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Jonathan Cheuk-hung Chan, Shing Chuen Chow, Jimmy Shiu-ming Lai Department of Ophthalmology, University of Hong Kong, Hong KongCorrespondence: Jonathan Cheuk-hung ChanDepartment of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong KongTel +852 3962 1405Email jonnochan@yahoo.comPurpose: To compare the efficacy and safety of diode laser transscleral cyclophotocoagulation using either the long duration or short duration protocol.Methods: Retrospective series of 23 consecutive patients with glaucoma who underwent continuous-wave diode laser transscleral cyclophotocoagulation from August 2016 to July 2018 at a tertiary hospital in Hong Kong. Laser pulse duration for the long and short duration protocols was defined as 3.0– 4.0 and 1.5– 2.0 s, respectively.Results: There were 15 male and 8 female Chinese subjects (23 eyes), age 49– 90 (71.3 ± 2.7), with 10 subjects that underwent long duration cyclophotocoagulation (power 1239.2 ± 78.3 mW, spots 13.9 ± 1.4) and 13 subjects that had short duration cyclophotocoagulation (mean power 1817.3 ± 85.7 mW, spots 14.4 ± 1.0). Six months after long and short duration cyclophotocoagulation, intraocular pressure decreased significantly from 29.9 ± 7.8 to 21.1 ± 6.5 (p < 0.01), and from 35.4 ± 2.7 to 24.1 ± 3.4 (p = 0.04), respectively, while glaucoma medications decreased significantly by 1.4 ± 0.5 (p = 0.02) in the long duration group only. Reduction of medications after short duration cyclophotocoagulation was less and did not reach statistical significance (0.9 ± 0.9, p = 0.15). There was no significant difference of visual deterioration and complication rates.Conclusion: Both types of cyclophotocoagulation were equally effective in lowering intraocular pressure by 6 months, but the short duration protocol, using higher laser power, was able to achieve a greater and earlier reduction, at 3 months. However, the long duration protocol, using less laser power, appears better at reducing medication requirement by 6 months.Keywords: cyclodiode, cycloablation, cyclodestruction, cyclodestructive, g-probe

To obtain precise cartometric measurements of forests is always a challenge and high-resolution data from Unmanned Aerial Vehicle (UAV) is currently the quickest method. Generation of a fine quality orthomosaic of the acquired image series is a pre-requisite for full exploitation of such data. This study examines six of the most frequently used photogrammetric software for popular and inexpensive UAV systems. It is assumed that ground control points (GCPs) are not required. The average Root Mean Square Error (RMSE) for raw orthophoto was 1.24 m and around 0.2 m precision for both X and Y axes. Additionally, the accuracy of UAV internal GNSS receiver was checked on reference points which slightly exceeds 2 m RMSE. The range of accuracy and precision of orthomosaic are provided as a valuable reference for the use of low-cost UAV in forest inventory.

Bonnie Nga Kwan Choy, Jimmy Shiu Ming Lai, Jane Chun Chun Yeung, Jonathan Cheuk Hung Chan Department of Ophthalmology, University of Hong Kong, Hong Kong, People’s Republic of China Purpose: This is a pilot study to compare the effectiveness and safety of diode laser transscleral cyclophotocoagulation (TSCP) with the Ahmed glaucoma valve (AGV) in the management of neovascular glaucoma (NVG). Methods: Eyes with NVG and an IOP greater than 21 mmHg on maximal medications, without previous glaucoma surgery or cyclodestruction, were randomized for either TSCP or AGV implantation. These eyes were followed for at least 6 months and analyzed with respect to their visual outcome, IOP, number of glaucoma medications required, and related complications. Results: Twenty eyes (eight TSCP and 12 AGV) of 19 subjects with a follow-up duration of greater than 6 months were recruited. Mean follow-up duration was 28.5±17.9 and 31.0±15.4 months for the TSCP and AGV groups, respectively (P=0.80). IOP was successfully controlled in 86% of the eyes for both interventions. By including preservation or improvement of visual acuity as additional criteria for overall success, success decreased to 63% for TSCP and 42% for AGV, although the difference was not statistically significant (P=0.65). Eyes that had TSCP had fewer complications and required less subsequent procedures, compared to those that underwent AGV implantation. Conclusion: Both procedures were equally effective in controlling the IOP and reducing glaucoma medications in NVG. However, eyes with AGV implant tended to have higher rates of visual loss and complications, as well as requiring more postoperative procedures, than eyes that were treated with TSCP, although the difference was not statistically significant. Keywords: tube shunts, glaucoma drainage devices, glaucoma implants, cyclodiode, rubeotic glaucoma

