The Incidence and Disease Course of Perianal Crohn's Disease: A Danish Nationwide Cohort Study, 1997-2015

BACKGROUND AND AIMS

Perianal Crohn's disease [CD] places a considerable burden on patients' quality of life and is complex to treat. Despite its impact and high frequency, few studies have investigated the incidence and disease course of perianal CD. The aim of this study was to assess the incidence and disease course of perianal CD in adult patients throughout a 19-year period.

METHODS

The cohort comprised all individuals aged 18 years or older who were diagnosed with CD in Denmark between January 1, 1997, and December 31, 2015, according to the National Patient Registry [NPR].

RESULTS

A total of 1812 [19%] out of 9739 patients with CD were found to have perianal CD. Perianal fistulas were the most common manifestation, accounting for 943 [52%] cases. The incidence of perianal CD remained stable over time. Patients with perianal CD were found to have an increased risk of undergoing major abdominal surgery compared with patients without perianal CD (hazard ratio: 1.51, 95% confidence interval [CI]: 1.40 to 1.64, p <0.001) in a multivariate Cox regression analysis. The incidence rate ratios of anal and rectal cancer in perianal CD patients were 11.45 [95% CI: 4.70 to 27.91, p <0.001] and 2.29 [95% CI: 1.25 to 4.20, p = 0.006], respectively, as compared with non-IBD matched controls.

CONCLUSIONS

In this nationwide study, 19% of CD patients developed perianal disease. Patients with perianal CD were at increased risk of undergoing major surgery compared with non-perianal CD patients. The risk of anal and rectal cancer was increased in patients with perianal CD compared with non-IBD matched controls.

PODCAST

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Uric Acid Variability and All-Cause Mortality: A Prospective Cohort Study in Northern China

OBJECTIVES

Uric acid(UA) is related with cardiovascular disease, but the association of UA variability with all-cause mortality is rarely known. This study aimed to investigate the relationship between UA variability and all-cause mortality in Kailuan cohort study in northern China.

DESIGN

Cohort study.

SETTING

Kailuan community hospitals in Tangshan, Hebei province, Northern China.

PARTICIPANTS

A total of 55717 participants from Kailuan Study were enrolled, and our study followed up biennially from 2006 to 2010.

MEASUREMENTS

Clinical records of the participants enrolled were analyzed. UA variation independent of mean (UAVIM) values were calculated and all the participants were quartile grouped into four groups as: Q1(UAVIM<0.68), Q2(0.68≤UAVIM<1.10), Q3(1.10≤UAVIM<1.67) and Q4(UAVIM≥1.67). The endpoint event was all-cause death. Cox regression model was performed to evaluate the hazard ratios(HRs) of all-cause mortality based on UAVIM groups.

RESULTS

During a median follow-up of 6.83 years, 2926 deaths occurred. The accumulated mortality rates were 4.6%, 4.8%, 5.4% and 6.1% in group Q1, Q2, Q3 and Q4 respectively. When adjusted potential confounders, the highest risk for all-cause mortality was in group Q4 and the adjusted HRs and 95% confidence intervals(CIs) of group Q2-Q4 for all-cause death were 1.044(0.937, 1.164), 1.182(1.064, 1.314) and 1.353(1.220, 1.501) compared with group Q1, respectively. Further analysis showed that the risk for all-cause death increased as UAVIM value increased. Sensitive analysis still showed the similar results when excluding participants with hyperuricemia or severe chronic kidney diseases. Sub-group analysis by age, gender, BMI or hypertension history also indicated analogous results.

CONCLUSION

Elevated UAVIM was related with increased all-cause mortality and UAVIM was an independent risk factor for all-cause mortality in the community cohort study.

[Design of huantai childhood cardiovascular health cohort study]

Cardiovascular disease (CVD) has been an important public health issue in China. Recently, the prevalence of obesity, elevated blood pressure, hyperglycemia, dyslipidemia, and unhealthy lifestyles was high in Chinese children and adolescents, which might increase the risk of short-term target organ damage and adult CVD. Therefore, we selected one primary school in Huantai County, Zibo City between November 2017 and January 2018 to establish the Huantai Childhood Cardiovascular Health Cohort Study. The aim of this project was to investigate the effects of childhood exposures on short-term target organ damage and adult CVD, and to provide evidence to curb the epidemic of CVD in China from the source. A total of 1 515 children aged 6-11 years old were included at the baseline. In this paper, we will introduce the overall design of the survey, including participants, methods, quality control, basic characteristics of the participants, study limitations, and future directions, which might provide some useful implications for similar researches in the future.

