A simulation approach for power calculation in large cohort studies based on multistate models

Realistic power calculations for large cohort studies and nested case control studies are essential for successfully answering important and complex research questions in epidemiology and clinical medicine. For this, we provide a methodical framework for general realistic power calculations via simulations that we put into practice by means of an R‐based template. We consider staggered recruitment and individual hazard rates, competing risks, interaction effects, and the misclassification of covariates. The study cohort is assembled with respect to given age‐, gender‐, and community distributions. Nested case‐control analyses with a varying number of controls enable comparisons of power with a full cohort analysis. Time‐to‐event generation under competing risks, including delayed study‐entry times, is realized on the basis of a six‐state Markov model. Incidence rates, prevalence of risk factors and prefixed hazard ratios allow for the assignment of age‐dependent transition rates given in the form of Cox models. These provide the basis for a central simulation‐algorithm, which is used for the generation of sample paths of the underlying time‐inhomogeneous Markov processes. With the inclusion of frailty terms into the Cox models the Markov property is specifically biased. An “individual Markov process given frailty” creates some unobserved heterogeneity between individuals. Different left‐truncation‐ and right‐censoring patterns call for the use of Cox models for data analysis. p‐values are recorded over repeated simulation runs to allow for the desired power calculations. For illustration, we consider scenarios with a “testing” character as well as realistic scenarios. This enables the validation of a correct implementation of theoretical concepts and concrete sample size recommendations against an actual epidemiological background, here given with possible substudy designs within the German National Cohort.     

Rigorous conformational analysis of right and left DNA helices and junction between them

On the basis of complete scanning through conformational space of dihedral angles, twelve structural genera were obtained. Subsequent energy minimization within these genera yielded a limited set of duplexes with stacking: right-handed B-form (Wilkins type), B2-form (Watson and Crick type) and left-handed Ll-form (Sasisekharan type) and the new L2-form. In the polymeric DNA only right-handed double-helices are possible, the left-handed helices are forbidden due to poor 1–5 interchain contacts. In contrast, for short fragments the left- and right-handed helicek have practically the same energies providing some physical ground for side-by-side form, which biologically is possible as recombination form and may be as replication form.     

Matching models of left ventricle and systemic artery

To reveal how the matching models of the left ventricle and its afterload affect the pressure and flow in the aortic root, the differences between the measured pressure and flow waveforms and those determined by three kinds of matching model were compared. The results showed that, compared with the results by both matching models 1 and 2, the pressure and flow waveforms determined by matching model 3 established in this work were in the closest agreement with the corresponding experimental waveforms, therefore indicating that matching model 3 was a matching model that closely and rationally characterized the match between the left ventricle and the systemic artery.     

高原人体左心室舒张功能和顺应性的改变

应用同步描记心电图、心音图、颈动脉搏动图和心尖搏动图以测定高原人体的左心室舒张功能和顺应性。在4个不同海拔高度进行实验,即76m(海平对照)、2161m、3270m和4179m,每一高度40名健康男性青年,高原3组世居、移居各20名。结果显示:随着海拔增高,主动舒张时间指数(TRTI)有减小趋势,RF波相对振幅(F/H)逐渐降低,A波相对振幅(A/D)则渐趋增大,3270m以上增大明显(p<0.05),舒张振幅时间指数(DATI)逐渐降低,3270m以上差异极显著(p<0.001)。高原世居与移居者相比,在海拔4179m出现明显差别,移居组TRTI、DATI、F/H较低而A/D较高(D<0.05)。测定射血前期与左室射血时间比值(PEP/LVET)、射血分数(EF)及左室周径纤维平均缩短速度(mVcf)3项指标作对照,显示在此高度左室收缩功能仍能保持。高原慢性心肌缺氧可能是导致左室舒张功能和顺应性轻度降低的原因。     

AGT基因SNPs与哈萨克族高血压左室肥厚关系的研究

目的探讨血管紧张素原基因（angiotensinogen gene,AGT）-6A／G,-20A／C,M235T和T174M 4个单核苷酸多态性（single nucleotide polymorphisms,SNPs）与新疆哈萨克族高血压患者左室肥厚的关系。方法采用低渗溶血法破裂血细胞、蛋白酶K消化、饱和酚／氯仿抽提法提取白细胞基因组DNA。采用聚合酶链反应-限制性片断长度多态性（polymerase chain reaction—restriction fragment length polymorphism,PCR-RFLP）技术进行个体基因型分型。结果①在不考虑年龄、高血压病史时间、性别及收缩压、舒张压对左室肥厚的影响的前提下,未发现-6A／G、-20A／C与哈萨克族高血压左室肥厚的相关关系。②在以性别作为亚变量的分析结果中,我们发现-6A／G和-20A／C分别与哈萨克族女性和男性高血压左室肥厚相关。③不同SNPs间的配对连锁不平衡分析结果显示,除M235T与T174M之间外,其他各位点间存在有统计学意义的连锁不平衡关系。④单体型分析结果发现,研究人群AGT基因-6A／G、-20A／C、M235T和T174M4个SNPs构成了11种主要的单体型,其中H2（A—G—M—T）、H5（C—A—M—M）、H6（C—A-T—T）、H9（C-A—T—M）的频率在左室肥厚、非左室肥厚两组的分布存在差异,且具有统计学意义（P〈0．05）。结论AGT基因-6A／G、-20A／C、M235T和T174M变异可能与新疆哈萨克族高血压左室肥厚有关。     

Is CD36 gene polymorphism in region encoding lipid-binding domain associated with early onset CAD?