Jacky WY Lee,1,2 Catherine CL Liu,3 Jonathan CH Chan,4 Raymond LM Wong,5 Ian YH Wong,2 Jimmy SM Lai2 1The Department of Ophthalmology, Caritas Medical Centre, Hong Kong, SAR, People’s Republic of China; 2The Department of Ophthalmology, The University of Hong Kong, Hong Kong, SAR, People’s Republic of China; 3Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China; 4The Department of Ophthalmology, Queen Mary Hospital, Hong Kong, SAR, People’s Republic of China; 5The Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong Kong, SAR, People’s Republic of China Purpose: To determine the predictors of success for adjuvant selective laser trabeculoplasty (SLT) in Chinese primary open angle glaucoma (POAG) patients. Methods: This prospective study recruited Chinese subjects with unilateral or bilateral POAG currently taking medication to reduce intraocular pressure (IOP). All subjects received a single session of 360° SLT treatment and continued their medications for 1 month. SLT success was defined as IOP reduction ≥20% at 1 month. The following covariates were analyzed in both groups via univariate and multivariate analyses: age, sex, lens status, initial IOPs, post-SLT IOPs, number and type of medications, SLT shots and energy, and pre-SLT investigations.Results: In 51 eyes of 33 POAG subjects, the success rate of SLT was 47.1%. Certain groups of patients were associated with greater success using univariate analysis. These groups included the following: older age (coefficient =0.1; OR: 1.1; P=0.0003), a higher pre-SLT IOP (coefficient =0.3; OR: 1.3; P=0.0005), using four types of antiglaucoma medication (coefficient =2.1; OR: 8.4; P=0.005), a greater degree of spherical equivalent (coefficient =2.1; OR: 8.4; P=0.005), and the use of a topical carbonic anhydrase inhibitor (coefficient =1.7; OR: 6.0; P=0.003). None of the covariates were significant using multivariate analysis. Conclusion: Older age, a higher pretreatment IOP, using multiple antiglaucoma medications especially topical carbonic anhydrase inhibitor, and higher refractive errors were associated with greater SLT success. Keywords: primary open angle glaucoma, selective laser trabeculoplasty, intraocular pressure, success, Chinese

BackgroundCurrent methods available for assessing alterations in lung mechanics require sophisticated equipment and are of limited availability. A method that could assess lung area change with respiration might be a clinically useful surrogate for assessing lung compliance.ObjectiveTo use fluoroscopy to determine percent change in thoracic and lung areas in healthy dogs.AnimalsForty-four client-owned dogs with no evidence of respiratory disease.MethodsProspective study. Resting respiration was recorded fluoroscopically, and peak inspiratory and expiratory frames were captured for 3 typical respiratory cycles. The number of intrathoracic pixels in the entire thoracic cavity was measured for both inspiration and expiration, and the average percent change in intrathoracic area was determined for each dog. This process was repeated by a hemithorax measurement of lung area that excluded the mediastinum and cardiac silhouette. Proposed reference ranges (and 95% confidence intervals [CI]) were computed by a nonparametric percentile distribution.ResultsMedian percent change in thoracic dimension for the total thorax measurement was 12.5% (CI, 8.9-24.0%). Median percent change for the hemithorax measurement was significantly (P < 0.001) larger (20.8%, CI, 14.3-37.6%). Both measurement techniques were correlated with body weight but not with age, sex, thoracic conformation, body condition score (BCS), or breed.Conclusions and clinical importanceFluoroscopy allows a noninvasive and repeatable measure of lung area changes during respiration that must be corrected for body weight. Additional studies in dogs with respiratory diseases are needed to determine its utility in detecting clinically useful alterations in lung area changes.

