Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis

Background and aims: The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases.

Methods: PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated.

Results: Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85–0.94, 0.7–0.89, and 0.82–0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8–0.86), 0.79 (95%CI = 0.7–0.85), and 0.82 (95%CI = 0.72–0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82–0.88), 0.8 (95%CI = 0.68–0.88), and 0.8 (95%CI = 0.6–0.92) for any varices, and 0.86 (95%CI = 0.83–0.89), 0.86 (95%CI = 0.76–0.92), and 0.61 (95%CI = 0.35–0.83) for high-risk varices, respectively.

Conclusions: LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.     

Development of sorafenib-related side effects in patients diagnosed with advanced hepatocellular carcinoma treated with sorafenib: a systematic-review and meta-analysis of the impact on survival

?Introduction: Clinical markers to predict the benefit from sorafenib in patients diagnosed with hepatocellular carcinoma (HCC) are lacking. A meta-analysis exploring the impact of development of sorafenib-related side effects on survival was conducted.

Areas covered: Eligible studies included all clinical studies reporting on the survival/toxicity relationship in sorafenib-treated HCC patients. Data sources included Pub-Med, the Cochrane Controlled Trials Register, and Google scholar. After exclusion of ineligible studies, 16 studies were included in the analysis. Pooled hazard ratio (HR) for overall survival (OS) for patients developing diarrhoea vs. patients who did not was 0.42 (95% confidence interval (CI): 0.30–0.60; p < 0.00001); pooled HR for patients developing hypertension vs. those who did not was 0.46 (95% CI: 0.30–0.70; p = 0.0003); pooled HR for patients developing hand foot skin reaction vs. those who did not was 0.47 (95% CI: 0.35–0.62; p < 0.00001); pooled HR for OS for all types of skin toxicities was 0.51 (95% CI: 0.36–0.72; p = 0.0002); while pooled HR for OS for a combination of selected side effects (hypertension, HFS and diarrhoea) was 0.38 (95% CI: 0.30–0.48; p < 0.00001). No information was available regarding the impact of thyroid dysfunction or proteinuria.

Expert commentary: This analysis of data demonstrated that the occurrence of sorafenib-related side effects (such as diarrhoea, hypertension and skin toxicities) is associated with a better OS in sorafenib-treated HCC patients.     

Survival impact of serum uric acid levels in children and adolescents

Evidence is limited on the association between hyperuricaemia and mortality in children and adolescents. This study was to investigate this association in the paediatric population. The study included children and adolescents who had undergone serum uric acid (SUA) measurement at the Chang Gung Memorial Hospital between 1997 and 2008. The survival status and cause of death of the included were ascertained by examining the National Death Registry of Taiwan. Hyperuricaemia was defined as a SUA level greater than 7.0 mg/dL. We included 13,241 patients (male, n = 7,454; female, n = 5,787) of mean age 14.3 ± 4.9 years. During the 82,800 person-years of follow-up, 455 deaths were identified, which corresponded to a crude mortality rate of 5.50 deaths per 1,000 person-years. Compared with individuals with a SUA <6.0 mg/dL, those with a SUA of 6.0–8.9, 9.0–11.9 and ≥12 mg/dL had an age- and sex-adjusted HR (95 % CI) of 1.02 (0.82–1.26), 1.48 (1.08–2.02) and 4.73 (2.67–8.37). After adjustment for age, sex and history of diabetes mellitus and hypertension, hyperuricaemia was found to be associated with a HR (95 % CI) of 1.38 (1.13–1.69; p < 0.001) for all-cause mortality. Hyperuricaemia was associated with an increased risk of mortality due to cardiovascular diseases (HR, 5.0; 95 % CI 1.79–13.94; p = 0.001) and kidney diseases (11.71; 3.13–43.78; p < 0.001). Paediatric patients with hyperuricaemia were at increased risk of mortality, especially due to kidney and cardiovascular diseases.     

