WIT120 data mining technology based on internet of things.

Background and aimWith multimorbidity becoming increasingly prevalent in the ageing population, addressing the epidemiology and development of multimorbidity at a population level is needed. Individuals subject to chronic heart disease are widely multimorbid, and population-wide longitudinal studies on their chronic disease trajectories are few.MethodsDisease trajectory networks of expected disease portfolio development and chronic condition prevalences were used to map sex and socioeconomic multimorbidity patterns among chronic heart disease patients. Our data source was all Danish individuals aged 18 years and older at some point in 1995-2015, consisting of 6,048,700 individuals. We used algorithmic diagnoses to obtain chronic disease diagnoses and included individuals who received a heart disease diagnosis. We utilized a general Markov framework considering combinations of chronic diagnoses as multimorbidity states. We analyzed the time until a possible new diagnosis, termed the diagnosis postponement time, in addition to transitions to new diagnoses. We modelled the postponement times by exponential models and transition probabilities by logistic regression models.FindingsAmong the cohort of 766,596 chronic heart disease diagnosed individuals, the prevalence of multimorbidity was 84.36% and 88.47% for males and females, respectively. We found sex-related differences within the chronic heart disease trajectories. Female trajectories were dominated by osteoporosis and male trajectories by cancer. We found sex important in developing most conditions, especially osteoporosis, chronic obstructive pulmonary disease and diabetes. A socioeconomic gradient was observed where diagnosis postponement time increases with educational attainment. Contrasts in disease portfolio development based on educational attainment were found for both sexes, with chronic obstructive pulmonary disease and diabetes more prevalent at lower education levels, compared to higher.ConclusionsDisease trajectories of chronic heart disease diagnosed individuals are heavily complicated by multimorbidity. Therefore, it is essential to consider and study chronic heart disease, taking into account the individuals’ entire disease portfolio.

The leading position in the structure of causes of death from cardiovascular diseases is occupied by coronary heart disease, which is the most serious problem of modern cardiology and medicine in general. Mortality rates from coronary heart disease are now on the decline, thanks to advances in diagnosis, treatment, and risk factor management. Chronic diseases have an important and adverse effect on the quality of life, and it is well known that its improvement is the ultimate and important goal of modern medicine. Aim. The study of quality of life indicators and factors influencing its decline in men with chronic coronary heart disease, with comorbid association with metabolic syndrome. Materials and methods. 115 men with chronic ischemic heart disease were examined, of which 67 had metabolic syndrome. Metabolic syndrome was diagnosed based on the criteria of clinical recommendations of the All-Russian Scientific Society of Cardiology in 2009. The quality of life and the degree of its decline were determined using the methodology developed by A.G. Gladkov et al. (1982) adapted by T.A. Ayvazyan et al. (1989). Results. Among the surveyed men with chronic coronary heart disease and metabolic syndrome, quality of life indicators of varying degrees of decline were found in more than 70% of the surveyed. A decrease in quality of life in men with chronic coronary heart disease with metabolic syndrome was more often observed in individuals with a five-component combination of metabolic syndrome. The most frequent metabolic syndrome clusters among men with different levels of quality of life decline were three- and four-component combinations, including abdominal obesity, arterial hypertension and dyslipidemia disorders. Conclusion. It was found that in men with chronic coronary heart disease, the decrease in quality of life was largely due to the presence of the metabolic syndrome.

Objectives: An aging population has more individuals with chronic diseases and greater medical utilization. In a fee-for-service payment system, patients tend to visit different specialists for their various conditions. This study analyzed the impact of patterns of chronic disease on medical utilization. Methods: This study used the National Health Insurance database to identify patients who had been diagnosed with chronic kidney disease, diabetes or hypertension, were aged 20 or older, and were alive at the end of 2006. The study measured the prevalence of chronic diseases in 2006 after excluding the patients who died in 2007. The study then analyzed current medical utilization by patients with chronic diseases. Results: There were 2,539,137 patients with at least one chronic disease in 2006, and the prevalence rate was 14.83%. The highest medical utilization was by patients with all three chronic diseases. For outpatient care, the numbers of visits, different departments, different physicians, and different hospitals/clinics were 33.20, 5.41, 8.46 and 4.57, respectively. For inpatient care, the average numbers of visits, hospital days, and hospitals/clinics were 0.71, 7.37 and 0.43, respectively. Outpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and hypertension were significantly higher than those of patients with hypertension alone. Inpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and diabetes was significantly higher than that of patients with hypertension alone. Conclusions: Patterns of chronic diseases influence medical utilization. We suggest that health authorities provide appropriate financial incentives to encourage physicians to provide services and better treatment recommendations for patients with multiple chronic conditions.