James F Donohue,1 J Stuart Elborn,2 Peter Lansberg,3 Afzal Javed,4 Solomon Tesfaye,5 Hope Rugo,6 Sita Ratna Devi Duddi,7,8 Niraksha Jithoo,9 Pai-Hui Huang,10 Kannan Subramaniam,11 Nagendra Ramanjinappa,12 Arkady Koltun,13 Shari Melamed,13 Juliana CN Chan14 1UNC School of Medicine, Chapel Hill, NC, USA; 2Queen’s University, Belfast, UK; 3University Medical Center, Groningen, the Netherlands; 4Warwick Medical School, University of Warwick, Warwick, UK & Pakistan Psychiatric Research Centre, Coventry, UK; 5Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, UK; 6University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA; 7International Alliance of Patients’ Organisations, London, United Kingdom; 8DakshamA Health and Education, Delhi, India; 9Viatris Ltd, Johannesburg, South Africa; 10Viatris Pharmaceutical Co., Ltd, Taipei, Taiwan; 11Viatris Ltd, Auckland, New Zealand; 12Viatris Ltd, Bangalore, India; 13Viatris Ltd, Canonsburg, PA, USA; 14Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Administrative Regions of the People’s Republic of ChinaCorrespondence: Juliana CN Chan, Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Administrative Regions of the People’s Republic of China, Tel +852 3505 3138, Email jchan@cuhk.edu.hkAbstract: According to the United Nations High-Level Meeting 2018, five non-communicable diseases (NCDs) including cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancer, and mental health conditions accounted for two-thirds of global deaths. These five NCDs share five common risk factors including tobacco use, unhealthy diets, physical inactivity, alcohol use, and air pollution. Low- and middle-income countries (LMICs) face larger burden of NCDs than high-income countries (HICs), due to differences in ecological, technological, socioeconomic and health system development. Based on high-level evidence albeit mainly from HICs, the burden caused by NCDs can be reduced by affordable medicines and best practices. However, “know-do” gaps, ie, gaps between what we know in science and what we do in practice, has limited the impact of these strategies, especially in LMICs. Implementation science advocates the use of robust methodologies to evaluate sustainable solutions in health, education and social care aimed at informing practice and policies. In this article, physician researchers with expertise in NCDs reviewed the common challenges shared by these five NCDs with different clinical courses. They explained the principles of implementation science and advocated the use of an evidence-based framework to implement solutions focusing on early detection, prevention and empowerment, supplemented by best practices in HICs and LMICs. These successful stories can be used to motivate policymakers, payors, providers, patients and public to co-design frameworks and implement context-relevant, multi-component, evidence-based practices. In pursuit of this goal, we propose partnership, leadership, and access to continuing care as the three pillars in developing roadmaps for addressing the multiple needs during the journey of a person with or at risk of these five NCDs. By transforming the ecosystem, raising awareness and aligning context-relevant practices and policies with ongoing evaluation, it is possible to make healthcare accessible, affordable and sustainable to reduce the burden of these five NCDs.Keywords: non-communicable diseases, know-do gaps, implementation science, evidence-based practices, healthcare policies

Jasper Ka Wai Wong,1 Jeremy Sze Wai John Kwok,1 Jonathan Cheuk Hung Chan,1 Kendrick Co Shih,1 ‪Renyuan Qin,2 Denvid Lau,2 Jimmy Shiu Ming Lai1 1Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; 2Department of Architecture and Civil Engineering, College of Engineering, City University of Hong Kong, Hong KongCorrespondence: Jimmy Shiu Ming LaiDepartment of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, 100 Cyberport Road, Hong KongTel +852 39621405Email smjlai@netvigator.comBackground: Concerns had been raised for the potential hazard of SARS-CoV-2 transmissions via aerosols and fluid droplets during cataract surgeries amid the COVID-19 pandemic. This study aims to evaluate the rate of visible aerosol generation and fluid spillage from surgical wounds during phacoemulsification in human subjects.Methods: This is a prospective consecutive interventional case series. High-resolution video captures of 30 consecutive uncomplicated phacoemulsification surgeries, performed by 3 board-certified specialists in ophthalmology, were assessed by 2 independent and masked investigators for intraoperative aerosolization and fluid spillage. Water-contact indicator tape was mounted on the base of the operating microscope, around the objective lens, to detect any fluid contact.Results: No visible intraoperative aerosolization was detected in any of the cases, irrespective of different surgical practices among the surgeons with regard to wound size and position, lens fragmentation technique, power settings and means of ocular lubrication, or the different densities of cataract encountered. Large droplets spillage was noted from the paracentesis wounds in 70% of the cases. For all cases where fluid spill was detected on video, there was no fluid contact detected on the water-contact indicator tape.Conclusion: Visible aerosolization was not detected during phacoemulsification in our case series. Although the rate of fluid spillage was high, the lack of detectable contact with the indicator tape suggested that these large droplets posed no significant infectious risks to members of the surgical team.Keywords: phacoemulsification, aerosols, aerosolization, droplets, COVID