Prospective single-arm observational study of human chymase inhibitor Polygonum hydropiper L in subjects with hypertension

ABSTRACT

Background and Purpose: Human chymase (h-chymase) is a serine protease that forms local angiotensin II and has been proven to be related to onset of hypertension, arteriosclerosis, and post myocardial infarction cardiac remodeling. Since no chymase inhibitor was clinically available, an extensive screening for inhibition of h-chymase in three different extracts (water, hot water, and ethanol) of approximately 800 food ingredients had been performed and we identified Polygonum hydropiper L (Polygonum). Using a dried and powdered Polygonum, we conducted a prospective, single-arm, pilot study to investigate its safety and antihypertensive effect in subjects with normal high blood pressure to moderate hypertension.

Methods: First, a single oral dose of Polygonum powder (4000 mg) was administered to assess acute toxicity. Then, a pilot study was conducted in 11 subjects using the sequence of placebo and Polygonum for 2 weeks each. The dose of Polygonum was increased sequentially (200–2000 mg/day). Home blood pressure and pulse rate were monitored.

Results: Oral administration of Polygonum (4000 mg) did not cause any adverse events. In the dose-escalation phase, evening systolic blood pressure was significantly decreased at 800 mg, 2000 mg doses post-treatment (p < 0.05, and p < 0.05, respectively). Depressor responders to Polygonum intake had significantly higher salt intake in spot urine (p < 0.05). No adverse events or reactions occurred.

Conclusion: This was the first investigation that an h-chymase inhibitory Polygonum intake for safety and tolerability was proven and, in addition, chymase inhibitory Polygonum appeared to have depressor effect especially in a hypertensive subject with excessive salt intake.     

Prevalence and associations of moderately increased albuminuria in patients with type 2 diabetes in United Arab Emirates

Background and aimsOur study sought to investigate the prevalence of moderately increased albuminuria in United Arab Emirates (UAE) nationals with type 2 diabetes, and to identify the associated factors.MethodsThis prospective cross-sectional study was conducted in two hundred and seven UAE nationals with type 2 diabetes mellitus attending the internal medicine department of a secondary care hospital. Moderately increased albuminuria was estimated in random spot urine samples and was defined as urinary albumin-to-creatinine ratio (UACR) of 3–30 mg/mmoL. Prevalence and associations of moderately increased albuminuria were evaluated.ResultsThe study population had a mean UACR of 7.2 ± 10.2 mg/mmoL with mean eGFR of 94.5 ± 11.7 mL/min/1.73 m². Prevalence of moderately increased albuminuria in our study population was found to be 44.0%. Multivariate logistic regression analysis showed that duration of diabetes (OR:1.72, 95% CI:1.34–2.19; p<0.001), presence of hypertension (OR:3.42, 95% CI:0.96–12.20; p=0.050) and neuropathy (OR:2.85, 95% CI:1.03–7.84; p=0.042), BMI (OR:1.08, 95% CI:1.01–1.16; p=0.019), HbA1c (OR:1.39, 95% CI:1.00–1.93; p=0.045), CRP (OR:1.10, 95% CI:1.00–1.22; p=0.035), serum creatinine (OR:1.04, 95% CI:1.02–1.06; p<0.001) and HDL-C (OR:0.10, 95% CI:0.01–0.28; p<0.001) were independently correlated with moderately increased albuminuria. Stepwise multiple linear regression analysis demonstrated that duration of diabetes, HbA1c, CRP and serum creatinine were independent predictors of UACR.ConclusionWe report a high prevalence of moderately increased albuminuria in UAE nationals with type 2 diabetes in a secondary care setting. Routine screening and timely management of moderately increased albuminuria in type 2 diabetes mellitus can lead to better patient outcomes.     