[Atypical renal cysts: a clinicopathological and molecular analysis of six cases]

Objective: To investigate the clinicopathological characteristics and molecular genetics of atypical renal cysts. Methods: Six cases of atypical renal cysts were collected from Zhejiang Provincial People's Hospital, Hangzhou, China, between February 2014 and February 2019. The clinicopathological characteristics and disease progression were analyzed. The 3p deletion and trisomy of chromosomes 7 and 17 were detected using fluorescence in situ hybridization (FISH). Results: All of the 6 patients were male, aged 43-63 years (median: 52 years). Preoperative Bosniak classification showed 4 cases of grade Ⅱ, 1 case of grade Ⅰ and 1 of grade Ⅲ. Histologically, atypical renal cysts appeared as unilocular or multilocular cysts, lined by multilayered flattened or cuboidal-shaped clear or eosinophilic cells. They often showed short papillary projections, and lacked solid or nodular growth of the lesional cells within the wall or septa of the cysts. Histologically, these cysts could be classified into three categories: acquired cystic disease-associated renal cell carcinoma (ACKD-RCC)-like (3 cases), clear cell type (2 cases), and eosinophilic papillary type (1 case). Two cases of ACKD-RCC-like atypical renal cysts were accompanied by clear cell renal cell carcinomas. On immunohistochemical staining, ACKD-RCC-like atypical renal cysts were focally CK7+/AMACR+/CD57+, the clear-cell type atypical renal cysts were CK7+/CAⅨ+, and eosinophilic papillary type atypical renal cysts were CK7+/AMACR+. FISH analyses showed that one case of ACKD-RCC-like atypical renal cysts had trisomy 17 and one case of clear cell type had 3p deletion, while no signal abnormality was detected in the other cases. The six patients were followed up for 13 to 70 months (median: 27 months), and no evidence of renal cell carcinoma was noted. Conclusion: Atypical renal cysts are a group of lesions that are heterogeneous in clinical, histological and immunophenotypical and molecular genetic features. FISH analyses suggest that a subset of the cases may be precursors of currently known renal cell carcinomas. Extensively sampling and careful observation of the histological characteristics of the cyst wall are important for distinguishing atypical renal cysts from extensively cystic renal cell carcinomas.

[Association between elevated blood pressure and high carotid intima-media thickness in children according to different blood pressure references]

Objective: To analyze the association between elevated blood pressure (BP) and carotid intima-media thickness (cIMT) in children according to four BP references. Methods: Study population came from"Huantai Childhood Cardiovascular Health Cohort Study"in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to conduct a cross-sectional survey on 1 515 children from November 2017 to January 2018 in a primary school. A total of 1 431 children aged 6-11 years old with complete data were included in this study. Data on demographic characteristics, BP and cIMT were collected through questionnaire survey, physical examination and ultrasound examination. High cIMT was defined as the level of cIMT ≥ age-and sex-specific 90^th percentile of this study population. Based on the Chinese Guideline reference, the Health Industry reference, the International reference and the U.S. reference, all participants were divided into three subgroups: the normal BP, high normal BP and, elevated BP. The multivariate logistic regression models were used to examine the association between BP status and high cIMT in children. Results: The age of children was (8.9±1.5) years, and boys accounted for 53.4% (n=682). The multivariate logistic regression models showed that after adjusting for relevant confounding factors, the risk of high cIMT in elevated BP group was increased compared with the normal BP group according to the four references (all P values<0.05) Conclusion: Elevated BP according to the four BP references is associated with high cIMT in children.

