Obesity, metabolic abnormalities, and mortality in older men

Background Older adults are prone to obesity and metabolic abnormalities and recommended to pursue a normal weight especially when obesity and metabolic abnormalities are co-existed. However, few studies have reported the possible differences in the effect of obesity on outcomes between older adults with metabolic abnormalities and those without metabolic abnormalities. Methods A total of 3485 older men were included from 2000 to 2014. All-cause mortality and cardiovascular mortality were obtained during a mean follow-up of five years Metabolic abnormalities were defined as having established hypertension, diabetes, or dyslipidemia and taking the disease-related medications. All participants were stratified by the presence or absence of metabolic abnormalities. Results In the non-metabolic abnormalities group, all-cause and cardiovascular deaths were lowest in overweight participants and highest in obese participants. In the metabolic abnormalities group, mortality was also lowest in overweight participants but highest in participants with normal weight. After adjustment for covariates, hazard ratios （95% CI） for all-cause death and cardiovascular death were 0.68 （0.51, 0.92） and 0.59 （0.37, 0.93）, respectively, in overweight participants with metabolic abnormalities. Furthermore, obesity was not associated with mortality risk in both groups. These findings were unchanged in stratified analyses. Conclusions Overweight was negatively associated with mortality risk in older men with metabolic abnormalities but not in those without metabolic abnormalities. Obesity did not increase death risk regardless of metabolic abnormalities. These findings suggest that the recommendation of pursuing a normal weight may be wrong in overweight/obese older men, especially for those with metabolic abnormalities.

Interaction between hepatitis C virus and metabolic factors

Hepatitis C virus (HCV) infection disrupts the normal metabolism processes, but is also influenced by several of the host’s metabolic factors. An obvious and significantly detrimental pathophysiological feature of HCV infection is insulin resistance in hepatic and peripheral tissues. Substantial research efforts have been put forth recently to elucidate the molecular mechanism of HCV-induced insulin resistance, and several cytokines, such as tumor necrosis factor-α, have been identified as important contributors to the development of insulin resistance in the distant peripheral tissues of HCV-infected patients and animal models. The demonstrated etiologies of HCV-induced whole-body insulin resistance include oxidative stress, lipid metabolism abnormalities, hepatic steatosis and iron overload. In addition, myriad effects of this condition have been characterized, including glucose intolerance, resistance to antiviral therapy, progression of hepatic fibrosis, development of hepatocellular carcinoma, and general decrease in quality of life. Metabolic-related conditions and disorders, such as visceral obesity and diabetes mellitus, have been shown to synergistically enhance HCV-induced metabolic disturbance, and are associated with worse prognosis. Yet, the molecular interactions between HCV-induced metabolic disturbance and host-associated metabolic factors remain largely unknown. The diet and lifestyle recommendations for chronic hepatitis C are basically the same as those for obesity, diabetes, and metabolic syndrome. Specifically, patients are suggested to restrict their dietary iron intake, abstain from alcohol and tobacco, and increase their intake of green tea and coffee (to attain the beneficial effects of caffeine and polyphenols). While successful clinical management of HCV-infected patients with metabolic disorders has also been achieved with some anti-diabetic (i.e., metformin) and anti-lipid (i.e., statins) medications, it is recommended that sulfonylurea and insulin be avoided.

Metabolic Abnormalities and Metabolic Syndrome among Cameroonian Women: Comparative Study between Pre- and Post-Menopausal Women