Nonalcoholic fatty liver disease as a sentinel marker for the development of diabetes mellitus in non-obese subjects

BackgroundNon alcoholic fatty liver disease (NAFLD) is associated with substantial cardiometabolic morbidity.AimsWe evaluated the long-term extrahepatic complications of NAFLD and sought to evaluate NAFLD in non-obese subjects.MethodsA total of 2920 participants were retrospectively selected from a health check-up center in 2000, and followed through to December 2010. NAFLD was diagnosed using ultrasonography. Subjects were stratified according to body mass index, NAFLD, and metabolic syndrome.ResultsThe prevalence of non-obese NAFLD subjects and metabolically unhealthy non-obese subjects was 14.4% and 8.7%, respectively. In the multivariate analysis, non-obese NAFLD subjects had a significantly higher risk for diabetes mellitus (DM; HR 2.69, 95% CI 1.72–4.20, P < 0.001); no increase was observed for hypertension or cardiovascular disease. Metabolically unhealthy non-obese subjects had a significantly higher risk for hypertension (HR 2.75, 95% CI 2.02–3.74, P < 0.001), DM (HR 5.72, 95% CI 3.68–8.89, P < 0.001), and cardiovascular disease (HR 2.93, 95% CI 1.53–5.63, P = 0.001). Subgroup analysis of non-obese subjects showed that NAFLD, without metabolic syndrome, conferred a higher risk for DM (HR 3.60, 95% CI 2.03–6.39, P < 0.001).ConclusionNon-obese subjects with NAFLD are at a higher risk for DM independent of metabolic syndrome.     

Predictors of septic shock in initially stable patients with pyogenic liver abscess

Objectives: The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock.

Methods: The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock.

Results: A review of medical records identified 453 patients (66.7% male), of mean age 61.4 years, diagnosed with PLA. Of these patients, 73 (16.1%) had septic shock and 10 (2.2%) died in-hospital. Of the 73 patients with septic shock, nine (12.3%) died in-hospital. The most common symptom was fever (79.5%), and the most common infectious agent was Klebsiella pneumoniae. Septic shock was significantly associated with age ≥60 years [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.38–6.48], malignancy (OR: 2.11, 95% CI: 1.08–4.09), systolic blood pressure <100?mmHg (OR: 3.63, 95% CI: 1.43–9.21), respiratory rate ≥24/min (OR: 3.15, 95% CI: 1.20–8.28) and lactate concentration ≥2?mmol/L (OR: 4.92, 95% CI: 2.51–9.64). Septic shock also tended to be associated with procalcitonin concentration, but this was not statistically significant (OR: 3.42, 95% CI: 0.96–12.18).

Conclusions: Septic shock was frequent in initially stable patients with PLA and was associated with older age, malignancy, low blood pressure, tachypnea and elevated lactate concentration.     

Race- and sex-specific association between alcohol consumption and hypertension in 22 cohort studies: A systematic review and meta-analysis

Background and aimsThe alcohol–hypertension relation has been well documented, but whether women have protective effect or race and type of beverage consumed affect the association remain unclear. To quantify the relation between total or beverage-specific alcohol consumption and incident hypertension by considering the effect of sex and race.Methods and resultsArticles were identified in PubMed and Embase databases with no restriction on publication date. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random effects models. Restricted cubic splines were used to model the dose–response association. This study involved 22 articles (31 studies) and included 414,477 participants. The hypertension risk was different among liquor, wine, and beer at 5.1–10 g/d of ethanol consumption (P_{-across subgroups} = 0.002). The hypertension risk differed between men (RR: 1.14, 95% CI: 1.07, 1.20) and women (RR: 0.98, 95% CI: 0.89, 1.06) at 10 g/d (P_{-across subgroups} = 0.005). We found a linear alcohol–hypertension association among white (P-_linearity = 0.017), black people (P-_linearity = 0.035), and Asians (P-_linearity<0.001). With 10 g/d increment of consumption, the RRs for hypertension were 1.06 (95% CI: 1.04, 1.08), 1.14 (95% CI: 1.01, 1.28), and 1.06 (95% CI: 1.01, 1.10) for Asians, black, and white people, respectively.ConclusionSex modifies the alcohol–hypertension association at low level of alcohol consumption and we did not find evidence of a protective effect of alcohol consumption among women. Black people may have higher hypertension risk than Asians and white people at the same ethanol consumption.     

