Treatment with atorvastatin is associated with a better prognosis in chronic heart failure with systolic dysfunction: results from The Daunia Heart Failure Registry

Background

Few works have evaluated the effect of statins on left ventricular dysfunction in patients with chronic heart failure (CHF), by using tissue Doppler imaging (TDI). We therefore aimed to investigate whether atorvastatin treatment may influence prognosis and myocardial performance evaluated by TDI in subjects with CHF.

Methods

Five hundred thirty-two consecutive CHF outpatients enrolled in a local registry, the Daunia Heart Failure Registry, were prospectively analysed. 195 patients with CHF and left ventricular ejection fraction (LVEF) ≤40 %, either in treatment with atorvastatin (N: 114) or without statins (N: 81), underwent TDI examination. Adverse events were evaluated during follow-up.

Results

The atorvastatin group showed a lower incidence of adverse events (cardiac death: 0 % vs 7 %, p < 0.01), and better TDI performance (E/E’ 15 ± 5.7 vs 18 ± 8.3, p < 001) than controls. Ischaemic CHF patients in treatment with atorvastatin also showed a lower incidence of adverse events (death: 10 % vs 26 %, p < 0.05; sustained ventricular arrhythmias: 5 % vs 19 %, p < 0.05, cardiac death: 0 vs 8 %, p < 0.05) and better TDI performance (E/E’ ratio: 15.00 ± 5.68 vs 19.72 ± 9.14, p < 0.01; St: 353.70 ± 48.96 vs 303.33 ± 68.52 msec, p < 0.01) than controls. The association between atorvastatin and lower rates of cardiac death remained statistically significant even after correction in a multivariable analysis (RR 0.83, 95 % CI 0.71–0.96, p < 0.05 in CHF with LVEF ≤40 %; RR 0.77, 95 % CI 0.62–0.95, p < 0.05 in ischaemic CHF with LVEF ≤40 %).

Conclusions

Treatment with atorvastatin in outpatients with systolic CHF is associated with fewer cardiac deaths, and a better left ventricular performance, as assessed by TDI.     

基于混合优化算法的经颅磁刺激线圈阵列设计

为了研究对经颅磁刺激激励线圈聚焦性能的优化,利用混合优化算法与CST软件的外部通信接口,建立优化的激励线圈模型。依据多信道线圈阵列方法,利用磁场叠加原理,对影响磁场分布的线圈可调参数进行分析,结合混合优化算法对可调参数进行优化。结果对比显示,经优化的线圈阵列有良好的磁聚焦性,其刺激强度与聚焦程度都有了不同程度提高。可用于改善TMS系统聚焦性能,实验有助于进一步探索全面优化激励线圈的空间结构。     

Effect of pentoxifylline treatment on testicular perfusion and semen quality in Miniature horse stallions

The objective was to investigate the effects of pentoxifylline (PTX) on testicular perfusion and sperm production in stallions. In a preliminary study, six mature Miniature horse stallions were given 0, 8.5, or 17.0 mg/kg of PTX orally, twice daily, for 3 d. Total Arterial Blood Flow Rate (TABFR) was higher (P < 0.05) in all treated versus control stallions during and after treatment. Two months later (during the fall and winter), the same stallions received either 0 or 17 mg/kg of PTX orally, twice daily for 60 d. Resistance and pulsatility indices (RI and PI, respectively) decreased in PTX-treated stallions between Treatment 1 and Post-treatment periods. Arterial diameter, as well as Total Arterial Blood Flow (TABF), decreased in controls between Baseline and Treatment 1 (P < 0.05). A similar decrease in arterial diameter was delayed in Group TREATED, but reached significance during Post-treatment (P < 0.05), whereas TABF did not change in this group. Furthermore, TABFR had a transient tendency to increase during Treatment 1 (P < 0.1), whereas it steadily decreased in controls and reached significance in the Post-treatment period (P < 0.05). Both RI and PI were negatively correlated with end diastolic velocity (EDV) in both groups (P < 0.0001). There were positive correlations between RI and peak systolic velocity (PSV) in treated stallions during Treatment 1 (RI: r = 0.53, P = 0.021; PI: r = 0.59, P = 0.007). Also, there were negative correlations between Time Averaged Maximum Velocity (TAMAX) and Doppler indexes in treated stallions during Treatment 2 period (RI: r = −0.49, P = 0.006; PI: r = −0.47, P = 0.008), and during Post-treatment periods (RI: r = −0.40, P = 0.049; PI: r = −042, P = 0.039). Transient hydrocele occurred in all treated stallions (a potential complication of high-dose PTX). Semen end points were not significantly affected by PTX treatment. In conclusion, PTX delayed the seasonal decrease of testicular perfusion in stallions. Sperm quality and quantity were not significantly affected; perhaps they would have been enhanced by prolonged treatment.     

