Nocturnal Hypertension and Left Ventricular Diastolic Dysfunction in Patients With Diabetes With the Absence of Heart Failure: Prospective Cohort HSCAA Study.

BACKGROUND: Diabetes is an important risk factor for heart failure (HF) and is associated with left ventricular (LV) diastolic dysfunction. However, diabetic comorbid conditions, such as nocturnal hypertension, as predictors of diastolic dysfunction are not known in the absence of an HF period. The present study was conducted as the longitudinal examination of the predictive value of nocturnal hypertension profiles on the progression of LV diastolic dysfunction in patients with and without diabetes without HF. METHODS: The subjects (154 diabetes and 268 nondiabetes) in the absence of HF were followed for 36.8±18.2 months. The relationships among the patterns of nocturnal hypertension and the outcome of LV diastolic dysfunction, defined as an increase in E/e'>14, were investigated in the patients with and without diabetes. RESULTS: The interaction effect of the diabetes status and the patterns of nocturnal hypertension on the hazard rate of the occurrence of E/e'>14 was statistically significant (P=0.017). Kaplan-Meier analysis results revealed that patients with diabetes with nondipper (P=0.021 versus dipper) and riser (P=0.006 versus dipper) had a greater risk for a diastolic dysfunction event. Furthermore, multivariable Cox proportional hazards analysis revealed that nondipper (hazard ratio, 4.56 [95% CI, 1.49-13.96]; P=0.007) and riser (hazard ratio, 3.89 [95% CI, 1.31-11.57]; P=0.014) patterns were associated with elevated risk of the outcome of LV diastolic dysfunction. In contrast, no similar significant associations were found in patients without diabetes. CONCLUSIONS: During the absence of HF periods, nocturnal hypertension is an important predictor for the progression of LV diastolic dysfunction in patients with diabetes.

Excessive daytime napping independently associated with decreased insulin sensitivity in cross-sectional study - Hyogo Sleep Cardio-Autonomic Atherosclerosis cohort study.

Background: Although excessive daytime napping has been shown to be involved in diabetes occurrence, its impact on insulin secretion and sensitivity has not been elucidated. It is speculated that excessive napping disrupts the sleep-wake rhythm and increases sympathetic nerve activity during the day, resulting in decreased insulin sensitivity, which may be a mechanism leading to development of diabetes. We previously conducted a cross-sectional study that showed an association of autonomic dysfunction with decreased insulin sensitivity, though involvement of autonomic function in the association between napping and insulin sensitivity remained unclear. Furthermore, the effects of napping used to supplement to short nighttime sleep on insulin secretion and sensitivity are also unknown. In the present cross-sectional study, we examined the relationships of daytime nap duration and autonomic function with insulin secretion and sensitivity in 436 subjects enrolled in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) Cohort Study who underwent a 75-g oral glucose tolerance test (75-g OGTT), after excluding those already diagnosed with diabetes. Methods: Daytime nap duration was objectively measured using actigraphy, with the subjects divided into the short (≤1 hour) and long (>1 hour) nap groups. Insulin secretion and sensitivity were determined using 75-g OGTT findings. Standard deviation of normal to normal R-R interval (SDNN), a measure of autonomic function, was also determined based on heart rate variability. Subgroup analysis was performed for the associations of napping with insulin secretion and sensitivity, with the results stratified by nighttime sleep duration of less or greater than six hours. Results: Subjects in the long nap group exhibited lower insulin sensitivity parameters (QUICKI: ß=-0.135, p<0.01; Matsuda index: ß=-0.119, p<0.05) independent of other clinical factors. In contrast, no associations with insulin secretion were found in either group. Furthermore, the association of long nap duration with insulin sensitivity was not confounded by SDNN. Specific subgroup analyses revealed more prominent associations of long nap habit with lower insulin sensitivity in subjects with a short nighttime sleep time (ß=-0.137, p<0.05). Conclusion: Long daytime nap duration may be a potential risk factor for decreased insulin sensitivity.

Factors related to the knowledge and skills of evidence-based practice among nurses worldwide: A scoping review.

