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Hammaréus F, Nilsson L, Ong KL, Kristenson M, Festin K, Lundberg AK, Chung RWS, Swahn E, Alfredsson J, Holm Nielsen S, Jonasson L. Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden. BMJ Open 2023; 13:e073561. [PMID: 37714678 PMCID: PMC10510861 DOI: 10.1136/bmjopen-2023-073561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES To investigate the association between type I collagen α1 chain (COL1α1) levels and coronary artery disease (CAD) by using absolute quantification in plasma. Also, to investigate the correlates of COL1α1 to clinical characteristics and circulating markers of collagen metabolism. DESIGN Life conditions, Stress and Health (LSH) study: prospective cohort study, here with a nested case-control design.Assessing Platelet Activity in Coronary Heart Disease (APACHE) study: prospective cohort study. SETTING LSH: primary care setting, southeast Sweden.APACHE: cardiology department, university hospital, southeast Sweden. PARTICIPANTS LSH: 1007 randomly recruited individuals aged 45-69 (50% women). Exclusion criteria was serious disease. After 13 years of follow-up, 86 cases with primary endpoint were identified and sex-matched/age-matched to 184 controls. APACHE 125 patients with myocardial infarction (MI), 73 with ST-elevation MI and 52 with non-ST-elevation MI. EXCLUSION CRITERIA Intervention study participation, warfarin treatment and short life expectancy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the association between baseline COL1α1 and first-time major event of CAD, defined as fatal/non-fatal MI or coronary revascularisation after 13 years. Secondary outcomes were the association between the collagen biomarkers PRO-C1 (N-terminal pro-peptide of type I collagen)/C1M (matrix metalloproteinase-mediated degradation of type I collagen) and CAD; temporal change of COL1α1 after acute MI up to 6 months and lastly, correlates between COL1α1 and patient characteristics along with circulating markers of collagen metabolism. RESULTS COL1α1 levels were associated with CAD, both unadjusted (HR=0.69, 95% CI=0.56 to 0.87) and adjusted (HR=0.55, 95% CI=0.41 to 0.75). PRO-C1 was associated with CAD, unadjusted (HR=0.62, 95% CI=0.47 to 0.82) and adjusted (HR=0.61, 95% CI=0.43 to 0.86), while C1M was not. In patients with MI, COL1α1 remained unchanged up to 6 months. COL1α1 was correlated to PRO-C1, but not to C1M. CONCLUSIONS Plasma COL1α1 was independently and inversely associated with CAD. Furthermore, COL1α1 appeared to reflect collagen synthesis but not degradation. Future studies are needed to confirm whether COL1α1 is a clinically useful biomarker of CAD.
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Affiliation(s)
- Filip Hammaréus
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Lennart Nilsson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Kwok-Leung Ong
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Margareta Kristenson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Karin Festin
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Anna K Lundberg
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Rosanna W S Chung
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Eva Swahn
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Joakim Alfredsson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Signe Holm Nielsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
- Nordic Bioscience, Herlev, Denmark
| | - Lena Jonasson
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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Hammareus F, Nilsson L, Ong KL, Kristenson M, Festin K, Lundberg A, Chung RWS, Swahn E, Alfredsson J, Holm Nielsen S, Jonasson L. Investigation of type 1 collagen a1 chain in plasma as a potential novel biomarker for prediction of coronary heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Remodeling of the extracellular matrix (ECM) plays a crucial role in development and progression of atherosclerosis. Collagens, in particular type I collagen, are the most abundant ECM proteins in an atherosclerotic plaque. Recently, type I collagen α1 chain (COL1α1) in plasma was identified as a potential predictor of coronary heart disease (CHD).
Aim
The aim was to further confirm the predictive value of COL1α1 and also to investigate its correlates in a population-based cohort as well as changes over time in patients with manifest CHD in Sweden.
Methods
In a total of 1007 well-characterized individuals (50% women), 86 CHD cases and 184 sex- and age-matched controls were identified at 13 years follow-up. CHD at follow-up was defined as first-time event of myocardial infarction (MI) or invasive coronary intervention. Plasma levels of COL1α1 was quantified by the Luminex assay while PRO-C1 and C1M, two markers of type I collagen synthesis and degradation, respectively, were quantified by ELISA. In Cox proportional hazard analysis, log2 values of biomarker levels were used. In addition, temporal change of COL1α1 levels was also examined in a cohort of 125 patients with acute MI followed for 6 months.
Results
COL1α1 levels were significantly associated with incident CHD, both unadjusted (HR = 0.69, 95% CI 0.56–0.87, p=0.001) and after multiple adjustment (HR = 0.55, 95% CI 0.41–0.75, p<0.001). PRO-C1 was similarly associated with CHD, unadjusted (HR = 0.62, 95% CI 0.47–0.82, p=0.001) as well as adjusted (HR = 0.61, 95% CI 0.43–0.86, p=0.005), while C1M was not. In patients with acute MI, COL1α1 levels remained stable over 6 months. COL1α1 was significantly correlated to PRO-C1 (r=0.73, p<0.001), while there were no correlations to C1M, markers of inflammation (C-reactive protein, interleukin-6, matrix metalloproteinase-9) or myocardial injury (troponin T).
Conclusions
Circulating COL1α1 in plasma was independently and inversely associated with incident CHD. Furthermore, COL1α1 levels appeared to be relatively stable after an acute MI. COL1α1 levels seem to reflect collagen synthesis rather than collagen degradation and inflammation. Future studies are needed to confirm whether COL1α1 is a clinically useful marker and/or predictor of CHD.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This research was in part financed by a grant from the Region of Östergötland, Sweden, aimed towards scientists early in their career. We would like to thank the people behind this grant for contributing to this research.This research was also partly supported by Futurum - the academy for healthcare in Region Jönköping County.
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Affiliation(s)
- F Hammareus
- Department of Medical and Health Sciences Linkoping University , Linkoping , Sweden
| | - L Nilsson
- Linkoping University , Linkoping , Sweden
| | - K L Ong
- University of New South Wales Sydney , Sydney , Australia
| | | | - K Festin
- Linkoping University , Linkoping , Sweden
| | - A Lundberg
- Linkoping University , Linkoping , Sweden
| | | | - E Swahn
- Linkoping University , Linkoping , Sweden
| | | | - S Holm Nielsen
- Technical University of Denmark , Kongens Lyngby , Denmark
| | - L Jonasson
- Linkoping University , Linkoping , Sweden
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Ong KL, Cochran BBiotech BJ, Manandhar B, Thomas S, Rye KA. HDL maturation and remodelling. Biochim Biophys Acta Mol Cell Biol Lipids 2022; 1867:159119. [PMID: 35121104 DOI: 10.1016/j.bbalip.2022.159119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
Cholesterol in the circulation is mostly transported in an esterified form as a component of lipoproteins. The majority of these cholesteryl esters are produced in nascent, discoidal high density lipoproteins (HDLs) by the enzyme, lecithin:cholesterol acyltransferase (LCAT). Discoidal HDLs are discrete populations of particles that consist of a phospholipid bilayer, the hydrophobic acyl chains of which are shielded from the aqueous environment by apolipoproteins that also confer water solubility on the particles. The progressive LCAT-mediated accumulation of cholesteryl esters in discoidal HDLs generates the spherical HDLs that predominate in normal human plasma. Spherical HDLs contain a core of water insoluble, neutral lipids (cholesteryl esters and triglycerides) that is surrounded by a surface monolayer of phospholipids with which apolipoproteins associate. Although spherical HDLs all have the same basic structure, they are extremely diverse in size, composition, and function. This review is concerned with how the biogenesis of discoidal and spherical HDLs is regulated and the mechanistic basis of their size and compositional heterogeneity. Current understanding of the impact of this heterogeneity on the therapeutic potential of HDLs of varying size and composition is also addressed in the context of several disease states.
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Affiliation(s)
- Kwok-Leung Ong
- School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Blake J Cochran BBiotech
- School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Bikash Manandhar
- School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Shane Thomas
- School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, New South Wales, Australia.
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Ong KL, Wu L, Januszewski AS, O’Connell R, Xu A, Scott RS, Sullivan DR, Rye KA, Li H, Ma RCW, Li L, Gebski V, Jenkins AJ, Jia W, Keech AC. The relationship of neutrophil elastase and proteinase 3 with risk factors, and chronic complications in type 2 diabetes: A Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) sub-study. Diab Vasc Dis Res 2021; 18:14791641211032547. [PMID: 34275349 PMCID: PMC8481737 DOI: 10.1177/14791641211032547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Neutrophil elastase (NE) and proteinase 3 (PR3) are novel inflammation biomarkers. We investigated their associations with chronic complications, determinants of biomarker levels and effects of fenofibrate in patients with type 2 diabetes mellitus (T2DM) from Fenofibrate Intervention and Event Lowering in Diabetes study. METHODS Plasma NE and PR3 levels were quantified at baseline (n = 2000), and relationships with complications over 5-years assessed. Effects of fenofibrate on biomarker levels (n = 200) were determined at four follow-up visits. RESULTS Higher waist-to-hip ratio, homocysteine and C-reactive protein and lower apoA-II were determinants of higher NE and PR3 levels. Higher NE levels were associated with on-trial stroke and cardiovascular mortality, and higher PR3 levels with on-trial stroke, but associations were not significant after adjustment for confounding factors. Although higher NE and PR3 levels were associated with baseline total microvascular disease, only NE levels were associated with on-trial neuropathy or amputation. These associations were not significant after adjusting for multiple comparisons. NE and PR3 levels did not change with fenofibrate. CONCLUSIONS In T2DM plasma NE and PR3 levels are associated with vascular risk factors, and total microvascular disease at baseline, but on rigorous analyses were not associated with on-trial complications. Levels were not changed by fenofibrate.
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Affiliation(s)
- Kwok-Leung Ong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Liang Wu
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | | | - Rachel O’Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Aimin Xu
- Department of Medicine, University of Hong Kong, Hong Kong, China
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - David R Sullivan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Huating Li
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ronald CW Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Liping Li
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Prof Anthony Keech, NHMRC Clinical Trials Centre, Level 6, Medical Foundation Building, 92–94 Parramatta Road, Camperdown, NSW 2050, Australia.