Pulmonary Hypertension: From an Orphan Disease to a Public Health Problem

Objectives. To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil.Study design. A Cross-sectional study comprising two population-based health surveys conducted in 2002 and 2003.Methods. A total of 8317 persons (165 with PD) were interviewed in the two studies. Variables concerning to health self-assessment; chronic disease and recent illness were compared in the people with and without PD. Negative binomial regression was used in the analysis.Results. Subjects with PD more often assessed their health as poor/very poor compared to non-disabled ones. They reported more illnesses in the 15 days prior to interview as well as more chronic diseases (skin conditions, anaemia, chronic kidney disease, stroke, depression/anxiety, migraine/headache, pulmonary diseases, hypertension, diabetes, arthritis/arthrosis/rheumatic conditions and heart disease). This higher disease prevalence can be either attributed to disability itself or be associated to gender, age and schooling.Conclusions. Subjects with PD had more recent illnesses and chronic diseases and poorer health self-assessment than non-disabled ones. Age, gender, schooling and disability have individual roles in disease development among disabled people.

The cerebral white matter hyperintensity (WMH) is frequently noted in patients with chronic heart disease. Long-term alteration of cardiac hemodynamics might have an influence on the mechanism of cerebral WMH. To investigate the association between chronically altered cardiac hemodynamics and severity of cerebral WMH in patients with chronic valvular heart disease. This cross-sectional analysis identified 303 consecutive patients at a tertiary referral center between 2008 and 2016 who were 50 years or older, and diagnosed with severe chronic valvular heart disease and underwent cardiac catherization, echocardiography, and received brain magnetic resonance imaging. Among these patients, 71 with other demonstrated cardiac disease, central nervous system disease, and/or without sufficient catheterization data were excluded, and the remaining 232 patients were included in further analyses. The site and mechanism of valve diseases, as well as clinical and medication profiles, were reviewed. Cardiac catheterization parameters such as right atrial (RA) mean pressure, right ventricular pressure, and aortic mean pressure were obtained. Comprehensive echocardiographic hemodynamic markers such as left ventricular (LV) ejection fraction, LV mass index, LV end diastolic volume, cardiac index, and E/e' ratio were also obtained. White matter hyperintensity volume was quantitatively evaluated using volumetric analysis. This study included 232 patients (103 men [44.4%] and 129 women [55.6%]; mean [SD] (range) age, 65.6 [8.8] (51-88) years) in the final analysis. The mean (SD) WMH volume was 5.93 (7.14) mL (median [interquartile range], 4.33 [1.33-8.62] mL), and mean (SD) RA pressure was 10.0 (4.7) mm Hg. From the catheterization data, 147 patients (63.4%) were classified as having a disease involving the mitral valve; 93 (40.1%), aortic valve; 37 (15.9%), tricuspid valve; and 4 (1.7%), pulmonary valve. In multivariate linear regression analysis, adjusting the type and mechanism of valve disease and clinical, echocardiographic, and/or other catheterization parameters, WMH volume was linearly associated with mean RA pressure (B coefficient, 0.702; 95% CI, 0.373-1.031; P = .001), along with age (B coefficient, 0.145; 95% CI, 0.029-0.261; P = .01) and mean aortic pressure (B coefficient, 0.112; 95% CI, 0.034-0.190; P = .005). Mean RA pressure was independently associated with the WMH volume in chronic valvular heart disease. Chronically altered RA hemodynamics might have a distinct influence on the pathomechanism underlying the development of WMH.

