Exposure to PM2.5 and its five constituents is associated with the incidence of type 2 diabetes mellitus: a prospective cohort study in northwest China.

Studies have demonstrated that fine particulate matter (PM2.5) is an underlying risk factor for type 2 diabetes mellitus (T2DM), but evidence exploring the relationship between PM2.5 chemical components and T2DM was extremely limited, to investigate the effects of long-term exposure to PM2.5 and its five constituents (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+]), organic matter [OM] and black carbon [BC]) on incidence of T2DM. Based on the "Jinchang Cohort" platform, a total of 19,884 participants were selected for analysis. Daily average concentrations of pollutants were gained from Tracking Air Pollution in China (TAP). Cox proportional hazards regression models were utilized to estimate the hazard ratios (HR) and 95% confidence interval (CI) in single-pollutant models, restricted cubic splines functions were used to examine the dose-response relationships, and quantile g-computation (QgC) was applied to evaluate the combined effect of PM2.5 compositions on T2DM. Stratification analysis was also considered. A total of 791 developed new cases of T2DM were observed during a follow-up period of 45254.16 person-years. The concentrations of PM2.5, NO3-, NH4+, OM and BC were significantly associated with incidence of T2DM (P-trend < 0.05), with the HRs in the highest quartiles of 2.16 (95% CI 1.79, 2.62), 1.43 (95% CI 1.16, 1.75), 1.75 (95% CI 1.45, 2.11), 1.31 (95% CI 1.08, 1.59) and 1.79 (95% CI 1.46, 2.21), respectively. Findings of QgC model showed a noticeably positive joint effect of one quartile increase in PM2.5 constituents on increased T2DM morbidity (HR 1.27, 95% CI 1.09, 1.49), and BC (32.7%) contributed the most to the overall effect. The drinkers, workers and subjects with hypertension, obesity, higher physical activity, and lower education and income were generally more susceptible to PM2.5 components hazards. Long-term exposure to PM2.5 and its components (i.e., NO3-, NH4+, OM, BC) was positively correlated with T2DM incidence. Moreover, BC may be the most responsible for the association between PM2.5 constituents and T2DM. In the future, more epidemiological and experimental studies are needed to identify the link and potential biological mechanisms.

Effect of CVAI on the incidence of MASLD compared to BMI in populations with different body types: A prospective cohort study in China.

BACKGROUND AND AIMS: To explore the relationship between body mass index (BMI), chinese visceral adiposity index (CVAI) and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) in populations with different body types defined by BMI. METHODS AND RESULTS: 24 191 participants from the Jinchang cohort were involved in the prospective cohort study with a 2.3-year follow-up. Information from epidemiological investigations, comprehensive health examinations and biochemical examinations was collected. MASLD was assessed by abdominal ultrasonography. BMI and CVAI were calculated using recognized formulas. Cox regressions, Restricted cubic spline (RCS) and Receiver operating characteristic (ROC) analysis were performed. The risk of MASLD increased with the increase in BMI and CVAI (Ptrend <0.001), and there was a nonlinear dose-response relationship. In the total population, BMI and CVAI increased the risk of MASLD with adjusted HR (95%CI) of 1.097 (1.091-1.104) and 1.024 (1.023-1.026), respectively. The results were similar in the lean and overweight/obese groups. There was also a nonlinear relationship between CVAI and MASLD (Pnon-linearity<0.001), no matter in which group. The area under the curve of CVAI was significantly higher than that of BMI in females with different body types, and the areas in the whole females were 0.802 (95%CI: 0.787-0.818) and 0.764 (95%CI: 0.747-0.780), respectively. There was no significant difference in the ability of BMI and CVAI to predict MASLD in all-sex and males, either in lean or overweight/obese groups. CONCLUSIONS: CVAI and BMI were independently associated with the risk of MASLD regardless of body types defined by BMI, and CVAI showed better diagnostic ability for MASLD in females.

The bidirectional relationship between NAFLD and type 2 diabetes: A prospective population-based cohort study.