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Abstract
Epidemiological studies have established that a high plasma high density lipoprotein cholesterol (HDL-C) level is associated with reduced cardiovascular risk. However, recent randomised clinical trials of interventions that increase HDL-C levels have failed to establish a causal basis for this relationship. This has led to a shift in HDL research efforts towards developing strategies that improve the cardioprotective functions of HDLs, rather than simply increasing HDL-C levels. These efforts are also leading to the discovery of novel HDL functions that are unrelated to cardiovascular disease. One of the most recently identified functions of HDLs is their potent antidiabetic properties. The antidiabetic functions of HDLs, and recent key advances in this area are the subject of this review. Given that all forms of diabetes are increasing at an alarming rate globally, there is a clear unmet need to identify and develop new approaches that will complement existing therapies and reduce disease progression as well as reverse established disease. Exploration of a potential role for HDLs and their constituent lipids and apolipoproteins in this area is clearly warranted. This review highlights focus areas that have yet to be investigated and potential strategies for exploiting the antidiabetic functions of HDLs.
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Affiliation(s)
| | | | | | - Kerry-Anne Rye
- Correspondence: ; Tel.: +61-2-9385-1219; Fax: +61-2-9385-1389
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Abstract
PURPOSE OF THE REVIEW Apolipoprotein (APO) A1, the main apolipoprotein of plasma high-density lipoproteins (HDLs), has several well documented cardioprotective functions. A number of additional potentially beneficial functions of APOA1 have recently been identified. This review is concerned with the therapeutic potential of all of these functions in multiple disease states. RECENT FINDINGS Knowledge of the beneficial functions of APOA1 in atherosclerosis, thrombosis, diabetes, cancer, and neurological disorders is increasing exponentially. These insights have led to the development of clinically relevant peptides and APOA1-containing, synthetic reconstituted HDL (rHDL) preparations that mimic the functions of full-length APOA1. APOA1 is a multifunctional apolipoprotein that has therapeutic potential in several diseases. Translation of this knowledge into the clinic is likely to be dependent on the efficacy and bioavailability of small peptides and synthetic rHDL preparations that are currently under investigation, or in development.
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Affiliation(s)
- Blake J Cochran
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Level 4E Wallace Wurth Building, Kensington, New South Wales, 2052, Australia
| | - Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Level 4E Wallace Wurth Building, Kensington, New South Wales, 2052, Australia
| | - Bikash Manandhar
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Level 4E Wallace Wurth Building, Kensington, New South Wales, 2052, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Level 4E Wallace Wurth Building, Kensington, New South Wales, 2052, Australia.
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Ong KL, Wu L, Januszewski AS, O'Connell RL, Xu A, Rye KA, Ma RCW, Li H, Jenkins AJ, Jia W, Keech AC. Relationships of adipocyte-fatty acid binding protein and lipocalin 2 with risk factors and chronic complications in type 2 diabetes and effects of fenofibrate: A fenofibrate Intervention and event lowering in diabetes sub-study. Diabetes Res Clin Pract 2020; 169:108450. [PMID: 32949655 DOI: 10.1016/j.diabres.2020.108450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/24/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
AIMS To investigate determinants of circulating levels of adipocyte-fatty acid binding protein (A-FABP) and lipocalin-2 (LCN2), their relationships with cardiovascular disease (CVD) and microvascular events, and effects of fenofibrate in type 2 diabetes (T2D). METHODS A-FABP and LCN2 were quantified in baseline plasma from 2000 T2D adults in a Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial sub-study and correlates thereof determined. In a subset (n = 200) adipokines were also measured on-trial. RESULTS Female sex, older age, higher body mass index (BMI), HbA1c, insulin resistance index, triglycerides, plasma creatinine and homocysteine, shorter diabetes duration, and use of oral hypoglycaemic agents alone were independent determinants of higher A-FABP. Higher BMI, fibrinogen and homocysteine, Caucasian race, and lower fasting glucose, HDL-cholesterol, apolipoprotein A-II and estimated glomerular filtration rate were independent predictors of higher LCN2 levels. Baseline A-FABP and LCN2 levels were associated with multiple new CVD and microvascular events over 5-years, though significance was lost after risk factor adjustment. Fenofibrate increased A-FABP but did not change LCN2 levels. CONCLUSIONS Baseline plasma A-FABP and LCN2 levels were associated with concurrent CVD risk factors, and on-trial chronic complications, likely mediated via traditional risk factors. Fenofibrate increased A-FABP modestly but did not affect LCN2 levels. CLINICAL TRIAL REGISTRATION ISRCTN 64783481.
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Affiliation(s)
- Kwok-Leung Ong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Liang Wu
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | | | - Rachel L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Aimin Xu
- Department of Medicine, University of Hong Kong, Hong Kong; State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Huating Li
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Abstract
Gouty arthritis commonly affects peripheral joints and is associated with hyperuricaemia. Spinal manifestations of gouty arthritis are not common, and majority of published articles worldwide were case reports. This is a case report of spinal gouty arthritis that presented with spinal vertebrae destruction and cauda equina syndrome. The magnetic resonance imaging (MRI) showed destruction of L5/S1end plates with cystic collection mimicking infective changes. The tissue histological examination confirmed presence of urate crystal needles that displayed negative double refraction on light microscopy. Spinal gouty arthritis is part of the differential diagnoses in gouty arthritis patients.
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Affiliation(s)
- K Thuraikumar
- Department of Orthopaedics and Traumatology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - K L Wan
- Department of Orthopaedics and Traumatology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - K L Ong
- Department of Orthopaedics and Traumatology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - S W Lim
- Department of Orthopaedics and Traumatology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
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Wu BJ, Li Y, Ong KL, Sun Y, Johns D, Barter PJ, Rye KA. The Cholesteryl Ester Transfer Protein Inhibitor, des-Fluoro-Anacetrapib, Prevents Vein Bypass-induced Neointimal Hyperplasia in New Zealand White Rabbits. Sci Rep 2019; 9:16183. [PMID: 31700015 PMCID: PMC6838195 DOI: 10.1038/s41598-019-52510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/18/2019] [Indexed: 11/25/2022] Open
Abstract
Coronary artery bypass grafting is among the most commonly performed of all cardiovascular surgical procedures. However, graft failure due to stenosis reduces the long-term benefit of the intervention. This study asks if elevating plasma high density lipoprotein cholesterol (HDL-C) levels by inhibition of cholesteryl ester transfer protein (CETP) activity with des-fluoro-anacetrapib, an analog of the CETP inhibitor anacetrapib, prevents vein bypass-induced neointimal hyperplasia. NZW rabbits were placed on a normal chow diet or chow containing 0.14% (wt/wt) des-fluoro-anacetrapib for 6 weeks. Bypass grafting of the jugular vein to the common carotid artery was performed 2 weeks after starting dietary des-fluoro-anacetrapib supplementation. The animals were euthanised 4 weeks post-bypass grafting. Relative to control, dietary supplementation with des-fluoro-anacetrapib reduced plasma CETP activity by 89 ± 6.9%, increased plasma apolipoprotein A-I levels by 24 ± 5.5%, increased plasma HDL-C levels by 93 ± 26% and reduced intimal hyperplasia in the grafted vein by 38 ± 6.2%. Des-fluoro-anacetrapib treatment was also associated with decreased bypass grafting-induced endothelial expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1), endothelial dysfunction, and smooth muscle cell (SMC) proliferation in the grafted vein. In conclusion, increasing HDL-C levels by inhibiting CETP activity is associated with inhibition of intimal hyperplasia in grafted veins, reduced inflammatory responses, improved endothelial function, and decreased SMC proliferation.
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Affiliation(s)
- Ben J Wu
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia.
| | - Yue Li
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Yidan Sun
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Immunology and Pathophysiology, Medical University of Graz, Graz, Austria
| | | | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, The University of New South Wales Sydney, New South Wales, Australia.
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Abstract
AIMS Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN. PATIENTS AND METHODS Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors. RESULTS The Medicare data yielded 56 522 patients who underwent primary THA, of whom 369 had previously been treated with a CMN. The percentage of THAs that were undertaken between 2002 and 2005 in patients who had previously been treated with a CMN (0.346%) more than doubled between 2012 and 2015 (0.781%). The CMN group tended to be older and female, and to have a higher Charlson Comorbidity Index and lower socioeconomic status. The mean LOS was 1.5 days longer (5.3 vs 3.8) in the CMN group (p < 0.0001). The incidence of complications was significantly higher in the CMN group compared with the non-CMN group: infection (6.2% vs 2.6%), dislocation (8.1% vs 4.5%), revision (8.4% vs 4.3%), revision for infection (1.1% vs 0.37%), and revision for dislocation (2.2% vs 0.6%). CONCLUSION The incidence of conversion to THA following failed intertrochanteric hip fracture fixation using a CMN continues to increase. This occurs in elderly patients with increased comorbidities. There is a significantly increased risk of infection, dislocation, and LOS in these patients. Patients with failed intertrochanteric hip fracture fixation using a CMN who require THA should be made aware of the increased risk of complications, and steps need to be taken to reduce this risk. Cite this article: Bone Joint J 2019;101-B(6 Supple B):91-96.