Can forearm muscle activity be selectively recorded using conventional surface EMG-electrodes in transcranial magnetic stimulation? A feasibility study

ObjectivesThis feasibility study evaluates the effect of varying the position of conventional surface EMG-electrodes on the forearm when using Transcranial Magnetic Stimulation (TMS). The aim was to find optimal bipolar electrode positions for forearm extensor muscles, which would be clinically relevant to predict motor recovery after stroke.MethodsIn a healthy female subject, three rings of surface EMG-electrodes were placed around the dominant forearm, leading to 200 different electrode pairs. Both peripheral electrical stimulation and TMS were applied at suprathreshold intensities.ResultsWith electrical stimulation of the median and radial nerve, similar waveform morphology was found for all electrode pairs, covering both flexors and extensors. Also with TMS, remarkable similarities between all electrode pairs were found, suggesting minimal selectivity. In both peripheral electrical stimulation and TMS, the curves became more irregular with decreasing inter-electrode distances.ConclusionNeither with peripheral electrical stimulation nor with TMS it was possible to selectively record extensor or flexor forearm muscle activity using conventional surface EMG-electrodes.SignificanceDespite this negative result, the important role of the forearm extensor muscles in the prognosis of motor recovery after stroke warrants further research into novel methods for selectively recording muscle activity in TMS other than by conventional surface EMG.     

Quantification of Global Diastolic Function by Kinematic Modeling-based Analysis of Transmitral Flow via the Parametrized Diastolic Filling Formalism

Quantitative cardiac function assessment remains a challenge for physiologists and clinicians. Although historically invasive methods have comprised the only means available, the development of noninvasive imaging modalities (echocardiography, MRI, CT) having high temporal and spatial resolution provide a new window for quantitative diastolic function assessment. Echocardiography is the agreed upon standard for diastolic function assessment, but indexes in current clinical use merely utilize selected features of chamber dimension (M-mode) or blood/tissue motion (Doppler) waveforms without incorporating the physiologic causal determinants of the motion itself. The recognition that all left ventricles (LV) initiate filling by serving as mechanical suction pumps allows global diastolic function to be assessed based on laws of motion that apply to all chambers. What differentiates one heart from another are the parameters of the equation of motion that governs filling. Accordingly, development of the Parametrized Diastolic Filling (PDF) formalism has shown that the entire range of clinically observed early transmitral flow (Doppler E-wave) patterns are extremely well fit by the laws of damped oscillatory motion. This permits analysis of individual E-waves in accordance with a causal mechanism (recoil-initiated suction) that yields three (numerically) unique lumped parameters whose physiologic analogues are chamber stiffness (k), viscoelasticity/relaxation (c), and load (x_o). The recording of transmitral flow (Doppler E-waves) is standard practice in clinical cardiology and, therefore, the echocardiographic recording method is only briefly reviewed. Our focus is on determination of the PDF parameters from routinely recorded E-wave data. As the highlighted results indicate, once the PDF parameters have been obtained from a suitable number of load varying E-waves, the investigator is free to use the parameters or construct indexes from the parameters (such as stored energy 1/2kx_o², maximum A-V pressure gradient kx_o, load independent index of diastolic function, etc.) and select the aspect of physiology or pathophysiology to be quantified.     

Storage Organs and Plant Growth

The purpose of this activity is to model the expansion of the universe by investigating the behavior of water waves. It is designed for students in the upper grades of physics and physical science who are learning about the wave nature of light and are ready to discover such important questions about science. The article explains first the Doppler effect through water waves and then extends to how to interpret light waves coming from other galaxies. Therefore, in addition to raising the scientific curiosity of the students, this activity also gives them an understanding of the hypothesis–evidence relation and the interpretation of data.     

脑卒中痉挛性患者经颅磁刺激联合物理治疗后上肢功能恢复状况的临床观察

摘要 目的：探讨脑卒中痉挛性患者经颅磁刺激联合物理治疗后上肢功能改善状况的临床观察。方法：选取我院2018年1月到2020年1月共收治的80例脑卒中患者,所有患者均出现不同部位痉挛现象,将患者随机分为观察组与对照组,每组40例。给予对照组患者常规治疗与康复训练,观察组患者在常规治疗基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练。对比两组患者的治疗效果与上肢功能改善情况。结果：观察组治疗总有效率95.00 %,高于对照组72.50 %（P＜0.05）;治疗前两组患者的NIHSS评分应用神经功能缺损量表（Neurological deficit scale,NIHSS）、MMSE评分应用认知功能量表（Cognitive function scale,MMSE）、ADL评分应用日常生活能力量表（Activities of daily living scale,ADL）评分对比无显著差异（P＞0.05）,治疗后,观察组的NIHSS评分低于对照组,ADL评分高于对照组（P＜0.05）;治疗前两组患者的肱二头肌和肱三头肌均方根值（Root mean square,RMS）对比无显著差异（P＞0.05）,治疗后,观察组患者的肱二头肌RMS低于对照组,肱三头肌RMS高于对照组（P＜0.05）;治疗前两组患者的运动功能评估表中的上肢功能部分（Upper limb function in motor function assessment table,FMA-UE）、手部精细化动作及上肢功能测量表（Measurement table of hand fine movement and upper limb function,Carroll）评分对比无显著差异（P＞0.05）,治疗后,观察组患者的FMA-UE、Carroll评分高于对照组（P＜0.05）。结论：对脑卒中上肢痉挛患者在常规治疗与康复训练的基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练,虽然对患者的认知功能无明显影响,但是能提升患者上肢痉挛的治疗效果,促进患者上肢功能恢复,提高生活能力,值得临床应用推广。     

