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The aims of our study were to examine whether initial or subsequent adiposity status had a greater effect on hypertension. We collected data in 1992 and again in 2007 from the same group of 597 individuals in the middle age. The subjects were classified into four groups: individuals with a normal body mass index (BMI) in 1992 and 2007 were in Group I; those with a normal BMI in 1992, but became overweight or obese in 2007 were in Group II; those who were overweight or obese in 1992, but had a normal BMI in 2007 were in Group III; and those who were overweight or obese in 1992 and 2007 were in Group IV. Their demographic data were recorded. The relationship between adiposity status and hypertension was analyzed using logistic regression model. The cumulative incidence of hypertension was 35.5%, 56.3%, 50.0%, and 65.1% for Group I to IV, respectively. Compared with Group I, after adjusted factors, the hazard ratio (HR) was 1.80 for Group II (P =.001), 1.40 for Group III (P =.150), and 2.31 for Group IV (P <.001). Adiposity status in 2007 could predict hypertension (OR = 2.5, P <.001), as opposed to the initial adiposity status (P =.148). Subsequently adiposity status could have major effects on hypertension. Our society is very short of public health resources, particularly in developing countries, we should pay more attention to current adiposity status and encourage middle‐aged people to lose weight. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the tolerance of endophytic fungi isolated from the fibrous roots of Polygonatum kingianum to arsenic (As) and cadmium (Cd) and their physiological response mechanisms. Five isolated strains were obtained with EC50 values for As(V) ranging from 421 to 1281 mg/L, while the other three strains tolerated Cd(II) with an EC50 range of 407–1112 mg/L. Morphological and molecular identification indicated that these eight strains were Cladosporium spp. belonging to dark septate endophytes (DSEs). The contents of metal ions in mycelium sharply increased, reaching 38.87 mg/kg for strain MZ‐11 under As(V) stress and 0.33 mg/kg for fungus PR‐2 under Cd(II). The physiological response revealed that the biomass decreased with increasing concentrations of As(V) or Cd(II), and the activity of superoxide dismutase significantly improved under the corresponding EC50‐concentration As/Cd of the strains, as well as the contents of antioxidant substances, including metallothionein, glutathione, malondialdehyde, melanin, and proline. Taken together, the filamentous fungi of Cladosporium spp. accounted for a high proportion of fungi isolated from the fibrous roots of P. kingianum and had a strong capacity to tolerate As(V) or Cd(II) stress by improving antioxidase activities and the content of antioxidant substances, and immobilization of metal ions in hyphae. [ABSTRACT FROM AUTHOR]

Background: Renal and liver dysfunctions are risk factors for mortality in patients with severe aortic stenosis (AS). Transcatheter aortic valve implantation (TAVI) has the potential to break the vicious cycle between AS and hepatorenal dysfunction by relieving aortic valve obstruction. Hypothesis: A part of patients can derive hepatorenal function improvement from TAVI, and this noncardiac benefit improves the intermediate‐term outcomes. Methods: We developed this retrospective cohort study in 439 consecutive patients undergoing TAVI and described the dynamic hepatorenal function assessed by model for end‐stage liver disease model for end‐stage liver disease (MELD)‐XI score in subgroups. The endpoint was 2‐year all‐cause mortality. Results: Receiver‐operating characteristic analysis showed that the baseline MELD‐XI score of 10.71 was the cutoff point. A high MELD‐XI score (>10.71) at baseline was an independent predictor of the 2‐year mortality hazard ratio (HR: 2.65 [1.29–5.47], p =.008). After TAVI, patients with irreversible high MELD‐XI scores had a higher risk of 2‐year mortality than patients who improved from high to low MELD‐XI scores (HR: 2.50 [1.06–5.91], p =.03). Factors associated with reversible MELD‐XI scores improvement were low baseline MELD‐XI scores (≤12.00, odds ratio [OR]: 2.02 [1.04–3.94], p =.04), high aortic valve peak velocity (≥5 m/s, OR: 2.17 [1.11–4.24], p =.02), and low body mass index (≤25 kg/m2, OR: 2.73 [1.25–5.98], p =.01). Conclusion: High MELD‐XI score at baseline is an independent predictor for 2‐year mortality. Patients with hepatorenal function improvement after TAVI have better outcomes. For patients with irreversible hepatorenal dysfunction after TAVI, further optimization of the subsequent treatment after TAVI is needed to improve the outcomes. [ABSTRACT FROM AUTHOR]

