The anatomical features of dorsal pancreatic artery in the pancreatic head and its clinical significance in laparoscopic pancreatoduodenectomy.

BACKGROUND: Bleeding control as one of the major challenges in laparoscopic pancreaticoduodenectomy (LPD) necessitates a considerable anatomical knowledge of the blood supply to the pancreatic head so as to improve the safety of this surgery. This study aimed towards a better understanding of the anatomical features of the dorsal pancreatic artery (DPA), as well as its clinical significance in LPD. METHOD: Thirteen Chinese cadaveric specimens were used to study the blood supply of the pancreatic head. Twelve of them were perfused with latex, and the other fresh one was used to build the intraorganic structure model of the pancreas by mold casting. Between July 2018 and June 2019, a total of thirty-five consecutive patients without vascular encasement, who underwent LPD in our institute, were performed with computed tomography as a preoperative detection of the DPA. The DPA was ligated prior to uncinate process dissection in seventeen patients ("early DPA ligation" group), as the others were assigned into the control group. RESULTS: In the thirteen cadaveric specimens, the DPA originates, respectively, from the splenic artery (46.1%), superior mesenteric artery (38.5%), common hepatic artery (7.7%) and right gastroepiploic artery (7.7%). The right branch of the DPA gives off terminal arteries to form an "inner ring" in the pancreatic head, which communicates with the pancreaticoduodenal arterial arches by plenty of collateral arteries. As compared to the control group, the "early DPA ligation" group showed a significantly lower mean blood loss (218 ± 111 vs 320 ± 162, P = 0.038), as well as shorter mean resection time (121 ± 23 vs 136 ± 22, P = 0.049). CONCLUSION: The DPA is one of the major blood supplies to the pancreatic head. A ligation of DPA prior to dissection of the uncinate process can help to completely block the blood supply to the pancreatic head, and therefore improve surgical outcome and safety in LPD.

Hyperhomocysteinemia accompany with metabolic syndrome increase the risk of left ventricular hypertrophy in rural Chinese.

BACKGROUND: To investigate the influence of hyperhomocysteinemia (HHcy) and metabolic syndrome (MetS) on left ventricular hypertrophy (LVH) in residents in rural Northeast China. METHODS: We performed a cross-sectional baseline data analysis of 6837 subjects (mean age: 54 ± 10 years) recruited from a rural area of China. Anthropometric indicators were measured according to standard methods. MetS was defined by the modified ATP III criteria. HHcy was defined according to the WHO standard: an Hcy level > 15 µmol/L representing HHcy. Four groups were defined: non-HHcy & non-MetS, HHcy & non-MetS, MetS & non-HHcy and HHcy & MetS. RESULTS: The left ventricular mass index for height2.7 (LVMH2.7) in both sexes was significantly higher in the HHcy & MetS group than in the non-HHcy & non-MetS group (females: 51.23 ± 16.34 vs. 40.09 ± 10.55 g-2.7, P < 0.001; males: 48.67 ± 12.24 g-2.7 vs. 42.42 ± 11.38 g-2.7, P < 0.001). A similar result was observed in those groups when using the left ventricular mass index (LVMI) for body surface area to define LVH (females: 103.58 ± 31.92 g- 2 vs. 86.63 ± 20.47 g- 2, P < 0.001; males: 106.10 ± 24.69 g- 2 vs. 98.16 ± 23.29 g- 2, P < 0.001). The results of multiple regression analysis indicated that the HHcy & MetS group had a higher risk of LVH than the other three groups (OR: 1.628 for LVMI, P < 0.001, OR: 2.433 for LVMH2.7, P < 0.001). Moreover, subjects in the HHcy & non-MetS group [OR (95% CI): 1.297 (1.058, 1.591) for LVMI, P < 0.05; OR (95% CI): 1.248 (1.044, 1.492) for LVMH2.7, P < 0.05] also had a statistically greater risk of LVH than subjects in the non-HHcy & non-MetS group. The HHcy & non-MetS group was also found to be significantly and independently associated with LVH. CONCLUSION: Hyperhomocysteinemia has an independent effect on LVH. The combined effect of MetS and hyperhomocysteinemia might increase the strength of the abovementioned effects.