The high prevalence of non-communicable diseases is a challenging problem in the Cameroonian population and women are the most affected. The aim of the present study was to determine and compare the prevalence of metabolic abnormalities and metabolic syndrome (MetS) among pre- and post-men- opausal women living in urban areas in Cameroon. A total of 499 women were recruited during a mass health campaign in 2018. Metabolic abnormalities were diagnosed using International Diabetes Federation (IDF) criteria. MetS was defined using IDF criteria with slight modification (total cholesterol used instead of HDL cholesterol). Logistic regression was used to estimate the association between menopausal status and metabolic abnormalities and MetS in age control and non-control models. The prevalence of high waist- to-hip ratio (56.8% vs 36.3%, p < 0.001), elevated fasting blood glucose (glycemia ≥ 100 mg/dL) (38.7% vs 26.9%, p = 0.006);diabetes (14.6% vs 5.7%, p = 0.001);high triglycerides level (29.7% vs 17.1%, p = 0.002);hyperlipidemia (high total cholesterol and or triglycerides levels) (45.0% vs 30.8%, p = 0.002);and elevated blood pressure (67.9% vs 56.1%, p = 0.007) were higher among post-menopausal than pre-menopausal women. The overall prevalence of MetS was 30.1% and post-menopausal women were more affected (33.8% vs 25.0%;p = 0.034). The odds ratio of MetS was 1.888 (95% CI: 1.016 - 3.507) when age was covariate, but was slightly reduced without age control (OR = 1.532;95% CI: 1.031 - 2.275). Metabolic abnormalities seem to be a major health problem among Cameroonian women and menopausal status increased the risk of developing a cardiovascular event.

Relationship between quality of life and adolescent glycolipid metabolism disorder:A cohort study

BACKGROUND The prevalence of glucolipid metabolic disorders(GLMDs)in children and adolescents has a recognized association with cardiovascular diseases and type 2 diabetes mellitus in adulthood.Therefore,it is important to enhance our understanding of the risk factors for GLMD in childhood and adolescence.AIM To explore the relationship between quality of life(QoL)and adolescent GLMD.METHODS This study included 1956 samples in 2019 from a cohort study established in 2014.The QoL scale and glycolipid indexes were collected during follow-up;other covariates of perinatal factors,physical measures,and socioeconomic indicators were collected and adjusted.A generalized linear regression model and logistic regression model were used to analyse the correlation between QoL and GLMD.RESULTS Higher scores of QoL activity opportunity,learning ability and attitude,attitude towards doing homework,and living convenience domains correlated negatively with insulin and homeostasis model assessment insulin resistance(IR)levels.Psychosocial factors,QoL satisfaction factors,and total QoL scores had significant protective effects on insulin and IR levels.Activity opportunity,learning ability and attitude,attitude towards doing homework domains of QoL,psychosocial factor,and total score of QoL correlated positively with high density lipoprotein.In addition,the attitude towards doing homework domain was a protective factor for dyslipidaemia,IR>3,and increased fasting blood glucose;four factors,QoL and total QoL score correlated significantly negatively with IR>3.In subgroup analyses of sex,more domains of QoL correlated with insulin and triglyceride levels,dyslipidaemia,and IR>3 in females.Poor QoL was associated with an increased prevalence of GLMD,and the effect was more pronounced in males than in females.Measures to improve the QoL of adolescents are essential to reduce rates of GLMD.CONCLUSION Our study revealed that QoL scores mainly correlate negatively with the prevalence of GLMD in adolescents of the healthy population.The independent relationship between QoL and GLMD can be illustrated by adjusting for multiple covariates that may be associated with glycaemic index.In addition,among females,more QoL domains are associated with glycaemic index.

EFFECTS OF DIABETES ON HEARING AND COCHLEAR STRUCTURES

Diabetes mellitus (DM) is a chronic systemic disease characterized by hyperglycemia, with various patho-genic mechanisms. From absolute or relative insulin deficiency, patients with DM often demonstrate vari-ous levels of metabolic disorders. Major clinical manifestations of DM include metabolic disorders, vascu-lar lesions, circulatory disturbances and neurologic complications. Along with advances in DM research, re-ports of DM related tinnitus and hearing impairment have increased continuously. Research on DM related auditory system dysfunction has focused on cochlear microcirculation, cellular homeostasis, genetics and ag-ing. Cochlear microcirculation plays an important role in cochlear physiology and its disorders are associat-ed with many inner ear diseases. Ischemia and subsequent reperfusion seen in cochlear microcirculation dis-orders are important factors in hearing damage. Understanding cochlear microcirculation and structural as well as functional changes in DM patients with hearing loss and their causal factors will help reveal patho-genic mechanisms in diabetic hearing loss and provide new ideas in developing interventions and preventing damages caused by diabetes.