舍曲林联合经颅磁刺激对青少年首发抑郁症认知功能的影响

目的:探讨舍曲林联合经颅磁刺激(TMS)对青少年首发抑郁症认知功能的影响。方法:选取2018年10月~2020年2月我院青少年首发抑郁症患者94例作为研究对象,简单随机化分为2组,各47例。对照组予以舍曲林治疗,观察组予以TMS联合舍曲林治疗,2组均连续治疗6周。比较2组疗效、不良反应发生率、随访12个月复发率及治疗前后血清微小核糖核酸(miR)-18a、miR-124水平、汉密尔顿抑郁量表(HAMD-17)评分、重复性成套神经心理状态测试(RBANS)中文版评分。结果:观察组总有效率(93.62%)高于对照组(78.72%),差异有统计学意义(P<0.05)。治疗3、6周后观察组血清miR-18a、miR-124水平低于对照组(P<0.05)。治疗3、6周后观察组焦虑/躯体化、睡眠障碍、抑郁迟滞及认知障碍评分低于对照组(P<0.05)。治疗3、6周后观察组即刻记忆、言语功能、视觉广度、注意力及延时记忆评分高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。观察组随访12个月复发率低于对照组(P<0.05)。结论:舍曲林联合TMS首次治疗青少年首发抑郁症,效果显著,能有效调节血清miR-18a、miR-124水平,减轻抑郁症状,从而提高认知功能,降低复发率,保证安全性。     

Neural excitability of lower extremity musculature in individuals with and without chronic ankle instability: A systematic review and meta-analysis

This systematic review and meta-analysis examined differences in lower extremity neural excitability between ankles with and without chronic ankle instability (CAI). We searched the literature for studies that compared corticomotor or spinal reflexive excitability between a CAI group and controls or copers, or between limbs of a CAI group. Random effects meta-analyses calculated pooled effect sizes for each outcome. Nineteen studies were included. Meta-analyses of motor thresholds of the fibularis longus (Z = 1.17, P = 0.24) and soleus (Z = 0.47, P = 0.64) exhibited no differences between ankles with and without CAI. Pooled data indicate that ankles with CAI had reduced soleus spinal reflexive excitability (Z = 2.18, P = 0.03) and significantly less modulation of the soleus (Z = 6.96, P < 0.01) and fibularis longus (Z = 4.75, P < 0.01) spinal reflexive excitability when transitioning to more challenging stances. Pre-synaptic inhibition was facilitated in ankles with CAI (Z = 4.05, P < 0.01), but no difference in recurrent inhibition existed (Z = 1.50, P = 0.13). Soleus spinal reflexive activity is reduced in those with CAI. Reduced ability of ankles with CAI to modulate soleus and fibularis longus reflexive activity may contribute to impaired balance.     

高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性研究

摘要 目的：探讨与研究高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性。方法：2018年2月到2020年1月在本院进行建档分娩的高危孕妇108例作为研究对象,都给予彩色多普勒超声结合四维超声检查,记录影像学特征,判定胎儿缺氧发生情况并进行相关性分析。结果：在高危孕妇108例中,发生宫内缺氧28例（宫内缺氧组）,发生率为25.9 %;宫内缺氧组的大脑中动脉、脐动脉的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速舒张期流速比值（S/D）均高于非宫内缺氧组（P<0.05）;宫内缺氧组的上腔静脉血流心室收缩期峰值流速（S波）、心房收缩期速度（A波）、心室舒张期峰值流速（D波）均高于非宫内缺氧组（P<0.05）;高危孕妇108例中,Spearsman分析显示大脑中动脉、脐动脉的RI、PI、S/D以及上腔静脉血流S、D、A均与宫内缺氧都存在相关性（P<0.05）;logistic多因素回归分析显示：大脑中动脉、脐动脉的S/D与上腔静脉血流S、A为导致胎儿缺氧的主要影响因素（P<0.05）。结论：高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查特征具有相关性,彩色多普勒超声结合四维超声可作为检查胎儿缺氧的可行、简单无创、方便快捷的方式,具有极高的应用价值。