Objective Investigate the clinical of chronic pulmonary heart disease (PHD) with pulmo-nary hypertension and the level of B-typo natriuretic peptide (BNP). Methods 80 cases of PHD measure pul-monary arterial pressure by cardiac ultrasound BNP, At the same time, Detected their blood BNP. According to the level of pulmonary arterial pressure is divided into normal, mild, moderate, severe pulmonary hypertension group,compared the level of BNP in each group. Results The level of BNP in Severe pulmonary hypertension group was the most highest in normal,mild and moderate pulmonary hypertension group (P<0.01). There has a positive correlation between Pulmonary artery pressure and the level of BNP (r=0.79, P<0.001). Conclu-sion In patients of Chronic pulmonary heart disease,pulmonary hypertension increased with the BNP,There has a positive correlation between Pulmonary artery pressure and the level of BNP. Key words: Chronic pulmonary heart disease; Pulmonary artery pressure; B-type natriuretic peptide

Objective To evaluate the effects of Lipo PGE1 on severe chronic pulmonary heart disease patients combined with pulmonary hypertension.Methods Sixty-eight cases of severe chronic pulmonary heart disease combined with pulmonary hypertension were randomly divided into treatment group (34 cases) and control group(34 cases).Both groups received the conventional antibiotics,oxygen therapy and other treatments,and 10 μg Lipo PGE1 were added to the treatment group every day.Serum CNP,ADM levels and pulmonary artery pressure,arterial oxygen tension (PaO2),partial pressure of arterial blood sputum dioxide (PaCO2) were measured before and after the treatment.Results After treatment,blood CNP,ADM levels and pulmonary artery pressure,PaCO2 was significantly lower than those before treatment,PaO2 was significantly higher than that before treatment.There were significant difference between the treatment group and the control group (P ＜ 0.05).Conclusions Lipo PGE1 can significantly reduce the serum CNP,ADM levels and pulmonary artery pressure of patients of chronic pulmonary heart disease combined with pulmonary hypertension,and improve the cardiac function,pulmonary hypertension and arterial blood gas. Key words: Lipo PGE1; C-type natriuretic peptide; Adrenomedullin; Pulmonary hypertension; Arterial blood gas

Long-term, flexible therapy strategies are needed for chronic diseases like cardiovascular ailments, diabetes, and chronic kidney disease and they have to deal with patient heterogeneity, changing physiological states and privacy constraints. This research suggests a framework for privacy-preserving and personalized artificial intelligence that combines Federated Learning (FL), a Res-HyperTransformerNet deep prediction model, Personalized Multi-Agent Reinforcement Learning (PMARL) and Explainable Artificial Intelligence (XAI) for adaptive chronic disease management. The framework is structured with two main aims: (i) to create an accurate and privacy-aware predictive model for chronic disease risk using diverse data sources, and (ii) to permit adaptive, individual therapy optimization through multi-agent reinforcement learning. Federated learning is utilized to conduct the training of Res-HyperTransformerNet over distributed Internet of Medical Things (IoMT) nodes without the requirement of transferring raw patient data. The embeddings that are created from patient data are then passed on to a PMARL module, where several agents optimize therapy dimensions like medications, diet, physical activity, and mental health interventions independently. To make the clinical support more understandable, the SHAP-based explainability method is used for both predictive and decision-making parts. The framework is tested using two public datasets—the CDC Chronic Disease dataset and the UCI Chronic Kidney Disease Risk Factor dataset. The performance is measured by employing classification metrics (accuracy, precision, recall, F1-score, MCC) as well as reinforcement learning metrics (reward score, convergence steps, episode return) and federated system metrics (communication overhead, convergence rounds, and training time). The experiments indicate that the proposed framework demonstrated improved performance in terms of predictive accuracy and policy convergence speed compared to the baseline deep learning and reinforcement learning models, and at the same time it is more cost-effective when it comes to communication in a federated setting. This means that the proposed method suggests the potential of being a reproducible and open AI framework for adaptive chronic disease therapy management. The combination of ResNet and Transformer blocks, i.e., Federated Res-HyperTransformerNet, achieved strong performance in both datasets, namely CDC Chronic Disease (Dataset 1) and UCI CKD Risk Factor (Dataset 2). The obtained accuracy for Dataset 1 was 98.61% and for Dataset 2, it was 97.75%, under the conducted experimental settings.