Effects of hypoxia on bone metabolism and anemia in patients with chronic kidney disease

BACKGROUND Abnormal bone metabolism and renal anemia seriously affect the prognosis of patients with chronic kidney disease(CKD).Existing studies have mostly addressed the pathogenesis and treatment of bone metabolism abnormality and anemia in patients with CKD,but few have evaluated their mutual connection.Administration of exogenous erythropoietin to CKD patients with anemia used to be the mainstay of therapeutic approaches;however,with the availability of hypoxia-inducible factor(HIF)stabilizers such as roxadustat,more therapeutic choices for renal anemia are expected in the future.However,the effects posed by the hypoxic environment on both CKD complications remain incompletely understood.AIM To summarize the relationship between renal anemia and abnormal bone metabolism,and to discuss the influence of hypoxia on bone metabolism.METHODS CNKI and PubMed searches were performed using the key words“chronic kidney disease,”“abnormal bone metabolism,”“anemia,”“hypoxia,”and“HIF”to identify relevant articles published in multiple languages and fields.Reference lists from identified articles were reviewed to extract additional pertinent articles.Then we retrieved the Abstract and Introduction and searched the results from the literature,classified the extracted information,and summarized important information.Finally,we made our own conclusions.RESULTS There is a bidirectional relationship between renal anemia and abnormal bone metabolism.Abnormal vitamin D metabolism and hyperparathyroidism can affect bone metabolism,blood cell production,and survival rates through multiple pathways.Anemia will further attenuate the normal bone growth.The hypoxic environment regulates bone morphogenetic protein,vascular endothelial growth factor,and neuropilin-1,and affects osteoblast/osteoclast maturation and differentiation through bone metabolic changes.Hypoxia preconditioning of mesenchymal stem cells(MSCs)can enhance their paracrine effects and promote fracture healing.Concurrently,hypoxia reduces the inhibitory effect on osteocyte differentiation by inhibiting the expression of fibroblast growth factor 23.Hypoxia potentially improves bone metabolism,but it still carries potential risks.The optimal concentration and duration of hypoxia remain unclear.CONCLUSION There is a bidirectional relationship between renal anemia and abnormal bone metabolism.Hypoxia may improve bone metabolism but the concentration and duration of hypoxia remain unclear and need further study.

Proteomic analysis of overweight/obesity and related abnormal glucose and lipid metabolism caused by phlegm-dampness retention

Objective:To investigate the proteomic characteristics of overweight/obesity and related abnormal glucose and lipid metabolism caused by phlegm-dampness retention to identify related biomarkers.Methods:Seventy-one subjects were enrolled in the study.We assessed blood glucose,blood lipids,body mass index(BMI),and phlegm-dampness pattern,which was confirmed by a traditional Chinese medicine clinician.Of the participants,we included healthy participants with normal weight(NW,n=23),overweight/obese participants with normal metabolism(ONM,n=19),overweight/obese participants with pre-diabetes(OPD,n=12),and overweight/obese participants with marginally-elevated blood lipids(OML,n=17).Among them,the ONM,OPD,and OML groups were diagnosed with phlegmdampness pattern.The data-independent acquisition(DIA)method was first used to analyze the plasma protein expression of each group,and the relevant differential proteins of each group were screened.The co-expressed proteins were evaluated by Venn analysis.The pathway analyses of the differential proteins were analyzed using Ingenuity Pathway Analysis(IPA)software.Parallel reaction monitoring(PRM)was used to verify the differential and common proteins in each group.Results:After comparing ONM,OPD,and OML groups with NW group,we identified the differentially expressed proteins(DEPs).Next,we determined the DEPs among OPD,OML,and ONM groups.Using Venn analysis of the DEPs in each group,24 co-expressed proteins were screened.Two co-expressed proteins were verified by PRM.IPA analysis showed that pathways including LXR/RXR activation,acute phase response signaling,and FXR/RXR activation were common to all three groups of phlegmdamp overweight/obesity participants.However,the activation or inhibition of these pathways was different among the three groups.Conclusion:Participants with overweight/obesity have similar proteomic characteristics,though each type shows specific proteomic characteristics.Two co-expressed proteins,VTN and ORM1,are potential biomarkers for glucose and lipid metabolism diseases with overweight/obesity caused by phlegmdampness retention.