BACKGROUND: Promoting evidence-based practice (EBP) among nurses may be a valuable component of improving health care. However, a comprehensive analysis of the factors associated with the knowledge and skill EBP in nurses has not been performed to date. This is essential for facilitating the acquisition of relevant knowledge and skills to effectively implement EBP. AIMS: The aim of the study was to determine the factors related to the knowledge and skills of EBP among nurses. METHODS: We searched various literature databases up to October 25, 2021, for relevant studies that investigated the factors associated with the knowledge and skills of EBP in nurses. The authors, year of study, country, study design, study subject information, instruments used for the assessment EBP knowledge and skills, use of multivariable analysis, and factors significantly associated with the knowledge and skills of EBP among nurses were extracted from each eligible study and collated to identify commonly reported factors. RESULTS: We identified 47 eligible studies conducted in a wide range of countries. Nine articles applied multivariable analyses, and 38 articles did not perform any multivariable analyses. The factors related to the knowledge and skill levels of EBP among nurses were classified into two categories: personal and work-environment factors. In the nine articles that conducted multivariable analysis, personal factors, which included educational level, participation in EBP education, and experience conducting research, and work-environment factors, such as resources and organizational support for EBP, were related to the knowledge and skills of EBP among nurses. LINKING EVIDENCE TO ACTION: Our review highlighted educational level, participation in EBP education, experience conducting research, and resources and organizational support for EBP as important factors that are associated with the knowledge and skills of EBP in nurses worldwide. Focusing on these factors may help improve nurses' understanding of EBP and facilitate the implementation of EBP.

Sleep Apnea and Physical Movement During Sleep, But Not Sleep Duration, Are Independently Associated With Progression of Left Ventricular Diastolic Dysfunction: Prospective Hyogo Sleep Cardio-Autonomic Atherosclerosis Cohort Study.

Background Although co-occurrence of sleep disorder with heart failure is known, it is not clear whether that condition is a cause or consequence of heart failure. The present study was conducted as a longitudinal examination of the predictive value of sleep parameters on progression of left ventricular diastolic dysfunction. Methods and Results Four-hundred fifty-two subjects were followed for a mean of 34.7 months. An outcome of diastolic dysfunction was defined as increase in early inflow velocity/early diastolic tissue velocity >14. Sleep apnea-hypopnea index, minimal oxygen saturation, sleep duration, and activity index (physical movement during sleep time, a potential parameter of poor sleep quality) were determined using apnomonitor and actigraphy findings, while heart rate variability was measured with a 24-hour active tracer device. Sixty-six of the patients developed diastolic dysfunction during the follow-up period, with a median time of 25 months. Kaplan-Meier analysis results revealed that those with sleep apnea classified as moderate (apnea-hypopnea index 15 to <30, P<0.01 versus none) or severe (apnea-hypopnea index ≥30, P<0.01 versus none), and with a high activity index (Q3 or Q4, P<0.01 versus Q1), but not short sleep duration (P=0.27) had a significantly greater risk for a diastolic dysfunction event. Results of multivariable Cox proportional hazards regression analysis indicated that moderate to severe sleep apnea after a follow-up period of 3 years (hazard ratio [HR], 9.26 [95% CI, 1.89-45.26], P<0.01) and high activity index (HR, 1.85 [95% CI, 1.01-3.39], P=0.04) were significantly and independently associated with future diastolic dysfunction. Moreover, significant association of high activity index with the outcome was not confounded by either minimal oxygen saturation or heart rate variability. Conclusions Sleep apnea and physical movement during sleep, but not sleep duration and autonomic nervous dysfunction, are independent important predictors for progression of left ventricular diastolic dysfunction.

Xanthine oxidoreductase activity is correlated with hepatic steatosis.

The enzyme xanthine oxidoreductase (XOR) catalyzes the synthesis of uric acid (UA) from hypoxanthine and xanthine, which are products of purine metabolism starting from ribose-5-phosphate. Several studies suggested a relationship between hyperuricemia and hepatic steatosis; however, few previous studies have directly examined the relationship between XOR activity and hepatic steatosis. A total of 223 subjects with one or more cardiovascular risk factors were enrolled. The liver-to-spleen (L/S) ratio on computed tomography and the hepatic steatosis index (HSI) were used to assess hepatic steatosis. We used a newly developed highly sensitive assay based on [13C2, 15N2] xanthine and liquid chromatography/triple quadrupole mass spectrometry to measure plasma XOR activity. Subjects with the L/S ratio of < 1.1 and the HSI of < 36 had increased XOR activity and serum UA levels. Independent of insulin resistance and serum UA levels, multivariate logistic regression analysis revealed that plasma XOR activity was associated with the risk of hepatic steatosis as assessed by the L/S ratio and HSI. According to the findings of this study, plasma XOR activity is associated with hepatic steatosis independent of insulin resistance and serum UA levels.