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Affiliation(s)
- A Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - K Denehy
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - K L Ong
- Exponent Inc., Philadelphia, Pennsylvania, USA
| | - E Lau
- Exponent Inc., Menlo Park, California, USA
| | - D Hagan
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - A Malkani
- Adult Reconstruction Program, University of Louisville, KentuckyOne Health, Louisville, Kentucky, USA
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Abstract
Objective- Insulin resistance and inflammation in pregnancy are risk factors for gestational diabetes mellitus. Increased plasma HDL (high-density lipoprotein) and apo (apolipoprotein) A-I levels have been reported to improve glucose metabolism and inhibit inflammation in animals and humans. This study asks whether increasing plasma apoA-I levels improves insulin sensitivity and reduces inflammation in insulin-resistant pregnant rats. Approach and Results- Insulin-resistant pregnant rats received intravenous infusions of lipid-free apoA-I (8 mg/kg) or saline on days 6, 9, 12, 15, and 18 of pregnancy. The rats were then subjected to a euglycemic-hyperinsulinemic clamp. Glucose uptake was increased in white and brown adipose tissue by 57±13% and 32±10%, respectively ( P<0.05 for both), and in quadriceps and gastrocnemius muscle by 35±9.7% and 47±14%, respectively ( P<0.05 for both), in the apoA-I-treated pregnant rats relative to saline-infused pregnant rats. The pregnant rats that were treated with apoA-I also had reduced plasma TNF-α (tumor necrosis factor-α) levels by 57±8.4%, plasma IL (interleukin)-6 levels by 67±9.5%, and adipose tissue macrophage content by 54±8.2% ( P<0.05 for all) relative to the saline-treated pregnant rats. Conclusions- These studies establish that apoA-I protects against pregnancy-induced insulin resistance in rats by increasing insulin sensitivity in adipose tissue and skeletal muscle and inhibiting inflammation. This identifies apoA-I as a potential target for preventing pregnancy-induced insulin resistance and reducing the incidence of gestational diabetes mellitus.
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Affiliation(s)
- Ben J Wu
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
| | - Yidan Sun
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
- Division of Immunology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Austria (Y.S.)
| | - Kwok-Leung Ong
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
| | - Yue Li
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
| | - Shudi Tang
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
| | - Philip J Barter
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
| | - Kerry-Anne Rye
- From the Lipid Research Group, School of Medical Sciences, University of New South Wales Sydney, Australia (B.J.W., Y.S., K.-L.O., Y.L., S.T., P.J.B., K.-A.R.)
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Hou L, Tang S, Wu BJ, Ong KL, Westerterp M, Barter PJ, Cochran BJ, Tabet F, Rye KA. Apolipoprotein A-I improves pancreatic β-cell function independent of the ATP-binding cassette transporters ABCA1 and ABCG1. FASEB J 2019; 33:8479-8489. [PMID: 30970222 DOI: 10.1096/fj.201802512rr] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Apolipoprotein A-I (apoA-I), the main protein constituent of HDLs, increases insulin synthesis and insulin secretion in pancreatic β cells. ApoA-I also accepts cholesterol that effluxes from cells expressing ATP-binding cassette transporter A1 (ABCA1) and ATP-binding cassette transporter G1 (ABCG1). Mice with conditional deletion of ABCA1 and ABCG1 in β cells [β-double knockout (DKO) mice] have increased islet cholesterol levels and reduced glucose-stimulated insulin secretion (GSIS). The project asks whether metabolic pathways are dysregulated in β-DKO mouse islets and whether this can be corrected, and GSIS improved, by treatment with apoA-I. β-DKO mice were treated with apoA-I or PBS, and islets were isolated for determination of GSIS. Total RNA was extracted from β-DKO and control mouse islets for microarray analysis. Metabolic pathways were interrogated by functional enrichment analysis. ApoA-I treatment improved GSIS in β-DKO but not control mouse islets. Plasma lipid and lipoprotein levels and islet cholesterol levels were also unaffected by treatment with apoA-I. Cholesterol metabolism, glucose metabolism, and inflammation pathways were dysregulated in β-DKO mouse islets. This was not corrected by treatment with apoA-I. In summary, apoA-I treatment improves GSIS by a cholesterol-independent mechanism, but it does not correct metabolic dysregulation in β-DKO mouse islets.-Hou, L., Tang, S., Wu, B. J., Ong, K.-L., Westerterp, M., Barter, P. J., Cochran, B. J., Tabet, F., Rye, K.-A. Apolipoprotein A-I improves pancreatic β-cell function independent of the ATP-binding cassette transporters ABCA1 and ABCG1.
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Affiliation(s)
- Liming Hou
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Shudi Tang
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ben J Wu
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Marit Westerterp
- Section Molecular Genetics, Department of Pediatrics, University of Groningen-University Medical Center Groningen, Groningen, The Netherlands
| | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Blake J Cochran
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fatiha Tabet
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA. Correction to: Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporos Int 2019; 30:703. [PMID: 30805676 PMCID: PMC6828487 DOI: 10.1007/s00198-019-04877-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The article Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials?, written by K. L. Ong, D. P. Beall, M. Frohbergh, E. Lau, and J. A. Hirsch was originally published electronically on the publisher's internet portal.
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Affiliation(s)
- K L Ong
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA.
| | | | - M Frohbergh
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA
| | - E Lau
- Exponent, Inc., Menlo Park, CA, USA
| | - J A Hirsch
- Massachusetts General Hospital, Boston, MA, USA
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Ong KL, McClelland RL, Allison MA, Kokkinos J, Wu BJ, Barter PJ, Rye KA. Association of elevated circulating fibroblast growth factor 21 levels with prevalent and incident metabolic syndrome: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2019; 281:200-206. [PMID: 30446181 PMCID: PMC6399036 DOI: 10.1016/j.atherosclerosis.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/18/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Fibroblast growth factor 21 (FGF21) plays an important role in glucose and lipid metabolism. We have investigated the relationship of plasma FGF21 levels with both prevalent and incident metabolic syndrome (MetS) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS 5783 participants from four major ethnic groups (non-Hispanic white, African American, Hispanic American, and Chinese American) were included in the cross-sectional analysis. Longitudinal analysis involved 3479 participants without MetS at baseline, of whom 1100 participants developed incident MetS over 9.2 years. RESULTS Elevated FGF21 levels were found in participants with prevalent MetS (median [interquartile range] = 189.4 [114.4-302.1] vs. 123.7 [65.9-210.3] pg/mL, p < 0.001) or incident MetS (145.6 [84.9-240.8] vs 112.0 [57.0-194.5] pg/mL, p < 0.001), compared to those without. After adjusting for baseline demographic, socioeconomic and lifestyle factors, as well as cardiovascular risk factors and biomarkers, and compared to the lowest quartile, the highest FGF21 quartile was associated with prevalent MetS (odds ratio 2.80; 95% confidence interval, 2.30-3.40, p < 0.001). Among participants without MetS at baseline, the highest FGF21 quartile was associated with higher risk of incident MetS (hazards ratio 1.76; 95% confidence interval, 1.46-2.12, p < 0.001). Similar results were obtained when assessing ln-transformed FGF21 levels. Overall, no significant interaction was found with age, sex, and race/ethnicity for both prevalent and incident MetS. CONCLUSIONS Higher FGF21 levels significantly predict the development of MetS in an ethnically diverse population followed long term. Further studies are needed to confirm the potential role of FGF21 as a biomarker for MetS.
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Affiliation(s)
- Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - John Kokkinos
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben J Wu
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Affiliation(s)
- K L Ong
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, 19104, USA.
| | | | - M Frohbergh
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, 19104, USA
| | - E Lau
- Exponent, Inc., Menlo Park, CA, USA
| | - J A Hirsch
- Massachusetts General Hospital, Boston, MA, USA
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16
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Lakhani I, Gong M, Wong WT, Bazoukis G, Lampropoulos K, Wong SH, Wu WKK, Wong MCS, Ong KL, Liu T, Tse G. Fibroblast growth factor 21 in cardio-metabolic disorders: a systematic review and meta-analysis. Metabolism 2018; 83:11-17. [PMID: 29410351 DOI: 10.1016/j.metabol.2018.01.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/31/2017] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fibroblast growth factor 21 is a signalling protein involved in cell differentiation, morphogenesis, proliferation and metabolism. Recent studies have associated increased levels of FGF21 in the development of cardiovascular diseases, whereas others have reported no significant associations. Therefore, this systematic review and meta-analysis evaluated the value in predicting the risk of cardio-metabolic disorders and mortality. METHODS PubMed and EMBASE were searched until 5th September 2017 for studies that evaluated the roles of FGF21 levels in cardio-metabolic disorders. RESULTS A total of 183 and 301 entries were retrieved; 24 studies met the inclusion criteria. Four studies were identified by an additional search. Therefore, 28 studies were included in the final meta-analysis. High FGF21 levels significantly predicted the incidence of coronary artery disease (hazard ratio [HR]: 1.29; 95% confidence interval [CI]: 1.06-1.55; P < 0. 01; I2 = 48%) and the risk of metabolic syndrome (HR: 1.70, 95% CI: 1.35-2.15; P < 0.0001 I2 = 24%). In diabetes mellitus, FGF21 predicted disease incidence or progression (HR: 1.35, 95% CI: 1.06-1.72, P < 0.05, I2 = 69%) and worsening renal failure (HR: 1.06, 95% CI: 1.03-1.09, P < 0.0001, I2 = 47%). FGF21 also predicted all-cause mortality (HR: 3.00, 95% CI: 1.23-7.33; P < 0.05; I2 = 51%), and cardiovascular mortality (HR: 2.33, 95% CI: 1.08-4.99, P < 0.05, I2 = 75%). CONCLUSION FGF21 significantly predicts the incidence of coronary artery disease, the risks of metabolic syndrome, diabetes mellitus and renal progression in diabetes. It also predicted all-cause and cardiovascular mortality.
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Affiliation(s)
- Ishan Lakhani
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Wing Tak Wong
- School of Life Science and State Key Laboratory of Agro-Biotechnology, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kwok-Leung Ong
- School of Medical Science, Faculty of Medicine, University of New South Wales, Australia
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
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Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials? Osteoporos Int 2018; 29:375-383. [PMID: 29063215 PMCID: PMC6394540 DOI: 10.1007/s00198-017-4281-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/17/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients. INTRODUCTION BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients. METHODS BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005-2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors. RESULTS The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007-2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3-4%; p < 0.001) greater in 2010-2014 versus 2005-2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19-19%; p < 0.001) and 7% (95% CI, 7-8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12-13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort. CONCLUSIONS Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.
