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OBJECTIVE--We evaluated whether cardiometabolic risk profiles differ for subjects identified as having prediabetes by AIC, fasting glucose (FPG), or 2-h postchallenge glucose (2-PG) criteria. RESEARCH DESIGN AND METHODS--Atherosclerosis risk factors, [...]

OBJECTIVE--Individuals with normal glucose tolerance (NGT), whose 1-h postload plasma glucose is [greater than or equal to]155 mg/dL (NGT 1h-high), have an increased risk of type 2 diabetes. The purpose [...]

OBJECTIVE--Subjects who are normal glucose tolerant (NGT) are considered at low risk, even if a plasma glucose value [greater than or equal to] 155 mg/dL for the 1-h postload plasma [...]

OBJECTIVE--To address whether glucose tolerance status, and in particular 1-h postload plasma glucose levels, may affect diastolic function in 161 never-treated hypertensive white subjects. Impaired left ventricular relaxation, an early [...]

OBJECTIVE--Left ventricular hypertrophy (LVH), an independent risk factor for cardiovascular (CV) morbidity and mortality, recognizes a multifactorial pathogenesis. A plasma glucose value [greater than or equal to] 155 mg/dL for [...]

OBJECTIVE--Type 2 diabetes and essential hypertension are major risk factors for cardiovascular diseases. Endothelial dysfunction is an early step in the development of atherosclerosis and has been demonstrated in hypertensive [...]

OBJECTIVE--We studied the relationships between plasma IGF-I concentrations and insulin sensitivity in subjects with various degrees of glucose tolerance. RESEARCH DESIGN AND METHODS--A total of 357 nondiabetic subjects, 54 subjects [...]

Uncoupling protein (UCP)-2 is a member of the mitochondrial inner membrane carriers that uncouple proton entry in the mitochondrial matrix from ATP synthesis. The -866G/A polymorphism in the UCP2 gene, which enhances its transcriptional activity, was associated with enhanced risk for type 2 diabetes in obese subjects. We addressed the question of whether the -866G/A polymorphism contributes to variation in insulin sensitivity by genotyping 181 nondiabetic offspring of type 2 diabetic patients. Insulin sensitivity, assessed by the hyperinsulinemic-euglycemic clamp, was reduced in -866A/A carriers compared with -866A/G or -866G/G carriers (P = 0.01). To directly investigate the correlation between UCP2 expression and insulin resistance, UCP2 mRNA levels were measured by real-time RT-PCR in subcutaneous fat obtained from 100 obese subjects who underwent laparoscopic adjustable gastric banding. UCP2 mRNA expression was significantly correlated with insulin resistance as assessed by the homeostasis model assessment index (r = 0.27, P = 0.007). We examined the association of the -866A/A genotype in a case-control study including 483 type 2 diabetic subjects and 565 control subjects. The -866A/A genotype was associated with diabetes in women (odds ratio 1.84, 95% CI 1.03-3.28; P = 0.037), but not in men. These results indicate that the -866A/A genotype of the UCP2 gene may contribute to diabetes susceptibility by affecting insulin sensitivity., The pathophysiology of type 2 diabetes includes two apparently distinct defects, i.e., impairments in insulin action at the level of skeletal muscle, fat, and liver and inadequate compensation by the [...]

OBJECTIVE--The aim of this study was to investigate whether diabetic patients carrying the [Arg.sup.972] insulin receptor substrate-1 (IRS-1) variant are at increased risk for secondary failure to sulfonylurea. RESEARCH DESIGN [...]

OBJECTIVE -- To test whether weight loss may improve endothelial dysfunction in human obesity, we recruited 28 healthy obese subjects, aged 30-46 years, with BMI 30-43 kg/[m.sup.2]. RESEARCH DESIGN AND [...]

To estimate the prevalence of nonalcoholic fatty liver disease (NAFLD) and its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF).

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are highly pathophysiologic heterogeneous prediabetes conditions that can occur in all age groups, from youth to elderly people.