Elaine Chow,1,2 Emily WM Poon,2 Benny SP Fok,1 Juliana CN Chan,2 Brian Tomlinson1–3 1Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Hong Kong; 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; 3Faculty of Medicine, Macau University of Science & Technology, Taipa, MacauCorrespondence: Elaine Chow Email e.chow@cuhk.edu.hkBackground: Previous studies suggest gliclazide is metabolised primarily by CYP2C19 rather than CYP2C9, unlike other sulphonylureas. CYP2C19 *2 and *3 polymorphisms are more common in Asians.Methods: We investigated the effect of CYP2C19 polymorphisms on gliclazide pharmacokinetics in 15 healthy male Chinese subjects after a single 80mg oral dose.Results: In CYP2C19 poor metabolisers (*2/*2, n=4), plasma area-under-the-curve was higher by nearly two-fold compared with intermediate metabolisers (*2 and *3 heterozygotes, n=7) and extensive metabolisers (*1/*1, n=4) (p

Hongjiang Wu,1,2 Eric SH Lau,3 Alice PS Kong,2,4 Ronald CW Ma,2,4 Risa Ozaki,4 Kitty KT Cheung,4 Elaine Chow,4 Chiu Chi Tsang,5 Kam Piu Lau,6 Eric MT Hui,7 Wing Yee So,8 Danijela Gasevic,1,9 Sarah H Wild,1 Juliana CN Chan,2–4 Andrea Luk2–4 1Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK; 2Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 3Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China; 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; 5Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China; 6Northern District Hospital, Fanling, Hong Kong SAR, China; 7Department of Family Medicine, Prince of Wales Hospital, Hong Kong SAR, China; 8Hospital Authority Head Office, Hong Kong SAR, China; 9School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Purpose: The aim of this study was to describe the association between educational level and incident cardiovascular disease (CVD) and all-cause mortality in Hong Kong Chinese patients with type 2 diabetes.Patients and methods: We included 12,634 patients with type 2 diabetes who were enrolled into the Joint Asia Diabetes Evaluation Program between June 1, 2007, and June 30, 2017. We classified patients’ educational level into the following three groups: ≤6 years, 6–13 years, and >13 years. Incident CVD events were identified using hospital discharge diagnoses. Death was identified from Hong Kong Death Register. We estimated HRs for incident CVD and all-cause mortality using Cox regression models.Results: Patients with the highest educational level were younger and had shorter diabetes duration and better glycemic control at enrollment than those with the lowest educational level. During the median follow-up of 6.2 years for CVD and 6.4 years for all-cause mortality, 954 CVD events and 833 deaths were recorded. HRs for CVD and all-cause mortality were 0.73 (95% CI: 0.57, 0.94) and 0.71 (95% CI: 0.54, 0.94) for the highest educational level compared to the lowest educational level, after adjustment for age, sex, diabetes duration, and family history of diabetes.Conclusion: Educational level is inversely associated with the risk of CVD and all-cause mortality among Hong Kong Chinese patients with type 2 diabetes. Hong Kong Chinese patients with type 2 diabetes and low educational level should be given special attention for the prevention of key complications of diabetes. Keywords: socioeconomic status, educational level, diabetes, cardiovascular disease, all-cause mortality