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Affiliation(s)
- K L Ong
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA.
| | | | - M Frohbergh
- Exponent, Inc., 3440 Market St, Suite 600, Philadelphia, PA, USA
| | - E Lau
- Exponent, Inc., Menlo Park, CA, USA
| | - J A Hirsch
- Massachusetts General Hospital, Boston, MA, USA
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Abstract
We report a case of a 79-year-old gentleman presenting with numbness of both hands. A magnetic resonance imaging of the cervical spine demonstrated features suggestive of subacute combined degeneration of the spinal cord which was further supported by a low serum vitamin B12. This is a reversible condition if early diagnosis can be made and vitamin B12 therapy promptly given. Delayed treatment can result in irreversible neurological impairment.
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Affiliation(s)
| | | | - GCY Fong
- 813 Medical Centre, Room 1617 Central Building, 1-3 Pedder Street, Central, Hong Kong
| | - KL Ong
- Pok Oi Hospital, Accident and Emergency Department, Au Tau, Yuen Long, N.T., Hong Kong
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Abstract
Appendicitis is one of the most common acute abdominal conditions encountered in the Emergency Department. It is a surgical condition that can affect any person of any age and often with varying clinical presentations. In the majority of cases, the diagnosis is straightforward. However in some, the diagnosis requires a heightened clinical suspicion. The application of adjuvant laboratory tests and diagnostic imaging helps to reduce the associated complications, morbidity and mortality of delayed diagnosis.
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Affiliation(s)
- LTH Tan
- Hong Kong Baptist Hospital, Department of Radiology, 222 Waterloo Road, Kowloon, Hong Kong
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Tan LTH, Ong KL. Painless Gross Haematuria. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Inflammatory pseudotumour is a benign mesenchymal lesion that has distinct pathological features. Patients often present with haematuria, abdominal pain or recurrent cystitis. There are overlapping features with bladder sarcoma in presentation, age range, and size, but the pseudotumour does not metastasise. Awareness of this unusual lesion is important to prevent its misinterpretation. Complete surgical excision of the tumour mass is the treatment of choice.
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Affiliation(s)
- LTH Tan
- Precious Blood Hospital, Department of Radiology, 113 Castle Peak Road, Sham Shui Po, Kowloon, Hong Kong
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Affiliation(s)
- LTH Tan
- Hong Kong Baptist Hospital, Department of Radiology, 222 Waterloo Road, Kowloon, Hong Kong
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Abstract
Purple discolouration of urine is not commonly encountered in accident and emergency departments. We report a case of an elderly gentleman on long-term urinary catheter who presented with purple discolouration of urine. He was found to have urinary tract infection caused by the bacteria Proteus mirabilis. The urine became clear after urinary catheter change and antibiotic treatment. This is called the purple urine bag syndrome and emergency physicians should be aware of this uncommon condition and the associated potentially dangerous conditions in order to initiate appropriate management.
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Tse CL, Lui CT, Wong CY, Ong KL, Fung HT, Tang SYH. Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome. Methods It is a before-and-after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan-Meier analysis and log-rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates. Results 64 patients were included, 31 patients were in the pre-intervention group whereas 33 post-intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log-rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality. Conclusion A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.
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Affiliation(s)
- CL Tse
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - CT Lui
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - CY Wong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - KL Ong
- Pok Oi Hospital, Department of Accident and Emergency, Au Tau, Yuen Long, N.T., Hong Kong
| | - HT Fung
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
| | - SYH Tang
- Tuen Mun Hospital, Department of Accident and Emergency, Tsing Chung Koon Road, Tuen Mun, N.T., Hong Kong
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Abstract
Computed radiography offers many advantages over the conventional radiography. With new technological breakthroughs and the development of systems that are more cost-effective, there has been an increase in its use in the recent years. However, like all imaging modalities, one must be aware of the various artifacts that are likely to lead to misdiagnosis. In this article, we illustrate the potential hardware and software artifacts that are associated with its use.
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Affiliation(s)
| | - KL Ong
- Prince of Wales Hospital, Department of Accident and Emergency, Ong Kim Lian, Consultant
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25
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Shek KC, Lo CM, Ong KL, Kam CW. Spontaneous Pneumomediastinum: An Uncommon Complication from an Augmented Physiological Belching (Imitating a TV Show Game). HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Noisy belching in front of other people, often considered to be an impolite manner, may not be as harmless as it seems. We report on a patient who had spontaneous pneumomediastinum after intentional induction of noisy belching by rapid excessive intake of carbonated drinks (imitating the game played in a popular local television program “The Super Trio Continues…”). The clinical features, investigations and management of spontaneous pneumomediastinum are discussed.
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Tan LTH, Ong KL. Painful Malignant Embryonal Carcinoma of the Testis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with clinically palpable testicular nodule, regardless of absence or accompanying symptom of pain, require further evaluation. Testicular carcinoma including embryonal carcinoma has varied appearances and the diagnosis can be difficult unless there is presence of local infiltration or distant metastatic deposits. Ultrasound examination is the imaging modality of choice to quickly confirm the clinical findings of testicular mass at the Emergency Department and distinguish a testicular mass from an extra-testicular mass and extent of the disease. Despite presentations in varying stages of disease, the treatment will include orchiectomy.
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Affiliation(s)
- LTH Tan
- Precious Blood Hospital, Department of Radiology, 113 Castle Peak Road, Sham Shui Po, Kowloon, Hong Kong
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Tan LTH, Ong KL. Sudden Onset of Calf Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Avulsion of the myo-tendinous junction of the medial head of the gastrocnemius muscle is commonly associated with strenuous physical activities such as racquet sports, skiing, and running. The injury is painful, distressing and can be disabling. Ready availability makes ultrasound study the imaging modality of choice in the emergency department.
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Affiliation(s)
- LTH Tan
- Precious Blood Hospital, Department of Radiology, 113 Castle Peak Road, Sham Shui Po, Kowloon, Hong Kong Tan Thuan Heng, Lawrence
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Abstract
Benign intratesticular lesions such as epidermoid cyst are rare, but recognition is important to avoid unnecessary surgical intervention (orchiectomy). The combination of ultrasonographic findings and negative tumour markers can help differentiate benign from malignant intratesticular lesions. At surgery, the lesion can be enucleated and frozen sections obtained to confirm the diagnosis, thus avoiding the need for orchiectomy.
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Affiliation(s)
- LTH Tan
- Precious Blood Hospital, Department of Radiology, 113 Castle Peak Road, Sham Shui Po, Kowloon, Hong Kong
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Ong KL, O'Connell R, Januszewski AS, Jenkins AJ, Xu A, Sullivan DR, Barter PJ, Scott RS, Taskinen MR, Waldman B, Colman PG, Best JD, Simes JR, Rye KA, Keech AC. Baseline Circulating FGF21 Concentrations and Increase after Fenofibrate Treatment Predict More Rapid Glycemic Progression in Type 2 Diabetes: Results from the FIELD Study. Clin Chem 2017; 63:1261-1270. [DOI: 10.1373/clinchem.2016.270876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/05/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
It is not known whether circulating fibroblast growth factor 21 (FGF21) concentrations are associated with glycemic progression in patients with established type 2 diabetes. This study reports this relationship in type 2 diabetes patients participating in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial.
METHODS
Plasma FGF21 was quantified in 9697 study participants. Among patients with lifestyle-only glucose control measures at baseline, glycemic progression was defined as the initiation of oral hypoglycemic agents or insulin therapy. We assessed the relationship of FGF21 concentrations with glycohemoglobin (Hb A1c), the homeostasis model assessment of β-cell function (HOMA-B) and insulin resistance (HOMA-IR), and glycemic progression.
RESULTS
Among 2584 patients with lifestyle-only glycemic therapy at baseline, plasma FGF21 concentrations were positively associated with HOMA-IR (5.1% increase per 100% increase in FGF21 concentrations). Patients with higher baseline plasma FGF21 concentrations had higher risk of glycemic progression over a 5-year period (P = 0.02), but the association was not significant after further adjusting for alanine aminotransferase (ALT) enzyme activity. During the fenofibrate active run-in phase, higher tertiles of fenofibrate-induced increase in FGF21 concentrations were associated with higher risk of glycemic progression (adjusted hazards ratio = 1.09 and 1.18 for tertiles 2 and 3, respectively, P for trend = 0.01), even after adjusting for ALT enzyme activity. This association was statistically significant in the fenofibrate group only (P = 0.01).
CONCLUSIONS
Higher baseline and fenofibrate-induced increase in FGF21 concentrations predict more rapid glycemic progression in type 2 diabetes patients. This association may be partly explained by hepatic function.
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Affiliation(s)
- Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Aimin Xu
- Department of Medicine, University of Hong Kong, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - David R Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Marja-Riitta Taskinen
- Heart and Lung Centre, Cardiovascular Research Unit, Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
| | - Boris Waldman
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter G Colman
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - James D Best
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - John R Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Ong KL, Morris MJ, McClelland RL, Maniam J, Allison MA, Rye KA. Lipids, lipoprotein distribution and depressive symptoms: the Multi-Ethnic Study of Atherosclerosis. Transl Psychiatry 2016; 6:e962. [PMID: 27898070 PMCID: PMC5290355 DOI: 10.1038/tp.2016.232] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 12/28/2022] Open
Abstract
Previous studies suggest lower concentrations of total and high-density lipoprotein (HDL) cholesterol to be predictive of depression. We therefore investigated the relationship of lipids and lipoprotein distribution with elevated depressive symptoms (EDS) in healthy men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were followed up over a 9.5-year period. EDS were defined as a Center for Epidemiological Studies Depression (CES-D) score ⩾16 and/or use of antidepressant drugs. Lipoprotein distribution was determined from plasma using nuclear magnetic resonance spectroscopy. Among 4938 MESA participants (mean age=62 years) without EDS at baseline, 1178 (23.9%) developed EDS during follow-up. In multivariable Cox regression analyses, lower total, low-density lipoprotein (LDL) and non-HDL cholesterol concentrations at baseline were associated with incident EDS over 9.5 years (hazards ratio (HR)=1.11-1.12 per s.d. decrease, all P<0.01), after adjusting for demographic factors, traditional risk factors including LDL cholesterol, HDL cholesterol and triglycerides. Lipoprotein particle subclasses and sizes were not associated with incident EDS. Among participants without EDS at both baseline and visit 3, a smaller increase in total or non-HDL cholesterol between these visits was associated with lower risk of incident EDS after visit 3 (HR=0.88-0.90 per s.d. decrease, P<0.05). Lower baseline concentrations of total, LDL and non-HDL cholesterol were significantly associated with a higher risk of incident EDS. However, a short-term increase in cholesterol concentrations did not help to reduce the risk of EDS. Further studies are needed to replicate our findings in cohorts with younger participants.