Association of abnormal serum electrolyte levels with hypertension in a population with high salt intake.

OBJECTIVE: The present epidemiological study aimed to evaluate the association of serum electrolyte levels with hypertension in a population with a high-salt diet. DESIGN: Secondary analysis of epidemiology data from the Northeast China Rural Cardiovascular Health Study conducted in 2012-2013. Blood pressure and hypertension status were analysed for association with serum sodium, potassium, chloride, total calcium, phosphate and magnesium levels using regression models. SETTING: High-salt diet, rural China.ParticipantsAdult residents in Liaoning, China. RESULTS: In total 10 555 participants were included, of whom 3287 had incident hypertension (IH) and 1655 had previously diagnosed hypertension (PDH). Fifty-six per cent of participants had electrolyte disturbance. Sixty-two per cent of hypercalcaemic participants had hypertension, followed by hypokalaemia (56 %) and hypernatraemia (54 %). Only hypercalcaemia showed significant associations with both IH (OR=1·70) and PDH (OR=2·25). Highest serum calcium quartile had higher odds of IH (OR=1·58) and PDH (OR=1·64) than the lowest quartile. Serum sodium had no significant correlation with hypertension. Serum potassium had a U-shaped trend with PDH. Highest chloride quartile had lower odds of PDH than the lowest chloride quartile (OR=0·65). Highest phosphate quartile was only associated with lower odds of IH (OR=0·75), and the higher magnesium group had significantly lower odds of IH (OR=0·86) and PDH (OR=0·77). CONCLUSIONS: We have shown the association of serum calcium, magnesium and chloride levels with IH and/or PDH. In the clinical setting, patients with IH may have concurrent electrolyte disturbances, such as hypercalcaemia, that may indicate other underlying aetiologies.

Effect of serum electrolytes within normal ranges on QTc prolongation: a cross-sectional study in a Chinese rural general population.

BACKGROUND: Many previous clinical studies have reported that prolongation of the QT interval corrected for heart rate (QTc) is associated with an increased risk of sudden cardiac death and all-cause mortality. This study aimed to explore associations between serum electrolytes and QTc prolongation in the north-eastern Chinese rural general population. METHODS: We performed a cross-sectional study including 10,334 (4820 men and 5514 women) from the general population aged ≥35 years in the Liaoning Province from 2012 to 2013. Anthropometric measurements, laboratory examinations and self-reported lifestyle factor information, echocardiography and electrocardiogram were collected by trained personnel. The associations between serum electrolytes and QTc prolongation were tested using multiple linear regression and logistic regression analyses. RESULTS: The mean QTc interval were 415.6 ± 18.8 and 470.1 ± 23.1 ms in normal group and QTc prolongation group respectively. The prevalence of QTc prolongation increased significantly with a decrease in serum potassium and an increase in magnesium. Stepwise multiple linear regression showed that age, hypertension, waist circumference were prominently positive associated with QTc interval both in male and female population. But serum potassium was significantly inversely associated with QTc interval. Serum magnesium and calcium also showed a positive relationship with QTc interval. Furthermore, multiple logistic regression found that lower quartile of serum potassium had higher risk for QTc prolongation, especially in female population (Q2 vs. Q4: OR: 1.54, 95%CI: 1.01-2.35; Q1 vs. Q4: OR: 2.02, 95%CI: 1.36-3.01). In addition, the higher serum magnesium increased the risk of QTc prolongation, which was significantly only in male population. CONCLUSIONS: In present Chinese rural general population, even with normal range, a decrease in serum potassium and an increase in serum magnesium are important risk factors for QTc prolongation.

Klotho Inhibits Proliferation and Migration of Angiotensin II-Induced Vascular Smooth Muscle Cells (VSMCs) by Modulating NF-κB p65, Akt, and Extracellular Signal Regulated Kinase (ERK) Signaling Activities.