Effects of Different Hemodialysis Treatments on Abnormal Mineral and Bone Metabolism in Patients with Chronic Renal Failure

Objective:To investigate the effects of different hemodialysis treatments on abnormal mineral and bone metabolism in patients with chronic renal failure.Methods:A random number table was used to divide 80 patients with chronic renal failure admitted to our hospital from January 2018 to January 2019 into 2 groups,with 40 cases in each group.Group A was treated with low-flux hemodialysis,and group B was treated with high-flux hemodialysis.The related indicators of mineral and bone metabolism of the two groups were compared.Results:Before treatment,the blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),type I procollagen amino terminal peptide(PINP),fibroblast growth factor 23(FGF23),serum creatinine(Scr)indicators of the two groups were compared.The difference was not statistically significant(P>0.05);After treatment,the blood calcium levels of the two groups were higher than before treatment,the blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than before treatment,and the blood calcium level of group B was higher than that of group A,while blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than group A,the difference was statistically significant(P<0.05).Conclusion:Compared with low-flux hemodialysis,patients with chronic renal failure treated with highflux hemodialysis have better results,which can correct abnormal bone metabolism and improve Scr levels.

Follow Up of Hypertensive Patients at Regional Hospital of Bafoussam, West Cameroon: Biochemical Profiles in Naive and Hypotensive Drug Treated Patients

Objective: The aim of this work was to study the effects of antihypertensive therapies on certain metabolic parameters in hypertensive patients. Methods: A cross-sectional and analytical study conducted within the Bafoussam Re-gional Hospital on 343 patients including 99 normotensives and 244 hyperten-sives distributed in 71 patients naive to treatment and 173 patients under treatment (84 under monotherapy, 67 under bitherapy and 21 under trithera-py). The antihypertensive medications were recorded from the medical records. A questionnaire survey was administered to study participants and potential risk factors for hypertension sought. Blood and urine samples were collected for lipid, renal and hepatic disorder analysis. Two blood pressure measure-ments enabled us to diagnose hypertensive patients. Measurements of bio-chemical parameters such as total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, creatinine, glucose, aspartate aminotransferase (ASAT), alanine aminotransferase (ALT), potassium, chloride and calcium were done in serum by methods resulting from commercial kits. Results: Cal-cium Channel Blockers were significantly associated with increases in blood potassium (odd-ratios (OR) = 8.63, p = 0.036) and sodium (OR = 0.20, p = 0.037). Angiotensin-converting enzyme/Angiotensin II receptor blockers were significantly associated with an increase in plasma activity of ASAT (OR = 0.12, p = 0.03) whereas Diuretics were significantly associated with an increase in ALAT plasma activity (OR = 0.003, p = 0.012). Dual therapies were associ-ated with highest frequencies of hypercreatininemia (41.8%) and hyperglyce-mia (44.8%) whereas hypocholesterolemia HDL (38.1%) was most observed in hypertensive patients on triple therapy. The different therapies resulted in very low frequencies of abnormal liver profiles (in general almost all below 10%). Tritherapy had the most beneficial effects on the different profiles, with no cases of hyperkalemia, glycosuria, hypochloremia, hematuria, hyponatremia, total hypercholesterolemia, ALAT and ASAT hyperactivity. Conclusion: Triple therapy should be recommended as it has the most beneficial effects on met-abolic parameters in the study population.

Abnormal skeletal metabolism and its changes after decopper therapy in patients with Wilson disease