Emerging data demonstrate that type 2 diabetes mellitus (T2DM) is associated with right ventricular (RV) dysfunction. A cutoff point of 155 mg/dL for the 1-hour (h) post-load plasma glucose, during oral glucose tolerance test (OGTT), identifies patients with normal glucose tolerance (NGT) at high risk to develop T2DM and cardiovascular (CV) disease. We investigated if 1-h post-load glucose may affect RV geometry and function in a group of never-treated hypertensive individuals. We enrolled 446 Caucasian newly diagnosed hypertensive outpatients. All patients underwent an OGTT and a standard echocardiography. The tricuspid annular plane systolic excursion (TAPSE) and the RV fractional area change (RVFAC) were measured together with systolic pulmonary arterial pressure (s-PAP) and pulmonary vascular resistances (PVR). Insulin sensitivity was evaluated using the Matsuda index. Among all partecipants, 296 had NGT, 100 impaired glucose tolerance (IGT), and 50 T2DM. Considering the cutoff point of 155 mg/dl for 1-h glucose, NGT subjects were stratified into two groups: NGT < 155 (n= 207), NGT ≥ 155 (n= 89). Subjects NGT ≥ 155 presented a worse metabolic and inflammatory profile than NGT < 155. RV functional parameters (TAPSE, RVFAC, TAPSE/s-PAP, and TAPSE/PVR) were significantly reduced in NGT ≥ 155 subjects compared with NGT < 155 patients. On the contrary, s-PAP and PVR were significantly higher. At multiple regression analysis, 1-h glucose was the strongest predictor of TAPSE in NGT ≥ 155, IGT, and T2DM. The presence of RV impairment in hypertensive NGT ≥ 155 subjects further complicates their CV burden and it may, at least in part, justify the worse clinical outcome in this setting of patients.

Recently, a value of 1-hour postload glucose concentration (1-h-PG) ≥155 mg/dL (8.6 mmol/L) in individuals with normal glucose tolerance (NGT) has been found to be associated with an increased risk for future type 2 diabetes mellitus (T2DM). In this review, we analyze the implication of 1-h-PG determination in prediction of T2DM and cardiovascular disease.

Review efficacy and safety of minimally-invasive treatments for Low Urinary Tract Symptoms (LUTS) in patients affected by Benign Prostate Hyperplasia (BPH). We performed a systematic review of the literature from 1993 to 2022 leveraging original research articles, reviews, and case-studies published in peer-reviewed journals and stored in public repositories. Prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), laser treatments and Cryoablation are valid and safe alternatives to the gold standard (surgery) in the treatment of LUTS in patients affected by BPH, with fewer undesired effects being reported.

This review is a brief overview of the current status and the potential role of robotics in interventional radiology. Literature published in the last decades, with an emphasis on the last 5 years, was reviewed and the technical developments in robotics and navigational systems using CT-, MR- and US-image guidance were analyzed. Potential benefits and disadvantages of their current and future use were evaluated. The role of fusion imaging modalities and artificial intelligence was analyzed in both percutaneous and endovascular procedures. A few hundred articles describing results of single or several systems were included in our analysis.

Context:Individuals with glycated hemoglobin (HbA1c)-defined prediabetes (HbA1c value of 5.7–6.4%) and 1-hour plasma glucose ≥155 mg/dL during an oral glucose tolerance test have an increased risk of developing type 2 diabetes.Objective:To evaluate the degree to which HbA1c-defined prediabetes and 1-hour postload glucose ≥155 mg/dL individually and jointly associate with hepatic steatosis and related biomarkers.Design and Patients:A cross-sectional analysis was performed on 1108 White individuals.Setting:Ambulatory care.Main Outcome Measures:Anthropometric and metabolic characteristics including hepatic steatosis assessed by ultrasonography.Results:Compared with the normal group (HbA1c <5.7%), HbA1c-defined prediabetic and diabetic individuals exhibit higher values of fasting, 1-hour, and 2-hour postload glucose; fasting and 2-hour postload insulin; triglycerides; uric acid; homeostasis model of assessment for insulin resistance; liver insulin resistance index; liver enzymes; and inflammatory biomarkers; and lower levels of high-density lipoprotein cholesterol and IGF-1. Prediabetic and diabetic subjects have increased risk of hepatic steatosis (1.5- and 2.46-fold, respectively). Stratifying participants according to HbA1c and 1-hour postload glucose, we found that individuals with HbA1c-defined prediabetes and 1-hour postload glucose ≥155 mg/dL have significantly higher risk of hepatic steatosis as compared with individuals with HbA1c-defined prediabetes but 1-hour postload glucose <155 mg/dL. Individuals with HbA1c-defined prediabetes and 1-hour postload glucose ≥155 mg/dL exhibit higher values of liver enzymes; fasting, 1-hour, and 2-hour postload glucose; insulin; triglycerides; uric acid; and inflammatory biomarkers; and lower levels of high-density lipoprotein and IGF-1.Conclusions:These data suggest that a value of 1-hour postload glucose ≥155 mg/dL may be helpful to identify a subset of individuals within HbA1c-defined glycemic categories at higher risk of hepatic steatosis.