BACKGROUND It has been proven that phenotype shifting, from the contractile phenotype to the synthetic phenotype, of vascular smooth muscle cells (VSMCs), plays an important role in vascular diseases such as atherosclerosis, restenosis, and hypertension. Recently, accumulating evidence suggests that Klotho is associated with many cardiovascular diseases or damage. Through the estimation of the proliferation and migration of Ang II-induced VSMCs and the related intracellular signal transduction pathways, we researched the effects of Klotho on phenotype modulation in this study. MATERIAL AND METHODS A rat vascular smooth muscle cell line was grown in vitro with or without Ang II or Klotho, and cell proliferation and migration were evaluated. RESULTS The dose-dependent inhibition of Ang II-induced proliferation and migration by Klotho was shown in VSMCs. The phenotype modulation was inhibited by Klotho co-treatment; this co-treatment promoted the expression of contractile phenotype marker proteins, including SM22α, and also the proliferation phenotype marker protein PCNA compared with Ang II alone, which was suppressed, and activated VSMCs. Furthermore, by reducing the expression of G0/G1-specific regulatory proteins such as cyclin D1, cyclin-dependent kinase (CDK) 4, cyclin E, and CDK2, cell cycle arrest was induced by Klotho at G0/G1 phase. Although Ang II strongly stimulated NF-κB, p65, Akt, and ERK phosphorylation, these activation events were diminished by co-treatment with Ang II and Klotho. CONCLUSIONS Phenotype modulation of Ang II-induced VSMCs and stimulation of the NF-κB, p65, Akt, and ERK signaling pathways were inhibited by Klotho, which suggests that Klotho may play an important role in the phenotype modulation of VSMCs.

Estimate of ischemic stroke prevalence according to a novel 4-tiered classification of left ventricular hypertrophy: insights from the general Chinese population.

BACKGROUND: Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population. METHODS: We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data were available to subdivide patients with LVH into four geometric patterns: indeterminate, dilated, thick and both thick and dilated hypertrophy. RESULTS: Compared with normal LV geometry, indeterminate and thick hypertrophy showed a higher prevalence of ischemic stroke (p < .05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115-2.398) and thick (2.143 [1.329-3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803-1.950]) and both thick and dilated hypertrophy (0.926 [0.435-1.971]) compared with normal geometry in multivariable analysis. CONCLUSIONS: Indeterminate and thick hypertrophy were significantly associated with the presence of ischemic stroke in the general Chinese population. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy. Key messages This was the first study to investigate whether a 4-tiered classification of LVH defines subgroups in the general population that are at variable risks of ischemic stroke. We identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH emerged as a valuable operational approach, a potential alternative to LVM, to refine ischemic stroke stratification in general population.

Body adiposity index, lipid accumulation product, and cardiometabolic index reveal the contribution of adiposity phenotypes in the risk of hyperuricemia among Chinese rural population.

Adiposity phenotypes, estimated by higher body adiposity index (BAI), lipid accumulation product (LAP), and cardiometabolic index (CMI), has conferred increased metabolic risk. The relative contribution of BAI, LAP, and CMI in hyperuricemia, however, is unknown. We hypothesized that these obesity indicators would refine identification of hyperuricemia. Information on serum uric acid (SUA), fasting lipid profiles, and body adiposity measures (BAI, LAP, and CMI) were recorded in a cross-sectional population-based sample of 11,102 participants (≥ 35 years old) from China. BAI, LAP, and CMI were strong independent predictors of SUA in both sexes after correction for potential confounders. In multivariable models, odds ratio (OR) for hyperuricemia for 1 SD increment in BAI, LAP, and CMI were 1.361 (95% CI, 1.224-1.513), 1.393 (95% CI, 1.273-1.525), and 1.332 (95% CI, 1.224-1.448) in females, respectively. For males, these adiposity indices corresponded to an increased hyperuricemia risk of 14, 47, and 33%, respectively. Additionally, compared to the bottom category, females with the top quartile of BAI, LAP, and CMI showed higher adjusted odds of having hyperuricemia, with ORs of 2.064, 7.500, and 4.944, respectively. ORs for hyperuricemia were statistically significant in the fourth quartile of BAI (1.622 [1.258-2.091]), LAP (5.549 [3.907-7.880]), and CMI (3.878 [2.830-5.313]) of male subgroup. Accumulation of ectopic adiposity in general (quantified by increased BAI), and of visceral adipose tissue in particular (reflected by elevated LAP and CMI), provided important insight regarding hyperuricemia risk and might potentially shed further light on our understanding of the metabolic sequelae of obesity.