Relationship between communicative and critical health literacy, health information sources, and participation in health checkups among middle-aged Japanese community residents.

We assessed the relationship between health literacy and participation in health checkups among middle-aged Japanese community residents. Additionally, we explored the health information sources related to participation in health checkups among those with low, medium, and high health literacy. This mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents with National Health Insurance (NHI), aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3582 participants. Health literacy was measured by the Communicative and Critical Health Literacy (CCHL) scale, and participants were classified into three groups (low, medium, and high health literacy groups) by the tertiles of CCHL scale score. After adjusting for confounding factors, the multivariable-adjusted odds ratios for non-participation in health checkups were 1.20 (95% CI 1.01-1.43, p = 0.039) in the medium health literacy group and 1.47 (95% CI 1.20-1.80, p < 0.001) in the low health literacy group compared with the high health literacy group. Additionally, some health information sources were associated with participation in health checkups in the medium and high health literacy groups, whereas none of the health information sources were associated with participation in health checkups in the low health literacy group. We believe that it is important to develop materials and interventions aimed at low health literacy populations to promote participation in health checkups.

Association between Recommendations from Public Health Nurses, Medical Professionals, and Family Members and Participation in Health Checkups among Middle-aged Community Residents with National Health Insurance.

Introduction: Participation in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). This study explored associations between recommendations from public health nurses, medical professionals, and family members and participation in specific health checkups among middle-aged Japanese community residents with NHI. Methods: This mail survey was conducted in 2020, and it included 33,902 community residents with NHI aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) community residents agreed to participate in the survey. After excluding those with missing data, 11,180 participants were included in the analyses. Participants were classified into a participation group and a nonparticipation group. Those who selected "I underwent a specific health checkup in the past year" were classified as the participation group. Results: Of the 11,180 community residents with NHI, 4,384 (39.2%) were classified in the participation group. After adjusting for confounding factors, the presence (vs. absence) of recommendations from public health nurses (multivariable-adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.47-2.24), primary care physicians (multivariable-adjusted OR, 2.79; 95% CI, 2.49-3.13), nurses (multivariable-adjusted OR, 2.06; 95% CI, 1.57-2.69), and family members (multivariable-adjusted OR, 1.22; 95% CI, 1.12-1.32) was positively associated with participation in specific health checkups. Conclusions: Our findings suggest that recommendations from public health nurses, medical professionals (primary care physicians and nurses), and family members may be important to promote participation in specific health checkups among middle-aged Japanese community residents with NHI.

An artificial intelligence-assisted diagnostic system improves the accuracy of image diagnosis of uterine cervical lesions.

The present study created an artificial intelligence (AI)-automated diagnostics system for uterine cervical lesions and assessed the performance of these images for AI diagnostic imaging of pathological cervical lesions. A total of 463 colposcopic images were analyzed. The traditional colposcopy diagnoses were compared to those obtained by AI image diagnosis. Next, 100 images were presented to a panel of 32 gynecologists who independently examined each image in a blinded fashion and diagnosed them for four categories of tumors. Then, the 32 gynecologists revisited their diagnosis for each image after being informed of the AI diagnosis. The present study assessed any changes in physician diagnosis and the accuracy of AI-image-assisted diagnosis (AISD). The accuracy of AI was 57.8% for normal, 35.4% for cervical intraepithelial neoplasia (CIN)1, 40.5% for CIN2-3 and 44.2% for invasive cancer. The accuracy of gynecologist diagnoses from cervical pathological images, before knowing the AI image diagnosis, was 54.4% for CIN2-3 and 38.9% for invasive cancer. After learning of the AISD, their accuracy improved to 58.0% for CIN2-3 and 48.5% for invasive cancer. AI-assisted image diagnosis was able to improve gynecologist diagnosis accuracy significantly (P<0.01) for invasive cancer and tended to improve their accuracy for CIN2-3 (P=0.14).

Work-related factors related to forgetting to take oral diabetes medication during the working day among Japanese male employees with diabetes.