[Association of abdominal obesity in childhood with high carotid intima-media thickness]

Objective: To examine the association of abdominal obesity assessed by waist circumference (WC) with carotid intima-media thickness (cIMT) in children. Methods: The study participants were from the "Huantai Childhood Cardiovascular Health Cohort Study" conducted in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to select a primary school in Huantai County to conduct the baseline survey from November 2017 to January 2018. A total of 1 515 children aged 6-11 years old were included. The first follow-up survey was conducted from November to December 2019, and a total of 981 children aged 8-13 years old were finally included after exclusion of those with high cIMT at baseline. Questionnaire survey, physical examination and ultrasonic examination were used to collect general demographic characteristics, WC and cIMT information. According to the status of WC at baseline, the participants were divided into normal WC group and abdominal obesity group. Covariance analysis was used to compare the cIMT levels of children between normal WC group and abdominal obesity group. Multivariable logistic regression models were used to evaluate the association between baseline abdominal obesity and high cIMT during the follow-up. Results: The age of 981 children was (8.5±1.5) years at the baseline. The follow-up age was (10.5±1.5) years, and 520 boys accounted for 53.0%. The cIMT of children in the abdominal obesity group was 0.54 mm, which was higher than that in the normal WC group (0.51 mm) (P<0.001). Similarly, the prevalence of high cIMT in children with abdominal obesity (23.9%) was higher than that of normal WC group (3.9%) (P<0.001). After adjusting for potential covariates at the baseline and during the follow-up period, compared with the normal WC group, abdominal obesity was significantly associated with high cIMT (OR=5.78, 95%CI:3.43-9.74). Conclusion: The abdominal obesity in children could increase the risk of high cIMT.

Defining heart disease risk for death in COVID-19 infection

BACKGROUND

Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD.

METHODS

Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People's Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD.

RESULTS

Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P < 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722-5.817) and patients with CVD (HR 2.166, 95% CI 1.189-3.948) were independent risk factors for death.

CONCLUSIONS

CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.

Risk factors for recurrent falls in older adults: A systematic review with meta-analysis

Older adults who fall recurrently (i.e., 2 or more falls/year) are at risk of functional decline and mortality. Understanding which risk factors for recurrent falls are most important will inform secondary fall prevention strategies that can reduce recurrent falls risk. Thus, we conducted a systematic review with meta-analysis to determine the relative risk of recurrent falls for different types of falls risk factors. MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched on April 25, 2019 (Prospero Registration: CRD42019118888). We included peer-reviewed prospective studies which examined risk factors that contributed to recurrent falls in adults aged ≥ 60 years. Using the falls risk classification system of Lord and colleagues, we classified each risk factor into one of the following domains: 1) balance and mobility; 2) environmental; 3) psychological; 4) medical; 5) medication; 6) sensory and neuromuscular; or 7) sociodemographic. We calculated the summary relative risk (RR) for each domain and evaluated the risk of bias and quality of reporting. Twenty-two studies were included in this systematic review and meta-analysis. Four domains predicted recurrent falls: balance and mobility (RR:1.32;95 % CI:[1.10, 1.59]), medication (RR:1.53;95 % CI:[1.11, 2.10]), psychological (RR:1.35;95 % CI:[1.03, 1.78]), and sensory and neuromuscular (RR:1.51;95 % CI:[1.18, 1.92]). Each of these four domains can be viewed as a marker of frailty. The risk of bias was low, and the study quality was high (minimum:19/22). Older adults with markers of frailty are up to 53 % more likely to experience recurrent falls. Strategies that identify and resolve frailty markers should be a frontline approach to preventing recurrent falls.

Self-Assembly of Nanoparticles from Evaporating Sessile Droplets: Fresh Look into the Role of Particle/Substrate Interaction

We studied the dependence of solid deposit shape obtained by free drying of sessile drops on particle concentration and Derjaguin-Landau-Verwey-Overbeek (DLVO) particle/substrate interaction. In contrast to previous contributions using pH as a control parameter of interactions, we investigated an unprecedentedly wide range of concentrations and particle/substrate DLVO forces by modifying the nature of the substrate and particles as well as their size and surface chemistry, whereas long-distance repulsive interactions between particles were maintained for most of the drying time. Our main result is that the different shapes of deposits obtained by modifying the particle concentration are the same in the different regimes of concentration regardless of particle/substrate interaction in the studied range of DLVO forces and particle concentrations. The second result is that, contrary to expectations, the dominant morphology of dry patterns at low particle concentration always shows a dotlike pattern for all the studied systems.