BACKGROUND: Researches indicate that patients with Wilson disease (WD) have abnormal skeletal metabolism, which is induced by various factors. OBJECTIVE: To probe into the changing characteristics of abnormal skeletal metabolism in WD patients and observe the effect of decopper therapy. DESIGN: Case-contrast and self-control study. SETTING: Department of Neurology, Affiliated Hospital of Neurological Institute, Anhui College of Traditional Chinese Medicine. PARTICIPANTS: A total of 35 patients with WD including 21 males and 14 females aged from 10 to 42 years with the mean age of (20±8) years were selected from Department of Neurology, Affiliated Hospital of Neurological Institute, Anhui College of Traditional Chinese Medicine from September 2000 to February 2001. All the patients were in compliance with the diagnostic criteria: history of family heredity; cone symptoms in vitro, physical sign or liver symptoms; positive Kayser-Fleischer ring; serum copper protein < 200 mg/L or A copper oxidase < 0.2; urine copper > 1.6 μmol/24 hours; liver copper > 250 μg/g (dry weight). The control group was selected from 25 cases of health individuals including 13 males and 12 females aged from 16 to 35 years with the mean age of (22±6) years. All patients who participated in the study were informed first and consented. METHODS: Patients in treatment group were treated with venous injection of 1.0 g sodium dimercaptosulfonate, once a day for totally 6 successive days. And then, patients rested for 2 days. This procedure mentioned above was regarded as a course, and the treatment lasted for 4-8 courses. Before and after injection of sodium dimercaptosulfonate, serum calcitonin (CT), osteocalcin (BGP), parathyroid hormone (PTH) and 1,25-(OH)2VitD3 were measured with radio-immunity method; blood, urine calcium, phosphorum and urine creatinine were measured with biochemical analyzer; urine dihydropyrimidine dehydrogenase(DPD) was detected with enzyme-immunity method; bone mineral density (BMD) was checked at the one third from distal end of ulna and radius with single photon absorptiometry (SPA). MAIN OUTCOME MEASURES: Relative indexes of bone metabolism of blood and urine and results of BMD in both two groups before and after treatment. RESULTS: Among 35 patients with WD and 25 healthy subjects, 5 patients were excluded because of uncompleted decopper therapy; therefore, 30 patients with WD and 25 healthy subjects were involved in the final analysis. ① Comparisons between the two groups: Contents of serum calcium, PTH and 1,25-(OH)2VitD3 were lower in treatment group than those in control group [(2.49±0.34) mmol/L vs. (2.69±0.19) mmol/L; (218.7±50.5) ng/L vs. (262.5±88.9) ng/L; (23.53±14.21) ng/L vs. (42.78±14.44) ng/L; P < 0.05-0.01]; however, contents of serum BGP and CT were higher in treatment group than those in control group [(10.22±6.11) μg/L vs. (5.78±4.22) μg/L; (282.8±109.6) ng/L vs. (62.5±37.9) ng/L, P < 0.01]; moreover, there was no significant difference of contents of serum phosphorum, urine calcium, phosphorum and DPD/creatinine between treatment group and control group (P > 0.05). BMD of males and females was lower in treatment group than that in control group [(0.617±0.197) g/cm2 vs. (0.718±0.274) g/cm2; (0.594±0.124) g/cm2 vs. (0.677±0.157) g/cm2, P < 0.05]. ② Comparisons in treatment group before and after treatment: Contents of CT and urine calcium were lower after treatment than those before treatment [(95.3±55.4) ng/L vs. (283.3±96.7) ng/L; (2.38±1.68) mmol/L vs. (3.31±2.30) mmol/L; P < 0.01, 0.05]; however, contents of 1,25-(OH)2VitD3 and DPD/creatinine were higher after treatment than those before treatment [(33.61±19.30) ng/L vs. (24.21±14.47) ng/L; (42.95±19.92) nmol/mmol vs. (19.51±9.96) nmol/mmol, P < 0.05]; moreover, there were no significant differences among other indexes before and after treatment (P > 0.05). Furthermore, there was no significant difference of BMD before and after treatment (P > 0.05). CONCLUSION: WD patients have changes in the related indexes of abnormal skeletal metabolism. In addition, contents of CT and urine calcium are decreased remarkably after decopper therapy; however, value of BMD is not changed obviously.

Inflammatory bowel disease and diabetes:Is there a link between them?

Patients with inflammatory bowel disease(IBD)are reported to have an increased risk of diabetes.IBD therapies may also modulate blood glucose substantially.These observations are indicative of mechanistic connection(s)between IBD and diabetes.

Metabolic evaluation of first-time uncomplicated renal stone formers:A prospective study