AIM: This study aimed to explore the work-related factors related to forgetting to take oral diabetes medication during the working day among Japanese employees with diabetes. METHODS: This worksite-based study was designed to clarify the important work-related factors for preventing the aggravation of diabetes among working-age people and support for coexisting diabetes treatment and work (Ryoritsu Shien). This cross-sectional survey was conducted in 2018. The participants were full-time employees with type 2 diabetes aged over 40 years who took oral diabetes medication during the working day. The participants were classified into forgetting and non-forgetting groups. Their characteristics and work-related factors were evaluated using a self-administered questionnaire and specific health checkup data. RESULTS: Of the 93 employees with diabetes, 22 (23.7%) were classified into the forgetting group. After adjusting for confounding factors, irregular meal times during the working day was positively associated with forgetting to take oral diabetes medication during the working day [multivariable-adjusted odds ratio (OR), 7.08; 95% confidence interval (CI): 1.38-36.32, irregular vs. regular]. Skipping meals during the working day was positively associated with forgetting to take oral diabetes medication during the working day (multivariable-adjusted OR 3.55, 95% CI 1.14-11.09 presence vs. absence). CONCLUSIONS: Our findings suggest that irregular meal times and skipping meals during the working day are important factors related to forgetting to take oral diabetes medication during the working day among Japanese male employees with diabetes.

The efficacy of human papillomavirus vaccination in young Japanese girls: the interim results of the OCEAN study.

Human papillomavirus (HPV) vaccine has been used to prevent chronic HPV infection, which accounts for cervical cancer. Japanese Ministry of Health, Labor and Welfare (MHLW) conducted an HPV vaccination campaign in 2010 and the Obstetrical Gynecological Society of Osaka initiated a multicenter, prospective cohort study in Osaka, Japan - OCEAN (Osaka Clinical resEArch of HPV vacciNe) study - to investigate the oncogenic HPV prevalence and the long-term protection rate of HPV vaccine. A total of 2814 participants were enrolled on their visit for HPV vaccination between 12 and 18 years old. Among them, 102 participants received HPV/Pap co-test as primary cancer screening at the age of 20-21. We compared the prevalence in two groups (the vaccinated and the unvaccinated group). HPV infection ratio was significantly lower in the vaccinated group compared to the unvaccinated (12.9% vs. 19.7%; p = .04). In particular, HPV 16 and 18 were not detected in the vaccinated group, while 4.9% of participants in the unvaccinated group were infected (p = .001), suggesting that vaccination provided effective protection against high-risk types of HPV. The cross-protection effect of HPV vaccines was also observed against HPV 31, 45, and 52. Although HPV vaccines were not contributed to the reduction of cervical intraepithelial neoplasia 1 (CIN) (p = .28), CIN2 or worse was not observed in vaccinated group. Our research showed that at the age of 20-21, HPV vaccine inhibited the infection of high-risk HPV and had impacted on the development to CIN2 or worse in Japan.

Sleep quality, autonomic dysfunction and renal function in diabetic patients with pre-CKD phase.

Diabetes has been established as a strong risk factor for chronic kidney disease (CKD). Sleep apnea, poor sleep quality (PSQ), and autonomic imbalance are also considered to be potential risk factors for decline in renal function, though no known study has examined their integrated predictive value in diabetic and non-diabetic patients without CKD. The present cohort consisted of 754 serial patients (diabetes; n = 231, non-diabetes; n = 523) without CKD registered in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) study. Patients underwent examinations to determine respiratory event index and objective sleep quality using actigraphy, as well as heart rate variability (HRV). Renal outcome was defined as a decline in estimated glomerular filtration rate to less than 60 ml/min/1.73 m2 for more than 3 months. Kaplan-Meier analysis showed that diabetic patients with PSQ or low HRV, but not sleep apnea, had a significantly increased risk for renal outcome. Furthermore, Cox proportional hazards analysis revealed that PSQ was significantly associated with elevated risk of renal outcome (HR: 2.57; 95% CI: 1.01-6.53, p = 0.045) independent of sleep apnea and classical risk factors. Low HRV tended to be, but not significantly (p = 0.065), associated with the outcome. In non-diabetic patients, PSQ was also significantly and independently associated with renal outcome, whereas sleep apnea and low HRV were not. In conclusion, PSQ and low HRV appear to be important predictors of decline in renal function in diabetic patients without CKD.

Association of abdominal obesity with crossing capillaries in the finger nailfold in type 2 diabetes mellitus.