[Clinicopathological characteristics of myxoid solitary fibrous tumor: analysis of seven cases]

Objective: To investigate the clinicopathological characteristics, immunophenotypes, and diagnostic and differential diagnostic features of myxoid solitary fibrous tumor (SFT). Methods: Seven cases of myxoid SFT were collected from the archives of Zhejiang Provincial People's Hospital from January 2014 to December 2019. The clinical features, histomorphology, immunohistochemistry, molecular genetics and prognosis were analyzed and the relevant literature was reviewed. Results: There were three male and four female patients ranging from 32 to 67 years. Locations included the pleura (three cases), pelvic cavity, vagina, parotid gland, and nasal cavity(one each). Tumor size ranged from 2.7 to 13.5 cm. Histologically, all cases were characterized predominantly by the presence of myxoid stroma comprising 55% to 90% of the tumor (mean 72%). The tumors were composed of predominantly stellated, spindled or ovoid cells disposed haphazardly, in loose fascicles, or in anastomosing strands imparting a microcystic/reticular appearance in a extensively myxoid, richly vascularized stroma. Staghorn-shaped branching vessels and thin strands of collagen were commonly seen between tumors cells amidst the myxoid background. These myxoid areas were punctuated by small cellular areas showing diagnostic features of classical SFT, which were present in all seven cases. Areas showing giant cell angifibroma-like change were noted in 2 cases and focal lipomatous metaplasia was identified in 1 case. Atypical features suggestive of aggressive behavior were present in 2 cases and in one of the cases myxoid SFT with high-grade sarcomatous overgrowth was noted. Immunohistochemically, tumor cells in all cases stained positively for STAT6 and CD34. Polymerase chain reaction technique showed in both the examined cases the characteristic NAB2ex4-STAT6ex2 fusion gene. According to the Demicco's risk assessment model, four cases were classfied as low, one was classified as moderate and 2 was classified as high. Follow-up information was obtained in 4 cases. One tumor recurred 3 times within 48 months after operation, and the other 3 cases had no tumor recurrence and metastasis. Conclusions: Myxoid SFT represents a rare morphologic variant of SFT with biological behaviors ranging from indolent to aggressive. Myxoid SFT should be included in the differential diagnostic spectrums of soft tissue tumors with significantly myxoid change. Carefully searching for the typical SFT histomorphology with the use of immunohistochemistry and if necessary, molecularly testing for NAB2-STAT6 fusion can help to distinguish myxoid SFT from its many mimickers.

[Association of abdominal obesity and obesity types with carotid intima-media thickness in children in China]

Objective: To evaluate the association of abdominal obesity and obesity types with carotid intima-media thickness (cIMT) in children and provide scientific evidence for the prevention of abnormal vascular structure. Methods: Based on the "Children's Cardiovascular Health Cohort" conducted in Huantai county of Zibo, Shandong province from November 2017 to January 2018, a total of 1 240 children, including 657 boys (53.0%), who had completed data of sex, age, physical examinations, blood biochemical indices and lifestyle variables (collected by questionnaires) were included for the analysis. Covariance analysis was used to compare the levels of cIMT in groups with normal waist circumference, pre-abdominal obesity and abdominal obesity. Logistic regression analysis was used to evaluate the association of pre-abdominal obesity and abdominal obesity with high cIMT, and the association of combined effect of general overweight or obesity and abdominal obesity or pre-abdominal obesity with high cIMT. Results: The levels of cIMT in children with pre-abdominal obesity (0.47±0.03) mm and abdominal obesity (0.50±0.04) mm were higher than that in children with normal waist circumference (0.45±0.05) mm, the difference was significant (P<0.001). The detection rates of high cIMT in children with pre-abdominal obesity(20.8%) and abdominal obesity (49.5%) were higher than that in children with normal waist circumference (8.8%), the difference was significant (P<0.001). Compared with normal waist circumference, pre-abdominal obesity and abdominal obesity were significantly associated with high cIMT (pre-abdominal obesity: OR=2.53, 95%CI: 1.67-3.84; abdominal obesity: OR=8.56, 95%CI: 5.97-12.29) after adjustment for potential covariates. Compared with normal body mass index and normal waist circumference, abdominal obesity or pre-abdominal obesity alone (OR=2.24, 95%CI: 1.36-3.69), and mixed overweight and obesity (OR=6.94, 95%CI: 4.87-9.90) were significantly associated with high cIMT. Conclusions: The association between abdominal obesity and high cIMT was significant in children, and the association was stronger between mixed overweight or obesity and high cIMT, suggesting that we should consider mixed overweight and obesity in the prevention of abnormal vascular structure.