Bor-Shiunn Lee,1,2 Hong-Ping Lin,3 Jerry Chun-Chung Chan,4 Wei-Chuan Wang,2 Ping-Hsuan Hung,2 Yu-Hsin Tsai,4 Yuan-Ling Lee1,2 1Graduate Institute of Oral Biology, 2Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University and Hospital, Taipei, 3Department of Chemistry, National Cheng Kung University, Tainan, 4Department of Chemistry, National Taiwan University, Taipei, Taiwan, Republic of China Abstract: Mineral trioxide aggregate (MTA) is the most frequently used repair material in endodontics, but the long setting time and reduced mechanical strength in acidic environments are major shortcomings. In this study, a novel sol-gel-derived calcium silicate cement (sCSC) was developed using an initial Ca/Si molar ratio of 3, with the most effective mixing orders of reactants and optimal HNO3 catalyst volumes. A Fourier transform infrared spectrometer, scanning electron microscope with energy-dispersive X-ray spectroscopy, and X-ray powder diffractometer were used for material characterization. The setting time, compressive strength, and microhardness of sCSC after hydration in neutral and pH 5 environments were compared with that of MTA. Results showed that sCSC demonstrated porous microstructures with a setting time of ~30 min, and the major components of sCSC were tricalcium silicate, dicalcium silicate, and calcium oxide. The optimal formula of sCSC was sn200, which exhibited significantly higher compressive strength and microhardness than MTA, irrespective of neutral or pH 5 environments. In addition, both sn200 and MTA demonstrated good biocompatibility because cell viability was similar to that of the control. These findings suggest that sn200 merits further clinical study for potential application in endodontic repair of perforations. Keywords: acidic environment, compressive strength, mesoporous, mineral trioxide aggregate, mixing order, sol-gel reaction

Objective: The AMP-activated protein kinase (AMPK) pathway is a master regulator in energy metabolism and may be related to cancer. In type 2 diabetes, low HDL cholesterol predicts cancer, whereas metformin usage is associated with reduced cancer risk. Both metformin and apolipoprotein A1 activate the AMPK signaling pathway. We hypothesize that the anticancer effects of metformin may be particularly evident in type 2 diabetic patients with low HDL cholesterol.Research Design and Methods: In a consecutive cohort of 2,658 Chinese type 2 diabetic patients enrolled in the study between 1996 and 2005, who were free of cancer and not using metformin at enrollment or during 2.5 years before enrollment and who were followed until 2005, we measured biological interactions for cancer risk using relative excess risk as a result of interaction (RERI) and attributable proportion (AP) as a result of interaction. A statistically significant RERI >0 or AP >0 indicates biological interaction.Results: During 13,808 person-years of follow-up (median 5.51 years), 129 patients developed cancer. HDL cholesterol <1.0 mmol/L was associated with increased cancer risk among those who did not use metformin, but the association was not significant among those who did. Use of metformin was associated with reduced cancer risk in patients with HDL cholesterol <1.0 mmol/L and, to a lesser extent, in patients with HDL cholesterol ≥ 1.0 mmol/L. HDL cholesterol <1.0 mmol/L plus nonuse of metformin was associated with an adjusted hazard ratio of 5.75 (95% CI 3.03-10.90) compared with HDL cholesterol ≥ 1.0 mmol/L plus use of metformin, with a significant interaction (AP 0.44 [95% CI 0.11-0.78]).Conclusions: The anticancer effect of metformin was most evident in type 2 diabetic patients with low HDL cholesterol. [ABSTRACT FROM AUTHOR]