Context:Subjects with normal glucose tolerance (NGT) but 1-h postload glucose ≥ 155 mg/dL (NGT-1h-high) exhibit an intermediate cardiometabolic risk profile between individuals with NGT and impaired glucose tolerance (IGT).Objective:This study aimed to evaluate whether NGT-1h-high subjects have different cardiometabolic characteristics and an increased risk of type 2 diabetes compared with individuals with isolated impaired fasting glucose (IFG).Setting, Design, and Patients:A cross-sectional analysis was performed on 595 nondiabetic subjects who underwent an oral glucose tolerance test and an euglycemic hyperinsulinemic clamp in an ambulatory care setting. In addition, a longitudinal analysis was performed on 392 individuals, who were reexamined after a followup of 5.2 ± 0.9 y.Main Outcome Measures:Insulin sensitivity, beta-cell function, and risk of developing diabetes were measured.Results:Subjects with NGT-1h-high have a significant reduction of peripheral insulin sensitivity and beta-cell function, assessed by the disposition index, compared with either 1-h postload glucose < 155 mg/dL (NGT-1h-low) or IFG individuals, but not compared with IGT. Among the 392 subjects studied in the longitudinal analysis the incidence rate of type 2 diabetes over the follow-up period was 2.9, 16.7, 12.5, and 31.4% for subjects with NGT-1h-low, NGT-1h-high, IFG, and IGT, respectively. In a Cox proportional hazard regression analysis the risk of developing diabetes for NGT-1h-high subjects was 4.02 (95% confidence interval [CI] 1.06–15.26); an even higher risk (6.67; 95% CI, 2.09–21.24) was observed in subjects with IGT, but not in the isolated IFG group (1.91; 95% CI, 0.44–8.29).Conclusions:NGT-1h-high subjects exhibit a higher risk of developing diabetes than those with IFG or NGT-1h-low, likely due to decreased insulin sensitivity and beta-cell function.

Aims:Essential hypertension, as well as other established cardiovascular risk factors, is associated with endothelial dysfunction. Hypertensive patients with a nondipper circadian pattern have a greater risk of cerebrovascular and cardiovascular complications in comparison with those with a dipper circadian pattern. In this study, we evaluated the association between nondipper pattern and endothelial function in patients with essential hypertension. Methods:We evaluated the forearm blood flow (FBF) response to intraarterial acetylcholine (ACh), an endothelium‐dependent vasodilator, and sodium nitroprusside (SNP), an endothelium‐independent vasodilator, infusions in 190 hypertensive patients stratified according to dipper and nondipper status. The FBF was measured by strain‐gauge plethysmography. Effects of oxidative stress on FBF were evaluated by intraarterial infusion of vitamin C. Ambulatory BP monitorings were obtained by a validated oscillometric device (SpaceLabs 90207 Monitor Inc., Issaquah, WA, USA). Results:Systolic and diastolic blood pressures were higher during daytime and lower during night‐time in dipper subjects than in nondippers. The peak percent increase in ACh‐stimulated FBF was higher in dippers than in nondippers (473% vs. 228%, P< 0.001). The FBF responses to SNP were similar in dipper and nondipper patients. The FBF response to ACh during coinfusion of vitamin C was higher in nondippers rather than in dipper hypertensives. Conclusions:Present data demonstrate that endothelium‐dependent vasodilation is impaired in patients who have nondipper hypertension. The effects of vitamin C on impaired ACh‐stimulated vasodilation support the hypothesis that oxidative stress contributes to endothelial dysfunction of nondipper hypertensive patients.