AIM: Increased crossing of finger nailfold capillaries could be a novel visual marker of early microvascular damage among type 2 diabetes mellitus patients. Although abdominal obesity is an important driver of early microvascular damage, its association with an increase in the percentage of crossing capillaries remains uncertain. We investigated the association between abdominal obesity and an increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus. METHODS: This cross-sectional study enrolled 123 type 2 diabetes mellitus patients (age 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital between May and October 2019. Abdominal obesity was defined as a waist circumference ≥ 90 cm in women and ≥ 85 cm in men. Capillary morphology was assessed by nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. The association between abdominal obesity and a high percentage of crossing capillaries in the finger nailfold (defined as the highest tertile of crossing capillaries) was analyzed using multivariable logistic regression. RESULTS: After adjusting for age, sex, smoking status, regular exercise, duration of diabetes, glycated hemoglobin, hypertension, and dyslipidemia, abdominal obesity was significantly associated with a high percentage of crossing capillaries (multivariable-adjusted odds ratios [95% confidence interval] = 2.70 [1.05-6.90], p = 0.038). CONCLUSIONS: Abdominal obesity may play an important role in the increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus.

Association of crossing capillaries in the finger nailfold with diabetic retinopathy in type 2 diabetes mellitus.

AIMS/INTRODUCTION: Crossing capillaries in the finger nailfold might potentially be a novel diabetic retinopathy (DR) biomarker that could be assessed non-invasively in the clinical setting. However, the association between crossing capillaries and DR is controversial. This study aimed to investigate the association between the percentage of crossing capillaries in the finger nailfold and DR in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: This cross-sectional study enrolled 108 type 2 diabetes mellitus patients (aged 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital, Osaka, Japan, between May and October 2019. Capillary morphology was assessed using nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. Details of DR and other laboratory data were obtained from medical records. The association between the tertile of the percentage of the crossing capillary and DR was analyzed using multivariable logistic regression. RESULTS: After adjusting for age, sex, diabetes duration, glycated hemoglobin, systolic blood pressure, body mass index, and use of renin-angiotensin system inhibitor and antihyperlipidemic medication, the percentage of crossing capillaries was significantly associated with DR (multivariable-adjusted odds ratios for increasing tertiles of the percentage of crossing capillary: 1 [reference], 2.05 [95% confidence interval 0.53-7.94], and 4.33 [95% confidence interval 1.16-16.21]; P-trend = 0.028). CONCLUSIONS: A higher percentage of crossing capillaries in the nailfold was associated with a higher risk of DR, independent of traditional risk and inhibiting factors, in patients with type 2 diabetes mellitus.

A survey of 20-year-old Japanese women: how is their intention to undergo cervical cancer screening associated with their childhood HPV vaccination status?

INTRODUCTION: In Japan, two groups of women, HPV vaccinated and unvaccinated, are approaching age 20, when they should begin cervical cancer screening. To improve Japan's current poor cervical cancer screening rate, we need to know how these women are thinking about screening. METHODS: We conducted an internet survey of 20-y-old women, exploring their understanding of HPV and cervical cancer screening. We then gave them leaflets with basic information about HPV and cervical cancer, stressing the importance of early detection by screening. We analyzed the leaflet's effects on their attitudes based on their vaccination status. RESULTS: Our study of 618 women found a significantly higher intention for engagement for cervical cancer screening in women HPV-vaccinated as teenagers (29% versus 17%). They were also more aware that: (1) HPV is transmitted by sexual intercourse (49.1% versus 39.2%); (2) the HPV vaccine prevents cervical cancer (49.0% to 34.0%); and (3) the appropriate cervical cancer screening interval is every 2 y (63.3% versus 56.2%). Women in both groups responded well to the leaflet, with significant improvements in intention to receive screening. However, 65%-67% were not swayed. DISCUSSION: HPV-vaccinated women were more knowledgeable about cervical cancer and had a greater intention to receive screening. Our educational leaflet was moderately effective in both groups for increasing intentions to screen, but the majority in both groups were still resistant to screening. CONCLUSION: Japan needs to develop more effective educational programs and tools to vigorously impart the importance of cervical cancer screening.

Work-related, personal, and diabetes-related factors relevant to dropout from outpatient diabetes treatment visits among Japanese male employees with diabetes.