Background: Angiotensin receptor neprilysin inhibitor (ARNI) sacubitril‐valsartan has been recommended as one of the first‐line therapies in heart failure with reduced ejection fraction. However, whether ARNI could benefit patients with ST‐segment elevation myocardial infarction (STEMI) by improving left ventricular (LV) remodeling remains unknown. The primary objective of the PERI‐STEMI trial is to assess whether sacubitril‐valsartan is more effective in preventing adverse LV remodeling for patients with STEMI than enalapril. Hypothesis: We hypothesize that sacubitril/valsartan is superior to enalapril in preventing adverse LV remodeling evaluated by cardiovascular magnetic resonance imaging at the 6‐month follow‐up. Methods: PERI‐STEMI is an investigator‐initiated, prospective, multi‐center, randomized, open‐label, superiority trial with blinded evaluation of outcomes. A total of 376 first‐time STEMI patients with primary percutaneous coronary intervention (PPCI) within 12 h after symptom onset will be randomized to sacubitril‐valsartan or enalapril treatment. All the patients will receive a baseline cardiovascular magnetic resonance (CMR) examination at 4–7 days post‐PPCI. The primary endpoint is the change of indexed LV mass at the 6‐month follow‐up CMR. Results: Enrollment of the first patient is planned in November 2021. Recruitment is anticipated to last for 12–18 months and patients will be followed for 5 years after randomization. The study is expected to complete in June 2027. Conclusions: The results of the PERI‐STEMI trial are expected to provide CMR evidence on whether ARNI could benefit patients with STEMI, so as to facilitate the strategy of CMR‐based risk stratification and therapy selection for these patients. PERI‐STEMI is registered at ClinicalTrials.gov (NCT04912167). [ABSTRACT FROM AUTHOR]

Primary percutaneous coronary intervention (PPCI), the preferred reperfusion strategy for all acute ST‐segment elevation myocardial infarction (STEMI) patients, is not universally available in clinical practice. Pharmacoinvasive strategy has been proposed as a therapeutic option in patients with STEMI when timely PPCI is not feasible. However, pharmacoinvasive strategy has potential delay between clinical patency and complete myocardial perfusion. The optimal reperfusion strategy for STEMI patients with anticipated PPCI delay according to current practice is uncertain. OPTIMAL‐REPERFUSION is an investigator‐initiated, prospective, multicenter, randomized, open‐label, superiority trial with blinded evaluation of outcomes. A total of 632 STEMI patients presenting within 6 hours after symptom onset and with an expected time of first medical contact to percutaneous coronary intervention (PCI) ≥120 minute will be randomized to a reduced‐dose facilitated PCI strategy (reduced‐dose fibrinolysis combined with simultaneous transfer for immediate invasive therapy with a time interval between fibrinolysis to PCI < 3 hours) or to standard pharmacoinvasive treatment. The primary endpoint is the composite of death, reinfarction, refractory ischemia, congestive heart failure, or cardiogenic shock at 30‐days. Enrollment of the first patient is planned in March 2021. The recruitment is anticipated to last for 12 to 18 months and to complete in September 2023 with 1 year follow‐up. The OPTIMAL‐REPERFUSION trial will help determine whether reduced‐dose facilitated PCI strategy improves clinical outcomes in patients with STEMI and anticipated PPCI delay. This study is registered with the ClinicalTrials.gov (NCT04752345). [ABSTRACT FROM AUTHOR]

Calculation of the static voltage stability margin (SVSM) of power system with high wind‐power penetration must consider the uncertain fluctuation of power output from wind farms (WFs). On the basis of a continuous power flow (CPF) and improved affine interval (IAI) algorithm that considers quadratic terms, a new method to calculate the SVSM interval of a power system that considers the uncertain fluctuation intervals of WF output is proposed. Considering the high penetration of wind power, the power variation of the active load, and wind‐power fluctuation are assigned by all conventional generators, except the swing generator in the CPF calculation model. In the proposed IAI algorithm, the non‐linear second‐order sensitivities are considered to obtain a more accurate SVSM interval. With the correlation of different WF output intervals described by relative angles, as well as the independent intervals obtained by decorrelation of the correlated WF output intervals, the SVSM interval is calculated by the CPF and IAI algorithms. Take the IEEE 39‐bus system and an actual 964‐bus provincial power grid as examples, and compared with Monte Carlo method, the results show that the SVSM interval calculated by the proposed method is more accurate, and the computation time is significantly reduced. [ABSTRACT FROM AUTHOR]