BACKGROUND AND AIMS: To explore the bidirectional relationship between NAFLD and type 2 diabetes and the possible directions of the main effect. METHODS AND RESULTS: 30 633 participants from the Jinchang cohort were enrolled. Firstly, cox proportional hazards regression model was used to assess the unidirectional causality between NAFLD and prediabetes and type 2 diabetes. Secondly, cross-lag path analysis model was conducted to estimate the bidirectional relationship between NAFLD and prediabetes and type 2 diabetes, and to determine the direction of the main effects. Finally, potential effect modifications were also considered by age, sex, hyperlipidemia, and overweight/obesity. We found that NAFLD increased the risk of prediabetes and type 2 diabetes with adjusted HR (95%CI) of 1.355(95%CI: 1.255-1.462) and 1.898(95%CI: 1.415-2.545), respectively. Prediabetes and type 2 diabetes also increased the risk of NAFLD, with adjusted HR (95%CI) of 1.245(95%CI: 1.115-1.392) and 1.592(95%CI: 1.373-1.846), respectively. Cross-lag path analysis showed that NAFLD significantly affected the incidence of prediabetes (ß = 0.285, P < 0.001), while the effect on type 2 diabetes was not statistically significant. The effect of prediabetes and type 2 diabetes on the risk of NAFLD was weak, and the path coefficients were 0.076 and 0.037, respectively. Stratified analyses showed similar results. CONCLUSION: This study provides evidence that there was a bidirectional causal association between NAFLD and type 2 diabetes, and the progression from NAFLD through prediabetes to type 2 diabetes may be the main pathway.

Interaction effect of blood glucose and pressure on the risk of chronic kidney disease: a population-based prospective cohort study.

OBJECTIVE: To evaluate the interaction effect of blood glucose and blood pressure on the risk of chronic kidney disease (CKD). METHODS: 31,165 subjects were selected without CKD at baseline and had completed the first follow-up from "Jinchang cohort". Cox regression model and restricted cubic splines functions were used to evaluate the effects of blood glucose or pressure on the incidence of CKD and dose-response relationship after adjusting for confounding covariates. Synergic effect was assessed by the multiplicative or additive interaction scale. RESULTS: Among 31,165 subjects, 1307 new-onset CKD were observed during 68905.78 person-years follow-up, and the incidence density was 18.97 per 1000 person-years. The risk of CKD gradually increased with the increase of blood pressure in diabetes, pre-diabetes and normal groups (Ptrend < 0.05). And, the risk was greatest when SBP/DBP reached ≥150/≥110 mmHg in three groups, and HRs (95% CI) were 1.610 (1.070-2.422), 2.142 (1.396-3.288) and 2.455 (1.941-3.106), respectively. Additionally, among hypertension, pre-hypertension and normal groups, the risk of CKD increased by 16.0%, 14.3% and 25.2% for each 1 mmol/L of FPG. When FPG level was more than 9.0 mmol/L, the risk was greatest and adjusted HRs (95% CI) were 2.856 (2.176-3.748), 2.979 (1.828-4.854) and 7.520 (4.517-12.519). Furthermore, the risk was highest when hypertension was accompanied by diabetes (HR = 4.915, 95% CI: 3.923-6.157). This analysis supported a less than multiplicative effect (HR = 0.634, 95% CI: 0.417-0.964) for the interaction term of diabetes and hypertension, while there was no additive interaction towards CKD in all interaction term. CONCLUSIONS: Blood glucose and pressure were independent risk factors in incidence of CKD, but there was only a negative multiplicative interaction between hypertension and diabetes, but no additive interaction effect between them.

Value of contrast-enhanced ultrasound in the differential diagnosis of gallbladder lesion.

AIM: To describe contrast-enhanced ultrasound (CEUS) features and evaluate differential diagnosis value of CEUS and conventional ultrasound for patients with benign and malignant gallbladder lesions. METHODS: This study included 105 gallbladder lesions. Before surgical resection and pathological examination, conventional ultrasound and CEUS were performed to examine for lesions. Then, all the lesions were diagnosed as (1) benign, (2) probably benign, (3) probably malignant or (4) malignant using both conventional ultrasound and CEUS. The CEUS features of these gallbladder lesions were analyzed and diagnostic efficiency between conventional ultrasound and CEUS was compared. RESULTS: There were total 17 cases of gallbladder cancer and 88 cases of benign lesion. Some gallbladder lesions had typical characteristics on CEUS (e.g., gallbladder adenomyomatosis had typical characteristics of small nonenhanced areas on CEUS). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 94.1%, 95.5%, 80.0%, 98.8% and 95.2%, respectively. These were significantly higher than conventional ultrasound (82.4%, 89.8%, 60.9%, 96.3% and 88.6%, respectively). CEUS had an accuracy of 100% for gallbladder sludge and CEUS helped in differential diagnosis among gallbladder polyps, gallbladder adenoma and gallbladder cancer. CONCLUSION: CEUS may provide more useful information and improve the diagnosis efficiency for the diagnosis of gallbladder lesions than conventional ultrasound.