AIM: In recent years, support for coexisting diabetes treatment and work (Ryoritsu Shien) has become increasingly important for employees with diabetes. It is important to identify factors associated with dropout from outpatient visits for diabetes treatment among employees with diabetes to determine appropriate support to prevent dropout. Therefore, we explored work-related, personal, and diabetes-related factors relevant for dropout from outpatient diabetes treatment visits among Japanese employees with diabetes. METHODS: This cross-sectional study was conducted in 2018. Participants were 140 full-time employees with type 2 diabetes aged over 40 years. Participants were classified into two groups: a dropout group and a continuation group. Work-related, personal, and diabetes-related factors were evaluated using a self-administered questionnaire and specific health checkup data. RESULTS: Of the 140 employees with diabetes, 12 (8.6%) were classified in the dropout group. Multivariable logistic regression analysis revealed three factors associated with a lower risk for dropout from diabetes treatment outpatient visits. These were: high supervisor support, as measured by the Job Content Questionnaire (multivariable-adjusted odds ratio [OR] 0.71, 95% confidence interval [CI] 0.52-0.97, per 1 score); older age (multivariable-adjusted OR 0.79, 95% CI: 0.66-0.95, per 1 year); and presence of metabolic syndrome (multivariable-adjusted OR 0.04, 95% CI 0.01-0.28, presence vs. absence). CONCLUSIONS: Our findings suggest that supervisor support, age, and metabolic syndrome are important factors related to dropout from outpatient diabetes treatment visits among Japanese male employees with diabetes.

Associations of sleep quality, sleep apnea and autonomic function with insulin secretion and sensitivity: HSCAA study.

RATIONALE AND PURPOSE: Although sleep disorders are shown to be involved in occurrence of diabetes, impacts of several quantitative parameters related to sleep on insulin secretion and sensitivity is yet to be elucidated. We cross-sectionally examined relationships among quantitative sleep quality, sleep apnea, and autonomic function with insulin secretion and sensitivity in 399 patients without previous diagnosed diabetes who underwent 75-g oral glucose tolerance test (75gOGTT). METHOD: Poor sleep quality (PSQ) was defined as an activity index ≥50 by actigraphy. Sleep apnea was measured by apnomonitor, while standard deviation of all normal-to-normal R-R intervals (SDNN) was measured by active tracer. Parameters of insulin secretion and sensitivity were measured by 75gOGTT. RESULTS: Patients with PSQ exhibited significantly lower insulinogenic index (r = 0.155, p < 0.01), a parameter of insulin secretion, with the association independent of other clinical factors including apnea and SDNN (ß = -0.156, p < 0.01). In contrast, presence of sleep apnea (r = -0.143, p < 0.05) and the lower SDNN (r = -0.150, p < 0.01) were significantly and inversely associated with BIGTT-S, an insulin sensitivity parameter, with the association of SDNN with BIGTT-S remaining significant even after adjustments for PSQ and sleep apnea (ß = -0.111, p < 0.05). CONCLUSION: Poor sleep quality is an independent predictor of pancreatic ß-cell function, which could be involved in occurrence of type 2 diabetes.

Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study.

Heart failure due to decreased diastolic function, HFpEF, is a growing health concern with rising prevalence. We examined subclinical cardiac autonomic and diastolic functions in 605 patients with metabolic diseases classified as pre-heart failure. Presence of glucose intolerance or diabetes, or visceral adiposity was significantly associated with reduced cardiac autonomic and diastolic functions. Higher autonomic functions were significantly associated with a parameter of better cardiac diastolic function (E/A) (SDNN: r = 0.306, p < 0.01; HF: r = 0.341, p < 0.01), with the association independent of diabetes, body mass index, visceral adiposity and insulin resistance index. Thus, reduced autonomic function may be a potential predictor for decreased cardiac diastolic functions in metabolic disorders.

Associations among work-related stress and mental fatigue, and regular exercise in Japanese employees with or without diabetes.

AIM: Understanding work-related factors associated with regular exercise in employees could be useful for determining appropriate interventions to prevent the onset and aggravation of diabetes. This study aimed to assess the associations among work-related stress and mental fatigue, and regular exercise in Japanese employees with or without diabetes. METHODS: This cross-sectional study was conducted in 2018, and included 2916 full-time employees aged older than 40 years without cardiovascular disease, cancer, respiratory disease, kidney disease, disc herniation, and depression. Work-related stress was measured by the Job Content Questionnaire and work-related mental fatigue was measured using the Numerical Rating Scale (NRS). RESULTS: Regular exercise was present in 23.9% of 117 employees with diabetes and in 21.3% of 2799 employees without diabetes. In employees with diabetes, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for regular exercise were 0.26 (0.07-0.96) in those with an NRS score of 4-6 (moderate) and 0.22 (0.06-0.85) in those with an NRS score of 7-10 (severe) compared with those with an NRS score of 0-3 (none or mild), after adjusting for confounding factors. Similarly, in employees without diabetes, the multivariable-adjusted ORs (95% CIs) for regular exercise were 0.77 (0.62-0.97) in those with an NRS score of 4-6 and 0.75 (0.59-0.94) in those with an NRS score of 7-10 compared with those with an NRS score of 0-3. CONCLUSIONS: Work-related mental fatigue was negatively associated with regular exercise in employees with and without diabetes.