Individual or familial diabetes in relation to eight cardiovascular diseases: A two-sample Mendelian randomization study

Background and aimsDiabetes is associated with increased risk of certain cardiovascular diseases, yet the causality remains to be determined. Meanwhile, given that first-degree relatives share 50% of genes, the effect of familial diabetes is also worthy of attention. Therefore, we sought to investigate the causal relations of individual or familial diabetes with eight cardiovascular diseases, including myocardial infarction, hypertension, atrial fibrillation, heart failure, cardiac death, pulmonary embolism, transient ischemic attack, and ischemic stroke.Methods and resultsApplying two-sample Mendelian randomization, we selected instruments for genetic predisposition to individual or familial diabetes based on published genome-wide association studies. The primary analyses were conducted using the random-effects inverse-variance weighted method. We found that genetically predicted individual diabetes was causally associated with higher risks of myocardial infarction (odd ratio [OR] = 1.09; 95% confidence interval [CI]: 1.05–1.13; P < 0.0001), hypertension (OR = 1.08; 95% CI: 1.03–1.13; P = 0.0006), and ischemic stroke (OR = 1.10; 95% CI: 1.05–1.15; P < 0.0001). Genetically predicted paternal diabetes could increase the risk of ischemic stroke (OR = 1.16; 95% CI: 1.04–1.30; P = 0.0061). Genetically predicted maternal diabetes could increase the risk of myocardial infarction (OR = 1.18; 95% CI: 1.09–1.29; P = 0.0001). Genetically predicted siblings’ diabetes was causally associated with higher risks of myocardial infarction (OR = 1.17; 95% CI: 1.08–1.27; P = 0.0001) and hypertension (OR = 1.19; 95% CI: 1.06–1.34; P = 0.0036). No significant differences were observed in other outcomes.ConclusionThis study supports causal effects of not only individual but also familial diabetes on the development of cardiovascular diseases, which will help realize the potential effect of family history in the prevention of cardiovascular diseases.     

Significant interaction of hypertension and homocysteine on neurological severity in first-ever ischemic stroke patients

It is not known whether combination of hypertension and high homocysteine (HHcy) impacts on stroke-related neurological severity. Our aim was to determine whether there is an interaction of hypertension and HHcy on neurological severity in first-ever ischemic stroke patients. We analyzed neurological severity among 189 consecutive first-ever ischemic stroke patients with or without hypertension or HHcy. Hypertension (odds ratio [OR]: 8.086, 95% confidence interval [CI]: 3.596–18.181, P < .001) and total homocysteine (OR: 1.403, 95% CI: 1.247–1.579, P < .001) were independently associated with neurological severity. In receiver-operating characteristic analysis, total homocysteine was a significant predictor of neurological severity (area under curve: 0.794; P < .001). A multiplicative interaction of hypertension and HHcy on more severe neurological severity was revealed by binary logistic regression (OR: 13.154, 95% CI: 5.293–32.691, P < .001). Analysis further identified a more than multiplicative interaction of hypertension and HHcy on neurological severity compared with patients without each condition (OR: 50.600, 95% CI: 14.775–173.285, P < .001). Interaction effect measured on an additive scale showed that 76.4% patients with moderate/severe neurological severity were attributed to interaction of hypertension and HHcy. Significant interaction of hypertension and HHcy on neurological severity was found on multiplicative and additive scale in first-ever Chinese ischemic stroke patients.     

Incidence of herpes zoster in Japanese patients with rheumatoid arthritis from 2005 to 2010

Abstract

Objective. To clarify the incidence and the risks of herpes zoster infection in Japanese patients with rheumatoid arthritis (RA).