Comparative Diagnostic Performance of Contrast-Enhanced ultrasound versus Baseline Ultrasound for Renal Pelvis Lesions.

The aim of this study was to assess the relative efficacy of contrast-enhanced ultrasound (CEUS) and baseline ultrasound (B-US) in diagnosing renal pelvic lesions. B-US findings on 58 suspected renal pelvis lesions were examined. The B-US and CEUS results were classified into five grades. Receiver operating characteristic curve analysis was used to compare the diagnostic efficacy of the two imaging modalities. CEUS characteristics of renal pelvis malignancies at different tumor stages and pathologic grades were examined. In the final diagnosis, 29 patients had malignant lesions (27 transitional cell carcinomas, 1 squamous cell carcinoma and 1 renal cell carcinoma) and 29 had benign lesions. On B-US, echogenicity and renal pelvis separation pattern in patients with malignant renal lesions overlapped those of patients with benign lesions. CEUS significantly increased the diagnostic grade of malignant lesions and decreased the grade of benign lesions (p = 0.000). The area under the receiver operating characteristic curve of CEUS was larger than that of B-US (p = 0.030). Enhancement shape and intensity in the wash-in phase markedly differed in lesions of higher tumor stage and higher pathologic grade, compared with lesions of lower stage and grade. In this study, compared with B-US, CEUS had significantly higher diagnostic efficacy in patients with renal pelvis lesions.

Application of fully automatic hollow fiber liquid phase microextraction to assess the distribution of organophosphate esters in the Pearl River Estuaries.

Organophosphate esters (OPEs) are widespread organic pollutants that could be detected in various environmental matrices. In this study, a sample pretreatment method was developed for the determination of 9 OPEs by automatic hollow fiber-liquid phase microextraction (HF-LPME) coupled with gas chromatography-mass spectrometry (GC-MS). High sensitivity of OPEs could be achieved after optimization of several important parameters with the limits of detection (LODs) ranging from 2.6 to 120 ng L(-1) for different individual OPEs, and the relative standard deviations (RSDs) ranged from 2.1% to 10.4%. Acceptable recoveries were observed and the proposed method was then successfully applied to determine OPEs in seawaters collected from 23 sampling sites of the Pearl River Estuaries in dry and wet seasons, respectively. All of the OPEs could be detected, except tris(2-ethylhexyl) phosphate (TEHP). The total concentrations of 9 OPEs in seawaters were ranging from 2.04 (Hemen) to 3.12 (Humen) µg L(-1) in the dry season and from 1.08 (Hemen) to 2.50 (Jitimen) µgL(-1) in the wet season. By using spatial interpolation method of ordinary kriging, the most polluted area of ΣOPEs was found in Humen in the dry season, while it was Jitimen in the wet season. Moreover, the annual input of ΣOPEs discharged via eight estuaries ranged from 384 tons (Jitimen) to 1,225 tons (Modaomen), and the total annual input was 5,694 tons.

Shorter hepatic transit time can suggest coming metastases: through-monitoring by contrast-enhanced ultrasonography?

OBJECTIVE: The aim of this study was to assess the value of the hepatic transit time in suggesting coming liver metastases by contrast-enhanced ultrasonography (CEUS). METHODS: Fifty patients with identified liver metastasis (metastasis group [Gmet]), 26 patients without liver metastasis (unclear group [Gunc]) who had proven extrahepatic malignant tumors, and 27 healthy control volunteers (control group [Gcon]) were included in this study. The Gmet group was divided into small and large subgroups. The Gmet group was also divided into pauci and multi subgroups. Every patient was examined by CEUS. The hepatic artery and hepatic vein arrival times were measured, and the difference between them was calculated as the hepatic artery-vein transit time (HAVTT). Patients in Gunc were given a CEUS examination and an enhanced computed tomography or magnetic resonance imaging examination 3 to 4 months later. RESULTS: The HAVTTs in Gmet were significantly shorter than those in Gcon (P < .05), but there were no statistical differences among the subgroups. A normal cutoff point of 8 seconds in the HAVTTs could distinguish Gmet and Gcon with accuracy, sensitivity, and specificity of 97.40%, 92.59%, and 100%, respectively. As for Gunc, when an HAVTT shorter than 8 seconds was used to predict liver metastasis, the accuracy, sensitivity, and specificity were 92.30%, 100%, and 91.67%. CONCLUSIONS: The HAVTT may be a useful tool in monitoring liver micrometastases. If a patient with a primary malignant tumor has a shorter HAVTT, it suggests that an extra examination and additional therapy are needed.