Overestimation of glomerular filtration rate calculated from serum creatinine as compared with cystatin C in patients with subclinical hypercortisolism: Hyogo Adrenal Metabolic Registry.

The skeletal muscle mass are decreased in the patients with hypercortisolism. Glomerular filtration rate (eGFR) is not accurately evaluated by calculation from serum creatinine (eGFRcre) in these patients. However, it is not known whether it applies to patients with subclinical hypercortisolism. We investigated the dissociation between eGFRcre and eGFR calculated from cystatin C (eGFRcys) in patients with subclinical hypercortisolism and its association with the skeletal muscle mass. This cross-sectional study includes 23 patients with overt Cushing's syndrome (CS), 84 patients with possible autonomous cortisol secretion (pACS) and 232 patients with non-functioning adenomas (NFA). eGFRcre, eGFRcys, the ratio of eGFRcre to eGFRcys (eGFRcre/eGFRcys) were calculated. Skeletal muscle index (SMI) was measured by a direct segmental multi-frequency bioelectrical impedance body composition analyzer. eGFRcre/eGFRcys was significantly higher (p < 0.01) in pACS (mean ± standard error: 1.15 ± 0.02) than NFA (1.06 ± 0.01). In multiple linear regression analysis, the presence of pACS (ß = 0.162, p < 0.01), and post 1 mg-DST cortisol levels (ß = 0.190, p < 0.01) were significantly associated with eGFRcre/eGFRcys independent of age, gender, BMI and diabetes. eGFRcre/eGFRcys was significantly and inversely associated with SMI (r = -0.164, p = 0.02). Furthermore, post 1 mg-DST cortisol levels was significantly associated with SMI in simple (r = -0.177, p = 0.01) and multiple (ß = -0.089, p = 0.01) regression analyses. In conclusion, dissociation between eGFRcre and eGFRcys was observed in patients with subclinical hypercortisolism at least partly explained by muscle mass. Our findings raise an important clinical point that eGFRcre value should be carefully evaluated even in the phase of subclinical hypercortisolism.

Hyperuricemia predicts the risk for developing hypertension independent of alcohol drinking status in men and women: the Saku study.

Hyperuricemia has been reported to be a risk factor for hypertension, but this association may be affected by alcohol consumption. This study aimed to investigate whether hyperuricemia remains a risk factor for hypertension after eliminating the effect of alcohol consumption. This study comprised 7848 participants (4247 men and 3601 women) aged 30-74 years without hypertension who had undergone a medical checkup between April 2008 and March 2009 at Saku Central Hospital, Nagano Prefecture, Japan. Hyperuricemia was defined as uric acid >7.0 mg/dl in men, ≥6.0 mg/dl in women, and/or receiving treatment for hyperuricemia or gout. The incidence of hypertension was defined as the first diagnoses of blood pressure ≥140/≥ 90 mmHg and/or initiations of antihypertensive drug treatment. Multivariable-adjusted hazard ratios (HRs) of hyperuricemia for the incidence of hypertension after adjustment for and classification by alcohol consumption were estimated using the Cox proportional hazard model. During a mean of 4.0 years of follow-up, 1679 individuals developed hypertension. After adjustment for alcohol consumption, the HRs (95% confidence interval) associated with hyperuricemia were 1.37 (1.19-1.58) in men and 1.54 (1.14-2.06) in women. Among nondrinkers, the HR was 1.29 (0.94-1.78) in men with hyperuricemia compared with men without, and the corresponding HR was 1.57 (1.11-2.22) in women. The corresponding HR was 1.88 (1.27-2.86) in all participants with baseline blood pressure <120/80 mmHg. The interactions between hyperuricemia and sex (P = 0.534) and between drinking and sex (P = 0.713) were not significant. In conclusion, hyperuricemia predicts the risk for developing hypertension independent of alcohol drinking status.