Background:Nephrolithiasis is a global health problem.The recurrence rate after the first stone clearance is approximately 50%at 5 years.Metabolic abnormalities are an important factor responsible for stone recurrence.Our prevalidated study aimed to evaluate metabolic abnormalities associated with first-time uncomplicated renal stone formers(FTURSF).Materials and methods:In this prospective,exploratory,time-bound,descriptive study,30 first-time renal stone formers were evaluated for metabolic abnormalities.High-risk stone formers were excluded from the study.Data were collected in a predefined proforma,transferred to an Excel sheet,and analyzed using the Statistical Package for Social Sciences 20 and Epi Info 7.Fisher exact test,Mann-Whitney U test,paired t test,and Pearson correlation coefficient were used for statistical analyses.Results:The mean age of the participants was 35.57±11.07 years,with a male-to-female ratio of 1.72.The most common abnormality was a 24-hour urine volume of<2.5 L in 73.33%of the participants.One or more metabolic abnormalities were detected in 76.67%of the participants.Other common metabolic abnormalities detected were hypocitraturia(60%),hypercalciuria(16.67%),hyperoxaluria(13.33%),and hyperuricosuria(3.33%).Parathyroid adenoma was detected in one participant(3.33%).Conclusions:Our study documented significant metabolic abnormalities in FTURSF.Therefore,a simplified metabolic evaluation protocol should be adopted while evaluating FTURSF.Detection of an underlying metabolic abnormality would enable the early institution of preventive measures to reduce stone recurrence and related complications.

Comparison of efficacy of treating obese patients with endocrine-metabolic abnormity by electroacupuncture of different types of wave modes

Objective To compare the efficacy of treating obese patients with abnormity of lipids and serum leptin by dilatational wave or continuous wave of electroacupuncture combined with thunder-fire moxibustion in order to provide a clinical basis for selecting wave types of electroacupuncture for different patterns of obesity. Methods Sixty obese patients with abnormal lipids and serum leptin were randomly divided into a dilatational wave group and a continuous wave group via random number table, with 30 cases in each group. They were divided by TCM differentiation into three types： stomachintestine excessive heat, weakness of the spleen-stomach and spleen-kidney yang deficiency, treated by electroacupuncture on Tianshu （天枢 ST 25）, Daheng （大横 SP 15）, Zusanli （足三里ST 36）, Shangjuxu （上巨虚 ST 37）, Fanglong （丰隆 ST 40）, Yinlingquan （阴陵泉 SP 9）, Quchi （曲池 LI 11）, Zhigou （支沟 TE 6） and Hegu （合谷 LI 4） along with thunder-fire moxibustion. The frequency of electro-acupuncture in the dilatational wave group and the continuous wave group was 2 Hz/100 Hz and 2 Hz, respectively. Patients in the two groups were treated once a day, six times a week. The treatment lasted for 4 weeks with 3-month follow-up. Body mass and body fat percentage before and after the treatment, as well as during the follow-up, were compared. The effectiveness rates in the two groups were compared, and the efficacy statistics of patients with different TCM patterns in the dilatational wave group were also analyzed. Lipid levels of the patients in two groups before and after the treatment were measured with an automatic biochemical analyzer, and serum leptin levels were detected with flow cytometry system. Results After the treatment, the patients＇ blood lipids, serum leptin levels, body mass and body fat percentage were effectively reduced in the two groups; three months＇ follow-up witnessed continuous decline of obesity indicators （P〈0.01 or P〈0.05）, and patients in the dilatat-ional wave group improved more significantly than those in continuous wave group （P〈0.05 or P〈0.01）. The efficacy in the dilatational wave group was superior to that in the continuous wave group （P〈0.01）. The best efficacy could be found among patients with weakness of the spleen and the stomach in the dilatational wave group. Conclusion Efficacy of treating obese patients with abnormity of lipids and serum leptin by electro-acupuncture combined with thunder-fire moxibustion in the dilatational wave group was significantly better than that of the continuous wave group, and efficacy for obese patients with weakness of the spleen and the stomach was superior to that of those with stomach-intestine excessive heat and spleen-kidney yang deficiency.

Reduced macular thickness and vascular density in abnormal glucose metabolism patients:A meta-analysis of optical coherence tomography(OCT)and OCT angiography studies