Context: Protein kinase C-beta (PKC-beta) is a cell-signaling intermediate implicated in development of diabetic complications.Objective: To examine the risk association of PKC-beta 1 gene (PRKCB1) polymorphisms and end-stage renal disease (ESRD) in an 8-year prospective cohort of Chinese patients with type 2 diabetes.Design, Setting, and Participants: We genotyped 18 common tag single-nucleotide polymorphisms (SNPs) that span the PRKCB1 gene (r(2) = 0.80) in 1172 Chinese patients (recruited 1995-1998) without renal disease at baseline. A validation cohort included an additional 1049 patients with early-onset diabetes who were free of renal disease at baseline and were recruited after 1998.Main Outcome Measures: Associations of PRKCB1 polymorphisms under additive, dominant, and recessive genetic models with new onset of ESRD (defined as estimated glomerular filtration rate <15 mL/min/1.73 m(2) or dialysis or renal-related death) were assessed by Cox proportional hazard regression, adjusted for all conventional risk factors including use of medications.Results: After a mean (SD) of 7.9 (1.9) years, 90 patients (7.7%) progressed to ESRD. Four common SNPs were associated with ESRD (P < .05). The closely linked T allele at rs3760106 and G allele rs2575390 (r(2) = 0.98) showed the strongest association with ESRD (hazard ratio [HR], 2.25; 95% confidence interval [CI], 1.31-3.87; P = .003, and HR, 2.26; 95% CI, 1.31-3.88; P = .003, respectively). Four common variants predicted ESRD in separate models. The HR for ESRD increased with increasing number of risk alleles (P < .001) in the joint effect analysis. The adjusted risk for ESRD was 6.04 (95% CI, 2.00-18.31) for patients with 4 risk alleles compared with patients with 0 or 1 risk allele. Incidence was 4.4 per 1000 person-years (95% CI, 0.5-8.2) among individuals with 0 or 1 risk allele compared with 20.0 per 1000 person-years (95% CI, 8.8-31.1) in those carrying 4 risk alleles (6.9% of the cohort). These results were validated in a separate prospective cohort of young-onset diabetic patients. Of 1049 patients in the validation cohort, 151 (14.3%) developed chronic kidney disease (CKD) during follow-up, and there were significant associations between both the T allele of rs3760106 and the G allele of rs2575390 and development of CKD (HR, 1.68; 95% CI, 1.10-2.57; P = .02, and HR, 1.62; 95% CI, 1.07-2.47; P = .02, respectively).Conclusion: Genetic variants in the PRKCB1 gene were independently associated with development of ESRD in Chinese patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objective: LDL cholesterol <2.80 mmol/l was associated with increased cancer risk in type 2 diabetes. We explored the 1) interaction between low LDL cholesterol and albuminuria and 2) interaction between copresence of these two risk factors and statin use for cancer in type 2 diabetes.Research Design and Methods: We analyzed prospective data for 3,793 Chinese type 2 diabetic patients who remained naive for statin treatment and 1,483 patients in whom statin treatment was initiated during a median follow-up period of 5.24 years. All patients were free of cancer at baseline. Biological interactions were estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). RERI > 0, AP > 0, or S > 1 indicates biological interaction.Results: In 3,793 statin-naive type 2 diabetic patients, copresence of low LDL cholesterol and albuminuria increased cancer risk by 2.8-fold (hazard ratio 2.77 [95% CI 1.78-4.31]) with significant biological interactions (RERI 1.05 [0.04-2.06]; AP 0.38 [0.09-0.66]). In the whole cohort of 5,276 type 2 diabetic patients, there was interaction between nonuse of statins and copresence of low LDL cholesterol and albuminuria with increased cancer risk (RERI 2.87 [0.64-5.09] and AP 0.60 [0.29-0.90]). Statin nonusers with LDL cholesterol <2.80 mmol/l and albumunuria had a 4.9-fold risk of cancer compared with statin users with or without both risk factors.Conclusions: In type 2 diabetes, there was interaction between low LDL cholesterol and albuminuria with increased cancer risks. The latter was attenuated in the presence of statin treatment. [ABSTRACT FROM AUTHOR]

Objective: Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes.Research Design and Methods: A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 micromol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure <130/80 mmHg, A1C <7%, LDL cholesterol <2.6 mmol/l, triglyceride <2 mmol/l, and persistent treatment with renin-angiotensin blockers. The primary end point was death and/or renal end point (creatinine >500 micromol/l or dialysis).Results: Of these 205 patients (mean +/- SD age 65 +/- 7.2 years; disease duration 14 +/- 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 +/- 12 vs. 71 +/- 12 mmHg, respectively, P = 0.02; A1C 7.3 +/- 1.3 vs. 8.0 +/- 1.6%, P < 0.01). After adjustment for age, sex, and study sites, the structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained >or=3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained >or=3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21-0.86] compared with that of those who attained Conclusions: Attainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes. [ABSTRACT FROM AUTHOR]

Context: With increasing globalization and East-West exchanges, the increasing epidemic of type 2 diabetes in Asia has far-reaching public health and socioeconomic implications.Objective: To review recent data in epidemiologic trends, risk factors, and complications of type 2 diabetes in Asia.Evidence Acquisition: Search of MEDLINE using the term diabetes and other relevant keywords to identify meta-analyses, systematic reviews, large surveys, and cohort studies. Separate searches were performed for specific Asian countries. The review was limited to English-language articles published between January 1980 and March 2009; publications on type 1 diabetes were excluded.Evidence Synthesis: The prevalence of diabetes in Asian populations has increased rapidly in recent decades. In 2007, more than 110 million individuals in Asia were living with diabetes, with a disproportionate burden among the young and middle aged. Similarly, rates of overweight and obesity are increasing sharply, driven by economic development, nutrition transition, and increasingly sedentary lifestyles. The "metabolically obese" phenotype (ie, normal body weight with increased abdominal adiposity) is common in Asian populations. The increased risk of gestational diabetes, combined with exposure to poor nutrition in utero and overnutrition in later life in some populations, may contribute to the increasing diabetes epidemic through "diabetes begetting diabetes" in Asia. While young age of onset and long disease duration place Asian patients with diabetes at high risk for cardiorenal complications, cancer is emerging as an important cause of morbidity and mortality.Conclusions: Type 2 diabetes is an increasing epidemic in Asia, characterized by rapid rates of increase over short periods and onset at a relatively young age and low body mass index. Prevention and control of diabetes should be a top public health priority in Asian populations. [ABSTRACT FROM AUTHOR]