Methods. By using a self-report of occurrence of herpes zoster in patients with RA in a large observational cohort study from 2005 to 2010, the standardized incidence rate was calculated. A Cox model was used to analyze risk factors for occurrence of herpes zoster.

Results. A total of 7,986 patients (female 83.1%) accumulated 30,140 patient-years of observation, and 366 events were confirmed. The standardized incidence rate per 1,000 patient-years was 9.1 (95% confidence interval (CI) 6.2–12.9) in total, 7.8 (3.6–14.8) in men, and 10.3 (6.8–15.0) in women. The risk factors for herpes zoster were age [/10 years: Hazard ratio (HR) 1.268, 95% CI 1.153–1.393, p < 0.0001), high disease activity compared with remission (HR 1.642, 95% CI 1.067–2.528, p < 0.05), prednisolone (< 5 mg/day compared with 0 mg/day: HR 1.531, 95% CI 1.211–1.936, p < 0.001; ≥ 5 mg/day compared with 0 mg/day: HR 1.471, 95% CI 1.034–2.093, p < 0.05), and methotrexate (HR 1.382, 95% CI 1.076–1.774, p < 0.05).

Conclusion. This study quantified the historical incidence and risk for herpes zoster in Japanese RA patients, and is a benchmark for future studies.     

Cough Effectiveness and Pulmonary Hygiene Practices in Patients with Pompe Disease

Purpose

While factors leading to hypoventilation have been well studied in Pompe disease, cough effectiveness and airway clearance practices are less understood. We aimed to identify significant factors that influence peak cough flow (PCF) in Pompe, and to detect whether pulmonary hygiene practices were reflective of reduced PCF.

Methods

This is a prospective observational study of 20 subjects with Pompe disease (infantile-onset: 7, juvenile-onset: 6, adult-onset: 14). Subjects performed spirometry, maximal respiratory pressures, and cough (voluntary: n = 24, spontaneous: n = 3). Subjects or their parents reported airway clearance and secretion management practices. Relationships between disease variables, pulmonary function, and cough parameters as well as group differences in cough parameters were evaluated.

Results

Subjects with infantile-onset disease had significantly lower PCF (p < 0.05) and tended to require more external ventilatory support (p = 0.07). In juvenile- and adult-onset disease, PCF differed according to external ventilatory requirement [daytime: 83.6 L/min (95% CI 41.2–126.0); nighttime: 224.6 L/min (95% CI 139.1–310.2); none: 340.2 L/min (95% CI 193.3–487.6), p < 0.005]. Cough inspiratory volume also differed significantly by ventilatory requirement [daytime: 5.5 mL/kg (95% CI 3.0–8.0); nighttime: 16.0 mL/kg (95% CI 11.8–20.2); none: 26.8 mL/kg (95% CI 11.9–41.7), p < 0.001]. However, routine airway clearance or secretion management practices were only consistently reported among patients with infantile-onset disease (infantile: 86%, juvenile: 0%, adult: 14%, p < 0.005).

Conclusions

Cough weakness was detected in the majority of patients with Pompe disease and was influenced by both inspiratory and expiratory muscle function. Patients at risk for problems or with ineffective PCF should be urged to complete routine pulmonary hygiene.

     

Long-term prediction of hepatocellular carcinoma using serum autotaxin levels after antiviral therapy for hepatitis C