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Affiliation(s)
- K L Ong
- School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia,School of Medical Science, University of New South Wales Australia, Sydney, NSW 2052, Australia. E-mail:
| | - M J Morris
- School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia
| | - R L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - J Maniam
- School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia
| | - M A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - K-A Rye
- School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia
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Wong YK, Lui CT, Li KK, Wong CY, Lee MM, Tong WL, Ong KL, Tang SYH. Prediction of en-route complications during interfacility transport by outcome predictive scores in ED. Am J Emerg Med 2016; 34:877-82. [PMID: 26947612 DOI: 10.1016/j.ajem.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to determine the accuracy of the outcome predictive scores (Modified Early Warning Score [MEWS]; Hypotension, Low Oxygen Saturation, Low Temperature, Abnormal ECG, Loss of Independence [HOTEL] score; and Simple Clinical Score [SCS]) in predicting en-route complications during interfacility transport (IFT) in emergency department. DESIGN This was a retrospective cohort study. METHODS All IFT cases by ambulances with either nurse-led or physician-led escort, occurring between 1 January 2011 and 31 December 2012, were included. Obstetric and pediatric cases (age < 18 years) were excluded. The condition of patients was quantified by using the predictive scores (MEWS, HOTEL, and SCS) at triage station and on ambulance departure. The accuracy of predictive scores was compared by the receiver operating characteristic (ROC) curves. RESULTS A total of 659 cases were included. Seventeen cases had en-route complications (2.6%). The complication rate in physician-escorted transport (2.2%) was similar to that in nurse-escorted transport (2.6%). None of the 57 intubated cases had en-route complications. The area under the ROC curve for MEWS was 0.662 (triage) and 0.479 (departure). The accuracy of MEWS at triage was better than that at departure (P = .049). The area under the ROC curve for HOTEL was 0.613 (triage) and 0.597 (departure), and that for SCS was 0.6 (triage) and 0.568 (departure). In general, the predictive scores at triage were better than those on departure. CONCLUSION None of the scores had good accuracy in prediction of en-route complications during IFT. MEWS at triage was among the best one already but was not ideal.
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Affiliation(s)
- Y K Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C T Lui
- Department of Accident and Emergency Medicine, Tuen Mun Hospital.
| | - K K Li
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - C Y Wong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - M M Lee
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - W L Tong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - K L Ong
- Department of Accident and Emergency Medicine, Pok Oi Hospital
| | - S Y H Tang
- Department of Accident and Emergency Medicine, Tuen Mun Hospital
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Ong KL, Januszewski AS, O'Connell R, Buizen L, Jenkins AJ, Xu A, Sullivan DR, Barter PJ, Scott RS, Taskinen MR, Rye KA, Keech AC. Relationship of fibroblast growth factor 21 with baseline and new on-study microvascular disease in the Fenofibrate Intervention and Event Lowering in Diabetes study. Diabetologia 2015; 58:2035-44. [PMID: 26055067 DOI: 10.1007/s00125-015-3652-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/13/2015] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS Baseline circulating fibroblast growth factor 21 (FGF21) levels can predict total cardiovascular disease events in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. This paper describes the relationship of baseline FGF21 levels and new on-study microvascular disease in patients with type 2 diabetes from the FIELD study. METHODS Baseline FGF21 levels were measured in plasma by enzyme-linked immunosorbent assay in 9697 study participants. Total microvascular disease was defined as the presence of any nephropathy, retinopathy, neuropathy and/or microvascular amputation. The relationship between FGF21 levels and microvascular disease was assessed by multivariable logistic regression. RESULTS Higher baseline FGF21 levels were found in patients with baseline total microvascular disease (p<0.001). The association remained significant after adjusting for potential confounding factors (OR [95% CI] 1.13 [1.08, 1.19] per SD increase in log e -transformed FGF21 levels, p<0.001). Of 6465 patients without baseline total microvascular disease, 1517 developed new on-study total microvascular disease over 5 years of follow-up. Higher baseline FGF21 levels were associated with a higher risk of new on-study total microvascular disease after adjusting for potential confounding factors (OR [95% CI] 1.09 [1.02, 1.16] per SD increase in log e -transformed FGF21 levels, p=0.01). Addition of FGF21 levels in a model of new on-study total microvascular disease with established risk factors significantly, but modestly, increased the integrated discrimination improvement and the net reclassification improvement (both p < 0.01). CONCLUSIONS/INTERPRETATION Higher baseline FGF21 levels are seen in patients with type 2 diabetes and established microvascular disease, and predict the future development of new microvascular disease.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, 2052, Australia,
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Ong KL, Ding J, McClelland RL, Cheung BMY, Criqui MH, Barter PJ, Rye KA, Allison MA. Relationship of pericardial fat with lipoprotein distribution: The Multi-Ethnic study of atherosclerosis. Atherosclerosis 2015; 241:664-70. [PMID: 26117404 DOI: 10.1016/j.atherosclerosis.2015.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/19/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pericardial fat and lipoprotein abnormalities contribute to increased risk of cardiovascular disease (CVD). We investigated the relationship between pericardial fat volume and lipoprotein distribution, and whether the association of pericardial fat volume with subclinical atherosclerosis and incident CVD events differs according to lipoprotein distribution. METHODS We analyzed data from 5407 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume, lipoprotein distribution, carotid intima-media thickness (IMT), and coronary artery calcium (CAC). All participants were free of clinically apparent CVD at baseline. Incident CVD was defined as any adjudicated CVD event. RESULTS After adjusting for demographic factors, traditional risk factors, and biomarkers of inflammation and hemostasis, a larger pericardial fat volume was associated with higher large VLDL particle (VLDL-P) concentration and small HDL particle (HDL-P) concentration, and smaller HDL-P size (regression coefficients = 0.585 nmol/L, 0.366 μmol/L, and -0.025 nm per SD increase in pericardial fat volume respectively, all P < 0.05). The association of pericardial fat volume with large VLDL-P concentration and HDL-P size, but not small HDL-P concentration, remained significant after further adjusting for each other as well as LDL cholesterol, HDL cholesterol, and triglycerides. The relationship of pericardial fat volume with incident CVD events, carotid IMT, and prevalence and severity of CAC did not differ by quartiles of large VLDL-P concentration, small HDL-P concentration, or HDL-P size (P for interaction>0.05). CONCLUSION Pericardial fat is associated with atherogenic lipoprotein abnormalities. However, its relationship with subclinical atherosclerosis and incident CVD events does not differ according to lipoprotein distribution.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia.
| | - Jingzhong Ding
- Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, NSW 2025, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
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Ong KL, Januszewski AS, O'Connell R, Jenkins AJ, Xu A, Sullivan DR, Barter PJ, Hung WT, Scott RS, Taskinen MR, Keech AC, Rye KA. The relationship of fibroblast growth factor 21 with cardiovascular outcome events in the Fenofibrate Intervention and Event Lowering in Diabetes study. Diabetologia 2015; 58:464-73. [PMID: 25425220 DOI: 10.1007/s00125-014-3458-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
AIMS/HYPOTHESIS Circulating fibroblast growth factor 21 (FGF21) levels are often elevated in obesity, dyslipidaemia, insulin resistance and type 2 diabetes. This study investigated the relationship of plasma FGF21 levels with cardiovascular events in patients with type 2 diabetes. METHODS Plasma FGF21 levels were measured by ELISA at baseline in 9,697 individuals with type 2 diabetes participating in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. We assessed the association of FGF21 levels with the incidence of different cardiovascular outcomes over 5 years. The primary outcome was total cardiovascular disease (CVD) events and the secondary outcomes were the four individual components: coronary heart disease events, total stroke, CVD mortality and coronary and carotid revascularisation. The tertiary outcome was hospitalisation for angina pectoris. RESULTS Higher baseline FGF21 levels were associated with higher risks of all cardiovascular outcome events after adjusting for the study treatment allocation (all p < 0.01). The associations remained significant for total CVD events and for coronary and carotid revascularisation after further adjusting for confounding factors, with the HR (95% CI) being 1.28 (1.10, 1.50) and 1.26 (1.01, 1.56), respectively, for the highest tertile compared with the lowest tertile (overall effect p = 0.002 and 0.007, respectively). The addition of FGF21 levels to a model including established CVD risk factors predicting total CVD events led to a non-significant increase in the C-statistic but there was a significant improvement in integrated discrimination and net reclassification. CONCLUSIONS/INTERPRETATION Higher baseline plasma FGF21 levels were associated with higher risk of cardiovascular events in patients with type 2 diabetes. TRIAL REGISTRATION ISRCTN64783481.
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Affiliation(s)
- Kwok-Leung Ong
- Lipid Research Group, Heart Research Institute, Sydney, NSW, Australia,
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Ong KL, McClelland RL, Rye KA, Cheung BMY, Post WS, Vaidya D, Criqui MH, Cushman M, Barter PJ, Allison MA. The relationship between insulin resistance and vascular calcification in coronary arteries, and the thoracic and abdominal aorta: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2014; 236:257-62. [PMID: 25108074 DOI: 10.1016/j.atherosclerosis.2014.07.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Insulin resistance may be related to vascular calcification as both are associated with abdominal obesity. We investigated the association of insulin resistance with abdominal aortic calcium (AAC), coronary artery calcium (CAC) and thoracic aortic calcium (TAC), and whether it differs according to different levels of subcutaneous fat area (SFA) and visceral fat area (VFA) in a cross-sectional study design. METHODS We investigated 1632 participants without diabetes from the Multi-Ethnic Study of Atherosclerosis with valid data on homeostasis model assessment index (HOMA-IR), AAC, CAC, and TAC. Adipocytokines, SFA, and VFA were also determined. RESULTS HOMA-IR was associated with the presence of CAC, but not AAC and TAC, and the association remained significant after adjusting for traditional risk factors, adipocytokines, abdominal muscle mass, SFA, and VFA (prevalence ratio = 1.04 per one interquartile range [IQR] increase, P = 0.01). As the strength of the association of HOMA-IR with vascular calcification may differ by abdominal fat composition, subgroup analysis was performed among participants with different tertiles of SFA and VFA. Significant interactions between HOMA-IR with SFA and VFA separately were observed for the presence of TAC, but not AAC and CAC, even after adjusting for confounding factors. The association of HOMA-IR with TAC tended to be stronger in participants with more SFA and VFA. CONCLUSIONS Atherosclerotic calcification, especially in the coronary arteries, is related to insulin resistance. Further studies are needed to delineate the mechanisms by which visceral obesity can lead to vascular calcification.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Wendy S Post
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington, VT, United States
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States.