Objective: The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.Research Design and Methods: Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n = 3,519), Asia (n = 5,888), Latin America (n = 2,116), and Africa (n = 276).Results: Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucose-lowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.Conclusions: In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control. [ABSTRACT FROM AUTHOR]

Background: Obesity is a growing global health problem. Obesity-associated inflammatory and metabolic consequences may vary in different ethnic populations, and data in Chinese adolescents are sparse. In this study, we analysed the clinical and biochemical factors associated with overweight and obesity in Chinese adolescents. Methods: This is a cross-sectional cohort study with 2102 Chinese adolescents randomly selected from 14 secondary schools in Hong Kong. Clinical and biochemical parameters including inflammatory markers, among different groups stratified by degrees of obesity, were compared by multivariate logistic regression analysis. Results: The median age was 16 yr (interquartile range: 14-17 yr) (45.6% boys and 54.4% girls). Among the boys, 16.5% were overweight and 6.8% were obese. The respective percentages in girls were 8.2 and 5.8%. Compared with the group with normal weight in both boys and girls, high systolic blood pressure (SBP), increased insulin resistance (by homoeostasis model assessment, HOMA-IR), elevated high-sensitivity C-reactive protein (hsCRP) level and low high-density lipoprotein cholesterol (HDL-C) level were independently associated with overweight/obesity. In boys, the respective odds ratio (95% CI) was 1.03 (1.01-1.05) for SBP, 21.0 (12.0-36.8) for HOMA-IR, 3.65 (2.10-6.35) for hsCRP and 0.24 (0.11-0.51) for HDL-C. In girls, the respective figures were 1.02 (1.00-1.04), 9.82 (5.65-17.1), 6.28 (3.12-12.6) and 0.18 (0.08-0.41). In girls, low-density lipoprotein cholesterol was also independently associated with overweight/obesity [1.56 (1.09-2.24)]. Conclusions: In Chinese adolescents, overweight/obesity is independently associated with SBP, insulin resistance, hsCRP and low HDL-C. Early intervention in overweight and obese adolescents may potentially retard the development of these cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Body mass index (BMI) is associated with death in a V-shaped manner in general populations but it is unknown whether BMI or other risk factors also exhibit V-shaped relationships with death in type 2 diabetic patients. METHODS: A prospective cohort of 7534 Chinese, type 2 diabetic patients enrolled since 1995 were censored on 30 July 2005. Spline Cox regression analysis with a stepwise algorithm (p < 0.05) was used to select predictors. Hazard ratio (HR) curves were used to explore the relationships, which were confirmed by standard Cox models. RESULTS: 763 patients died during the 5.5 years of follow-up. BMI, high-density lipoprotein cholesterol (HDL-C) and white blood cell (WBC) count were related to all-cause mortality in a V-shaped manner. The nadirs of the risk curves were at 26 kg/m(2) for BMI, 1.15 mmol/L for HDL-C and 6.25 x 10(9) counts/L for WBC. The multivariate hazard ratio of BMI away from 26.0 kg/m(2) was 1.08; HDL-C, 1.06 per mmol/L for values less than the nadir and 6.97 per mmol/L for greater than the nadir; and WBC, 1.16 per 10(9) count/L for less than 6.25 x 10(9) and 1.47 for greater than the nadir. Respiratory and neoplastic deaths were the major contributors to the increased death in patients with low or high BMI. Neoplastic death was the major contributor to the increased death in those with low WBC. Genitourinary death was the major contributor to the increased death in those with low and high HDL-C. CONCLUSION: BMI, HDL-C and WBC are associated with death in a V-shaped manner in type 2 diabetic patients. Copyright (c) 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]