Introduction and objectivesContinuous monitoring for hepatocellular carcinoma is necessary following treatment with direct-acting antivirals in patients with hepatitis C virus infection. We investigated whether the long-term follow-up of serum autotaxin levels could predict the development of hepatocellular carcinoma.Patients and MethodsThis prospective observational study enrolled adult patients with chronic hepatitis C virus infection who presented to the study center from January 2016 to March 2021. Among the patients who achieved a sustained viral response, the relationship between the development of hepatocellular carcinoma and serum autotaxin levels was assessed before treatment with direct-acting antivirals; at the end of therapy; at 12 and 24 weeks; and at 12, 24, 36, and 48 months after treatment.ResultsData were analyzed for 139 patients. Thirteen patients developed hepatocellular carcinoma 48 months after treatment. The cut-off serum autotaxin values that predicted hepatocellular carcinoma after 24 weeks were 1.22 (men) and 1.92 (women) mg/L. The area under the curve for serum autotaxin was 0.83 (95% confidence interval [CI]:0.71–0.95) in men and 0.90 (95% CI: 0.82–0.99) in women. The positive predictive value of serum autotaxin was 0.208 (95% CI: 0.139–0.248), and the negative predictive value was 0.971 (95% CI: 0.939–0.990). The cumulative incidence of hepatocellular carcinoma was significantly higher when serum autotaxin levels were above the cut-off value after 24 weeks (p < 0.0001).ConclusionsSerum autotaxin is a candidate biomarker for predicting hepatocellular carcinoma during the long-term follow-up of patients with a sustained viral response following treatment with direct-acting antivirals.     

Relationship between the NF-κB1-94ins/del ATTG locus polymorphism and risk of hypertension in the Chinese Han population

Objective: The onset of essential hypertension is the result of a combination of genetic factors and the environment. The nuclear factor (NF)-κB1-94ins/del ATTG locus polymorphism is associated with the occurrence of various diseases. The purpose of this study was to find out the relationship between the NF-κB1-94ins/del ATTG locus polymorphism and the risk of hypertension in the Chinese Han population.

Methods: A total of 585 Chinese Han patients with essential hypertension and 585 Chinese Han healthy volunteers were recruited. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to analyze the genotype of the NF-κB1-94ins/del ATTG locus in all the subjects.

Results: For the NF-κB1-94ins/del ATTG locus, the dominant (adjusted odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.13–1.54, P < 0.001), recessive (adjusted OR = 1.17, 95% CI = 1.02–1.32, P = 0.03) and additive (adjusted OR = 1.19, 95% CI = 1.03–1.36, P = 0.01) models showed significant increase in the risk of hypertension. The NF-κB1-94ins/del ATTG locus II genotype was an independent risk factor for hypertension (OR = 1.15, 95% CI = 0.78–1.69, P = 0.02). The interaction between the NF-κB1-94ins/del ATTG locus polymorphism and BMI, alcohol consumption, and diabetes significantly increased the risk of hypertension (OR = 1.71, 95% CI = 1.26–1.86, P < 0.01).

Conclusion: The NF-κB1-94ins/del ATTG polymorphism is an independent risk factor for essential hypertension. The NF-κB1-94ins/del ATTG locus, obesity, drinking, and diabetes also interact to yield a higher risk of hypertension.     

High-Sensitivity Cardiac Troponin T levels in prehypertensive patients

Background: High-sensitivity cardiac troponin T (hs-cTNT) is an important non-invasive laboratory-based marker of subclinical myocardial injury. Prehypertension, which may be a precursor of hypertension, is a major public health issue. Our aim was to evaluate the importance of serum hs-cTnT as a marker predicting prehypertension.

Methods: A total of 100 subjects (45 women and 55 men) consisting of 50 consecutive prehypertensive patients with blood pressures between 120/80 and 139/89 mmHg and 50 normotensive patients with blood pressures < 120/80 mmHg were enrolled prospectively. The hs-cTNT level was calculated and compared between the two groups. Echocardiographic examinations were performed in all patients.

Results: The hs-cTnT level was significantly higher in the prehypertensive group (p < 0.001) and was positively correlated with prehypertension (r = 0.625, p < 0.001). Hs-cTnT was an independent predictor of prehypertension (odds ratio = 1.043, 95% confidence interval [CI] 1.019–1.067, p < 0.001). An Hs-cTnT level of 0.55 ng/L was predictive of prehypertension with a sensitivity of 86% and specificity of 60% (area under the curve = 0.861; 95% CI, 0.787–0.935; p < 0.001).

