculosis, family history of lung disease, indoor air pollution, occupational exposure, PM
, and body mass index.
A total of 2768 participants were recruited for the investigations. An interquartile range (IQR) increase in NDVI was associated with better FVC (153.33mL, 95%CI: 44.07mL, 262.59mL), FEV
(109.09mL, 95%CI: 30.31mL, 187.88mL), FEV
(138.04mL, 95%CI: 39.43mL, 236.65mL), FEV
(145.42mL, 95%CI: 42.36mL, 248.47mL). However, there were no significant associations with PEF, FEF
, FEF
, FEF
, MMEF, FEV
/FVC, FEV
/FEV
, FEV
/FVC. The stratified analysis displayed that an IQR increase in NDVI was related with improved lung function in less than 60 years, females, urban populations, nonsmokers, areas with medium concentrations of PM
and individuals with BMI of less than 28 kg/m
. Sensitivity analyses based on another greenness indice (enhanced vegetation index, EVI) and annual maximum of NDVI remained consistent with the main analysis.
Our findings supported that exposure to greenness was strongly related with improved lung function.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Prior studies have investigated the clinical and imaging factors for hemorrhagic transformation (HT), especially symptomatic intracranial hemorrhage (sICH); however, whether alteplase increases the ...risk of HT after endovascular thrombectomy (EVT) is unknown. This study aimed to assess clinical and imaging features associated with HT, sICH, and parenchymal hematoma (PH) in patients with acute ischemic stroke after EVT, with and without intravenous alteplase in DIRECT-MT (Direct Intraarterial Thrombectomy to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial).
The DIRECT-MT trial is a randomized trial of EVT alone versus intravenous thrombolysis combined with EVT. HT, sICH, and PH was evaluated on follow-up computed tomography. Multivariable ordinal logistic regression analysis was used to test the association of stepwise selected determinants with HT, sICH, and PH.
In total, 633 patients were analyzed; 261 (41.2%) had HT; 34 (5.4%) had sICH; and 85 (13.4%) had PH. The median age was 69, and 56.7% were men. The median National Institutes of Health Stroke Scale score was 18, and 320 patients were in combination-therapy group. Symptomatic intracranial hemorrhage was associated with higher baseline National Institutes of Health Stroke Scale score (adjusted odds ratio OR, 1.06 95% CI, 1.10-1.12) and higher glucose level at hospital arrival (adjusted OR, 1.14 95% CI, 1.00-1.29). No association was found between alteplase treatment and HT, sICH, or PH. The independent predictor of sICH was higher baseline National Institutes of Health Stroke Scale score (adjusted OR, 1.09 95% CI, 1.01-1.18) in EVT alone group, and history of anticoagulant drugs (adjusted OR, 3.75 95% CI, 1.07-13.06), higher glucose level at hospital arrival (adjusted OR, 1.19 95% CI, 1.03-1.38), >3 passes of device (adjusted OR, 4.42 95% CI, 1.36-14.32) in combination-therapy group.
In DIRECT-MT, independent predictors of sICH were baseline National Institutes of Health Stroke Scale score and glucose level at hospital arrival. Alteplase treatment did not increase the risk of HT, sICH, or PH after EVT. The independent predictor of sICH was different in EVT alone group and combination-therapy group.
URL: https://www.
gov; Unique identifier: NCT03469206.
Objectives
To evaluate a quantitative radiomic approach based on high-resolution magnetic resonance imaging (HR-MRI) to differentiate acute/sub-acute symptomatic basilar artery plaque from ...asymptomatic plaque.
Methods
Ninety-six patients with basilar artery stenosis underwent HR-MRI between January 2014 and December 2016. Patients were scanned with T1- and T2-weighted imaging, as well as T1 imaging following gadolinium-contrast injection (CE-T1). The stenosis value, plaque area/burden, lumen area, minimal luminal area (MLA), intraplaque haemorrhage (IPH), contrast enhancement ratio and 94 quantitative radiomic features were extracted and compared between acute/sub-acute and asymptomatic patients. Multi-variate logistic analysis and a random forest model were used to evaluate the diagnostic performance.