[Detection of hypertension based on measurements at three occasions in different days and its relationship with obesity in children]

Objective: To analyze the trends in blood pressure (BP) values and the elevated BP based on the measurements at three occasions in different days and its relationship with obesity in children and provide scientific evidence for the identification and prevention of hypertension in children. Methods: A public primary school in Huantai county of Zibo, Shandong province, was selected as the investigation field by using a convenient cluster sampling method. The baseline survey of "Children's Cardiovascular Health Cohort" was carried out from November 2017 to January 2018. All the students with willingness and informed consent in this school were included in the survey, and the valid sample size was 1 505 children (aged 6-11 years). Children with elevated BP at the measurement of the first occasion should had a second measurement 2 weeks later, and a third measurement was given 2 weeks later if BP was still high at the measurement of the second occasion. Hypertension was confirmed if elevated BP was detected in the measurements at all the three occasions in different days. Multivariate linear regression model was used to assess the trend in BP values in children in the measurements at three occasions in different days, Cochran-Armitage trend analysis was used to evaluate the trend of elevated BP, and logistic regression model was used to analyze the relationship of elevated BP with obesity at three occasions in different days. Results: In this study, with the increase of follow-up visits, the BP levels continued to rise (trend P<0.05). The elevated BP rates at three occasions were 15.5%, 4.0% and 1.9%, respectively, showing a significantly downward trend (trend P<0.05). Compared with both normal weight and normal waist circumference, the association between obesity types (general obesity only, abdominal obesity only, and mixed obesity) and elevated BP at three occasions increased (the first occasion: OR=3.62, 95%CI: 2.65-4.96; the second occasion: OR=9.50, 95%CI: 4.95-18.22; and the third occasion: OR=8.94, 95%CI: 3.48-22.96; all P<0.05). Stratified analysis by gender showed similar results. Conclusions: The elevated BP rates based on the measurements at three occasions in different days in children aged 6-11 years showed a significant decrease trend. The association between different types of obesity (especially mixed obesity) and elevated BP in children became stronger gradually with the progress of the follow up.

Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy via MAPK pathway

OBJECTIVE

To investigate the effect of melatonin on diabetic retinopathy rats through the mitogen-activated protein kinase (MAPK) pathway.

MATERIALS AND METHODS

A total of 48 Sprague Dawley (SD) rats were randomly divided into normal group (n=12), model group (n=12), melatonin group (n=12), and inhibitor group (n=12). The rats in normal group received no treatment. Those in model group, melatonin group, and inhibitor group were prepared into models of diabetic retinopathy and intraperitoneally injected with normal saline, melatonin, and SB 203580, respectively. After 7 days of intervention, the materials were taken. The expressions of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) were detected through immunohistochemistry. Western blotting was employed to determine the protein expression levels of p38 MAPK, phosphorylated (p)-p38 MAPK, and cysteinyl aspartate specific proteinase-3 (Caspase-3). The messenger ribonucleic acid (mRNA) expression levels of Bax and Bcl-2 were measured via quantitative Polymerase Chain Reaction (qPCR). Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of serum interleukin-1β (IL-1β) and IL-18. The apoptosis was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL).