Conclusion: hs-cTnT may complement other diagnostic biomarkers in predicting prehypertension.

Abbrevations: high-sensitivity cardiac troponin T, prehypertension, subclinical myocardial injury     

Relationship between white blood cells and hypertension in Chinese adults: The Cardiometabolic Risk in Chinese (CRC) study

Abstract

Increased blood pressure was associated with increased white blood cell count (adjusted p?<?0.001) in a community-based health examination survey of adults in China (n?=?39?282; aged 18–93 years). Adjusted odds ratios (95% confidence intervals) for hypertension across white blood cell count quintiles were 1.00, 0.99 (0.89–1.09), 1.11 (1.01–1.22), 1.09 (0.99–1.20), and 1.19 (1.08–1.31) (p for trend?<?0.001). Body mass index and white blood cell count had an additive effect on systolic blood pressure (p for interaction?=?0.047). Therefore, white blood cell count could independently predict hypertension in Chinese adults.     

Predicting variceal bleeding in patients with biliary atresia

Abstract

Background/aims: Variceal bleeding is the main cause of morbidity and mortality in children with portal hypertension and biliary atresia. The aim of this study is to predict high-risk varices by analyzing various clinical factors, thus improve prognosis of patients with biliary atresia.

Methods: A total of 157 patients with biliary atresia who underwent Kasai portoentrostomy were enrolled in a single center. Clinical data including laboratory values, endoscopic findings and values of transient elastography (FibroScan^®) were analyzed retrospectively.

Results: The bleeding group and the non-bleeding group showed statistically significant differences in several variables; The FibroScan^® value (HR 1.05, 95% CI (1.03–1.07), p < .01) was higher in the bleeding group. The bleeding group had values of lower albumin after 3?months of operation (HR 0.28, 95% CI (0.11–0.73), p = .01), higher bilirubin after 3?months of operation (total bilirubin: HR 1.18, 95% CI (1.04–1.33), p = .01), (direct bilirubin: HR 1.21, 95% CI (1.05–1.41), p = .01). Gastric varix (HR 4.10, 95% CI (1.62–10.36), p < .01) was more frequent in the bleeding group. And the presence of red sign was also predictive of bleeding. The FibroScan^® cut-off value with the predictive power of bleeding was 31.5?kPa (HR 7.7, 95% CI (3.36–17.73), p < .01).

Conclusions: Several clinical factors including high value of transient elastography (FibroScan^®), gastric varix or red sign of endoscopy, and low albumin or high bilirubin values after 3?months of Kasai operation can be useful in predicting variceal bleeding in patients with biliary atresia.     

Bidirectional association between nonalcoholic fatty liver disease and hypertension from the Dongfeng-Tongji cohort study

The relation between nonalcoholic fatty liver disease (NAFLD) and hypertension is not fully understood. To examine the effect of the change in NAFLD status on the risk of incident hypertension, and vice versa, 6704 eligible hypertension-free subjects and 9328 NAFLD-free subjects from the Dongfeng-Tongji cohort study at baseline were enrolled in the study. Among the hypertension-free subjects, development and persistence of NAFLD were associated with an increased odds ratio (OR) for incident hypertension (OR: 1.49, 95% confidence interval [CI]: 1.26–1.76, P < .0001; OR: 1.50, 95% CI: 1.27–1.78, P < .0001). However, the resolution of NAFLD was not a risk factor for incident hypertension. Among the NAFLD-free subjects, the risk of new-emerging NAFLD was robust for hypertension status both in no-yes (OR: 1.45, CI: 1.23–1.71) and yes-yes (OR: 1.61, CI: 1.35–1.92). Moreover, stratified analysis by diabetes and overweight/obese for the risk of incident NAFLD showed that incident hypertension (no-yes) and persistent hypertension (yes-yes) were associated with risk of incident NAFLD in subjects without diabetes or overweight/obesity. In the overweight/obese participants, persistent hypertension (yes-yes) was a risk factor for incident NAFLD (OR: 1.29, 95% CI: 1.01–1.64, P = .0387). Conclusively, incidence and persistence of NAFLD are associated with increased risk of hypertension, and vice versa.     