The impact of nontraditional lipid profiles on left ventricular geometric abnormalities in general Chinese population.

BACKGROUND: Despite current interest in the unfavorable impact of nontraditional lipid profiles on cardiovascular disease, information regarding its relations to abnormal left ventricular (LV) geometry has not been systemically elucidated. This study sought to understand predictive implication of nontraditional lipid profiles in specific LV geometric patterns in the general population of rural China. METHODS: Analyses were based upon a cross-sectional study of 10,756 participants (mean age 53.8 years; 54.0% females) who underwent assessment of biochemical, anthropometric, and blood pressure variables in rural areas of China. Participants were classified into four groups of LV morphologic pattern according to left ventricular mass index (LVMI) and relative wall thickness with quantitative echocardiographic data. RESULTS: By multivariable-adjusted linear regression models, nontraditional lipid profiles were positive determinants of concentricity index and LV wall thickness (all P < 0.05), with modest effects on LVMI. Non-high-density lipoprotein cholesterol (non-HDL-C) emerged as an independent correlate of concentric LV hypertrophy (LVH) (adjusted odds ratio [OR]: 1.174 per 1 SD increment in non-HDL-C, 95% confidence interval [CI]: 1.075-1.281), followed by low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio (1.158 [1.059-1.266]), total cholesterol (TC)/HDL-C ratio (1.150 [1.050-1.260]), and triglyceride (TG)/HDL-C ratio (1.134 [1.030-1.249]). The ORs for concentric LVH by tertiles further provided insight into that excess risk was associated with the highest tertile of nontraditional lipid profiles. The areas under the ROC curves to predict concentric LVH were statistically identical among nontraditional lipid parameters. CONCLUSION: Nontraditional lipid profiles, easily measured in the everyday routine examination, were responsible for increased risk of concentric LVH, potentially providing enhanced clinical utility at no additional cost, which emphasized the beneficial effect of these markers to supplement and improve CVD risk stratification.

Atorvastatin Attenuates Myocardial Hypertrophy in Spontaneously Hypertensive Rats via the C/EBPß/PGC-1α/UCP3 Pathway.

BACKGROUND/AIMS: Many clinical and experimental studies have shown that treatment with statins could prevent myocardial hypertrophy and remodeling induced by hypertension and myocardial infarction. But the molecular mechanism was not clear. We aimed to investigate the beneficial effects of atorvastatin on hypertension-induced myocardial hypertrophy and remodeling in spontaneously hypertensive rats (SHR) with the hope of revealing other potential mechanisms or target pathways to interpret the pleiotropic effects of atorvastatin on myocardial hypertrophy. METHODS: The male and age-matched animals were randomly divided into three groups: control group (8 WKY), SHR (8 rats) and intervention group (8 SHR). The SHR in intervention group were administered by oral gavage with atorvastatin (suspension in distilled water, 10 mg/Kg once a day) for 6 weeks, and the other two groups were administered by gavage with equal quantity distilled water. Blood pressure of rats was measured every weeks using a standard tail cuff sphygmomanometer. Left ventricular (LV) dimensions were measured from short-axis views of LV under M-mode tracings using Doppler echocardiograph. Cardiomyocyte apoptosis was assessed by the TUNEL assay. The protein expression of C/EBPß, PGC-1α and UCP3 were detected by immunohistochemistry or Western blot analysis. RESULTS: At the age of 16 weeks, the mean arterial pressure of rats in three groups were 103.6±6.1, 151.8±12.5 and 159.1±6.2 mmHg respectively, and there wasn't statistically significant difference between the SHR and intervention groups. Staining with Masson's trichrome demonstrated that the increased interstitial fibrosis of LV and ventricular remodeling in the SHR group were attenuated by atorvastatin treatment. Echocardiography examination exhibited that SHR with atorvastatin treatment showed an LV wall thickness that was obviously lower than that of water-treated SHR. In hypertrophic myocardium, accompanied by increasing C/EBPß expression and the percentage of TUNEL-positive cells, the expression of Bcl-2/Bax ratio, PGC-1α and UCP3 were reduced, all of which could be abrogated by treatment with atorvastatin for 6 weeks. CONCLUSION: This study further confirmed that atorvastatin could attenuate myocardial hypertrophy and remodeling in SHR by inhibiting apoptosis and reversing changes in mitochondrial metabolism. The C/EBPß/PGC-1α/UCP3 signaling pathway might also be important for elucidating the beneficial pleiotropic effects of atorvastatin on myocardial hypertrophy.