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Cheung CYY, Hui EYL, Cheung BMY, Woo YC, Xu A, Fong CHY, Ong KL, Yeung CY, Janus ED, Tse HF, Sham PC, Lam KSL. Adiponectin gene variants and the risk of coronary heart disease: a 16-year longitudinal study. Eur J Endocrinol 2014; 171:107-15. [PMID: 24760538 DOI: 10.1530/eje-14-0079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Circulating adiponectin levels have been shown to be associated with a risk of coronary heart disease (CHD). However, its primary role in protecting against the development of CHD remains controversial due to conflicting observations in prospective studies. To gain further insight into the primary role of adiponectin, our major objective was to investigate the relationship between single nucleotide polymorphisms (SNPs) of the adiponectin gene (ADIPOQ) and incident CHD in a population-based cohort with no CHD at baseline. DESIGN AND METHODS We conducted a 16-year longitudinal study in 2196 subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). During 33 862 person-years of follow-up, 184 subjects developed CHD (cumulative incidence rate=5.4 per 1000 person-years). Nine ADIPOQ SNPs with potential functional relevance or shown to be associated with adiponectin levels and/or CHD were genotyped. RESULTS Among the nine ADIPOQ SNPs, +276G>T (rs1501299) was independently associated with incident CHD in men but not in women, even after adjustments for traditional cardiovascular risk factors (Padjusted=5.5×10(-3) to 0.023; hazard ratio=1.39-1.54). Furthermore, there was a significant association of the T allele of +276G>T with a lower adiponectin level (P=0.027; β (95% CI)=-0.05 (-0.10, -0.01). CONCLUSIONS This study demonstrated that +276G>T may be an independent predictor of CHD development. Our findings suggest that low adiponectin levels, as may be influenced by +276G>T, confer a higher risk of CHD, in keeping with a role of hypoadiponectinaemia in the development of CHD in the general population.
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Affiliation(s)
- Chloe Y Y Cheung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine Y L Hui
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bernard M Y Cheung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Y C Woo
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aimin Xu
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol H Y Fong
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - K L Ong
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Y Yeung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward D Janus
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hung-Fat Tse
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pak C Sham
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karen S L Lam
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Ong KL, Waters DD, Messig M, DeMicco DA, Rye KA, Barter PJ. Effect of change in body weight on incident diabetes mellitus in patients with stable coronary artery disease treated with atorvastatin (from the treating to new targets study). Am J Cardiol 2014; 113:1593-8. [PMID: 24666618 DOI: 10.1016/j.amjcard.2014.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/12/2014] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
Features of the metabolic syndrome are independent risk factors for new-onset diabetes mellitus (NODM) related to statin therapy. Obesity is the predominant underlying risk factor for the metabolic syndrome and diabetes mellitus. This study investigated whether change in body weight may predict NODM in statin-treated patients. A total of 7,595 patients without prevalent diabetes mellitus at baseline from the Treating to New Targets (TNT) study were included in this analysis. They were randomized to atorvastatin 10 or 80 mg/day and monitored for a median of 4.9 years. NODM developed in 659 patients (8.1% in the 10-mg group and 9.2% in the 80-mg group). There was a significant increase in body weight (0.9 kg, p <0.01 in both men and women) over 1 year after randomization. The increase in body weight was greater in patients with NODM than those without NODM (1.6 vs 0.9 kg, p <0.001). The association of change in body weight with NODM risk remained significant after adjusting for confounding factors (hazard ratios 1.33, 1.42, and 1.88 for quartiles 2, 3, and 4 compared with quartile 1, respectively). Similar results were obtained in patients with normal fasting glucose level. In conclusion, 1-year change in body weight is predictive of NODM in patients who underwent statin therapy from the TNT trial. Our study highlights the importance of weight control as a lifestyle measure to prevent statin-related NODM.
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Ong KL, Allison MA, Cheung BMY, Wu BJ, Barter PJ, Rye KA. The relationship between total bilirubin levels and total mortality in older adults: the United States National Health and Nutrition Examination Survey (NHANES) 1999-2004. PLoS One 2014; 9:e94479. [PMID: 24728477 PMCID: PMC3984185 DOI: 10.1371/journal.pone.0094479] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/15/2014] [Indexed: 12/20/2022] Open
Abstract
Objective Due to its anti-oxidant and anti-inflammatory properties, bilirubin has been associated with reduced cardiovascular risk. A recent study demonstrated an L-shaped association of pre-treatment total bilirubin levels with total mortality in a statin-treated cohort. We therefore investigated the association of total bilirubin levels with total mortality in a nationally representative sample of older adults from the general population. Methods A total of 4,303 participants aged ≥60 years from the United States National Health and Nutrition Examination Survey 1999–2004 with mortality data followed up through December 31, 2006 were included in this analysis, with a mean follow-up period of 4.5 years. Results Participants with total bilirubin levels of 0.1–0.4 mg/dl had the highest mortality rate (19.8%). Compared with participants with total bilirubin levels of 0.5–0.7 mg/dl and in a multivariable regression model, a lower total bilirubin level of 0.1–0.4 mg/dl was associated with higher risk of total mortality (hazard ratios, 1.36; 95% confidence interval, 1.07–1.72; P = 0.012), while higher levels (≥0.8 mg/dl) also tended to be associated with higher risk of total mortality, but this did not reach statistical significance (hazard ratios, 1.24; 95% confidence interval, 0.98–1.56; P = 0.072). Conclusion In this nationally representative sample of older adults, the association of total bilirubin levels with total mortality was the highest among those with a level between 0.1 and 0.4 mg/dl. Further studies are needed to investigate whether higher total bilirubin levels could be associated with a higher mortality risk, compared to a level of 0.5–0.7 mg/dl.
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Affiliation(s)
- Kwok-Leung Ong
- Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Matthew A. Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, United States of America
| | | | - Ben J. Wu
- Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Philip J. Barter
- Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kerry-Anne Rye
- Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Giesbrecht M, McCarthy M, Elliott ML, Ong KL. First Report of Fusarium oxysporum f. sp. palmarum in Texas Causing Fusarium Wilt of Washingtonia robusta. Plant Dis 2013; 97:1511. [PMID: 30708476 DOI: 10.1094/pdis-05-13-0488-pdn] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fusarium wilt of palms occurs worldwide, caused by different Fusarium oxysporum ff. spp. including F. oxysporum f. sp. elaeidis, F. oxysporum f. sp. canariensis, and F. oxysporum f. sp. albedinis (3). Prior to 2010, F. oxysporum f. sp. canariensis was the only palm infecting species known to occur in the United States. In 2010, isolates of F. oxysporum were reported from dying Syagrus romanzoffiana and Washingtonia robusta in Florida. Based on morphological and molecular data, as well as the unique host species affected by the pathogen, this fungus was determined to be a new forma specialis of F. oxysporum, designated f. sp. palmarum (1). The pathogen infects foliar tissue, causing complete necrosis of the crown and leading to tree death within 2 to 3 months. In June 2012, the Texas Plant Disease Diagnostic Laboratory (TPDDL) received a plant sample from a dying W. robusta palm, exhibiting reddish-brown stripes on the petiole with chlorotic and necrotic leaves, from an established palm in the landscape from Harris County, Texas. Fungal cultures were obtained from symptomatic foliar tissue and identified as F. oxysporum based on morphology. Microconidia were oval to reniform, 1- to 2-septate, measuring 5 to 18 × 2.5 to 5 μm. Phialides were short with microconidia produced in false heads. Macroconidia were curved and slender with a foot-shaped basal cell, usually 3-septate, and 22 to 37 × 2.5 to 5 μm. Chlamydospores were roundish and ranged from 7 to 13 μm in diameter. Fungal colonies had white to purple mycelia when grown on potato dextrose agar. DNA from a single spore culture was extracted, amplified by PCR using primers corresponding to a segment of the translation elongation factor 1α (EF-1α) gene, and the PCR product sequenced (2). Using the sequence alignment tool (BLASTn) in GenBank, the TPDDL's sequence (GenBank Accession No. KC897693) was aligned with EF-1α regions from F. oxysporum f. sp. palmarum isolates previously entered into the database ([1]; accessions GQ154455[=NRRL53544] and GQ154456[=NRRL46589]), revealing 100% homology between the isolates. Based on host source and sequence similarity, the fungus was tentatively identified as F. oxysporum f. sp. palmarum. Pathogenicity tests were performed on three leaf seedlings of W. robusta and W. filifera. Fifteen plants of each species were inoculated with the suspect isolate (designated KB2012) and 10 control plants were mock-inoculated as described by (1). Plants were grown in a greenhouse for 8 weeks post-inoculation. During this time, 83% of inoculated plants developed foliar lesions and died or severely declined, and all control plants remained healthy. F. oxysporum was recovered in culture from 100% of the symptomatic plants. DNA was extracted from fungal cultures, and EF-1α was amplified by PCR and sequenced, as described above. The amplicon was determined to share 100% homology with known F. oxysporum f. sp. palmarum isolates, confirming this fungus as the cause of disease in W. robusta. This is the first report of this pathogen in Texas, as well as the first report outside of Florida. This is also the first documentation of W. filifera as a host of this pathogen. References: (1) M. L. Elliott et al. Plant Dis. 94:31, 2010. (2) D. M. Geiser et al. Eur. J. Plant Pathol. 110:473, 2004. (3) G. W. Simone. Pages 17-19 in: Compendium of Ornamental Palm Diseases and Disorders, M. L. Elliott et al., eds. The American Phytopathological Society, St. Paul, MN, 2004.