Essential hypertension is a clinical condition associated with insulin resistance and progressive impairment of renal function that increases cardiovascular events. Insulin-like growth factor (IGF)-1, which is inversely related to insulin levels, increases renal blood flow and glomerular filtration rate (GFR). The aim of the present study was to investigate the relationship between circulating IGF-1 levels and GFR in a group of never treated hypertensive patients.

Recent studies demonstrated that in normoglucose-tolerant subjects (NGT), 1-h post load plasma glucose value ≥155 mg/dL, during OGTT, identifies a worse cardio-metabolic risk profile with increased risk for Type 2 Diabetes Mellitus (T2DM). T2DM patients present increased oxidative stress, due to high blood glucose levels, which plays a central role in the development of CV events. The aim of our study was to evaluate the correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography, in NGT patients with 1-h post load ≥155 mg/dL vs. NGT < 155 subjects, impaired glucose tolerance (IGT) and T2DM patients. We enrolled 100 Caucasian patients (61 M, 39 W, mean age 61.4 ± 10.7) afferent to CATAMERI study. Main exclusion criteria were CV complications, history of malignant or chronic respiratory disease, alcohol, drug influencing glucose metabolism or smoking abuse. All subjects underwent clinical and laboratory evaluation, OGTT and HOMA-IR. The serum values of the markers of oxidative stress (8-isoprostane and NOX-2) were assessed with ELISA sandwich. Statistical analysis was performed with ANOVA test, linear correlation analysis and stepwise multivariate linear regression model. According to OGTT results, subjects were divided into 4 groups: NGT < 155 (n= 30), NGT ≥ 155 (n= 24), IGT (n= 28), T2DM (n= 18). Serum levels of 8-isoprostane and NOX-2 were significantly increased (P< 0.0001) in NGT  ≥ 155 compared to NGT < 155 group, but similar with IGT, indicating an increase in oxidative stress with the worsening of the metabolic status. The left global systolic function, evaluated as myocardial deformation and global longitudinal strain (GLS), appeared progressively lower proceeding from the NGT < 155 group to the T2DM group (P< 0.0001). Moreover, for similar values of ejection fraction (EF), NGT ≥ 155 subjects presented reduced GLS compared to NGT < 155 (P= 0.001), but similar to IGT patients. The linear correlation analysis showed that endo/epi ratio was significantly and inversely correlated with 1 h post load glycaemia (r= −0.632, P< 0.0001), NOX-2 (r= −0.638, P< 0.0001), 8-isoprostane (r= −0.508, P< 0.0001); GLS was inversely correlated with 1 h post load glycaemia (r= −0.734, P< 0.0001) and directly and significantly correlated with 8-isoprostane (r= 0.564, P< 0.0001), NOX-2 (r= 0.625, P< 0.0001). From stepwise multivariate linear regression model, NOX-2 resulted the major predictor of endo/epi ratio, justifying 40.7% of its variation. 1-h post load glycaemia was the second predictor of endo/epi ratio justifying another 9.2% of its variation. Similarly 1-h post load glycaemia was the strongest predictor of the GLS, explaining 53.9% of its variation. Our study demonstrated that NGT ≥ 155 subjects present functional alterations of myocardial contractile fibres, compared to NGT < 155 subjects, but similar to IGT, and these alterations are correlated with oxidative stress. Moreover, GLS is able to identify early alterations in the contractility of subendocardial longitudinal fibres long before the alteration of EF. This data have a central role in ongoing research on the association between hyperglycaemia at 1-h post load and CV risk.

The article offers information on the opening of the Endurocross which will be held at the Orleans Arena in Las Vegas, Nevada. It highlights on Taddy Blasuziak who was ready for the opening of the event. It stresses that Blasuziak's chance for winning started to look bleak, as he had a major issues of transferring out his race. It reveals that he had trouble getting around with his opponents Nick Brozovich and Canada's Bobby Prochnau. He missed to be in the main by one spot.