The association between curry-rice consumption and hypertension,type 2 diabetes,and depression: The findings from KNHANES 2012–2016

Background and aimsWe aim to evaluate the association between curry-rice consumption, cardiovascular diseases (CVDs), type 2 diabetes (T2DB), arthritis, and depression.Methods17,625 participants aged ≥18 years were recruited to obtain data on sociodemographic characteristics, lifestyle, medical history, current medications, family history, and food consumption. The association between curry-rice consumption, CVDs, T2DB, arthritis, and depression was examined using multivariable-adjusted analyses.ResultsIn the logistic model, risks of elevated triglyceride (OR 0.89; 95% CI, 0.82–0.97, p = 0.006), elevated HbA1c (OR 0.81; 95% CI, 0.73–0.91, p < 0.001), and elevated glucose (OR 0.86; 95% CI, 0.79–0.94, p < 0.001) were significantly lower in the high curry-rice consumption group than in the low curry-rice consumption group. Risk of hypertension (OR 0.88; 95% CI, 0.78–0.98, p = 0.044), T2DB (OR, 0.82; 95% CI, 0.68–0.98, p < 0.001), and depression (OR 0.82; 95% CI, 0.70–0.97, p = 0.026) was significantly lower among the high curry-rice consumption group than in the low curry-rice consumption group. These findings were consistent with the results of the analysis when curry-rice consumption was treated as a continuous variable.ConclusionsThe potential health benefits resulting from the intake of curry-rice via an ordinary diet could protect the public from the burden of non-communicable diseases (NCDs) and mental health. These results highlight an ongoing need to understand the role of curry-rice in NCDs and mental health.     

Prevalence of hypertension in argentinean indigenous children living at high altitudes versus US children

ABSTRACT

Background: Exposure to hypoxia at high altitude is increasingly being recognized as a risk factor for hypertension.

Objective: To compare the prevalence of hypertension in Indigenous Argentinean children living at high altitude with that reported in the 2011–2012 National Health and Nutrition Examination Survey (NHANES) of US children.

Methods: A cross-sectional study of 811 (400 females) Argentinean Indigenous school children (8–14 years) from San Antonio de los Cobres (SAC) was performed between 2011–2014. SAC is located in the Andean foothills 3,750 m above sea level. 98% of its population is Indigenous. Anthropometric, BP, and biochemical data were obtained from SAC and compared with those of 1279 (625 females) US children. Pre-hypertension and hypertension were defined by BP≥90th to <95th percentile or ≥95th percentile, respectively.

Results: The prevalence of obesity was significantly lower in SAC (22; 2.7%) than in the US (310; 24.3%). However, the prevalence of hypertension was significantly higher in SAC (129; 15.9%) than in US children (35; 2.9%). Multiple logistic regression analyses showed that SAC children had four times the odds of having pre-hypertension compared with US children (OR 4.47; 95% CI 3.29–6.08), and eight times the odds of presenting hypertension (OR 8.36; 95% CI 5.36–13.05), adjusted for age, gender, and BMI.

Conclusions: This study shows a higher prevalence of hypertension in Indigenous Argentinean children living at high altitude compared with US children. Various factors such as high hemoglobin levels, lifestyle behavior, and genetics may have an influence on BP in high altitude Indigenous SAC children.

Abbreviations: BP: Blood pressure; SAC: San Antonio de los Cobres; CDC: Centers for Disease Control and Prevention; NHANES: National Health and Nutrition Examination Survey