Contribution of non-traditional lipid profiles to reduced glomerular filtration rate in H-type hypertension population of rural China.

BACKGROUND: Despite current interest in the unfavourable impact of non-traditional lipid profiles on cardiovascular disease, information regarding its relations to reduced glomerular filtration rate (GFR) in H-type hypertension population has not been systemically elucidated. METHODS: Analyses were based upon a cross-sectional study of 3259 participants with H-type hypertension who underwent assessment of biochemical, anthropometric and blood pressure values. Reduced GFR was considered if meeting estimated GFR <60 ml/min/1.73 m2. RESULTS: A stepwise multivariate regression analysis indicated that non-traditional lipid parameters remained as independent determinants of estimated GFR (all p < .001). In multivariable models, we observed a 50%, 51%, 31%, and 24% higher risk for decreased GFR with each SD increment in TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C levels, respectively. The highest quartile of TC/HDL-C, TG/HDL-C and LDL-C/HDL-C ratios carried reduced GFR odds (confidence intervals) of 5.50 (2.50 to 12.09), 6.63 (2.58 to 17.05) and 2.22 (1.15 to 4.29), respectively. CONCLUSIONS: The relative independent contribution of non-traditional lipid profiles, as indexed by TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, towards reduced GFR putting research evidence at the very heart of lipoprotein-mediated renal injury set a vital example for applying a clinical and public health recommendation for reducing the burden of chronic kidney disease. KEY MESSAGES Non-traditional lipid profiles has been linked with the occurrence of cardiovascular disease, but none of the studies that address the effect of non-traditional lipid profiles on reduced GFR risk in H-type hypertension population has been specifically established. A greater emphasis of this study resided in the intrinsic value of TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C that integrate atherogenic and anti-atherogenic lipid molecules to predict the risk of reduced GFR among H-type hypertension population and provide insight into the pathophysiology of subsequent cardio-cerebrovascular outcomes. In a large Chinese H-type hypertension adults, the relative independent contribution of non-traditional lipid profiles, as indexed by TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, towards reduced GFR putting research evidence at the very heart of lipoprotein-mediated renal injury set a vital example for applying a clinical and public health recommendation for reducing the burden of CKD.

Validity of cardiometabolic index, lipid accumulation product, and body adiposity index in predicting the risk of hypertension in Chinese population.

OBJECTIVES: Adiposity, defined by higher cardiometabolic index (CMI), lipid accumulation product (LAP), and body adiposity index (BAI), has conferred increased metabolic risk. However, the incremental utility of CMI, LAP, and BAI in association with prevalent hypertension has not been well described in a population-based setting. We hypothesized that CMI, LAP, and BAI would provide important insight into hypertension risk. METHODS: Blood pressure (BP), fasting lipid profiles, and anthropometric parameters were recorded in a cross-sectional study of 11,400 participants (mean age, 54 years; 53% women) from China. Logistic regression models were used to assess associations of CMI, LAP, and BAI with prevalent hypertension. BAI was evaluated according to hip (cm)/[height (m)1.5]-18; LAP was calculated separately for men [(WC-65) × TG] and women [(WC-58) × TG]; and CMI was defined by TG/HDL-C × waist-to-height ratio. RESULTS: CMI, LAP, and BAI were independently correlated with higher SBP and DBP, with nonstandardized (B) coefficients ranging from 1.827 to 4.590 mmHg and 1.475 to 2.210 mmHg (all P < 0.001). After adjustment for hypertension risk factors and potential confounders, CMI, LAP, and BAI, modeled as continuous measures, carried hypertension odds (95% CI) of 1.356 (1.259-1.459), 1.631 (1.501-1.771), and 1.555 (1.454-1.662) in women, respectively, per SD increment. In men, each SD increase in CMI, LAP, and BAI experienced a 31%, 65%, and 53% higher hypertension risk, respectively. Moreover, among women, the odds ratio (95% CI) for hypertension were 2.318 (1.956-2.745), 3.548 (2.985-4.217), and 3.004 (2.537-3.557) in the 4th quartile vs the first quartile of CMI, LAP, and BAI, respectively. For men, the corresponding figures were 2.200 (1.838-2.635), 3.892 (3.238-4.677), and 3.288 (2.754-3.927), respectively. CONCLUSION: Measurements of CMI, LAP, and BAI provide a more complete understanding of hypertension risk related to variation in body fat distribution and pinpoint hypertensive participants in great risk of cardiovascular disease in the future.