Results
IPH, MLA and enhancement ratio were independently associated with acute/subacute symptoms. Radiomic features in T1 and CE-T1 images were associated with acute/subacute symptoms, but the features from T2 images were not. The combined IPH, MLA and enhancement ratio had an area under the curve (AUC) of 0.833 for identifying acute/sub-acute symptomatic plaques, and the combined T1 and CE-T1 radiomic approach had a significantly higher AUC of 0.936 (
p
= 0.01). Combining all features achieved an AUC of 0.974 and accuracy of 90.5%.
Conclusions
Radiomic analysis of plaque texture on HR-MRI accurately distinguished between acutely symptomatic and asymptomatic basilar plaques.
Key Points
• High-resolution magnetic resonance imaging can assess basilar artery atherosclerotic plaque.
• Radiomic features in T1 and CE-T1 images are associated with acute symptoms.
• Radiomic analysis can accurately distinguish between acute symptomatic and asymptomatic plaque.
• The highest accuracy may be achieved by combining radiomic and conventional features.
Abstract Background and aims Recent development of high resolution MRI techniques have enabled imaging of intracranial atherosclerotic plaque in vivo . However, identifying plaque composition remains ...challenging given the small size and the lack of histological validation. This study aims to quantify the relaxation times of intracranial plaque components ex vivo at 3 T and to determine whether multi-contrast MRI could classify intracranial plaque according to the American Heart Association classification with histological validation. Methods A total of 53 intracranial arteries with atherosclerotic plaques from 20 cadavers (11 male, age 73.8 ± 10.9) were excised. Quantitative T1 /T2 /T2 * mapping sequences and multi-contrast fast-spin echo sequences (T1 , T2 , proton-density weighted and short time inversion recovery) were acquired. Plaque components including: fibrous cap, lipid core, fibrous tissue, calcification, and healthy wall were segmented on histology, and their relaxation times were derived from quantitative images. Two radiologists independently classified plaque type blinded to the histology results. Results Relaxation times of plaque components are distinct and different. T2 and T2 * values of lipid core are lower than fibrous cap (p = 0.026 & p < 0.0001), but are comparable with fibrous tissue and healthy wall (p = 0.76 & p = 0.42). MRI reliably classified plaque type compared with histology (κ = 0.69) with an overall accuracy of 80.7%. The sensitivity and specificity using MRI to identify fibro-lipid atheroma (type IV-V) was 94.8% and 77.1%, respectively. Inter-observer agreement was excellent (κ = 0.77). Conclusion Intracranial plaque components have distinct and different relaxation times at 3 T. High-resolution MRI is able to characterize intracranial plaque composition and classify plaque types ex vivo at 3 T.
Physical activity(PA) is associated with health-related quality of life (HRQoL) among older adults, and both are associated with mood, such as depression. However, the indirect effects of PA on HRQoL ...in older adults have not been clearly established. This study explained how different types and intensities of PA were associated with HRQoL while considering the effects of depression in older adults.
A cross-sectional study was conducted with 7,518 community-dwelling older adults aged 60 years and older. PA (leisure-time, household, and work-related), depression, and HRQoL were measured using the Physical Activity Scale for the Elderly (PASE), the 30-item Geriatric Depression Scale (GDS-30), and the 36-Item Short-Form Health Survey (SF-36), respectively. Information on age, gender, education, monthly income, activities of daily living, smoking, and alcohol drinking was also collected. Regression analysis was used to explore the relationship between PA, depression and HRQoL, and a mediation effect test process was used to verify the mediating mechanism of the depression on this relationship.