RESULTS

Based on immunohistochemistry, model group, melatonin group, and inhibitor group exhibited significantly increased positive expression of Bax but notably decreased positive expression of Bcl-2 in comparison with normal group (p<0.05). Compared with those in model group, the positive expression of Bax was clearly reduced, while the positive expression of Bcl-2 was overtly raised in melatonin group and inhibitor group (p<0.05). The results of Western blotting showed that there was no difference in the protein expression of p38 MAPK among all groups (p>0.05). Compared with normal group, the other three groups had remarkably elevated protein expressions of p-p38 MAPK and Caspase-3 (p<0.05). The protein expressions of p-p38 MAPK and Caspase-3 in melatonin group and inhibitor group were significantly lower than those in model group decreased (p<0.05). QPCR assay revealed that the mRNA expression of Bax was markedly lower in normal group than that in the other three groups, while the mRNA expression of Bcl-2 was significantly higher in normal group than that in the other three groups (p<0.05). Compared with model group, melatonin group, and inhibitory group showed clearly declined mRNA expression level of Bax and notably increased mRNA expression level of Bcl-2 (p<0.05). TUNEL results revealed that the apoptosis rate was remarkably elevated in the other three groups compared with that in normal group (p<0.05). In comparison with model group, melatonin group and inhibitor group exhibited significantly reduced apoptosis rate (p<0.05).

CONCLUSIONS

Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy by repressing the MAPK pathway.

Feasibility and advantages of endoscope-assisted parotidectomy: a systematic review and meta-analysis

The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included 'Endoscope', 'Endoscopes', 'Cancer of Parotid', and 'Parotid Cancer'. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery. This meta-analysis included seven studies, involving 170 patients in the endoscopy group and 270 patients in the control group. The analysis using the pooled data showed that there were no significant differences in the operating times between the two groups; however, the endoscopy group had significantly shorter incisions and less intraoperative bleeding. In addition, the patients who received endoscope-assisted surgery had lower incidences of temporary facial paralysis and Frey's syndrome after surgery. Patients in the endoscopy group had greater postoperative satisfaction. Endoscope-assisted parotid tumour resection results in only a small, concealed incision wound and fewer postoperative complications. Therefore, it is promising for the surgical treatment of parotid tumours.

Hemorrhagic patterns and their risk factors in patients with moyamoya disease

BACKGROUND AND PURPOSE

The aim was to describe the profiles of hemorrhagic patterns of moyamoya disease (MMD) and analyze the risk factors in a large population.

METHODS

A total of 335 conservatively managed MMD patients with hemorrhage in our hospital were included in this cross-sectional study. The correlation between clinical and angiographic characteristics and hemorrhagic patterns (anterior or posterior hemorrhage) was assessed in the hemorrhagic hemisphere by univariate and multivariate logistic regression models. In addition, stratified analysis was performed.

RESULTS

The 335 hemorrhagic hemispheres (patients) comprised 179 (53.4%) anterior and 156 (46.6%) posterior hemorrhages. For all cases, age at onset [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.96-1.00; P = 0.048] and choroidal anastomosis (OR 1.87; 95% CI 1.19-2.94; P = 0.007) were found by multivariate regression analysis to be negatively and positively associated with a significantly increased risk of posterior hemorrhage, respectively. After stratified analysis, hypertension (OR 0.37; 95% CI 0.14-0.97; P = 0.043) was identified by multivariate regression analysis as a risk factor for anterior hemorrhage in patients without dilation of choroidal anastomosis. On the other hand, choroidal anastomosis (OR 2.62; 95% CI 1.02-6.72; P = 0.045) and involvement of the posterior cerebral artery (OR 3.39; 95% CI 1.20-9.63; P = 0.022) were associated with significantly increased risk of posterior hemorrhage in children and young adults (<30 years of age).

CONCLUSIONS

A dynamic change in hemorrhagic patterns in MMD patients with increasing age at onset was observed. Choroidal anastomosis is a predictor of posterior hemorrhage. Hypertension is a risk factor for anterior hemorrhage in patients without extreme dilation of choroidal anastomosis.

[Relationship between parental history of hypertension and childhood hypertension]

To explore the relationship between parental hypertension history and hypertension in children and adolescents based on the relevant data of 6 049 children and adolescents aged 6 to 17 years old in Jinan city from September 2012 to September 2014. The results showed that the history of hypertension in parents was positively correlated with systolic blood pressure in children and adolescents, with the value of coefficient β (95%CI) about 0.91 (0.23-1.59). Compared with children and adolescents whose parents had no history of hypertension, those with history of hypertension in one parent and both parents were more likely to develop hypertension, with OR values (95%CI) about 1.28 (1.01-1.61) and 2.24 (1.09-4.61), respectively. Therefore, it is suggested that prevention and intervention measures should be taken as soon as possible for children and adolescents whose parents have a history of hypertension.