BAG3 promotes the phenotypic transformation of primary rat vascular smooth muscle cells via TRAIL.

Under normal physiological condition, the mature vascular smooth muscle cells (VSMCs) show differentiated phenotype. In response to various environmental stimuluses, VSMCs convert from the differentiated phenotype to dedifferentiated phenotype characterized by the increased ability of proliferation/migration and the reduction of contractile ability. The phenotypic transformation of VSMCs played an important role in atherosclerosis. Both Bcl-2-associated athanogene 3 (BAG3) and tumor necrosis factor-related apopt-osis inducing ligand (TRAIL) involved in apoptosis. The relationship between BAG3 and TRAIL and their effects the proliferation and migration in VSMCs are rarely reported. This study investigated the effects of BAG3 on the phenotypic modulation and the potential underlying mechanisms in primary rat VSMCs. Primary rat VSMCs were extracted and cultured in vitro. Cell proliferation was detected by cell counting, real-time cell analyzer (RTCA) and EdU incorporation. Cell migration was detected by wound healing, Transwell and RTCA. BAG3 and TRAIL were detected using real-time PCR and western blotting and the secreted proteins in the cultured media by dot blot. The expression of BAG3 increased with continued passages in cultured primary VSMCs. BAG3 promoted the proliferation and migration of primary rat VSMC in a time-dependent manner. BAG3 significantly increased the expression of TRAIL while had no effects on its receptors. TRAIL knockdown or blocking by neutralizing antibody inhibited the proliferation of VSMCs induced by BAG3. TRAIL knockdown exerted no obvious influence on the migration of VSMCs. Based on this study, we report for the first time that BAG3 was expressed in cultured primary rat VSMCs and the expression of BAG3 increased with continued passages. Furthermore, BAG3 promoted the proliferation of VSMCs via increasing the expression of TRAIL. In addition, we also demonstrated that BAG3 promoted the migration of VSMCs independent of TRAIL upregulation.

Regulation of angiotensin II-induced B-cell lymphoma-2-associated athanogene 3 expression in vascular smooth muscle cells.

Previous studies have demonstrated that angiotensin II (Ang II) is involved in the process of atherosclerosis and vascular restenosis through its proinflammatory effect. Bcl­2­associated athanogene 3 (BAG3) had been suggested to be associated with proliferation, migration and invasion in many types of tumor. However, the role of BAG3 among the proliferative process of vascular smooth muscle cells (VSMCs) induced by Ang II, to the best of our knowledge, remains to be investigated. The present study demonstrated that in growth­arrested VSMCs, Ang II­induced VSMC proliferation, accompanied by increased BAG3 mRNA and protein expression levels in a dose­ and time­dependent manner. BAG3 expression levels were measured in VSMCs treated in the presence or absence of Ang II. The proliferation of VSMCs was assessed using manual cell counting and Cell Counting kit­8 assays. mRNA and protein expression levels of BAG3, Toll­like receptor 4 (TLR4), proliferating cell nuclear antigen, nuclear factor (NF)­κB p65, smooth muscle protein 22α and phosphorylated NF­κB p65 were assessed by reverse transcription­quantitative polymerase chain reaction and western blotting, respectively. In non­transfected or scramble short hairpin RNA (shRNA)­transfected VSMCs cells, Ang II significantly induced VSMC proliferation. However, this Ang II­induce proliferation was attenuated when BAG3 was silenced, suggesting that inhibition of BAG3 may somehow reduce proliferation in Ang II­induced VSMCs. Furthermore, the TLR4/NF­κB p65 signaling pathway was involved in BAG3 gene upregulation. In conclusion, to the best of our knowledge, the present study demonstrated for the first time that inhibition of BAG3 attenuates cell proliferation. Furthermore, Ang II induced VSMCs proliferation through regulation of BAG3 expression via the TLR4/NF­κB p65 signaling pathway.