The study showed that after adjusting for a set of covariates, SF-36 Physical Component Summary (PCS) scores were negatively associated with depression (B = -2.046, 95% CI 2.584, -1.509) and positively with PA (p < 0.001). Similarly, SF-36 Mental Component Summary (MCS) scores were negatively associated with depression (B = -11.657, 95% CI -12.190, -11.124). In mediation analyses, we found that depression partially mediated the relationship between different types and intensities PA and PCS (moderate leisure-time PA: B = 0.223, 95%CI 0.153,0.293, P < 0.001; vigorous leisure-time PA: B = 0.323, 95%CI 0.232,0.413, P < 0.001; moderate household PA: B = 0.092, 95%CI 0.045,0.139, P < 0.001; vigorous household PA: B = 0.137, 95%CI 0.085,0.190, P < 0.001; work-related PA: B = 0.193, 95%CI 0.658,0.190, P < 0.001) and MCS (moderate leisure-time PA: B = 1.243, 95%CI 1.008,1.479, P < 0.001; vigorous leisure-time PA: B = 1.800, 95%CI 1.585,2.015, P < 0.001; moderate household PA: B = 0.496, 95%CI 0.274,0.718, P < 0.001; vigorous household PA: B = 0.742, 95%CI 0.521,0.963, P < 0.001; work-related PA: B = 1.026, 95%CI 0.819,1.234, P < 0.001).
This study suggested that leisure-time, household, and work-related PA were negatively associated with depression, while positively affecting HRQoL in Chinese older adults. The relationships between different types and intensities of PA and HRQoL were mediated by depression. Interventions aimed at promoting purposeful exercise and different types of PA may have mental health benefits. It is recommended that geriatric health managers and healthcare planners prioritize interventions to help improve PA intensities, alleviate depressive symptoms to promote beneficial effects on HRQoL in older adults.
The relationship between physical disability and depressive symptoms has been associated with social support. Different aspects of social support may play distinct roles in health-related quality of ...life. The aim of this study was to examine the mediation of social support in the relationship between physical disability and depressive symptoms among old people in Mainland China. Subjective support and utilization of support mediated the relationship between ADL and depressive symptoms, with the indirect effect of subjective support and utilization of support at 0.038 and 0.030 respectively (the total effect was 0.180). Subjective support was negatively associated with depressive symptoms in independent elderly people, utilization of support was negatively associated with depressive symptoms in partially dependent elderly people, and utilization of support had a greater association with geriatric depressive symptoms than subjective support in severely dependent elderly people. Social support mechanism and positive psychological intervention should be established and introduced in accordance with the physical disability of the elderly people, to protect them from depressive symptoms.
Circular RNAs (circRNAs) are involved in atherosclerosis (AS) development. However, the function and mechanism of circRNA hsa_circ_0003204 (circ_0003204) in carotid artery AS remain unclear.
Oxidized ...low-density lipoprotein (ox-LDL)-treated human carotid artery endothelial cells (HCtAECs) and THP-1 cells were used as cell models of carotid artery AS. Relative levels of circ_0003204, microRNA-188-3p (miR-188-3p), and transient receptor potential canonical channel 6 (TRPC6) were detected by quantitative reverse transcription-polymerase chain reaction or Western blotting. The targeting relationship between circ_0003204 or TRPC6 and miR-188-3p was assessed via dual-luciferase reporter analysis and RNA immunoprecipitation. Cell proliferation was assessed via 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2
-tetrazolium bromide assay and 5-ethynyl-2'-deoxyuridine (EdU) assay. Cell apoptosis was analyzed via assessing cell caspase-3 activity, apoptosis, and apoptosis-related protein. Inflammatory response was analyzed via analysis of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α). Oxidative stress was assessed via determination of reactive oxygen species (ROS), malondialdehyde (MDA), and superoxide dismutase (SOD).
Circ_0003204 and TRPC6 levels were elevated, and miR-188-3p expression declined in ox-LDL-treated HCtAECs and THP-1 cells. Circ_0003204 could regulate TRPC6 expression via mediating miR-188-3p. Circ_0003204 silencing weakened ox-LDL-induced viability inhibition and apoptosis in HCtAECs, and inflammatory response and oxidative stress in THP-1 cells via regulating miR-188-3p. MiR-188-3p overexpression attenuated ox-LDL-induced injury in HCtAECs and THP-1 cells by targeting TRPC6.