To investigate the value of tissue Doppler imaging (TDI) in the diagnosis of right ventricular hypertrophy in patients with silicosis complicated by chronic pulmonary heart disease. A total of 50 cases of silicosis complicated by chronic pulmonary heart disease in our hospital underwent conventional electrocardiography (ECG) and TDI. The detection rates for right ventricular hypertrophy by two methods were compared. Of 50 cases of silicosis complicated by chronic pulmonary heart disease, 19 were diagnosed with right ventricular hypertrophy by ECG, with a detection rate of 38.0%; 29 were diagnosed with right ventricular hypertrophy by TDI, with a detection rate off 58.0%. Statistical analysis suggested that TDI leads to a significantly higher detection rate for right ventricular hypertrophy in patients with silicosis complicated by chronic pulmonary heart disease (χ² = 4.006, P = 0.036). Both TDI and ECG can be used for detecting right ventricular hypertrophy in patients with silicosis complicated by chronic pulmonary heart disease, but the detection rate is higher when TDI is employed. In addition, ECG cannot directly reflect the increase in pulmonary artery pressure. Therefore, TDI is more suitable for the diagnosis of right ventricular hypertrophy in patients with silicosis complicated by chronic pulmonary heart disease and provides a strong diagnostic basis for the clinical treatment of silicosis complicated by pulmonary heart disease.

The aim of this study was to analyze patients with air-travel-related venous leg thromboembolism (VTE) concerning the occurrence of patient-related and cabin-related risk factors. Twenty-five patients, still in hospital, with deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) with onset of symptoms during or after air travel were questioned according to a study protocol. There were 14 women and 11 men with an age range of 36-79 years. Flight times were 5-18 hours. All patients had DVT, and nine (36%) had PE as well. The proximal extensions of the thrombus were in tibial vein, five patients; popliteal vein, two patients; superficial femoral vein, three patients; common femoral vein, four patients; greater saphenous vein, four patients; and iliac vein, seven patients. All but two patients (92%) had one or more patient-related risk factors; the mean was three. Overweight was present in 76% of the patients; chronic heart disease in 44%; hormone medication in 40%; chronic disease, except chronic heart disease and malignancy in 32%; history of previous VTE in 28%; malignancy in 28%; smoking in 20%; recent lower limb injury in 16%; and recent surgery in 12%. Only two patients had no known patient-related risk factor. The flight travel itself does not seem to be an important risk factor in healthy individuals. However, when patient-related risk factors are superimposed, there is increasing evidence that cabin-related risk factors, such as immobilization, cramped “coach” position, insufficient fluid intake, low humidity, and hypoxia contribute to development of VTE. Improved information is required so that passengers can prepare their travel in good time. Active precautions are recommended.

As the world’s population ages, mortality increasingly reflects the ravages of complex chronic diseases, particularly cancer and heart disease. A person’s risk of succumbing to a chronic disease is linked to his or her genetics. This genome-centric view of causation is motivated by the technologic ability to detect and manipulate genes, and fosters the notion that genetic factors are necessary determinants of disease that operate in a causal background of diverse exposures. Chronic venous disease is highly prevalent in the Western side. The recent developments in sequencing technology, clinicians and geneticists alike are embarking on a journey to identify and unravel the genetic candidates of chronic venous disease. Currently substantial evidence to suggest the presence of genetic influences in the aetiology and pathology of venous disease. The researchers should be urged to foster collaborative links and design a genome-wide case-control association study as an international consortium to provide a statistically robust paradigm in the field of chronic venous disease genetics. Family history is a well-known risk factor for developing many common chronic diseases, such as diabetes, asthma, and coronary heart disease, and reflects inherited genetic and shared environmental contribution in disease. The future directions include incorporating genotype information to partition DNA-transmitted genetic versus environmental variance in phenotype in family history to decompose the various components of risk influenced by familial disease. An accurate diagnosis is also crucial for genetic counseling and family planning and allows reproductive options, such as prenatal or pre-implantation genetic testing. It allows screening of at-risk family members, which may also be important in determining their eligibility as kidney transplant donors. At present, phenotype-associated multigene panels and ES are the preferred diagnostic MPS-based testing modalities, but it is expected that when GS becomes more feasible, both in terms of cost-effectiveness and complex data interpretation, GS-based diagnostic testing will replace most current testing modalities.