Endothelium-dependent vasodilatation is impaired in essential hypertension. Besides traditional and emerging cardiovascular risk factors, genetic factors may also promote deleterious alterations of endothelial physiology. The aim of the present study was to investigate the relationship between the 460Trp allele of ADD1and endothelium-dependent vasodilation in 110 never-treated hypertensive patients.

Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) interfere with cardiac mass (left ventricular mass; LVM) development. We investigated the role of the GH/IGF-1 axis on LVM and ventricular geometry in a group of 230 never-treated hypertensive patients.

The article reports on the highlights of the 2010 Catalina Grand Prix motocross racing competition in Santa Catalina, California. It describes the long process of organizing the event from the transportation of bikes to the island to staging and storing them. It also mentions various activities before the main event which includes some bikers' meetings and the registration processes.

Supplemental Digital Content is available in the text.

Introduction:Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western countries. The prevalence of NAFLD as well its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF) is unknown.Hypothesis:To assess the prevalence of NAFLD in a large cohort of patients with AF and to correlate the presence of NAFLD to bleeding and ischemic complications.Methods:Prospective multicentre cohort study including 1735 patients with non-valvular AF on vitamin K antagonists (VKAs) or non-VKAs anticoagulants (NOACs). NAFLD was diagnosed by the validated Fatty Liver Index (FLI), with a cut-off ?60. Primary endpoints were the occurrence of major bleedings and cardiovascular events (CVEs).Results:NAFLD was diagnosed in 732 (42.2%) patients. Patients with NAFLD were younger, less frequently women, more likely to be treated with NOACs and to have obesity, dyslipidaemia and persistent/permanent AF. During a median follow-up of 18.7 months (3155 patient-years), we recorded 78 major bleedings (Incidence Rate [IR] 2.5%/year): 29 (2.1%/year) in patients with and 49 (2.7%/year) in patients without NAFLD (log-rank test p=0.227). Univariate Cox proportional regression analysis showed no association of NAFLD with major bleedings (HR 0.752, 95%CI 0.473-1.196, p=0.229). Similar findings were seen according to therapy with VKAs (HR 0.484, 95%CI 0.229-1.024, p=0.058) or NOACs (HR 1.027, 95%CI 0.546-1.935, p=0.933). One-hundred fifty-five CVEs occurred (IR 3.1%/year), 55 in patients with and 100 in patients without NAFLD (log-rank test p=0.122). No significant association was found between NAFLD and CVEs at multivariate Cox proportional regression analysis. In the entire population NOACs use was associated with lower CVEs compared to VKAs (HR, 0.611 95%CI 0.421-0.887, p=0.010).Conclusions:NAFLD is highly prevalent in AF but is not associated with higher bleeding or thrombotic risk.

We assessed the prognostic value of different indexations of left ventricular (LV) mass in a large cohort of patients with essential hypertension. In a 2-center study, 2180 patients with essential hypertension [mean age 50, 47% women, baseline blood pressure (BP) 160/98 mmHg (SD 13/6)], good-quality echo tracings before treatment and no previous events were followed for an average of 4.6 years (range 0-14). Treatment was tailored to the single patient. During follow-up there were 250 major cardiovascular morbid events, at a rate of 2.47 events per 100 person-years. At entry, LV mass was 107.9 (SD 28) g/body surface area (m2), 118.9 (SD 34) g/height (m) and 49.8 g/height (m2.7). In a Cox analysis stratified by center, after adjustment for age (p<0.0001), 24-hour ambulatory pulse pressure (p=0.0002), current smoking (p<0.0001), total cholesterol (p=0.05) and diabetes (p<0.0001), LV mass provided the best improvement in the model fitting when indexed by body surface area (-2L=2942.2) and by height (-2L=2946.9), while indexation by height2.7 was less efficient (-2L=2949.3; p < 0.05) than the one by body surface area. In a ROC curve analysis, the best efficiency of LV mass for identification of subjects with future events (sens/spec = 1 on the ROC curve) was achieved by the following cut-off points: 111.8 g/body surface area (m2), 122.8 g/height (m) and 51.0 g/height (m2.7). The corresponding prevalence of LV hypertrophy was 37.8%, 39.4% and 40.3%, and the ROC areas were 0.67, 0.66 and 0.67 (p=n.s.), respectively. These data suggest that the tested indexations of LV mass are comparable in terms of sensitivity and specificity for identification of subjects at risk of events; however, after controlling for concomitant risk factors, adjustment for body surface area provides a slightly superior prognostic information. (See Figure)