Circ_0003204 knockdown mitigated ox-LDL-induced injury in HCtAECs and THP-1 cells via regulating the miR-188-3p/TRPC6 axis, indicating that circ_0003204 might play an important role in carotid artery AS.
Background
There is limited evidence supporting a relationship of ambient particulate matter (PM), especially PM
1
, with hospital admissions, hospital costs, and length of hospital stay (LOS) due to ...cardiovascular disease (CVD). We used a generalized additive model (GAM) to estimate the associations of these indicators due to CVD for each 10 μg/m
3
increase in the level of PM
1
, PM
2.5
, and PM
10
, and the attributable risk caused by PM on CVD was determined using the WHO air quality guidelines from 2005 and 2021.
Results
For each 10 μg/m
3
increase in the level of each PM and for a 0-day lag time, there were significant increases in daily hospital admissions for CVD (PM
1
: 1.006% 95% CI 0.859, 1.153; PM
2.5
: 0.454% 95% CI 0.377, 0.530; PM
10
: 0.263% 95% CI 0.206, 0.320) and greater daily hospital costs for CVD (PM
1
: 523.135 thousand CNY 95% CI 253.111, 793.158; PM
2.5
: 247.051 thousand CNY 95% CI 106.766, 387.336; PM
10
: 141.284 thousand CNY 95% CI 36.195, 246.373). There were no significant associations between PM and daily LOS. Stratified analyses demonstrated stronger effects in young people and males for daily hospital admissions, and stronger effects in the elderly and males for daily hospital costs. Daily hospital admissions increased linearly with PM concentration up to about 30 µg/m
3
(PM
1
), 60 µg/m
3
(PM
2.5
), and 90 µg/m
3
(PM
10
), with slower increases at higher concentrations. Daily hospital costs had an approximately linear increase with PM concentration at all tested concentrations. In general, hospital admissions, hospital costs, and LOS due to CVD were greater for PM
2.5
than PM
10
, and the more stringent 2021 WHO guidelines indicated greater admissions, costs, and LOS due to CVD.
Conclusions
Short-term elevation of PM of different sizes was associated with an increased risk of hospital admissions and hospital costs due to CVD. The relationship with hospital admissions was strongest for men and young individuals, and the relationship with hospital costs was strongest for men and the elderly. Smaller PM is associated with greater risk.
To evaluate the scan-rescan reproducibility of high-resolution magnetic resonance imaging (MRI) of middle cerebral artery (MCA) plaque, and calculate the number of subjects needed for future ...longitudinal clinical studies.
Twenty two patients with MCA plaque were scanned twice by a T2-weighted fast-spin-echo sequence at 3T. Areas and volumes of MCA lumen, total vessel and plaque were quantified and compared between two repeated scans. Agreement and measurement error was quantified by intraclass correlation coefficient (ICC) and coefficient of variance (CV) as defined by standard deviation (SD) of pair wise difference / mean. Sample size needed to detect 5% to 20% changes in area/volume was calculated using 80% power and 5% significance level.
There was no significant different between the area and volume measurements of two repeated scans (p>0.05) with good agreement (ICC range 0.97-0.98 for area and 0.99 for volume). Relatively small measurement errors were observed with CVs range 6.1%-11.8% for area quantification and 4.9%-8.0% for volume quantification. Volume measurements tended to have 19.7% to 32.2% smaller CVs compared with area measurements. Sample size calculation showed a group of 47 patients was sufficient to detect 5% to 10% changes in MCA area/volume.
High resolution MRI is feasible for quantifying intracranial plaque area and volume in longitudinal clinical studies with low scan-rescan variability. Volume measurement tends to be more reproducible compared with area measurements.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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