Systolic wall stress is the main determinant of myocardial O2 consumption in chronic clinical heart disease as well as following acute inotropic pharmacological interventions. The fundamental relationship between stress and O2 consumption may be modified by alterations in myocardial contractility and/or left ventricular function parameters; these, however, contribute to the overall energy demand by a maximum 10-15%. The therapeutic consequences in chronic heart disease--with regard to left ventricular function and myocardial energy demand--has implications for the degree of left ventricular hypertrophy and dilatation.

Background Rheumatic fever has a marked tendency to recur leading to high risk of chronic heart lesions or worsening lesions in patients with previous rheumatic heart disease. For secondary prevention of RF, long acting penicillin can be used. Some rheumatic heart disease patients suffer from atrial fibrillation. Cardiac rhythm may affect the response of the body to the long acting penicillin, so it would be helpful to study the effect of cardiac rhythm on serum levels of inflammatory mediators in patients with chronic rheumatic heart disease. Objectives Our study is a prospective cross-sectional controlled study that aims to study the effect of cardiac rhythm on serum levels of the inflammatory mediators; C-Reactive Protein and Interleukin-6 in patients with chronic rheumatic heart disease. Methods The study included 70 rheumatic heart disease patients on regular long acting penicillin. Patients were divided into to 2 groups: Group A; 56 patients with rheumatic heart disease who have sinus rhythm, and Group B; 14 patients with rheumatic heart disease who have atrial fibrillation (AF) and Group C; control group of 10 healthy individuals. Results There was no significant difference between sinus patients and AF patients in CRP and IL-6 levels (p = 0.3050 and 0.6758, respectively). Also, there was no significant difference between 15, 21 and 30 days regimens of penicillin in CRP and IL-6 levels (p = 0.9467and 0.0795, respectively). IL6 values were significantly correlated with CRP values (r = 0.5435, p &amp;lt; 0.0001). There was a significant difference in CRP and IL-6 levels between compliant and non-compliant patients (p = 0.0053 and 0.0308). Conclusion Our study results disprove that cardiac rhythm has an effect on the serum levels of the inflammatory mediators C-Reactive Protein and Interleukin-6 in chronic rheumatic heart disease. Our study also disproves the preference of any regimen of long acting penicillin (15 days, 21 days and 30 days) over each other for secondary prevention of chronic rheumatic heart disease. Our study results emphasized that chronic rheumatic heart disease is an inflammatory process mediated with some mediators as CRP and IL-6 that are strongly correlated with each other.

One previous, preliminary study reported that the length of the umbilical cord at birth is related to the risk of developing chronic rheumatic heart disease in later life. We sought to replicate this finding. Prospective, population-based birth cohort. We traced 11,580 individuals born between 1915 and 1929 in Uppsala, Sweden. We identified cases with a main or secondary diagnosis of chronic rheumatic heart disease in the Swedish national inpatient, outpatient or death registers. Archived obstetric records provided data on umbilical cord length, gestational age, birthweight and placental weight. There were 136 patients with chronic rheumatic heart disease (72 men and 64 women) with a mean age at first hospital admission of 68years (range 36-92). There was evidence of a positive association between umbilical cord length and risk of subsequent chronic rheumatic heart disease. The overall hazard ratio in the Swedish study (1.13, 95% confidence interval 1.01 to 1.27) was similar to that of the previous study, with some suggestion of larger effect in men than in women. No other birth characteristics were predictive except for weak evidence of a protective effect of higher birthweight in men. People with longer umbilical cords at birth are more likely to develop chronic rheumatic heart disease in later life. As longer umbilical cords have more spiral arteries and a higher vascular resistance, we hypothesize that the increased pressure load on the heart leads to changes in endothelial biology and increased vulnerability to the autoimmune process initiated by infection with β-haemolytic streptococci.