Abstract: Aims/Introduction: Recently, a new anthropometric parameter (a new hip index [HI]) was developed, and the HI shows a U‐shaped relationship to mortality in the USA population. It is well known that there is an inverse relationship between hip circumference (HC) and the risk of diabetes mellitus. Accordingly, the study sought to investigate whether HI could predict future diabetes mellitus, as compared with HC and the waist‐to‐hip ratio (WHR), in a general Chinese population. Materials and Methods: In 2007, we carried out a health examination of 687 participants (mean age 48.1 ± 6.2 years, male 58.1%). Development of diabetes mellitus by the 2007 examination was studied in relation to data from a baseline health examination carried out in 1992. Results: During the follow up, 74 participants were diagnosed with diabetes mellitus. Across the quintiles of baseline HI, the incidence rates of diabetes mellitus were 12.4, 12.4, 9.9, 7.8 and 11.3% in quintile (Q)1, Q2, Q3, Q4 and Q5, respectively (P = 0.698). With the lowest quintile (Q1) as reference, univariate and multivariate Cox regression analyses showed that HI was not associated with diabetes mellitus. In contrast, HC and WHR could predict future diabetes mellitus. Furthermore, WHR had the best discriminatory power for diabetes mellitus (area under the receiver operating characteristic curve 0.691, 95% confidence interval 0.621–0.761), followed by HC (area under the receiver operating characteristic curve 0.623, 95% confidence interval 0.558–0.689) and HI (area under the receiver operating characteristic curve 0.464, 95% confidence interval 0.396–0.531). Conclusions: Compared with HC and WHR, HI was not an independent risk factor for diabetes mellitus in the Chinese population. More studies are required to delineate the limits of the utility of HI. [ABSTRACT FROM AUTHOR]

GLO:55QH/01jul21:jdb13180-toc-0001.jpg PHOTO (COLOR): . gl Historical studies have shown that, even within normal fasting plasma glucose (FPG) level, higher FPG levels still carry a higher risk for type 2 diabetes mellitus (T2DM).1-7 Meanwhile, there was still inconsistency in these studies, especially for individuals without obesity.1 It is well known that obesity is a significant risk factor for T2DM.8 However, for Asians, the risk of T2DM starts at a lower body mass index (BMI)9,10 and may be more attributed to abdominal obesity.10,11 Moreover, nonobese subjects may not take preventive measures for T2DM. 4 Janghorbani M, Amini M. Normal fasting plasma glucose and risk of prediabetes and type 2 diabetes: the Isfahan diabetes prevention study. The present study demonstrated a nonlinear association between normal FPG and T2DM, and after the FPG level of 4.3 mmol/L, a significantly increased risk of T2DM was observed. [Extracted from the article]

Aims/Introduction Materials and Methods Results Conclusions To evaluate the differences in cardiac autonomic function, cardiac structure and diastolic function between individuals with diabetic foot (DF) and those with diabetes but without DF.A total of 413 individuals with DF and 437 without DF who underwent a 24‐h electrocardiogram Holter and a Doppler echocardiogram were included. The heart rate variability parameters to evaluate cardiac autonomic function, and the indices for the assessment of cardiac structure and left ventricular (LV) diastolic function, including left atrium, LV posterior wall thickness, interventricular septum and E/e′ ratio, were measured or calculated. Propensity score matching was used for the sensitivity analysis to minimize potential imbalance.In both the crude and propensity score matching analyses, significant differences were observed in heart rate variability between individuals with and without DF, as evidenced by lower standard deviation of the normal sinus interval, lower low‐frequency power/high‐frequency power ratio, lower standard deviation of the 5‐min average RR intervals, lower low‐frequency power, lower percentage of normal adjacent RR interval difference >50 ms, lower root mean square of successive RR interval differences and lower high‐frequency power (all P < 0.05). In multivariate analysis, DF showed an independent negative correlation with the aforementioned indices of heart rate variability (all P < 0.05). Individuals with DF showed higher left atrium, LV posterior wall thickness, interventricular septum and a higher E/e′ ratio than those without DF in the crude analysis (all P < 0.05), whereas these indices were no longer associated with DF in the multivariate analysis and the propensity score matching analyses.Cardiac autonomic modulation was more severely impaired in individuals with DF than in their counterparts without DF. There has been insufficient evidence to demonstrate the independent association of DF and LV diastolic dysfunction. [ABSTRACT FROM AUTHOR]