CD36 is a fatty acid translocase in striated muscle cells and cardiomyocytes. Some study suggested that alterations in CD36 gene may be associated with coronary artery disease (CAD) risk. The aim of the current study was to compare the frequency of CD36 variants in region encoding lipid-binding domain in Caucasian patients with early-onset CAD, no-CAD adult controls and neonates. The study group comprised 100 patients with early onset CAD. The genetic control groups were 306 infants and 40 no-CAD adults aged over 70 years. Exons 4, 5 and 6 including fragments of flanking introns were studied using the denaturing high-performance liquid chromatography technique and direct sequencing. Changes detected in analyzed fragment of CD36: IVS3-6 T/C (rs3173798), IVS4-10 G/A (rs3211892), C311T (Thr104Ile, not described so far) in exon 5, G550A (Asp184Asn, rs138897347), C572T (Pro191Leu, rs143150225), G573A (Pro191Pro, rs5956) and A591T (Thr197Thr, rs141680676) in exon 6. No significant differences in the CD36 genotype, allele and haplotype frequencies were found between the three groups. Only borderline differences (p = 0.066) were found between early onset CAD patients and newborns in the frequencies of 591T allele (2.00% vs 0.50%) and CGCGCGT haplotype (2.00% vs 0.50%) with both IVS3-6C and 591T variant alleles. In conclusion, CD36 variants: rs3173798, rs3211892, rs138897347, rs5956, rs143150225 rs141680676 and C311T do not seem to be involved in the risk of early-onset CAD in Caucasian population.     

慢性肾脏病并发左室肥厚现况及其危险因素

目的：探索中老年慢性肾脏病并发左室肥厚（LVH）的现况及其危险因素。方法：对我院肾内科住院的40-75岁CKD2-5期患者210例的病历资料进行回顾性分析。结果：（1）心脏舒张功能减退发生率高于收缩功能减退（79.1%VS 20.3%P=0.000）;左房扩大检出率高于左室扩大检出率（46.5%VS 19.8%P=0.000）;室间隔增厚检出率（IVSH）也高于左室后壁增厚检出率（LVPWH）（43.0%VS 21.1%P=0.000）;LVH的发生率高于IVSH检出率（47.9%VS 35%P=0.001）,其中女性LVH高于男性（73.2%VS31.0%P=0.000）,然而若采用另外一种诊断标准,两者并无统计学差异（50%VS 34.5%P=0.068）。（2）IVSH组收缩压、脉压、血肌酐均高于无IVSH组。IVSH组除上述因素外血磷尚高于无IVSH组,但在CKD5期的亚组分析中仅收缩压与对照组相比有统计学差异。LVH组收缩压、脉压均高于无LVH组,而血红蛋白、体质指数则低于对照组。进一步Logistic回归分析提示仅性别、体质指数有统计学意义。结论：（1）40-75岁的心血管疾病高危的CKD患者中,采用超声心动图诊断LVH,根据公式计算的LVMI诊断阳性率最高,但诊断切点仍需进一步研究。（2）收缩压升高、脉压增大、贫血、低体质指数、女性均可能是LVH的危险因素,控制血压、纠正贫血和营养不良可能是防治LVH的重要靶点。     

Rescuing infusion of miRNA-1 prevents cardiac remodeling in a heart-selective miRNA deficient mouse

Objective

The decreased expression of muscle-specific microRNA-1 (miR-1) has been found in many cardiovascular diseases and is considered to contribute to heart failure (HF). Here we investigated the role of miR-1 in myocardium protection by infusion of miR-1 in a cardiac global miRNA-deficient mouse.

清醒大鼠在体左心室力学性能的导管测定方法

本文采用左心室导管保留法对清醒小动物（大鼠）进行了在体心脏心肌力学性能的测定。该法如操作得当,成功率较高,得到的结果也令人满意;且较简便、经济和具有一定价值     

Anticoagulation for the Acute Management of Ischemic Stroke

Few prospective studies support the use of anticoagulation during the acute phase of ischemic stroke, though observational data suggest a role in certain populations. Depending on the mechanism of stroke, systemic anticoagulation may prevent recurrent cerebral infarction, but concomitantly carries a risk of hemorrhagic transformation. In this article, we describe a case where anticoagulation shows promise for ischemic stroke and review the evidence that has discredited its use in some circumstances while showing its potential in others.