New anthropometric indices or old ones: which perform better in estimating cardiovascular risks in Chinese adults.

BACKGROUND: Various anthropometric indices can be used to estimate obesity, and it is important to determine which one is the best in predicting the risk of coronary heart disease (CHD) and to define the optimal cut-off point for the best index. METHODS: This cross-sectional study investigated a consecutive sample of 11,247 adults, who had lived in rural areas of China and were older than 35 years of age. Eight obesity indices, including the body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI) and a body shape index (ABSI) were investigated. The risk of CHD was evaluated by the 10-year coronary event risk (Framingham risk score). Receiver operating characteristic (ROC) curve analyses were used to evaluate the predictive ability of the obesity indices for CHD risk. RESULTS: Of the whole population, 3636 (32.32%) participants had a risk score higher than 10%. Those who suffered medium or high CHD risk were more likely to have higher mean anthropometric indices, except for BMI in males. In the multivariate-adjusted logistic regression, all these anthropometric measurements were statistically associated with CHD risk in males. After adjusting for all the possible confounders, these anthropometric measurements, except for ABSI, remained as independent indicators of CHD risk in females. According to the ROC analyses, ABSI provided the largest area under the curve (AUC) value in males, and BMI showed the lowest AUC value, with AUC varying from 0.52 to 0.60. WHtR and BRI provided the largest AUC value in female, and similarly, BMI showed the lowest AUC value, with AUC varying from 0.59 to 0.70. The optimal cut-off values were as follows: WHtR (females: 0.54), BRI (females: 4.21), and ABSI (males: 0.078). CONCLUSIONS: ABSI was the best anthropometric index for estimating CHD risk in males, and WHtR and BRI were the best indicators in females. Males should maintain an ABSI of less than 0.078, and females should maintain a WHtR of less than 0.54 or a BRI of less than 4.21.

Relation of four nontraditional lipid profiles to diabetes in rural Chinese H-type hypertension population.

BACKGROUND: Mounting evidence suggested that nontraditional lipid profiles have been recognized as a reliable indicator for unfavorable cardiovascular events. The purpose of this study was to explore the role of nontraditional lipid profiles as potential clinical indices for the assessment of prevalent diabetes in rural Chinese H-type hypertension population. METHODS: During 2012 to 2013, we conducted a large cross-sectional study of 2944 H-type hypertension participants (≥35 years of age) from rural areas in northeast China. Subjects underwent accurate assessment of lipid profiles, fasting plasma glucose (FPG), homocysteine (Hcy) according to standard protocols. RESULTS: The proportion of diabetes showed a graded and linear increase across the quartiles for all four nontraditional lipid parameters. Nontraditional lipid variables were independent determinants of FPG, and its correlation for TG/HDL-C was strongest, whether potential confounders were adjusted or not. Multivariable logistic regression analysis established that the highest triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C) quartile manifested the largest ORs of prevalent diabetes (OR: 3.275, 95%CI: 2.109-5.087) compared with the lowest quartile. The fully adjusted ORs (95%CI) were 2.753 (1.783-4.252), 2.178 (1.415-2.351), 1.648 (1.097-2.478) for the top quartile of total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C), respectively. On the basis of the area under receiver-operating characteristic curve (AUC), TG/HDL-C showed the optimal discriminating power for diabetes (AUC: 0.684, 95% CI: 0.650-0.718). CONCLUSIONS: Nontraditional lipid profiles (TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C) were all consistently and independently correlated with prevalent diabetes among the H-type hypertension population in rural China. TG/HDL-C was prone to be more profitable in assessing the risk of prevalent diabetes and should be encouraged as an effective clinical tool for monitoring and targeted intervention of diabetes in H-type hypertension adults.