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Affiliation(s)
- M Giesbrecht
- Texas A&M AgriLife Extension Service, College Station, TX
| | - M McCarthy
- Texas A&M AgriLife Extension Service, College Station, TX
| | - M L Elliott
- University of Florida-IFAS, Fort Lauderdale Research and Extension Center
| | - K L Ong
- Texas A&M AgriLife Extension Service, College Station, TX
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Ong KL, Lau E, Kemner JE, Kurtz SM. Two-year cost comparison of vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: are initial surgical costs misleading? Osteoporos Int 2013; 24:1437-45. [PMID: 22872070 DOI: 10.1007/s00198-012-2100-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED The costs for treating kypho- and vertebroplasty patients were evaluated at up to 2 years postsurgery. There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8-7.9% in the remaining periods through 2 years postsurgery. INTRODUCTION Vertebral augmentation has been shown to be safe and effective for treating vertebral compression fractures. Comparative cost studies of initial treatment costs for kypho- and vertebroplasty have been mixed. The purpose of our study was to compare the costs for treating kypho- and vertebroplasty patients at up to 2 years postsurgery. METHODS Vertebroplasty and kyphoplasty patients diagnosed with pathologic or closed lumbar/thoracic vertebral fractures were identified from the 5% sample of the Medicare dataset (2006-2009). The final study cohort with at least 2 years follow-up comprised of 1,609 vertebroplasty and 2,878 kyphoplasty patients. The cumulative treatment costs (adjusted to June 2011 US$) were determined from the payer perspective. Differences in costs and length of stay were assessed by generalized linear mixed model regression, adjusting for covariates. RESULTS The average adjusted costs for vertebroplasty patients within the first quarter and the first 2 years postsurgery were $14,585 [95% confidence interval (CI), $14,109-15,078] and $44,496 (95% CI, $42,763-46,299), respectively. The corresponding average adjusted costs for kyphoplasty patients were $15,117 (95% CI, $14,752-15,491) and $41,339 (95% CI, $40,154-42,560). There were no significant differences in adjusted costs in the first 9 months postsurgery, but kyphoplasty patients were associated with significantly lower adjusted treatment costs by 6.8-7.9% in the remaining periods through 2 years postsurgery. CONCLUSION Our present study addresses some of the limitations in previous comparative cost studies of vertebroplasty and kyphoplasty. The higher adjusted costs for vertebroplasty patients than kyphoplasty patients by 1 year following the surgery reflect greater utilization of medical resources.
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Affiliation(s)
- K L Ong
- Exponent, Inc., 3401 Market St, Suite 300, Philadelphia, PA 19104, USA.
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Abstract
SUMMARY The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients. INTRODUCTION Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment. METHODS Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005-2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%). RESULTS Adjusted life expectancy was 85% greater for operated than non-operated patients (p < 0.001; 95% confidence interval: 82-89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p < 0.001; 95% confidence interval: 111-119%) and 44% (p < 0.001; 95% confidence interval: 42-47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p < 0.001; 95% confidence interval: 31-36%). Across all gender-age groups, the median life expectancy predicted by the parametric Weibull model was 2.2-7.3 years greater for operated than non-operated patients. CONCLUSIONS Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.
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Affiliation(s)
- A A Edidin
- Medtronic, Inc, 1221 Crossman Ave, Sunnyvale, CA 94089, USA
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Isakeit T, Hassett BT, Ong KL. First Report of Leaf Spot of Sesame Caused by Xanthomonas sp. In the United States. Plant Dis 2012; 96:1222. [PMID: 30727095 DOI: 10.1094/pdis-03-12-0284-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In July 2010 in Texas, extensive leaf spots (10 to 30% leaf area affected) occurred on a commercial planting of sesame (Sesamum indicum L.) in Hidalgo County and to a lesser extent (1 to 5% leaf area) on leaves of several varieties in experimental trials in Colorado and Victoria Counties. The leaf spots were light to dark brown, somewhat circular, and 1 to 3 mm in diameter. A symptomatic leaf from each of three to five plants per county was sampled for isolations. Leaves were sprayed with 70% ethanol and immediately blotted dry with a paper towel. The margins of spots (2 mm2) were excised with a scalpel and placed in a drop of sterile water for 5 min. Drops were streaked on nutrient agar (NA) and incubated at 30°C. The 12 isolations consistently yielded gram-negative, rod-shaped bacteria with yellow, translucent colonies that were visible after 2 days of incubation. The DNA of 11 isolates was extracted with the Norgen (Thorold, ON) Bacterial genomic DNA isolation kit (Cat. #17900) and the ITS region was amplified by 16S uni 1330 and 23S uni 322 anti primers (1). PCR products were treated with the ZymoResearch (Irvine, CA) DNA clean & concentrator kit (Cat. #D4003) and sequenced. With the NCBI database, a BLAST search of the 1,100 bp amplicons showed 93 to 99% identity with pathovars of either Xanthomonas oryzae or X. axonopodis (GenBank Accession Nos. CP003057.1 and CP002914.1, respectively). Amplicon sequences of the sesame isolates were deposited in GenBank as Accession Nos. JQ975037 through JQ975047. The reported species on sesame is X. campestris pv. sesami (2). To fulfill Koch's postulates, potted sesame plants (var. Sesaco 25), 15 to 20 cm tall, were sprayed until runoff with a suspension of bacteria (106 to 107 CFU/ml) from a 2-day-old NA culture. All 12 isolates were evaluated, with five to seven plants per isolate. Plants were maintained in a mist chamber in a greenhouse at 27 to 30°C and 100% relative humidity. The pathogenicity trial was repeated once. Leaf spots were first seen 7 days after inoculation and were prevalent 14 days after inoculation. All 12 isolates were pathogenic. There were no symptoms on leaves sprayed with sterile water. Bacteria that produced colonies consistent with Xanthomonas were reisolated on NA from symptomatic leaves but not from controls. The identities of three isolates were reconfirmed with PCR analysis and sequencing. In 2007, more than 2,000 ha of sesame were grown in the continental United States, with 80% of that in Texas. Currently, acreage of shatter-free varieties of sesame is increasing in arid areas of Texas, Oklahoma, and Kansas. In such areas, the yield impact of this disease is likely to be minimal, except in years with above-average rainfall. To our knowledge, this is the first report of this disease in the United States. References: (1) E. R. Gonçalves and Y. B. Rosato. Int. J. Syst. Evol. Microbiol. 52:355, 2002. (2) J. M. Young et al., New Zealand J. Agric. Res. 21:153, 1978.
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Affiliation(s)
- T Isakeit
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX 77843
| | - B T Hassett
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX 77843
| | - K L Ong
- Department of Plant Pathology and Microbiology, Texas A&M University, College Station, TX 77843
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Chen C, Tso AWK, Cheung BMY, Law LSC, Ong KL, Wat NMS, Janus ED, Xu A, Lam KSL. Plasma concentration of pigment epithelium-derived factor is closely associated with blood pressure and predicts incident hypertension in Chinese: a 10-year prospective study. Clin Endocrinol (Oxf) 2012; 76:506-13. [PMID: 21777264 DOI: 10.1111/j.1365-2265.2011.04178.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pigment epithelium-derived factor (PEDF) is secreted from the adipose tissue. It circulates at high concentrations, and was reported to play a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Previous cross-sectional studies also demonstrated plasma PEDF concentration correlated positively with systolic blood pressure (BP) and pulse pressure, and inversely with small artery elasticity. Here we investigated the relationship of plasma PEDF concentration with BP and incident hypertension in a 10-year prospective study. METHODS Baseline plasma PEDF concentrations were measured by ELISA in 520 Chinese subjects, aged 51 ± 12 years, followed up long-term from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study. The association between plasma PEDF concentration and BP was investigated in both cross-sectional and prospective studies, using multiple linear regression and path analyses. Cox proportional hazards analysis was used to determine whether baseline PEDF concentration was independently related to the subsequent development of hypertension over 10 years. RESULTS Baseline plasma concentrations of PEDF were higher in men (P < 0·001), and were directly related to systolic BP at 2 and 5 years, and to diastolic BP at 2 years, after adjustment for covariates. Of the 386 normotensive subjects at baseline, high baseline PEDF concentration was predictive of incident hypertension, independent of the effects of age, sex, baseline BP and obesity parameters (hazard ratio: 1·135; 95% CI: 1·039-1·241; P = 0·005). CONCLUSION Our data suggest that plasma PEDF concentration is significantly associated with BP, and incident hypertension. PEDF may be involved in the pathogenesis of hypertension in humans.
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Affiliation(s)
- Cheng Chen
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Ong KL, Tso AWK, Cherny SS, Sham PC, Lam TH, Lam KSL, Cheung BMY. Role of Genetic Variants in the Gene Encoding Lipocalin-2 in the Development of Elevated Blood Pressure. Clin Exp Hypertens 2011; 33:484-91. [DOI: 10.3109/10641963.2010.549276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cheung BMY, Ong KL, Tso AWK, Cherny SS, Sham PC, Lam TH, Lam KSL. Gamma-glutamyl transferase level predicts the development of hypertension in Hong Kong Chinese. Clin Chim Acta 2011; 412:1326-31. [PMID: 21466796 DOI: 10.1016/j.cca.2011.03.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Plasma activities of alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase, and γ-glutamyl transferase (GGT) are often increased in cardiometabolic diseases. We investigated if hypertension is associated with increased activities of these plasma markers. METHODS We included 235 hypertensive and 708 normotensive subjects (mean age 47.3±9.6 and 58.0±10.2 years respectively) from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS-2) in 2000-2004 who had drank <1/week. In the follow-up study in 2005-2008 (CRISPS-3), 126 out of the 708 subjects had developed hypertension. RESULTS Raised plasma ALT (OR=1.22 per SD of log-transformed level, P=0.045) and GGT (OR=1.38 per SD of log-transformed level, P=0.001) levels were associated with hypertension at baseline in CRISPS-2 after adjusting for covariates. Among subjects not on anti-hypertensive medications, plasma ALP, ALT and GGT were related to blood pressure (P<0.01). In subjects normotensive at CRISPS-2, plasma GGT, but not ALP, ALT and AST, was an independent predictor of new-onset hypertension at CRISPS-3 (OR=1.38 per SD of log-transformed level, P=0.020 and OR=2.68 for 3rd tertile vs. 1st tertile, P=0.004) after adjusting for covariates. CONCLUSIONS Among the 4 plasma markers, increased GGT activity is the strongest predictor for existing and new-onset hypertension in Hong Kong Chinese.