Epidemiologic data suggest that hypertensive cardiac hypertrophy and insulin resistance are important predictors of cardiovascular morbidity and mortality. To investigate the possible relationship among ACE-gene polymorphism, insulin resistance and cardiac mass in a group of never treated hypertensive patients. Two hundred and thirty (133M, 97F; age=45.4+5.4 years) hypertensive never treated outpatients were enrolled. We evaluated clinic and ambulatory blood pressure, echocardiographic left ventricular mass indexed by body surface area and height2.7, fasting glucose and insulin levels. Insulin resistance was calculated using the homeostasis model assessment (HOMA). ACE genotypes were detected by double PCR, and ACE activity by colorimetric kit. No significant differences were observed in age, body mass index, blood pressure and glucose among the three ACE genotypes (DD, ID, II). Instead, fasting insulin (µU/mL) and HOMA were significantly (p<0.0001) higher in DD genotype (16.4+4.1; 3.7+1.0) than ID (9.6+3.7; 2.1+0.8) and II (8.0+3.0; 1.8+0.7) groups. Similarly, the cardiac mass was significantly (p<0.0001) increased in DD patients (143.1+31.1 g/m2, and 65.9+31.1 g/m2.7) when compared with ID (126.8+25.8 g/m2, and 58.3+12.5 g/m2.7) and II (115.7+22.8 g/m2, and 52.0+11.1 g/m2.7) groups. However, the polymorphism of the ACE-gene affects cardiac mass only in males, suggesting a gender effect. Moreover, we detected a significant linear relationship (p<0.0001) between ACE activity and HOMA (r=0.678), and HOMA and cardiac mass (r=0.620). The final model for cardiac mass included only HOMA (38.4%) and blood pressure (5.1%). In conclusion, our data suggest that insulin resistance is a powerful independent determinant of left ventricular mass in hypertensive DD patients.

The association between angiotensin-converting enzyme (ACE)-gene polymorphism and insulin resistance (IR) in hypertensives remains controversial. Thus, the aim of present study was to evaluate the possible association between IR and ACE-gene polymorphism and in a group of hypertensive patients in comparison with normotensive control group. We enrolled 200 (114M/86F; age = 45.5 ± 4.7 years) never treated hypertensive patients compared with 96 (54M/42F; age = 44.0 ± 4.7 years) normotensive subjects. Using a double PCR assay identified ACE genotypes. Blood was analyzed for glucose and insulin levels by using the glucose oxidase method and standard radioimmunoassay technique, respectively. IR was estimated by using the homeostasis model assessment (HOMA IR). Both fasting glucose (5.0 ± 0.3 mmol/L vs 4.7 ± 0.3 mmol/L; p < 0.0001) and insulin levels (12.3 ± 4.7 µU/mL vs 4.9 ± 1.5 µU/mL; p < 0.0001) were significantly higher in hypertensive patients than in normotensive control group. HOMA IR was significantly higher (2.7 ± 1.1 vs 1.1 ± 0.3; p < 0.0001) in hypertensives than in normotensives. When we subdivided hypertensive patients according to ACE genotype, we observed: fasting insulin levels and HOMA IR were 16.3 ± 3.3 µU/mL and 3.6 ± 0.8 in DD genotype, 9.4 ± 3.1 µU/mL and 2.1 ± 0.7 in ID, and 8.3 ± 2.8 µU/mL and 1.9 ± 0.7 II group (p < 0.0001, by ANOVA). No significant differences were observed in the normotensive control group. We extended previous data regarding the relationship of hypertension and insulin resistance by demonstrating a dependence of this relationship upon the ACE genotype.