Usefulness of cardiometabolic index for the estimation of ischemic stroke risk among general population in rural China.

OBJECTIVES: Cardiometabolic index (CMI) has been recognized as a novel and practical marker for the assessment of cardiometabolic risk as it is independently related to diabetes and atherosclerotic progression. This study tested the hypothesis that CMI represents a risk of ischemic stroke in a general population of rural China. METHODS: From July 2012 to August 2013, we examined data from a large cross-sectional study of 11,345 participants (mean age 53.8 years; 60.8% females) who underwent biochemical determinations and anthropometric measurements in rural areas of northeast China. Ischemic stroke was documented as a history of cerebrovascular events and verified by medical record review. RESULTS: The prevalence of ischemic stroke was given to 3.1% of females and 3.2% of males. The cardio-metabolic profile was notably more adverse in ischemic stroke groups, irrespective of gender. A dose-response manner was detected for the prevalence of ischemic stroke, exhibiting a significant increase from the lowest to the highest quartiles of CMI (1.2% to 6.4% in females, P for trend<0.001; 2.3% to 4.3% in males, P for trend = 0.017). In multivariable analysis, for every 1 SD increment in CMI, the probability of ischemic stroke increased by 18% in females and 14% in males, respectively. The odds ratios for ischemic stroke comparing the top versus bottom quartiles of CMI were 2.047 (95%CI: 1.168-3.587) for females and 1.722 (95%CI: 1.019-2.910) for males. According to the area under receiver operating characteristic (AUC), the discrimination power of CMI in predicting ischemic stroke was relatively higher for females (AUC: 0.685) than males (AUC: 0.573). CONCLUSION: The strong and independent association of CMI with ischemic stroke in females, in comparison with the much lesser degree in males, provides further insight to better stratify by sex in investigations of ischemic stroke and solidly corroborates the potential role of ischemic stroke prevention targeted at CMI.

Sex-specific association between serum uric acid and self-reported snoring in rural China: a cross-sectional study.

PURPOSE: Until now, information has been rare on the association of serum uric acid (SUA) with self-reported snoring. Therefore, the purpose of this study was to explore the sex-specific relationship between SUA and self-reported snoring in a general Chinese population. METHODS: A large cross-sectional study of 10,912 participants aged ≥35 years old were recruited from rural areas of Liaoning Province in China during 2012 to 2013. SUA were divided into quartiles separated for males and females. Anthropometric measurements and blood biochemical indexes were examined according to standard protocols. Sleep duration and self-reported snoring status were investigated by trained personnel using a structured questionnaire. RESULTS: The prevalence of self-reported snoring was 37.9% (n = 2197) among females and 47.4% (n = 2420) among males, respectively. The proportion of self-reported snoring presented a significant linear increase across the quartile of SUA level in both sexes. In multivariate logistic regression analysis adjusted for possible confounders, the odds ratio (OR) for SUA with regard to self-reported snoring was significantly higher in females. The OR of self-reported snoring associated with per 1 SD increase in SUA was 1.208 (95%CI 1.118-1.305, P<0.001). The highest quartile of SUA (>293 µmol/L) conferred an independently increased risk for self-reported snoring with OR of 1.643 (95%CI 1.384-1.950, p < 0.001) compared to the lowest quartile of SUA (<209 µmol/L). However, there were no significant relationships between SUA and self-reported snoring among males in all the models. CONCLUSIONS: Our study showed that in rural China, SUA was positively correlated with an increased risk for self-reported snoring in females but not in males. The strong association of SUA levels with self-reported snoring in females emphasizes the necessity of stratifying the sex in investigations of self-reported snoring and encourages exploration of SUA as an effective clinical tool of self-reported snoring risk.