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Affiliation(s)
- Bernard M Y Cheung
- Department of Medicine, University of Hong Kong, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong.
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Cheung CYY, Tso AWK, Cheung BMY, Xu A, Ong KL, Law LSC, Wat NMS, Janus ED, Sham PC, Lam KSL. Genetic variants associated with persistent central obesity and the metabolic syndrome in a 12-year longitudinal study. Eur J Endocrinol 2011; 164:381-8. [PMID: 21147891 DOI: 10.1530/eje-10-0902] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Central obesity predisposes to various cardiometabolic diseases and is a key component of the metabolic syndrome (MetS). We have previously demonstrated that three obesity-susceptible single nucleotide polymorphisms (SNPs), rs10938397 (GNPDA2), rs8050136 (FTO) and rs17782313 (MC4R), were associated with obesity and waist circumference in cross-sectional studies in the Chinese population. In this study, we investigate whether these SNPs could also predict the persistence of central obesity and MetS in subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS) cohort. DESIGN AND METHODS We genotyped these SNPs in i) 354 subjects with and 994 subjects without central obesity at both baseline and a 12-year follow-up, ii) 2214 subjects (816 cases and 1398 controls) in an MetS cross-sectional case-control study and iii) 225 subjects with and 1221 subjects without MetS at both baseline and the 12-year follow-up. RESULTS Both FTO rs8050136 (P(age, sex-adjusted)=0.019; odds ratio (OR) (95% confidence intervals (CI)): 1.35 (1.05, 1.73)) and GNPDA2 rs10938397 (P(age, sex-adjusted)=3 × 10(-3); OR (95% CI): 1.34 (1.11, 1.63)) were significantly associated with persistent central obesity. GNPDA2 rs10938397 was also significantly associated with MetS (P(age, sex-adjusted)=0.011, OR (95% CI): 1.20 (1.04, 1.38)) in the case-control study. However, none of these SNPs showed an individual association with persistent MetS. In the combined genetic risk analyses for persistent central obesity and persistent MetS, the combined genetic risk score of the three SNPs showed an OR of 1.25 (95% CI: 1.10, 1.42; P(age, sex-adjusted)=4.92 × 10(-3)) and 1.19 (95% CI: 1.03, 1.38; P(age, sex-adjusted)=0.019) for each additional risk allele respectively. CONCLUSION This study demonstrated that FTO and GNPDA2 variants predicted persistent central obesity in the Chinese population, further supporting their importance as obesity-susceptible genes.
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Affiliation(s)
- Chloe Y Y Cheung
- Department of Medicine, LKS Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, China
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Cheung BMY, Ong KL, Tso AWK, Leung RYH, Xu A, Cherny SS, Sham PC, Lam TH, Lam KSL. C-reactive protein as a predictor of hypertension in the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS) cohort. J Hum Hypertens 2011; 26:108-16. [DOI: 10.1038/jhh.2010.125] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
During the 2009 to 2010 growing season, symptoms of an unknown leaf spot were observed on spinach (Spinacia oleracea L.) in production fields in southwest Texas. Approximately 500 ha were affected, especially cvs. Rakaia and Viceroy. Disease incidence was 30 and 2% for Rakaia and Viceroy, respectively. Diseased plants exhibited small (1 to 3 mm in diameter), tan, necrotic lesions with a circular to oval shape and were void of any signs of a pathogen. Symptomatic leaves were surface sterilized in 1.5% NaOCl for 1 min, rinsed with sterile water, and air dried. Leaf sections (~1 cm2) were cut and placed on acidified potato dextrose agar (APDA), or APDA supplemented with streptomycin (SAPDA). Fungal mycelia growing from the edges of infected leaf sections were transferred to PDA and incubated at 25°C with a 12-h/12-h light/dark cycle. After 14 days of incubation, dark brown mycelia giving rise to unbranched conidiophores bearing brown, deeply septate, ovoid conidia were observed. Conidia measured 16.8 to 27.3 × 13.1 to 19.6 μm. On the basis of these morphological characteristics, the fungus was identified as Stemphylium botryosum (3). Cultures were transferred to clarified V8 juice agar to obtain inoculum for pathogenicity tests. Eight-week-old plants (n = 20) of spinach cvs. Hybrid 310, Wintergreen, Ashley, and Rakaia were sprayed until runoff with a suspension containing 0.001% Tween 80 and 1 × 104 conidia/ml. Noninoculated plants served as a control treatment. Plants were placed in a growth chamber and incubated in the dark at 25°C and 95% relative humidity. Following 36 h of incubation, plants were transferred to a plastic enclosure and maintained at 23 ± 4°C. After 7 to 10 days, tan, oval-shaped lesions were observed on all inoculated spinach plants. All control plants, with the exception of Rakaia, failed to develop symptoms. Isolates of S. botryosum were recovered on SAPDA from symptomatic leaves, confirming Koch's postulates. Previous reports have shown that S. botryosum can be transmitted from infected seed (1), thus, additional plants of each cultivar (n = 36) were grown in the greenhouse to determine the potential for seedborne contamination. After 8 weeks, leaf spot symptoms identical to those observed on the original plants developed on 75% of the Rakaia plants, while symptom development on the other cultivars was negligible. Isolates of S. botryosum were only recovered from symptomatic Rakaia leaves. Similar field observations were made during the 2001 to 2002 growing season; however, attempts to isolate S. botryosum in that season were unsuccessful. Recent outbreaks of Stemphylium leaf spot have been reported in Arizona (4), California (3), Delaware and Maryland (2), and Washington (1). To our knowledge, this is the first report of S. botryosum on spinach in Texas. While the origin of inoculum causing the disease in Texas is unknown, S. botryosum may have been seedborne (2). The implementation within the past few years of very high density plantings of spinach (1.9 to 3.7 million seeds/ha) may lead to an increase in incidence and severity of this disease in Texas. References: (1) L. J. du Toit and M. L. Derie. Plant Dis. 85:920, 2001. (2) K. L. Everts and D. K. Armentrout. Plant Dis. 85:1209, 2001. (3) S. T. Koike et al. Plant Dis. 85:126, 2001. (4) S. T. Koike et al. Plant Dis. 89:1359, 2005.
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Affiliation(s)
- J D Reed
- Texas AgriLife Research and Extension Center, Lubbock 79403
| | - J E Woodward
- Texas AgriLife Research and Extension Center, Lubbock 79403
| | - K L Ong
- Texas AgriLife Extension Service, College Station 77843
| | - M C Black
- Texas AgriLife Extension Service, Uvalde 78802
| | - L A Stein
- Texas AgriLife Extension Service, Uvalde 78802
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Chen C, Tso AWK, Law LSC, Cheung BMY, Ong KL, Wat NMS, Janus ED, Xu A, Lam KSL. Plasma level of pigment epithelium-derived factor is independently associated with the development of the metabolic syndrome in Chinese men: a 10-year prospective study. J Clin Endocrinol Metab 2010; 95:5074-81. [PMID: 20685859 DOI: 10.1210/jc.2010-0727] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Pigment epithelium-derived factor (PEDF), a serine protease inhibitor, is secreted from the adipose tissue and circulates at high concentrations. A recent study found that PEDF played a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Here we investigated whether circulating PEDF levels predicted the development of the metabolic syndrome (MetS) in a 10-yr prospective study. RESEARCH DESIGN AND METHODS Baseline plasma PEDF levels were measured with an ELISA in 520 nondiabetic subjects, recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort. Multiple logistic regression was used to analyze whether PEDF was an independent factor related to the MetS at baseline. The role of PEDF in predicting the development of the MetS over 10 yr was analyzed using Cox regression analysis. RESULTS Plasma levels of PEDF were significantly higher in men than women. At baseline, sex-adjusted PEDF levels were significantly higher in subjects with MetS (P < 0.001), and the association remained significant (odds ratio: 1.17, P = 0.015), even after adjustment for covariates. Among the components of the MetS, PEDF was independently associated with hypertriglyceridemia (P = 0.026) and hypertension (P = 0.005). Of the 396 subjects without the MetS at baseline, a total of 80 had developed the MetS over 10 yr. High baseline sex-adjusted PEDF was an independent predictor of the development of the MetS in men (hazard ratio: 1.25, P = 0.034) but not in women. CONCLUSION Plasma PEDF was significantly associated with the presence of the MetS and predicted the development of the MetS in Chinese men.
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Affiliation(s)
- Cheng Chen
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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50
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Lee KH, Chang PC, Lie DT, Koh JS, Ong KL. An unusual case of knee locking. Singapore Med J 2010; 51:e140-e142. [PMID: 20848054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Knee locking is an incapacitating condition that requires urgent orthopaedic intervention. The most common cause is meniscal injury, followed by torn anterior cruciate ligament, osteochondral loose bodies and foreign bodies in the joint space. This report describes a patient who had an unusual case of left knee locking. After clinical examination and radiological investigations, the provisional diagnosis was a lateral meniscal tear, which was not visible on magnetic resonance imaging. Diagnostic arthroscopy of the left knee revealed a 1-cm yellowish lump on the medial meniscus, and the histology revealed pigmented villonodular synovitis. The menisci and cruciate ligaments were intact.
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Affiliation(s)
- K H Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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