Background:Alterations in macular thickness and vascular density before clinically visible diabetic retinopathy(DR)remain inconclusive.This study aimed to determine whether retinal manifestations in abnormal glucose metabolism(AGM)patients differ from those in the healthy individuals.Methods:PubMed,Embase,and Web of Science were searched between 2000 and 2021.The eligibility criteria were AGM patients without DR.Primary and secondary outcomes measured by optical coherence tomography(OCT)and OCT angiography(OCTA)were analyzed and expressed as standardized mean differences(SMDs)with 95%confidence intervals(CIs).A random-effects model was used in the data synthesis.The potential publication bias for the variables was evaluated using Egger’s test.Results:A total of 86 observational studies involving 13,773 participants and 15,416 eyes were included.OCT revealed that compared to healthy controls,the total macular thickness of AGM patients was thinner,including the thickness of fovea(-0.24,95%CI[-0.39,-0.08];P=0.002,I^(2)=87.7%),all regions of parafovea(-0.32,95%CI[-0.54,-0.11];P=0.003;I^(2)=71.7%)and the four quadrants of perifovea;the thickness of peripapillary retinal nerve fiber layer(pRNFL),macular retinal nerve fiber layer(mRNFL),and ganglion cell layer(GCL)also decreased.OCTA indicated that the superficial and deep vascular density decreased,the foveal avascular zone(FAZ)area enlarged,and the acircularity index(AI)reduced in AGM individuals.Conclusions:Retinal thinning and microvascular lesions have occurred before the advent of clinically detectable DR;OCT and OCTA may have the potential to detect these preclinical changes.Registration:PROSPERO;http://www.crd.york.ac.uk/prospero/;No.CRD42021269885.

Metabolic hypertension:concept and practice

Hypertension is a serious public health problem worldwide.More than 60%of the risk factors for hypertension are associated with metabolic disturbances.Metabolic abnormalities increase the risk for hypertension and cause high blood pressure.Improving metabolic disturbances is beneficial for hypertension treatment.Due to the importance of metabolic abnormalities in the pathogenesis of hypertension,we propose a concept of metabolic hypertension.In this review,we discuss and review the clinical types,pathogenesis,risk evaluation and management of metabolic hypertension.Elucidation of the mechanism of metabolic hypertension should facilitate the design of novel pharmacotherapeutics and dedicated antihypertensive manipulations.

Increased levels of lipid metabolism and cystatin-C, but not glucose, affect virtual P vector

Background In this study, we aimed to evaluate the impact of abnormal glucose, lipid and Cystatin-C on the virtual P vector characteristics, which haven＇ t been reported in previous studies. Methods 204 of non-diabetes mellitus （NDM）, 130 of DM （type 2） and 39 of impaired glucose tolerance （IGT） patients were consecutively and retrospectively recruited. We selected a one-minute length of electrocardiogram at 4AM for analysis. After a series of calculating algorisms, we obtained the virtual planar P vector parameters. Results There were no significant differences in FPV, FPA, RSPV, RSPA, HPV and HPA groups. After adjusting confounding factors, the re- gression coefficients （RC） were estimated as follow： for FPV, female gender （RC -0.21, P = 0.02）, triglyceride （RC -0.09, P 〈 0.01）, RVOT （RC 0.03, P = 0.02）; for RSPV, female gender （RC -0.21, P 〈 0.01）, triglyceride （RC -0.10, P 〈 0.01）, average heart rate （RC 0.01, P = 0.02）; for HPV, triglyceride （RC -0.08, P 〈 0.001）, LDL （RC -0.19, P 〈 0.01）, Apo B （RC 0.67, P 〈 0.01）; for RSPA, B type of blood （RC -22.06, P = 0.02）, Cystatin-C （RC -72.79, P = 0.02）, thickness of interventricular septum （RC 3.70, P = 0.01）. Cystatin-C was suggested as a cure related to RSPA, and the cut-off point was 1.6 mg/L. There were no significant risk factors associated with FPA and HPA. There was no difference in virtual P vector among DM, IGT and NDM groups. Conclusion In- creased levels of lipid and Cystatin-C significantly impact the characteristics of virtual P vector, whereas glucose does not. These changes may come from a higher low voltage atrial area and abnormal orientation of atrial depolarization.

A cohort study on the association between fasting plasma glucose level over 5. 3 mmol / L and risks of abnormal glucose metabolism and cardiovascular diseases in the elderly

Objective To evaluate the association of fasting plasma glucose(FPG)level over 5.3 mmol/L with the development of abnormal glucose metabolism and cardiovascular disease(CVD).Methods This was a retrospec-tive cohort study with 1 064 non-diabetic subjects(980males;84 females)aged 60 or over,who carried out annual health check-up in Chinese PLA General